Date Presented 04/22/21
The Comprehensive Operating Room Ergonomics (CORE) program was developed to address the physical and environmental demands among surgeons. This feasibility study examined the design and implementation process of an evidence-based OT ergonomics intervention using a mixed-methods research design. The CORE program supports the American Occupational Therapy Association’s Vision 2025 of promoting population health and wellness, especially among surgeons who are essential to our health care system.
Primary Author and Speaker: Pamela Hess
Additional Authors and Speakers: Elena Donoso Brown
BACKGROUND: Work-related musculoskeletal disorders (WMSD) among procedural physicians, such as surgeons and interventional medical specialties, have dramatically risen over the past decade and is expected to continue (Voss et al., 2017). There is a strong demand for research addressing the surgeons’ ergonomic needs both in and out of the operating room (OR), especially surgeons who perform minimally invasive surgeries (MIS). Given the current ergonomic needs in surgery, occupational therapy (OT) practitioners are well equipped to provide a holistic support system for reducing WMSD risk factors and injuries among surgeons.
PURPOSE: The purpose of this study was to test the design and feasibility of an evidence-based OT ergonomics intervention, the Comprehensive Operating Room Ergonomics (CORE) program for surgeons. Research
DESIGN: An exploratory embedded mixed-methods design was used where the qualitative strand took precedence over the quantitative strand. A convenience sample of six surgeons who perform MIS participated in this study.
METHODS: A six-step theory-based intervention mapping protocol guided the design and implementation of the ergonomics intervention (Dalager et al., 2019; Pollock et al., 2015). Several assessment tools and qualitative data gathering were used to examine the feasibility of the CORE program. The qualitative approaches included semi-structured interviews and observations of the surgeons in the operating room (OR) where data were coded to produce themes. The quantitative assessment tools included postural assessment and the Rapid Upper Limb Assessment (RULA) (McAtamney & Corlett, 1993). The quantitative data were mixed within the qualitative data at the design and analysis levels to assess the feasibility of the CORE program.
RESULTS: The five themes resulting from the qualitative data of which the quantitative data supported showed that the CORE program is a feasible ergonomic intervention for surgeons that is ready for further research. The themes identified included posture alignment, operating room environment setup, commonly reported areas of physical pain or discomfort, surgical ergonomics training, and ergonomics into everyday life. Information gained from the OR observations and the initial postural assessments compared to the demands of the MIS may be creating the swayback posture and other physical asymmetries affecting the surgeon’s occupational performance. Additionally, the robotic system had limited capacity for ergonomic adjustments possibly putting the surgeon more at risk of injury. The change in RULA scores between the pre- and post-intervention time periods showed a significant estimated effect of 0.996 with a p-value of .03 with a medium effect size of 0.408. These findings demonstrate that the surgeons applied ergonomics strategies to positively decrease the physical demands of the working environment and tasks on posture in the operating room.
CONCLUSION: The CORE program for surgeons directly supports AOTA Vision 2025 as an opportunity to promote population health, well-being and quality of life for an at risk population. The impact of this occupational therapy ergonomics program for surgeons may help eliminate barriers that inhibit a surgeon’s physical and mental occupational performance and decrease the potential risks of losing well-trained practitioners who are essential to our health care system. This ergonomics feasibility study is ready for further study through a randomized control trial or a cohort design.
References
Dalager, T., Højmark, A., Jensen, P. T., Søgaard, K., & Andersen, L. N. (2019). Using an intervention mapping approach to develop prevention and rehabilitation strategies for musculoskeletal pain among surgeons. BMC Public Health, 19(320), 1-13. https://doi.org/10.1186/s12889-019-6625-4
McAtamney, L., & Corlett, E. N. (1993). RULA: A survey method for the investigation of work-related upper limb disorders. Applied ergonomics, 24(2), 91-99. https://doi.org/10.1016/0003-6870(93)90080-S
Pollock, R. V., Jefferson, A. M., Wick, C. W., & Wick, C. (2015). The six disciplines of breakthrough learning. Hoboken, New Jersey: John Wiley & Sons, Inc.
Voss, R. K., Chiang, Y. J., Cromwell, K. D., Urbauer, D. L., Lee, J. E., Cormier, J. N., & Stucky, C. C. H. (2016). Do no harm, except to ourselves? A survey of symptoms and injuries in oncologic surgeons and pilot study of an intraoperative ergonomic intervention. Journal of the American College of Surgeons, 224(1), 16-25. https://doi.org/10.1016/j.jamcollsurg.2016.09.013
