| Summary: | 碩士 === 國立陽明大學 === 物理治療暨輔助科技學系 === 99 === Background: Ninety-one percent of physical therapists (PTs) reported experiencing work-related musculoskeletal pain or discomforts at some time in their working life. Over 60% of Taiwanese PTs reported experiencing work-related shoulder or low back pain and over 50% experiencing neck, wrist or knee pain within half a year. As work-related musculoskeletal disorders (WMSDs) occured, they would have negative emotional effect such as bad mood and loss of enthusiasm to work, negative work effect such as decreasing time of patient contact and taking sick leave. All of the above might influence quality of medical treatment given by the injured PTs and the quality of daily activities and medical expense of the injured PTs. Since the musculoskeletal pain occurred in Taiwanese PTs has not been vigorously investigated we conducted this survey study.
Purposes: (1) To determine 1-year prevalence of WMSDs of PTs in Taiwan. (2) To investigate the responses to injuries of Taiwanese PTs with WMSDs (3) To determine work-related factors of WMSDs in Taiwanese PTs. (4) To investigate the influence of WMSDs of work ability index.
Study Design: An exploratory cross-sectional study.
Materials and Methods: A structural questionnaire was designed for this study. Two experts were consulted to assess the content validity of the questionnaire. Then 10 PTs were recruited for answering the questionnaire twice with 1 week apart to determine the test-retest reliability of the questionnaire. The percent agreement was 95.5%. A convenient sample of 403 Taiwanese licensed PTs who currently worked more than 30 hours per week were recruited. The exclusion criteria included subjects who were not willing to fill in the questionnaire completely, had systematic diseases or had injuries which were not work-related within 5 years, or were pregnant. Chi-square tests (for nominal variables) and/or independent t-tests (for interval/ratio variables) and/or appropriate nonparametric analyses (for ordinal variables) were used to investigate the effect of each factor. Significant differences of all factors between pain and painfree groups was set at P <0.15. A multiple stepwise logistic regression was then used to determine the association among work-related factors and WMSDs. Spearman’s rho was used to determine the association among work-related factors and the influence of WMSDs. A multiple regression was used to determine the body region that causes negative effect of work ability index. Significant difference was set at P <0.05.
Results: Four hundred and six questionnaires were returned. The overall response rate was 90.4%. There were 403 valid questionnaires. The 1-year prevalence of pain occurred in any body region was 97.3%. The 1-year prevalence of work-related neck pain was 54.6% and work-related low back pain was 72.7%.The most common area of the WMSDs was low back (77.2%), the second common area was shoulder and neck and then the upper extremities. The less common area occurring WMSDs was the lower extremities. The response of PTs who suffered WMSDs tended to use their own professional knowledge to adjust their work habits. Very few therapists went to seek for other traditional or western medicine. Female physical therapists were more likely to develop WMSDs than males. The factors that were related to upper extremities, neck and low back pain included performing manual therapy, poor posture while working and mental status. Pediatric physical therapists who often need to squat and adopt awkward working postures had higher prevalence of self-reported musculoskeletal symptoms in the knee area. Lower extremity pain was significantly related to the design of working environment. The correlation coefficient between the impact of the WMSDs and the work ability index was -0.425. The more serious the pain was, the lower score of the work ability index. The work ability index of the participants averaged 38.4±3.9, which was lower than the norm of the nation-wide workers in Taiwan (41.4±4.5).
Discussion: The prevalence of each body area pain in physical therapists was 2 to 3 times higher than nation-wide workers in Taiwan. Female therapists tended to develop WMSDs easier than male therapists. Significant factors associated with each body region pain were related to overuse of that body region, prolonged time of sustaining a poor posture and inappropriately designed work environment. The study was an exploratory cross-sectional study. Therefore, the cause and effect relationship could not be established.
Conclusion: The issue of WMSD of Taiwanese physical therapists is very serious and it may influence their performance of job duties. Significant determinants of WMSDs in physical therapists included poor posture, inappropriate work environment and too much workload.
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