An individualized ergonomic wellness approach for the practicing gastroenterologist (with video).

Abstract

BACKGROUND AND AIMS\nThe prevalence and burden of ergonomic related musculoskeletal injury is well established in the literature, though there is a paucity of data on techniques that can be used to avoid injury. This pilot study aimed to develop a new method of endoscopist wellness assessment. This technique presented here is an intervention by a physical therapist assessing ergonomic position and posturing during endoscopy to create an individualized wellness plan.\n\n\nMETHODS\nVolunteer endoscopists were identified in a single ambulatory surgical center. Demographics, previous injury, current pain, and posture were evaluated. A comprehensive assessment was developed by the physical therapist while observing endoscopists performing at least 2 colonoscopies and while working at their computer workspace. The detailed personalized wellness program included recommendations for individualized exercises, static and dynamic posture re-education during and between procedures, optimization of procedure suite set-up, pain education, and opportunity for follow-up one-on-one sessions with the physical therapist. The endoscopists were later interviewed regarding their perception of and adherence to the wellness plan. Specific outcomes evaluated included changes in musculoskeletal pain, acceptance, and incorporation of wellness recommendations and procedure suite alterations into clinical practice.\n\n\nRESULTS\nAs we developed this new method of endoscopic wellness assessment, 8 endoscopists representing a wide range of ages and clinical experience were assessed. Twenty-two pain sites were identified among 5 of the subjects with back and neck pain being the most common pain sites. A variety of ergonomic inefficiencies and suboptimal movement patterns were observed resulting in highly variant wellness plans. By the end of the study, 63% of pain sites were reduced in intensity or resolved, whereas 32% of pain sites were unchanged and 4% increased in intensity. Seven of the 8 participants found the pictures depicting their posture that supported their movement analysis helpful and 3 participants requested reassessment by the physical therapist. All of the participants reported static and dynamic postural education and procedure suite set-up recommendations to be impactful to their ergonomic performance.\n\n\nCONCLUSIONS\nErgonomic assessment and instruction by a physical therapist was well received and resulted in improvement of musculoskeletal complaints among a cohort of endoscopists reporting baseline pain associated with performing endoscopy. In addition, this intervention provided ergonomic education that can be carried forward throughout their professional endoscopic career. We believe that ongoing individualized assessment and optimization of ergonomics is necessary as generalized wellness programs or even modifications to endoscopic equipment would not target all of the unique ergonomic challenges faced by each physician. Ergonomic programs using the new method presented here could potentially contribute to career longevity, decreased burnout, reduce lost days of work and most importantly reduction in pain and fatigue among practitioners.