Work caused musculoskeletal disorders in health professionals

1Primary Health Care Services of Canton Sarajevo, Center for Physical Rehabilitation Center, Sarajevo, Bosnia and Herzegovina, 2Department of Physiotherapy, Faculty of Health Studies, University of Sarajevo, Sarajevo, Bosnia and Herzegovina, 3Department of Home Care, Wiener Rotes Kreuz, Wien, Austria, 4Medical High School Sarajevo, Sarajevo, Bosnia and Herzegovina, 5Department of Physical Therapy, Institute of Sports Medicine of Canton Sarajevo, Sarajevo, Bosnia and Herzegovina, 6PhD student, Faculty of Health Studies, University of Sarajevo, Sarajevo, Bosnia and Herzegovina


INTRODUCTION
Work-related musculoskeletal disorders (WRMSDs) are the most common work-related diseases [1] and describe a wide range of degenerative and inflammatory conditions affecting blood vessels, peripheral nerves, joints, ligaments, tendons, and muscles [2]. Occupational factors related to the development of disorders of the musculoskeletal system were recognized as early as in the 18 th century. However, it was not until the 1970s that a more active epidemiological research of the correlation between these conditions and Member States with 39% and 36%, respectively [6]. Health problems range from minor pain and disturbances to more serious health conditions that require absence from work or treatment. In severe cases, they can lead to disability and need for premature retirement. Most MSDs develop over time [1]. In the early phase, there is pain and fatigue of the affected part during work, which disappears at night and during days off, and in this phase, we do not have a decrease of work performance. In the middle phase, there is pain during work that lasts at night, and here we have a reduced work capacity for repetitive work. In the third or late phase, pain is constantly present, and the person may feel weakness and fatigue that require rest. In this phase, there is an inability to sleep and perform light work tasks [7]. Usually there is no single cause of MSDs [1]. In general, none of the causal factors act separately on their own, but a combination and interaction of several factors is required for disorder occurrence [7]. Physical risks and organizational risk factors include handling loads especially when bending, bending or rotating, repetitive or sudden movements, awkward and static body positions, vibrations, poor lighting, heat or cold in the environment, rapid pace of work, and prolonged sitting or standing in the same position [1].
WRMSDs are becoming an increasing problem in modern society. They are the second biggest cause of short-term or temporary incapacity for work just following a cold. MSDs are responsible for the disease of many working populations and represent an important occupational problem that causes increased health costs, reduced work productivity and lower quality of life [8]. At the workplace, health professionals represent a very vulnerable category in terms of the MSD's development [9]. Studies conducted in many countries around the world reveal that these disorders pose an important problem among healthcare professionals [5]. It is estimated that almost one third of all cases of absence from work among health care professionals are related to MSDs. Studies also show that a large number of health professionals report the occurrence of MSDs in one or more regions of the body, with a problem with the lower back being as one of the most common [8].
Many disciplines are involved in providing advice and in work to prevent WRMSD as well as to reduce its consequences [4]. Solving the problem of MSDs helps to improve the lives of workers, and it also represent a good business strategy [1]. Protecting the health of workers is an integral part of general health and daily life. Occupational health and safety require a multidisciplinary approach in which it is usually sufficient to discontinue exposure, reduce the duration or intensity of exposure to a risk factor and return the worker to adapted working conditions or an adapted workplace. Health and safety at the workplace are a major factor in sustainable development. It has been scientifically confirmed that organizations that manage occupational safety and health well have improved productivity and economic development [10].

METHODS
This article presents a non-experimental (qualitative) research, or a scientific review of the published literature where the databases were reviewed in which the key words for the review were: MSDs, work, health, intervention program, and ergonomics. Various databases were used in the preparation of this article, including: PubMed, Google Scholar, Medline, Hrčak, Dabar, Science Direct, and Science Citation.
Out of a total of 61 scientific papers found, 18 articles were selected as they dealt with the same issues or WRMSDs in health professionals.

RESULTS
The results include a review and analysis of 18 published scientific articles in the period 2001-2020. (Table 1). The studies published in these articles has been conducted in the United States (US), Australia, Switzerland, Portugal, Slovenia, Turkey, China, Nigeria, Israel, Tunisia, Iran, Croatia, Taiwan, Bangladesh, Serbia, Macedonia, and Greece.

