Upper limb disorders in anaesthetists

Upper limb disorders in anaesthetists – a survey of
Association of Anaesthetists members

S. Leifer, S. W. Choi, K. Asanati and S. M. Yentis

Background
There is an acknowledged anecdotal frequency of upper limb disorders (ULD) in anaesthetists, but no published data is available

This bears importance to:

  • Ensuring psychological and physical well being
  • Reducing sick leave
  • Staff shortages

Patient safety: 

Anaesthetists may compromise techniques or avoid certain procedures altogether      

ULD are often task related: repetition, poor working posture, excessive force and duration of the task

Aim

To explore the prevalence and type of formal ULDs among anaesthetists, and associated risk factors.

Methods

10,231 AAGBI members, contacted by email in March 2017. Not all members in the NHS, with some outside the UK Third party company distributed the survey
No ethics required, as per the National Research Authority
The survey performed over 1 month, 2 reminders to non responders

Statistics

For initial comparisons: Fishers exact test, T test, Mann Whitney U test Univariate logistic regression for significant (p<0.05) differences (with plausible associations) Then multi variate logistic regression for these significant associations


Results

3884 of 10,231 (38%) responded

34% had a formal diagnosis of an Upper Limb Disorder 


Significant associations

Age, years of anaesthesia, height, weight, BMI, children, right handedness

Multivariate regression showed significance in:

  • Having children (irrespective of number of children or sex of respondent) 
  • Right handedness
  • Years of anaesthetic training

Only 33% answered question about days off in the past year

10% reported non work activities as a caused of their ULD

8% reported medical conditions as causes for their ULD

10% incidence of surgery

Discussion

 Most common ULDs were    

– Cervical disc prolapse/degeneration   

– Rotator cuff tendinitis

Potential causes include:

  • Poor posture
  • Improper trolley height
  • Repetitive, prolonged or forceful exertion during procedures like intubation and other procedures – spinals, central lines, blocks

Methods to avoid ULD:

  • Video laryngoscope
  • Manual handling sessions
  • Avoid extreme rotation, over reaching, tense postures
  • Is ergonomic analysis of equipment required?

Strengths of study:

Demonstrated significant ULD occupational health risk, especially among those with higher years of experience

Right handedness a new and significant association

Weaknesses:

  • 38% response rate, although this is relatively good for a survey, therefore there is a risk of having an unrepresentative representation of anaesthetists
  • Non-AAGBI members were not included
  • Those affecter by ULDs are probably more likely to respond
  • Unanswered survey question mean that some number cannot be added acccurately
  • Unclear which specific statistical tests apply to specific groups
  • Only 33% answered the open question about days off work
  • Why was no ethical approval required?


Conclusion

This survey has provided a quantifiable backing to previously anecdotal knowledge regarding ULD in Anaesthetists. It has provided new evidence on influencing factors in ULD, which can now potentially be researched in more depth, and also acted upon immediately at local levels, thus helping our current and future colleagues.

Summary by Dr Dineth Seneviratna

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