Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Mohan Z Mani

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On Sep 2018




Prof. Somashekhar Nimbalkar

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Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



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Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
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Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
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I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




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"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Original article / research
Year : 2023 | Month : March | Volume : 17 | Issue : 3 | Page : TC12 - TC18 Full Version

Prevalence of Musculoskeletal Pain among Sonographers in Makkah Province and Factors Associated with the Pain: A Cross-sectional Study


Published: March 1, 2023 | DOI: https://doi.org/10.7860/JCDR/2023/57189.17610
Ibrahem Hussain Kanbayti, Ibrahem Abbas Awad, Rawan A Ibrahim, Reem H Al-Sharif, Roaa M Al-Sulbi, Yousef Hamoud Almaimoni

1. Assistant Professor, Department of Radiologic Sciences, King Abdulaziz University, Jeddah, Makkah Almukarmah, Saudi Arabia. 2. Associate Professor, Department of Radiologic Sciences, King Abdulaziz University, Jeddah, Makkah Almukarmah, Saudi Arabia. 3. Researcher, Department of Radiologic Sciences, King Abdulaziz University, Jeddah, Makkah Almukarmah, Saudi Arabia. 4. Researcher, Department of Radiologic Sciences, King Abdulaziz University, Jeddah, Makkah Almukarmah, Saudi Arabia. 5. Researcher, Department of Radiologic Sciences, King Abdulaziz University, Jeddah, Makkah Almukarmah, Saudi Arabia. 6. Researcher, Department of Radiologic Sciences, King Abdulaziz University, Jeddah, Makkah Almukarmah, Saudi Arabia.

Correspondence Address :
Ibrahem Hussain Kanbayti,
Assistant Professor, Department of Radiologic Sciences, King Abdulaziz University, Almurtad a Street, Jeddah, Makkah Almukarmah, Saudi Arabia.
E-mail: Ikanbayti@kau.edu.sa

Abstract

Introduction: Work-related musculoskeletal pain is a serious public health issue affecting healthcare providers, particularly, sonographers. The lack of research into this issue, together with the limited knowledge of factors associated with pain among Saudi sonographers promoted the authors to perform this study.

Aim: To explore the prevalence of work-related musculoskeletal pain and potential factors related to this disorder among sonographers.

Materials and Methods: This cross-sectional study targeted 102 sonographers working in the Radiology Departments of hospitals located in the Makkah province from September 2019 to February 2020. The questionnaire comprised 27 questions- 11 questions related to demographic and psychosocial, nine on work scheduling and task factors (average time per scan and amount of job tasks), one on anatomical areas affected by pain over the last six months, six questions on work-related posture factors (position of the body during scanning). Bivariate analysis was considered to investigate the relationships between work-related musculoskeletal pain and potential factors affecting the musculoskeletal system of sonographers.

Results: The prevalence of work-related musculoskeletal pain among Saudi sonographers was 81 (98.78%), and the pain was located at a single or multiple body sites, with the highest being in shoulders (70, 86.4%), followed by lower back (61, 75.3%), hand and wrist (58, 71.6%). Mental stress was only associated with shoulder pain (p-value: 0.03), and demographic factors (institution type) were related to hand and wrist pain (p-value ≤0.003). Upper back pain was significantly related to work-related posture factors (p-value ≤0.008), and both work related posture factors, as well as task factors, have shown a significant relationship with lower back pain (p-value ≤0.04).

Conclusion: Work-related musculoskeletal pain is highly prevalent among Saudi sonographers and the pain from different anatomical parts were found to be associated with different factors including psychological, demographic, task, and work-related posture factors.

Keywords

Lower back, Mental stress, Radiology, Shoulders

The painful injuries of the musculoskeletal system that are caused by workplace activities are known as Work-Related Musculoskeletal Disorders (WRMSDs) (1). These disorders include muscles, nerves, ligaments, and tendons of different body parts. WRMSDs were first documented by Craig M in 1985 (2), and then they were intensely investigated by scholars between 1996 and 2017 [3-9]. The incidence of these disorders may increase in the future as a result of continuous exposure to risk factors at workplace (10). Additionally, WRMSDs can negatively influence the working life of healthcare providers, particularly sonographers, by restricting their extremities’ movement resulting in lower productivity and poor quality care services (10). Also, these are associated with a considerable economic burden, estimated at $87.6 billion in the USA (11). It has been estimated that the annual cost of compensation claims on WRMSDs in the United States of America (USA) is between 20 billion dollars suggesting that WRMSDs are a serious health concern that should be addressed (10).