DISCUSSION
As stated in the introduction, health professionals, or health professionals at their workplace, represent a very vulnerable category in terms of the occurrence of MSDs caused by occupation. Studies conducted in many countries around the world reveal that these disorders pose an important problem among healthcare professionals [5]. A total of 9614 health professionals from seventeen countries were surveyed in these 18 research articles. The results of our survey show that of the total number of surveyed health professionals, most had personal experience with MSDs caused by work. Of these, the largest number is related to pain in the lower back, neck, arms, and knees.
It is estimated that almost one third of all cases of absence from work among health care professionals are related to MSDs. Research also shows that a large proportion of health professionals report the occurrence of MSDs in one or more regions of the body, with a problem with the lower back being one of the most common [8].
By an insight into the review study, we can state that all health professionals are at high risk of MSDs caused by work, but three occupations within the health profession have a much more expressed risk of developing these disorders, namely nurses, physiotherapists, and dentists.
West and Gardner [11] in their study based on the obtained data indicate that the frequency of injuries of the musculoskeletal system exceeds the official statistics, but shows similar trends with studies conducted in Victoria (Australia), the United Kingdom, the US, and Canada. Salik and Özcan [12] found in their study that the rate of MSDs in physiotherapists in Izmir (Turkey) is high, which they attribute to the severity of the profession itself. Adegoke et al. dealt with the same issue [9] and concluded that the prevalence of WRMSDs among physiotherapists in Nigeria is much higher than most values reported by colleagues worldwide.
Vodanović et al. [18] in a study among dentists in Croatia state that dentists have a high frequency of work-related health problems, among which MSDs take the first place. Furthermore, Ranjova et al. [22] came up with similar data stating that the prevalence rate among dentists in the public

West and
Gardner [11] Australia

Conclusion
WRMSDs. The most commonly adopted coping strategy identified was for the therapists to modify their position and/or the patient's position (64.3%). Majority of the respondents (87.0%) did not leave the profession but 62.6% changed and/or modified their treatment because of their WRMSDs Rozenfeld et al. [13] Israel Although PTs have extensive knowledge of body mechanisms and injury prevention, WRMSDs are quite common in this population. The purposes of this study were: to determine the prevalence and impact of WRMSD among Israeli PTs; to investigate WRMSD risk factors and to identify preventive strategies used by PTs; and to compare the risk of injuries in two professional settings: RCs and OPCs The sample included all PTs (n=182) working in five RCs (n=112) and six OPCs of the Maccabí Healthcare Services (n=70) in the Tel Aviv area.
All participants had at least a bachelor's degree in physical therapy, which is mandatory to work in authorized institutes, had been employed for at least 1 year in their present place of employment and worked a minimum of 20 hours/  Occupational and work-related diseases or disorders have become increasingly common among dental professionals and can initiate a series of events that could result in a too early career ending. Croatian dentists have a high prevalence of occupational health problems. Musculoskeletal, sight, and skin disorders were among most commonly reported health problems. The first and most important step in protecting against occupational diseases is to improve dental health professional's awareness and understanding of occupational and work-

Conclusion
Božić [21] Serbia The main aims of this study were: To determine the prevalence of lumbar pain among nurses, to examine the relationship between sociodemographic characteristics (age, gender, were mostly female (89%), with an average age of 38 years. The prevalence of lumbar pain among nurses in the past 12 months was about 94%. Two-thirds of nurses had moderate or severe lumbar pain in the past 12 months. In the study, there is a statistically highly significant correlation between BMI increase and lumbar pain. Significantly higher prevalence of lumbar pain occurs in female respondents and those with completed high school. Only about 8% of respondents changed jobs due to lumbar pain As a preventive measure, it is necessary to emphasize the reduction of physical load on the lower back and the reduction of manual carrying of loads, which can be achieved using beds with adjustable height, introduction of mechanical equipment and creating teams for lifting and carrying patients. Applying an adequate ergonomic approach, better organization of work, a stimulating atmosphere at work, and the willingness of the competent structures to show greater care for employees, would reduce the incidence of lumbar pain Rendžova et al. [22] Macedonia The aim of our study was to examine the presence of MSDs among dentists at the university dental clinic in correlation with risk factors A questionnaire survey was carried out among 78 dental practitioners aged between 20 and 60 years old, employed at the university dental clinic. Questions included data on physical and psychosocial workload, perceived general health and occurrence of musculoskeletal complaints in the past 12 months, chronic complaints, frequency and length of breaks, exercising habits as well as medical care seeking Pain in the back, neck, and shoulders (84.6%/85.9%) was the most common complaint among the majority of respondents, while reduced range of movement was noticed among significantly fewer subjects, mostly between 40 and 60 years of age. Prolonged statistic position was considered to be one of the main causes of MSDs (82.05%), while 73.08% of respondents stated at least two more reasons beside this one The percentage of MSDs prevalence among dentists in public health sector is high. More extensive surveys should be undertaken to cover larger group of dentists from both private and public sector, to get complete analysis of the prevalence of occupational disorders in our country. Consequently, appropriate measures should be taken to inform and educate dentists regarding MSD. Awareness should be raised pointing out that dentistry, as a profession, is susceptible to high risk of occupational disorders and injuries. Ignorance and avoidance of the MSDs symptoms could lead to early career ending and therefore it is important to have a knowledge regarding its prevention

