Comprehensive Investigation of Ergonomic Challenges and Work-related Musculoskeletal Disorders among Intensive Care Unit Healthcare Providers of Western India through Mixed Methods Study

Comprehensive Investigation of Ergonomic Challenges and Work-related Musculoskeletal Disorders among Intensive Care Unit Healthcare Providers of Western India through Mixed Methods Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Comprehensive Investigation of Ergonomic Challenges and Work-related Musculoskeletal Disorders among Intensive Care Unit Healthcare Providers of Western India through Mixed Methods Study Sonali Detroja, Rajkumar Mahajan, Ankit Sheth This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4394065/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 07 Feb, 2025 Read the published version in BMC Musculoskeletal Disorders → Version 1 posted 4 You are reading this latest preprint version Abstract Background: Work-related musculoskeletal disorders (WRMSDs) are significant concern in healthcare sector, specifically intensive care units (ICUs) due to distinct work environment. This study aims to comprehensively investigate determinants of WRMSDs and ergonomic challenges, specific to ICU healthcare providers, providing valuable insights for targeted interventions. Methods: In this mixed methods study, 200 consenting healthcare providers from seven ICUs participated. Structured questionnaires were used to collect details of socio-demographics, occupation, physical and workplace factors, risk perception, and musculoskeletal pain through modified Nordic Musculoskeletal Questinnaire. Qualitative insights were obtained through in-depth interviews until saturation of responses. Statistical analyses included inferential statistics, logistic regression, and thematic analysis. Results: Study revealed a high prevalence of WRMSDs (84%), with low back pain and neck reported to be most affected regions. Logistic regression analysis identified longer tenure in the ICU, high shift frequency, high physical workload and risk perception, and low exercise habits as significant predictors of WRMSDs among ICU healthcare providers. Qualitative study underscored challenges of heavy patient loads, long hours, and emotional strain faced by ICU healthcare providers, while also highlighting institutional support strategies for prevention of WRMSDs. Conclusion: This study offers valuable insights into the multifaceted challenges faced by ICU healthcare providers and underscores the importance of multidimensional interventions incorporating physical, behavioural, and environmental factors. There is urgent need to address modifiable risk factors, including ergonomic training, workplace modifications, schedule adjustments, and educational programs to enhance risk awareness and preventive behaviours to effectively combat the burden of WRMSDs. Work-related musculoskeletal disorders (WRMSDs) intensive care units (ICUs) healthcare providers ergonomic factors risk perception. Figures Figure 1 Figure 2 INTRODUCTION Work-related musculoskeletal disorders (WRMSDs) are conditions in which the work environment and performance of work contribute significantly to the condition and/or the condition is made worse or persists longer due to work conditions. [ 1 ] Work-related musculoskeletal disorders (WRMSDs) are a prevalent and significant concern within the healthcare sector. These disorders arise due to various factors inherent to the nature of the work performed in these settings, including prolonged duty hours, demanding tasks, repetitive movements [ 2 ] and unsafe working conditions. [ 3 , 4 ] WRMSDs encompass a range of conditions affecting muscles, tendons, intervertebral discs, nerves, joints, and cartilage, [ 5 ] leading to debilitating symptoms such as lower back pain, neck discomfort, and shoulder issues. [ 6 ] For nurses, musculoskeletal disorders (MSDs) are a significant occupational health problem, with a substantial global prevalence. Worldwide, the annual prevalence of work-related musculoskeletal disorders (WRMDs) among nurses is reported to range from 40–85% in studies from various countries including Brazil, Italy, Estonia, Uganda, Nigeria, and California. [ 6 – 10 ] Similarly, in China, WRMDs among nurses have been reported to have a prevalence ranging from 56–92%. [ 11 – 13 ] These disorders commonly manifest as pain in the lower back, neck, and shoulders, reflecting the physically demanding nature of nursing work. Differences in the estimated prevalence of WRMDs across countries may reflect differences in working environments, facilities, and the nature of the work, resulting in inconsistent reporting of risk factors. Despite the attention given to WRMSDs among nurses, there remains a notable gap in understanding its prevalence and ergonomic challenges faced by ICU healthcare providers specifically. The patients in intensive care units (ICUs) are often immobile with severe physical weakness and little ability to care for themselves. The demands of the ICU setting differ significantly from other healthcare settings, with healthcare providers facing distinct challenges such as frequent patient handling, complex medical procedures, and prolonged periods of standing or exertion. [ 14 – 16 ] In India, where staff shortages and a high patient volume are prevalent, heavy workload and repetitive movements emerge as the most common risk factors contributing to WRMSDs among ICU healthcare providers. [ 17 ] Existing literature primarily emphasizes the prevalence and risk factors of WRMSDs among nurses in general healthcare settings, with few studies addressing the distinct challenges faced by ICU healthcare providers. Moreover, the few studies that have examined WRMSDs in the ICU setting often lack comprehensive assessments of ergonomic factors and fail to consider the