Work-related musculoskeletal pain among sonographers have rarely been investigated in eastern societies, such as the Saudi population. Only one study explored the prevalence of work related musculoskeletal pain among Saudi sonographers, and did not investigate the risk factors of work related musculoskeletal pain by anatomical parts (12). The global demand for ultrasound is growing overtime, due its desirable characteristics including safety and non invasive nature (13). Accordingly, the workload on sonographers, such as number of scans, and working hours is expected to increase, which in turn, could escalate the risk of work related musculoskeletal pain.

The causes of work-related musculoskeletal pain are multifactorial and include work-related postures, demographic, psychosocial, and scheduling task factors (14). Importantly, these risk factors vary geographically due to differences in working environment, practices, and cultures among countries. For instance, workload and psychosocial factors have been shown to cause work related musculoskeletal pain among Sweden sonographers (15), while work-related posture and ergonomic factors have been reported to be precursors of work related musculoskeletal pain among Australian and Nigerian sonographers (7),(16). In Pakistan, scheduling and task factors have been shown as potential determinants of work related musculoskeletal pain among sonographers (17). Therefore, it is crucial to investigate the relationship between these factors and work related musculoskeletal pain among Saudi sonographers.

The purpose of this study was to investigate the prevalence of work related musculoskeletal pain among Saudi sonographers in Makkah province. Also, it was designed to explore the potential factors associated with work related musculoskeletal pain.

Material and Methods

This cross-sectional study was conducted among sonographers in Makkah province, Saudi Arabia between September 2019 to February 2020.

Sample size estimation: Using a 95% confidence interval, a 5% margin error, and a 84% prevalence of work-related musculoskeletal pain from a previous study (12), atleast 76 sonographers were required to conduct the study. Considering that there were nearly 102 registered sonographers working at government and private hospitals in Makkah region, the survey was sent to all sonographers working in the region.

Inclusion criteria: The on duty ultrasound technologists working at private and government hospitals in the main cities (Jeddah, Altaif, and Makkah), and conducting general, gynaecological, and obstetrical ultrasound examinations were invited to participate in the current study.

Exclusion criteria: Sonographers who performed cardiac ultrasound investigations, had a history of trauma related to accidents, or are currently retired were excluded from the study.

Study Procedure

A Google form link was created and sent through a WhatsApp group of sonographers. The link was also shared on Twitter, and Facebook. Monthly follow-up messages were send to remind participants to complete the survey. Before filling out the survey, participants were asked to read the opening statement of the survey which informs them about the objectives of study, inclusion criteria, instructions on how to fill out the survey, and if they are willing to participate. To ensure anonymity, and confidentiality of participants’ information, personally identifying information was not requested in the questionnaire. The Helsinki guidelines were followed to conduct this study.

Questionnaire: The survey was designed based on reviewing current literature [18,19], and comprised of 27 closed multiple choice questions, written in English language. These questions were divided into several domains; the first domain covers demographic and psychosocial information (11 questions); the second domain focuses on work scheduling and task factors details (nine questions);

the third domain is related to anatomical areas affected by pain in the last six months (one question); the last domain is about work-related postures (six questions). Before distributing the questionnaire, the survey was reviewed by an expert for the content validity. The reliability of questionnaire was examined by Cronbach’s alpha that was found to be closer to 0.70 (Cronbach’s alpha=0.683).

Statistical Analysis

The data were analysed by Statistical Package for Social Sciences (SPSS) version 25.0. Only those anatomical parts affected by pain with high prevalent rates (more than 60%) were considered for analysis in this study (shoulders, lower back pain, wrist and hand, and upper back pain). Frequencies and percentages were computed to describe categorical variables, while medians as well as means were used to represent continuous variables. To investigate the relationships of demographic information, psychosocial information, work scheduling and task factors, and work-related postures with anatomical areas affected by pain in the last six months data, bivariate analysis such as chi-square test, independent median test, and t-test were used as appropriate. The p-values below 0.05 were considered to be significant.