Anyfantis and
Biska [23] Greece The aim of this study is to investigate MSDs experienced by physiotherapists in Greece, their causes and specific measures, and good practices followed. Additional emerging risk factors will be examined The study was conducted in the second half of 2015 in the regions of central and northern Greece. It covered all working categories such as public hospitals (32.9%), private RCs (37.7%), and private practices (29.4%). In total, 320 questionnaires were distributed to physiotherapists for completion. There were 252 responses, giving a response rate of 79% Analysis indicated that 89% of the respondents had experienced a work-related MSD; 32.2% of those injuries occurred within the first 5 years of working. The most lumbered physiotherapists were those working as private practitioners and almost half of the injured respondents chose to work while injured. The most common measure taken to tackle work related MSDs was found to be physical therapy sessions. Job satisfaction and psychosocial issues were also identified as side-

effects of the economic slowdown
Physiotherapists in Greece were found to suffer from MSDs; workplace musculoskeletal injuries were quite common but under-reported. The body parts most affected were the lower back, the upper back, the shoulders, and the neck. There was a strong correlation between the workplace setting and the number of MSDs. A well-defined occupational safety and health management system and strict administration steering were found to reduce MSDs. The economic slowdown experienced in Greece during the execution of this study placed additional pressure on physiotherapists Almost every fourth of the studied health professionals reported severe or even very severe MSDs and nearly every seventh severe SDs. These prevalence rates were significantly or at least slightly higher among nurses than among physicians and other healthcare workers. General stress, work stress, physical effort at work, and particularly a painful or tiring posture at work were found to be clear and strong risk factors for MSDs, whereas only general and work-related stress were found to be significantly associated with SDs. There was no or only weak association between MSDs and SDs MSDs among health professionals in this study are found to be clearly work-related, that is, to be primarily and quite strongly associated with physically demanding and psychologically stressful work and with general stress. In contrast, SDs have proven not to be workrelated. SDs turned out to be only or mainly associated with general stress and -against expectations -only weakly associated with musculoskeletal pain and not at all with physical strain and psychological stress at work. As a result, MSDs (unlike SDs) are more prevalent

Slovenia
This study aimed to determine the prevalence of WMSD on a sample of physiotherapists from Slovenia and to identify associations between demographic/anthropometric variables, job satisfaction, and physical activity with WRMSD aiming to contribute to the development of effective prevention and control strategies The cross-sectional prospective study included physiotherapists from two prominent governmental rehabilitation institutions, the IMR University Medical Centre Ljubljana and the URI, Republic of Slovenia. The extended NMQ was used to obtain data from a sample of 102 physiotherapists. Data were presented with descriptive statistics and processing was performed with the Spearman's rank correlation coefficient for non-parametric variables. The level of statistical significance was set as p≤0.05 The 1-year prevalence of WMSD was 92.2%.
One-year prevalence of WMSD was highest for the neck (64%) and lower back (63%). Higher age and more years of practice were correlated with WMSD for shoulders and ankles/feet areas. Several patients treated by a physiotherapist were a risk factor for difficulties in the neck and multiple body areas. The level of physical activity was not correlated with WMSD in different body areas The prevalence of WMSD found in our study sample was among the highest compared to other countries, despite probably having similar working conditions as elsewhere in Europe. The first WMSD of Slovenian physiotherapists mostly did not occur in the first 5 years of practice as other studies reported, which could be explained as a result of a good educational training of young physiotherapists. Possible reasons for the high prevalence of WMSD could be that our study sample represented only secondary and tertiary levels of health care; another reason could also be non-ergonomic and hard-working conditions during their careers. Physiotherapists are mostly adequately physically active, however, that did not turn out to be effective WMSD prevention in our sample.  health sector in Macedonia is high. Božić [21] in his study on nurses' states that the prevalence of lumbar pain among nurses in the past 12 months was about 94%, which indicates the very high vulnerability of this population to the development of MSDs caused by work. A similar study was conducted by Akodu and Ashalejo [24] and reached the results where it can be seen that 70.4% of nurses in Lagos (Nigeria) in the past 12 months had some of the disorders of the musculoskeletal system.

CONCLUSION
This article should indicate the magnitude of the problems of WRMSDs in health professionals and that this topic is an inexhaustible and very interesting basis for further studies by current and future researchers to create strategies for prevention and treatment of this disorder and to eliminate their causes.