Risk of Musculoskeletal Disorder Among Taiwanese Nurses
Risk of Musculoskeletal Disorder Among Taiwanese Nurses
A high incidence of MSDs among nurses has been demonstrated in numerous reports. However, most of these surveys used questionnaires as measurement tools, which may not be compatible with the clinical diagnosis and evaluation of MSDs. The strength of this study is that most of the nurses in Taiwan were included for statistical analysis. The NHI in Taiwan is a mandatory universal health insurance program with more than 96% coverage. Because of the use of randomly selected reference subjects, the measurement of MSD incidence in the present study was reliable and similar to that obtained using the whole population as the denominator. Thus, information bias was substantially reduced. To our knowledge, no previous study has used nationwide health insurance data to investigate MSDs in nurses. However, this study is limited with respect to its generalizability because the incidence of MSDs was work related. In addition, not all nurses suffering MSDs seek medical attention that would be listed in the claim files. The database used in this study cannot provide information on an occupation-matched reference population; thus, another limitation of the present study is that we were unable to include both working and non-working populations as reference subjects. We can also assume that not every nurse with a MSD receives the same treatment as the non-nurse general public. Our statistical analysis was designed simply to indicate whether nurses have a higher incidence of MSDs than the general public.
This study demonstrated a higher incidence of MSDs among nurses. Our results agree with those published by Tinubu et al., who reported a lifetime MSD incidence of 84.4% among nurses. Similar incidences of MSDs in nurses have been reported by other studies of various populations. The seven-year cumulative incidence in Taiwan was 76.24%, which is consistent with those previous reports. However, the incidence of MSDs among nurses was higher than that found in Chinese restaurant cooks, hotel-servers and community food service workers in Taiwan. The relatively high incidence among our nurse cohort suggests that nurses work in a relatively high-risk environment for MSDs. The peak of age-specific MSD incidence in 20–24-year-olds (85.61%) warrants further discussion. Musculoskeletal pain has become a major complaint among young nurses and is increasingly occurring at a younger age. The average age and seniority of nursing personnel are 26 and 4.73 years, respectively, and our findings should be considered when developing policies for the prevention of MSDs in the workplace, particularly with respect to occupation-associated injuries.
Lumbago, backache and HIVD were the most common site-specific disorders. LBP is prevalent among nurses, nursing aides and nursing students. The seven-year cumulative incidence of LBP was significantly higher in the nurse cohort (58.76%) than in the reference group (49.02%). This large difference may indicate which is the most vulnerable part of the body in nurses at work. The high incidence of lumbago may be a consequence of nurses spending long periods of time standing, and their lifting and moving of patients.
Chiou et al. reported that the lifetime incidence of LBP is 77.9%. Nursing tasks involving heavy physical labor and standing with the trunk in a bent or twisted position were the most common sources of back pain among nurses. Overexertion of the back muscles can injure or tear ligaments in the back, which in turn leads to pain. Coping strategies include change of working technique, use of lifting equipment and avoiding strenuous tasks at work. Educational programs on the prevention of or coping strategies for MSDs may be helpful in reducing their incidence.
In a questionnaire survey, Chen and Ting found that MSDs in nurses in Taiwan are primarily due to high workload and work pressure. In other studies, Feng et al. and Nien found that 94.3% of Taiwanese nurses thought that MSDs may be caused by incorrect work-related posture/movement, insufficient rest or psychological conditions. They also considered the rolling shift system as a major cause of MSDs among Taiwanese nurses.
Discussion
A high incidence of MSDs among nurses has been demonstrated in numerous reports. However, most of these surveys used questionnaires as measurement tools, which may not be compatible with the clinical diagnosis and evaluation of MSDs. The strength of this study is that most of the nurses in Taiwan were included for statistical analysis. The NHI in Taiwan is a mandatory universal health insurance program with more than 96% coverage. Because of the use of randomly selected reference subjects, the measurement of MSD incidence in the present study was reliable and similar to that obtained using the whole population as the denominator. Thus, information bias was substantially reduced. To our knowledge, no previous study has used nationwide health insurance data to investigate MSDs in nurses. However, this study is limited with respect to its generalizability because the incidence of MSDs was work related. In addition, not all nurses suffering MSDs seek medical attention that would be listed in the claim files. The database used in this study cannot provide information on an occupation-matched reference population; thus, another limitation of the present study is that we were unable to include both working and non-working populations as reference subjects. We can also assume that not every nurse with a MSD receives the same treatment as the non-nurse general public. Our statistical analysis was designed simply to indicate whether nurses have a higher incidence of MSDs than the general public.
This study demonstrated a higher incidence of MSDs among nurses. Our results agree with those published by Tinubu et al., who reported a lifetime MSD incidence of 84.4% among nurses. Similar incidences of MSDs in nurses have been reported by other studies of various populations. The seven-year cumulative incidence in Taiwan was 76.24%, which is consistent with those previous reports. However, the incidence of MSDs among nurses was higher than that found in Chinese restaurant cooks, hotel-servers and community food service workers in Taiwan. The relatively high incidence among our nurse cohort suggests that nurses work in a relatively high-risk environment for MSDs. The peak of age-specific MSD incidence in 20–24-year-olds (85.61%) warrants further discussion. Musculoskeletal pain has become a major complaint among young nurses and is increasingly occurring at a younger age. The average age and seniority of nursing personnel are 26 and 4.73 years, respectively, and our findings should be considered when developing policies for the prevention of MSDs in the workplace, particularly with respect to occupation-associated injuries.
Lumbago, backache and HIVD were the most common site-specific disorders. LBP is prevalent among nurses, nursing aides and nursing students. The seven-year cumulative incidence of LBP was significantly higher in the nurse cohort (58.76%) than in the reference group (49.02%). This large difference may indicate which is the most vulnerable part of the body in nurses at work. The high incidence of lumbago may be a consequence of nurses spending long periods of time standing, and their lifting and moving of patients.
Chiou et al. reported that the lifetime incidence of LBP is 77.9%. Nursing tasks involving heavy physical labor and standing with the trunk in a bent or twisted position were the most common sources of back pain among nurses. Overexertion of the back muscles can injure or tear ligaments in the back, which in turn leads to pain. Coping strategies include change of working technique, use of lifting equipment and avoiding strenuous tasks at work. Educational programs on the prevention of or coping strategies for MSDs may be helpful in reducing their incidence.
In a questionnaire survey, Chen and Ting found that MSDs in nurses in Taiwan are primarily due to high workload and work pressure. In other studies, Feng et al. and Nien found that 94.3% of Taiwanese nurses thought that MSDs may be caused by incorrect work-related posture/movement, insufficient rest or psychological conditions. They also considered the rolling shift system as a major cause of MSDs among Taiwanese nurses.
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