Work-related musculoskeletal injuries and disorders are a serious health and economic concern for individuals, the workforce and the community in general. Laboratory technicians are not immune, with 72 to 80% of laboratory work-related musculoskeletal problems reported in studies from Iran and India [16, 17] using the SNMQ [18].
This study investigating the prevalence, common sites and impact of work-related musculoskeletal problems amongst medical science students found concerning rates of self-reported musculoskeletal problems during their training. Results indicate that more than a third of medical science students experience work-related musculoskeletal problems early in their practical laboratory based training. While over a third of students reported one or more musculoskeletal problems occurring within the last 12 months, almost a quarter also reported a more recent musculoskeletal problem within the last 7 days. This prevalence is around half of that reported amongst full time laboratory technicians, despite students only working one-sixth of hours worked by full time workers [16, 17]. Furthermore, this is likely to be an underestimation of the workforce weekly hours with many workers reporting working in excess of 50 h a week [14]. While female gender is associated with high reported work-related musculoskeletal problems [14, 16], this study with medical science students was not consistent with this evidence.
Musculoskeletal problems and consistency with workforce data
Consistent with previous research with laboratory technicians using the SNMQ, common sites for musculoskeletal problems in medical science students during laboratory activities, were the lower back (30% compared to 31 to 43%), neck (24% compared to 18 to 33%) and upper back (21% compared to 20%) [16, 17]. This is also similar to research from America, Ethiopia, Iran, Sweden and Switzerland indicating the neck (40–60%) and lower back (9–57%) were common sites musculoskeletal problems in laboratory technicians [14, 15, 19,20,21,22]. The high prevalence of back problems is also consistent with Australian data with back problems accounting for 33% of musculoskeletal injuries [1]. Workplace musculoskeletal problems occurring early in careers needs further investigation to understand the potential contribution to national economics costs, particularly given back injuries were estimated to cost $1.2 billion in Australia in 2008–2009 [25].
Laboratory activities and prevalence of musculoskeletal problems
Repetitive and physical demands associated with laboratory activities are identified as contributing factors to the development of musculoskeletal problems [13]. Awkward and prolonged working postures with static loads on muscles have been implicated in the development of back, shoulder and neck problems [13], which is consistent with the common sites of reported problems by medical science students. Students who perceived they had poor postures were more likely to report musculoskeletal problems in both the 12 month and 7 day recall period. Students were also conscious about the ergonomic demands of laboratory tasks reporting the need for ‘better seating design’ and to ‘learn about better posture’.
Particular activities, such as pipetting have also been associated with musculoskeletal symptoms in hands, shoulders and the neck, with high usage and fatigue adding to the injury statistics [17, 22]. Medical science students also reported spending around a third of their time performing pipetting activities, which could contribute to their reported problems in the hands (12%), shoulders (15%) and neck (24%). Consistent with previous literature, poorly designed workstation height (for example, too high or low) used by laboratory technicians may have contributed to these musculoskeletal problems [17]. As the majority of medical science students used non- adjustable stools seating, the one size fits all model, may be exacerbating their musculoskeletal problems. Furthermore, medical science students voiced views about the need for better height adjustable chairs and back support, to avoid ‘hunching’ during laboratory activities.
Fatigue and workload related musculoskeletal problems
Fatigue and increased years within the profession has been indicated to be a contributor to workplace musculoskeletal problems [15, 22]. However this study found no difference in year of study or reported problems. The homogeneity of hours of laboratory activities across the years of study, which is a curriculum constraint, may offer one explanation for this difference. While the average hours of laboratory activities were only around six hours per week, this was sufficient to affect musculoskeletal heath. As such, fatigue management was considered a possible solution by students to take more breaks and limit class duration, suggesting an understanding of the accumulative effects of laboratory activities and the need for a proactive participatory culture [10, 13].
