UTILITY OF PRACTICAL EDUCATIONAL ERGONOMIC INTERVENTION TO PREVENT MSK PAIN IN EARLY OPHTHALMOLOGY CAREER TRAINING

Improving ergonomic practices can alleviate chronic musculoskeletal (MSK) pain and promote sustainable healthy habits. The goal of this study was to assess ergonomic practices among ophthalmology residents, and evaluate the utility of a practical educational intervention in improving MSK pain.

University of Ottawa Eye Institute.

This is a quality improvement study involving ophthalmology residents at a single site. Observation of ergonomics occurred both pre- and post-educational intervention, which consisted of teaching by a trained physiotherapist and an ergonomic assessment in the clinic and operating room (OR) with individualized feedback. Pain rating was evaluated using the Cornell MSK Discomfort Questionnaire (CMDQ), and compared at initial visit and 5-months post-intervention, along with observed ergonomic changes by physiotherapy evaluation.

Nine ophthalmology residents were evaluated. Based on pre-intervention survey responses, poor ergonomics contributed to MSK pain, with a greater tendency for pain in clinical activities than OR. Skills perceived to contribute the most pain included using the slit lamp (89%) and indirect ophthalmoscope (78%). Residents reported an average of 3-4 areas with MSK pain, the most common being the neck (100%) and lower back (56%). Residents tried various interventions in the past including medications, different specialists (physician, physiotherapy, chiropractor), and massage therapy, but indicated an interest in educational training to improve their practice. Feedback based on physiotherapy assessment of residents in the OR included utilization of the chair backrest for support, engagement in preventative stretching/strengthening, and adjustment of equipment, while clinical recommendations included avoidance of exaggerated movement, adjustment of stool height, and resting of the elbow on a soft/cushioned surface to eliminate fatigue and muscle tension. Majority of residents found the educational intervention and individual feedback to be helpful, and all tried to implement suggested recommendations into their practice. Their CMDQ pain scores decreased by 31% post-intervention, as calculated using a one-tailed paired-samples t-test, which showed significant difference between CMDQ scores pre- and post-intervention (58 vs 40, p=0.027). Residents reported the biggest barrier to implementation being lack of time (67%) followed by poor ergonomic setup (50%) and a changing work environment (50%).

The implementation of recommendations from ergonomic assessment and education by trained professionals demonstrated improvement in MSK pain among ophthalmology residents 5-months following intervention. Proposed recommendations included optimizing the work environment and increasing awareness of body position. In summary, practical educational interventions focusing on ergonomics at an early stage in ophthalmology residency training may be valuable in preventing chronic MSK pain resulting from clinical and OR activities.