Results

A total of 82 out of 102 sonographers responded to the survey (response rate: 80.3%). The majority of them were female (71.95%). Of the 82 sonographers, 75.60% were from Jeddah city and nearly 68% were from public health sector. In terms of work related posture, majority of sonographers hold transducers with palmer grip (82%), sit in one position for long time (79.26%) (Table/Fig 1).

Irrespective of the site of pain, a total of 81 (98.78%) of sonographers experienced work-related musculoskeletal pain over the last six months. This pain was reported in single and multiple body parts sites with the highest being in shoulder (86.4%), lower back (75.3%), hand and wrist (71.6%), and upper back region (60.5%) (Table/Fig 2).

Sonographers who suffered from shoulder pain are more likely to have mental stress during their work (p-value: 0.03), participants with hand and wrist pain were more likely to be younger (p-value=0.001), female (p-value=0.001), employed at public hospitals (p-value=0.003) (Table/Fig 3).

Compared to respondents who did not experience any lower back pain over the last six months those who had lower back pain performed portable ultrasound (p-value=0.01), had higher average number of hours doing portable ultrasound (p-value=0.02), and sat in one position for long time during procedure (p-value=0.01) (Table/Fig 4),(Table/Fig 5). Sonographers with upper back pain sat either on awkward position (p-value=0.001), or with their trunk in asymmetrical position during procedure (p-value=0.008) (Table/Fig 5).

Discussion

The findings from this study show that the prevalence of work-related musculoskeletal pain is high among Saudi sonographers and the pain occurs frequently in shoulder, lower back, hand and wrist. This high prevalence is in line with national and international studies that similarly reported prevalence between 75.17% and 98.3% (12),(17),(20). It can be assumed that the global high prevalence of work-related musculoskeletal pain is due to a public stigma where the reporting rate of pain by sonographers is low and not encouraged as an acceptable part of their job. Therefore, overcoming this stigma would help in relieving this high prevalence and improve the incidence of diagnosis.

In the current study, the pain was very common in shoulder and lower back regions of Saudi ultrasound technologists. Okeji M et al., who investigated WRMSDs among fifty-one Nigerian sonographers found that 41% of sonographers experience back pain and a quarter suffer from wrist pain (7). A study from Pakistan reported a higher rate of low back pain (53%) among ultrasound technologists (17). Furthermore, a cross-sectional study conducted on Chinese population showed that sonographers perceived higher prevalence of neck (93.5%), and shoulder pain (92.2%) (20). The differences with the current study may be attributed to differences in workload, body postures, and work environment of these populations. In consistent to our study, Feng Q et al., study reported higher shoulder pain among Chinese sonographers due to sustained unnatural position during scanning and shoulder abduction (20). Ergonomic environment also has been shown to cause upper extremity pain among Chinese and Nigerian sonographers (7),(20), and lower back pain among Pakistani ultrasound technologists (17). In combination with the factors mentioned above, heavy workload and an absence of break time have been found to cause back pain and wrist pain among Nigerian technologists (7).

Similar to the present study, Arvidsson I et al., study shows that half of Swedish female sonographers commonly reported shoulder pain (15). This can be expected, since Swedish and Saudi sonographers suffer from a higher work stress level (21),(22), and mental stress has been considered as important contributing factors in work-related shoulder pain (18).

It is not surprising that those using portable ultrasound machine for a longer time are experiencing lower back pain in the current study. The nature of portable ultrasound procedures requires twisting the trunk of body, excessive arm abduction to reach the region of interest, and frequent repetitive movements due to poor ergonomic of equipment and patients. Therefore, proposing guidelines that improve practice and minimise the risk of pain is recommended. Furthermore, female sonographers were more likely to experience hand and wrist pain in the present study. Gender differences in the presentation of hand and wrist pain has been documented by previous studies. In line with the present study, Silverstein BA et al., Armstrong TJ et al., and Schulte PA et al., reported that female sonographers are more prone to hand and wrist pain (23),(24),(25). Schoenfeld A et al., also showed that carpel tunnel syndrome injuries are more prominent among females (26).