Lower limb musculoskeletal problems
Lower limb musculoskeletal problems were less prevalent sites reported by medical science students however, the prevalence was similar to the literature. The prevalence of knees, ankles and foot problems in this study were between 5 and 10% compared to 10 to 20% in the workforce literature [15, 17, 22]. The association between lower limb problems and prolonged standing, and moving across the workplace for different equipment, such as fume cupboards and centrifuging equipment has been previously reported [15, 17]. In this study students reported 15% of their time in these lower limb loading tasks.
While some work-related musculoskeletal problems are less prevalent, they still can have impact on daily activities and need for medical assistance. For example, in the students reporting problems in the ankle and feet, almost all problems (82%) prevented them participating in daily activities and required them to seek medical assistance (73%). This raises concerns that undergraduate medical science students, already in their training, are experiencing work related musculoskeletal problems which impact on daily activities and require treatment regardless of the prevalence rate. In fact, across all sites of reported problems, the majority of problems prevented daily activity as well as requiring treatment in a 12 month and 7 day recall period.
Musculoskeletal problems in early career professionals
Previous research findings have also shown that early career health professionals account for 45% of reported musculoskeletal injury, occurring within the first five years of practice [12]. It is concerning that the current study suggests medical science undergraduate students may be pre-exposed to musculoskeletal problems, heightening their risk of developing more severe musculoskeletal disorders early in their career. It is likely students in training are more vulnerable to work-related musculoskeletal problems, because of the lack of musculoskeletal conditioning, experience in the laboratory when learning new skills [12, 20] and stress to meet laboratory tasks and assessment schedules [13]. This leads to the importance of managing laboratory workplace ergonomics and training, even as part of university curriculums, particularly in light that musculoskeletal injury has been associated with burnout, workplace stress and health workforce shortages [4, 6, 7]. While this is the first study to investigate musculoskeletal problems experienced in medical science students during their university training, this study replicates the high prevalence of musculoskeletal workplace problems experienced in the laboratory professional workplace.
Educational needs
To address the high prevalence of laboratory work related musculoskeletal problems, previous recommendations include the need for better ergonomic education within university curriculums and the workplace [14, 20]. While ergonomic improvements in equipment and workplace design may be needed, a participatory model approach [10, 20] is recommended at the job front. The intention to address postural issues and for individuals to learn how to manage their own postural variations, within different workstations they may be presented with. While only 10% of students provided written comments to address work-related musculoskeletal problems, it seems they are ready to engage in ergonomic education, with students indicating that ‘learning about better posture’ would help them manage musculoskeletal problems. Furthermore, this study found an association with reported problems and participation in ergonomic exercises. It is likely, that the many students seeking assistance for their musculoskeletal problems are being advised to undertake exercises to manage them. Further research is needed to investigate the acceptability, content and benefits of ergonomic postural education to prevent/manage musculoskeletal problems experienced during undergraduate medical science workplace training activities.
Limitations
While this study was able to provide important data on reported musculoskeletal problems in medical science students, several limitations are noted. Only one class list from each year was used to send emails to students, without direct student contact to promote the research project. While the survey reached students across all years the response rate was low (38%). It is known students receive numerous emails through their student account and do not always prioritise these notifications. However, the response rate is relatively consistent with previous reported research (50%) investigating work-related musculoskeletal in the workforce [20]. It is possible that students with work-related musculoskeletal problems were more likely to respond, however 66% of respondents who completed the survey did not report any laboratory work-related musculoskeletal problem.
As in any cross-sectional study, causal relationships cannot be determined. Similarity in hours of laboratory participation across the years of the study was a curriculum constraint and also limited exposure investigation. While we were able to investigate associations between musculoskeletal problems and key variables, causation could not be established, nor were ergonomic audits of workstations and activities undertaken. Furthermore, even though the response rate was comparable to other studies, the results need to be considered with some caution given the response rate may not be fully representative of the total student cohort.
While students provided rich information about their experience within the open ended questions, this only accounted for 10% of the total sample and 30% of students reporting problems, thus may not comprehensively represent the opinion of the whole sample. Further studies monitoring musculoskeletal problems over time with more complete response rates are needed. As students were studying in one program at one university, it is possible that results may differ in different programs and contexts.
