Prevalence of Musculoskeletal Disorders and Postural Assessment during Endoscopy and Colonoscopy among Gastroenterologists in Isfahan City, Iran

  • Babak Vahdatpour Associate Professor, Department of Physical Medicine and Rehabilitation, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
  • Mostafa Sayed-Mirramazani General Practitioner, Isfahan University of Medical Sciences, Isfahan, Iran
Keywords: Posture; Gastroenterologist; Musculoskeletal disorders


Background: Gastroenterologists may be susceptible to various musculoskeletal disorders (MSDs) in the absence of correct posture because of working in various positions in offices and hospitals. The aim of this study was to assess the relationship between posture and MSDs among gastroenterologists in Isfahan city, Iran.

Methods: Three methods of posture evaluation are self-report, observational method, and direct measurement. Based on previous studies, the validity and reliability of the observational method is higher than others. In this study, gastroenterologists' postures during endoscopy and colonoscopy were analyzed using the two observational methods of Rapid Upper Limb Assessment (RULA) and Ovako Working Posture Assessment System (OWAS). They also completed the Nordic Musculoskeletal Questionnaire (NMQ).

Results: Based on OWAS, the posture risk was 1 in 22.2% and 2 in 77.8% of gastroenterologists, while based on RULA, this risk was 4 in 38.9%, 5 in 38.9%, and 6 in 22.2% of the subjects. The incidence of MSDs had a direct relationship with the level of risk based on RULA, but had no significant association with the level of risk based on OWAS. The level of risk based on RULA had a direct relationship with the number of procedures per day. In addition, the prevalence of MSDs had a direct relationship with the number of procedures per day and body mass index (BMI). The level of risk based on RULA had a direct relationship with incidence of MSDs in the neck, upper back, and knees.

Conclusion: musculoskeletal disorders are highly prevalent among gastroenterologists in Isfahan. Postural analysis results showed that the risk of incidence of these disorders is very high. High BMI was one of the factors contributing to the occurrence of MSDs. Since about half of the target group subjects were overweight, losing weight can help to reduce the incidence of MSDs. In addition, the high number of procedures per day increases the risk of posture and musculoskeletal problems simultaneously. Thus, reducing the number of procedures or increasing the rest time between appointments, performing endoscopy and colonoscopy as uncontinuous procedures, increasing precision and accuracy of positioning, and using tele-robotic techniques instead of manual ones could be effective in gastroenterologists who have a high workload.