A potential explanation for these findings is that women have different muscle composition, physiology, contractile characteristics, and performance from men (27). Compared to men, women have a smaller quantity of skeletal muscle (fibers) which might reflect their limited muscle strength and minimal muscular endurance, and make them more susceptible for work related musculoskeletal pain [27,28].

In contrast to the present study, Okeji M et al., did not depict the relationship between work related musculoskeletal pain and sex; however, this study was based on small sample size and the majority of participants (69%) were males which might underestimate the relationship (7). Additionally, studies have shown a significant relationship between age and work-related musculoskeletal pain (7),(17),(29). Likewise, findings of present study showed that lower back pain, hand and wrist pain are more prevalent in younger sonographers. Theoretically, the risk of work-related musculoskeletal pain should increase with aging since several degenerative changes, such as bone stiffness, and osteoarthritis might take place in the musculoskeletal system of this age group. However, the prevalence of hand and wrist pain in younger age group in the current study is more likely due to the heavy workload that younger sonographers experienced.

Moreover, the authors explore for the first time that hand and wrist pain is very common among sonographers working at public hospitals. This finding is plausible, since Saudi public hospitals providing healthcare services for more than 62% of in-patient care (30), and the demand for ultrasound procedures is increasing overtime resulting in an increase of workload on sonographers and risk of having work-related musculoskeletal pain. In the current study, it is noted that taller sonographers are more likely to perceive with work related musculoskeletal pain, such as hand and wrist pain. This finding is in line with the study of Okeji M et al., (7) and in contrast with other study conducted by Junejo and his team. It is unclear how sonographer’s height can seriously affect musculoskeletal system of healthcare providers. This link might be explained by the quantity of muscle (muscle mass) among taller people which is found to be associated with musculoskeletal pain (31). Therefore, further studies are needed with considering muscle mass of participants to explore the potential relationship between height and work-related musculoskeletal pain.

In a sharp contrast to those who have a good posture (neutral position) while they perform scanning, those siting with a sustained bending or twisting at the waist for long time, sitting in one position for long time, or sitting in a sustained unnatural position (described in the tables above) to reach the area of interest experience back pain. This is in agreement with the findings of a Chinese study that reports those who have inefficient scanning postures during ultrasound procedure have four times higher risk of lower back pain (20).

Knowledge of factors that are related to work-related musculoskeletal pain is essential in clinical practice. The present findings can be used to inform stakeholders about the potential factors which negatively influence the health and well-being of workers. Also, they are helpful for policy makers to establish proactive and preventive work safety programs to keep the staff free of such physical pains. To reduce the high prevalence of work-related musculoskeletal pain, a multifactorial method that include the awareness about this disorder, educating sonographers regarding the potential factors that cause this health issue and the implementation of preventive measures that ensure the safety among sonographers is recommended.

To date, there is no much evidence on the prevalence of work-related musculoskeletal pain and factors associated with it in Saudi Arabia, and therefore this study may constitute the initial knowledge base on this subject, to guide further investigations in the future.

Limitation(s)

Being a cross-sectional survey, the findings are prone to a recall bias. Although the sample size of our work is limited, the data are likely to be representative of the selected population. Additionally, due to the limited number of respondents who experienced no pain in this work, it was very difficult to investigate the contribution of risk factors on work-related musculoskeletal pain using logistic regression analysis.

Conclusion

The prevalence of work-related musculoskeletal pain among Saudi sonographers is very high and the pain was more prominent in shoulder, lower back, hand and wrist, and upper back areas. Factors including mental stress, height, sex, age, work scheduling, and work-related posture have been shown to be related with higher rates of work related musculoskeletal pain. Thus, raising the awareness of work-related musculoskeletal pain among sonographers and establishing best practices that preserve health and well-being of sonographers is needed in Saudi Arabia. This can be done by addressing the factors that predispose these sonographers to such musculoskeletal pain.

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DOI and Others

DOI: 10.7860/JCDR/2023/57189.17610

Date of Submission: Apr 20, 2022
Date of Peer Review: Jun 14, 2022
Date of Acceptance: Nov 22, 2022
Date of Publishing: Mar 01, 2023

AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? NA
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA

PLAGIARISM CHECKING METHODS:
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