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