1. Jose JA. Outcome measures and prognosis of WRMSD. Work 2012; 41(Suppl 1): 4848-9.
2. Scopel J, Oliveira PA, Wehrmeister FC. RSI/WRMSD in the third decade after restructuring of banking: new associated factors?. Rev Saude Publica 2012; 46(5): 875-85. [In Portuguese].
3. Coutu MF, Baril R, Durand MJ, Cote D, Cadieux G. Health and illness representations of workers with a musculoskeletal disorder-related work disability during work rehabilitation: a qualitative study. J Occup Rehabil 2011; 21(4): 591-600.
4. Gillen M, Cisternas MG, Yen IH, Swig L, Rugulies R, Frank J, et al. Functional recovery following musculoskeletal injury in hospital workers. Occup Med (Lond) 2010; 60(7): 532-9.
5. Morse TF, Dillon C, Warren N, Levenstein C, Warren A. The economic and social consequences of work-related musculoskeletal disorders: the Connecticut Upper-Extremity Surveillance Project (CUSP). Int J Occup Environ Health 1998; 4(4): 209-16.
6. David GC. Ergonomic methods for assessing exposure to risk factors for work-related musculoskeletal disorders. Occup Med (Lond) 2005; 55(3): 190-9.
7. David G, Woods V, Li G, Buckle P. The development of the Quick Exposure Check (QEC) for assessing exposure to risk factors for work-related musculoskeletal disorders. Appl Ergon 2008; 39(1): 57-69.
8. Kuorinka I, Jonsson B, Kilbom A, Vinterberg H, Biering-Sorensen F, Andersson G, et al. Standardised Nordic questionnaires for the analysis of musculoskeletal symptoms. Appl Ergon 1987; 18(3): 233-7.
9. Dockrell S, O'Grady E, Bennett K, Mullarkey C, Mc CR, Ruddy R, et al. An investigation of the reliability of Rapid Upper Limb Assessment (RULA) as a method of assessment of children's computing posture. Appl Ergon 2012; 43(3): 632-6.
10. Dawson AP, Steele EJ, Hodges PW, Stewart S. Development and test-retest reliability of an extended version of the Nordic Musculoskeletal Questionnaire (NMQ-E): a screening instrument for musculoskeletal pain. J Pain 2009; 10(5): 517-26.
11. Choobineh A, Lahmi M, Shahnavaz H, Jazani RK, Hosseini M. Musculoskeletal symptoms as related to ergonomic factors in Iranian hand-woven carpet industry and general guidelines for workstation design. Int J Occup Saf Ergon 2004; 10(2): 157-68.
12. Pinheiro FA, Troccoli BT, Carvalho CV. Validity of the Nordic Musculoskeletal Questionnaire as morbidity measurement tool. Rev Saude Publica 2002; 36(3): 307-12. [In Portuguese].
13. Baron S, Hales T, Hurrell J. Evaluation of symptom surveys for occupational musculoskeletal disorders. Am J Ind Med 1996; 29(6): 609-17.
14. McAtamney L, Nigel CE. RULA: a survey method for the investigation of work-related upper limb disorders. Appl Ergon 1993; 24(2): 91-9.
15. Scott GB, Lambe NR. Working practices in a perchery system, using the OVAKO Working posture Analysing System (OWAS). Appl Ergon 1996; 27(4): 281-4.
16. Karhu O, Harkonen R, Sorvali P, Vepsalainen P. Observing working postures in industry: Examples of OWAS application. Appl Ergon 1981; 12(1): 13-7.
17. Jafari-Adli S, Jouyandeh Z, Qorbani M, Soroush A, Larijani B, Hasani-Ranjbar S. Prevalence of obesity and overweight in adults and children in Iran; a systematic review. J Diabetes Metab Disord 2014; 13(1): 121.
18. Mehrdad R, Dennerlein JT, Morshedizadeh M. Musculoskeletal disorders and ergonomic hazards among Iranian physicians. Arch Iran Med 2012; 15(6): 370-4.
19. Ridtitid W, Cote GA, Leung W, Buschbacher R, Lynch S, Fogel EL, et al. Prevalence and risk factors for musculoskeletal injuries related to endoscopy. Gastrointest Endosc 2015; 81(2): 294-302.
20. Rambabu T, Suneetha K. Prevalence of work related musculoskeletal disorders among physicians, surgeons and dentists: a comparative study. Ann Med Health Sci Res 2014; 4(4): 578-82.
21. Tirgar A, Javanshir K, Talebian A, Amini F, Parhiz A. Musculoskeletal disorders among a group of Iranian general dental practitioners. J Back Musculoskelet Rehabil 2015; 28(4): 755-9.
22. Rafeemanesh E, Jafari Z, Kashani FO, Rahimpour F. A study on job postures and musculoskeletal illnesses in dentists. Int J Occup Med Environ Health 2013; 26(4): 615-20.
23. Rahimi A, Vahdatpour B, Khosrawi S, Mogtaderi A, Sattari S, Dabiri F, et al. Work-related musculoskeletal disorders among pathologists in Isfahan: A cross-sectional study. Research Journal of Biological Sciences 2010; 5(12): 793-7.
24. Khosrawi S, Rahimi A, Vahdatpour B, Dabiri Skouie F, Mashrabi O. Work-related musculoskeletal disorders among cardiologists. Research Journal of Biological Sciences 2011; 6(4): 170-4.
25. Szeto GP, Ho P, Ting AC, Poon JT, Cheng SW, Tsang RC. Work-related musculoskeletal symptoms in surgeons. J Occup Rehabil 2009; 19(2): 175-84.
26. MacDonald K, King D. Work-related musculoskeletal disorders in veterinary echocardiographers: a cross-sectional study on prevalence and risk factors. J Vet Cardiol 2014; 16(1): 27-37.
27. Kumar VK, Kumar SP, Baliga MR. Prevalence of work-related musculoskeletal complaints among dentists in India: a national cross-sectional survey. Indian J Dent Res 2013; 24(4): 428-38.
28. Oude Hengel KM, Visser B, Sluiter JK. The prevalence and incidence of musculoskeletal symptoms among hospital physicians: a systematic review. Int Arch Occup Environ Health 2011; 84(2): 115-9.
29. Caberlon CF, Padoin AV, Mottin CC. Importance of musculoskeletal pain in work activities in obese individuals. Obes Surg 2013; 23(12): 2092-5.
30. Vahdatpour B, Khosravi S, Rahimi A, Sattari S, Mogtaderi A, Dabiri Scoie F, et al. Work-related musculoskeletal disorders among radiologists in Isfahan: A cross-sectional study. Research Journal of Biological Sciences 2010; 5(10): 664-9.
31. Yasobant S, Rajkumar P. Work-related musculoskeletal disorders among health care professionals: A cross-sectional assessment of risk factors in a tertiary hospital, India. Indian J Occup Environ Med 2014; 18(2): 75-81.
32. Warren N, Dillon C, Morse T, Hall C, Warren A. Biomechanical, psychosocial, and organizational risk factors for WRMSD: population-based estimates from the Connecticut upper-extremity surveillance project (CUSP). J Occup Health Psychol 2000; 5(1): 164-81.
33. Petromilli Nordi Sasso GP, Polli GS, Campos JA. Working postures of dental students: ergonomic analysis using the Ovako Working Analysis System and rapid upper limb assessment. Med Lav 2013; 104(6): 440-7.
34. Levanon Y, Lerman Y, Gefen A, Ratzon NZ. Validity of the modified RULA for computer workers and reliability of one observation compared to six. Ergonomics 2014; 57(12): 1856-63.
35. Hignett S, McAtamney L. Rapid entire body assessment (REBA). Appl Ergon 2000; 31(2): 201-5.
36. Lee EC, Rafiq A, Merrell R, Ackerman R, Dennerlein JT. Ergonomics and human factors in endoscopic surgery: a comparison of manual vs telerobotic simulation systems. Surg Endosc 2005; 19(8): 1064-70.
Original Article(s)