unique environmental and workload-related challenges specific to ICU care. Given the critical role of ICU healthcare providers in delivering care to critically ill patients, it is imperative to address these gaps in knowledge. This study aims to investigate the prevalence of WRMSDs among ICU healthcare providers in India and explore the underlying work environment and job-related factors contributing to these disorders. Additionally, the study seeks to identify perceived ergonomic challenges within the ICU environment and propose potential strategies to mitigate them. By shedding light on these issues, this research endeavours to inform targeted interventions and policies aimed at promoting the occupational health and well-being of ICU healthcare providers. METHODS Study Design and Setting: This cross-sectional mixed-method study was conducted in Gujarat, India, focusing on assessing musculoskeletal symptoms and associated factors among registered doctors, nurses, and other healthcare providers working in the intensive care units (ICUs) of three tertiary care hospitals. These ICUs admitted critically ill patients from various departments of the hospital. By employing both qualitative and quantitative components, the study aimed to comprehensively explore the prevalence and determinants of work-related musculoskeletal disorders (WRMSDs) in ICU health care providers. Participants and Sampling: The study utilized a simple random sampling technique to select 200 healthcare providers from seven ICUs across the three tertiary care hospitals in Gujarat. Inclusion criteria required participants to have at least one year of ICU experience and be actively involved daily in patient care duties. Individuals diagnosed with genetic musculoskeletal disorders or recent viral infections which may lead to viral myalgias were excluded to minimize potential confounding factors. Data collection tools: Quantitative data were collected using a structured questionnaire designed to capture a comprehensive range of variables related to musculoskeletal symptoms and associated factors. The questionnaire covered sociodemographic details, including age, sex, marital status, and highest education level, as well as occupational details such as years of experience, job title, duty hours, and frequency of breaks. Physical factors, including patient handling frequency and physical workload, were assessed using Likert scale-based questions. Environmental factors, ergonomic habits, and risk perception were also evaluated using structured items. The Modified Nordic Musculoskeletal Questionnaire (NMQ) [ 18 ] was employed to accurately locate musculoskeletal pain sites and assess pain severity among participants. Qualitative data were collected through in-depth interviews to gain deeper insights into the challenges faced by healthcare providers in ICUs, their coping mechanisms, institutional support, and potential preventive measures for WRMSDs. Interviews and discussions continued until saturation of responses was achieved, ensuring a comprehensive understanding of participants' perspectives. Study Variables and Measures: The primary dependent variable was musculoskeletal symptoms, defined as symptoms lasting ≥ 1 week, occurring ≥ 1 per month, of at least moderate intensity, and attributed to work-related events. The symptoms were measured using modified NMQ in which diagram of the body was depicted to help participants accurately locate the region and duration of pain by author herself. Participants were then asked to rate the intensity of their pain on a Likert scale ranging from 1 (excruciating) to 4 (mild), describe the type of pain experienced, and indicate whether they sought medical intervention for symptom management. Independent variables included demographics, physical factors, job and workplace-related factors, environmental factors, and risk perception. Demographic details included age, sex, marital status and highest education level. Occupational details comprised years of experience, job title, and specifics regarding duty hours, breaks, and frequency of patient handling activities. Personal habits , such as smoking status, duration, and daily cigarette consumption, were also recorded. Physical factors were assessed through a series of five-point Likert scale-based questions (1 = never to 5 = very often) regarding the frequency of patient handling tasks, lifting and transferring patients, utilization of lifting aids, and assistance from colleagues during patient shifting from wheelchair to bed and vice versa. Additionally, questions regarding continuous standing, repetitive bending, heavy lifting (> 20 kgs), and the frequency of performing repetitive movements were included to gauge the physical workload/ demand experienced by participants. Environmental factors and risk perception were evaluated through inquiries regarding ergonomic training, patient handling techniques, and comfort level in reporting issues to superiors. Engagement of the participants in stretching and exercise activities, sleep disturbances, perceptions of work-related pain causation, and disruptions in personal life due to work were assessed using five-point Likert scale responses (1 = never/strongly disagree to 5 = very often/strongly agree). Additionally, the Rapid Entire Body Assessment (REBA) scale was employed to evaluate the ergonomic challenges associated with specific tasks performed by participants, thereby assessing their potential contribution to the development of work-related musculoskeletal disorders (WRMSDs). REBA provides a single final score based on the posture evaluated, force requirement, type of movement, frequency of movement and coupling observed within the task. A single value ranging from 1 to 15, represents WRMSD risk to the investigator. Data Analysis: Quantitative data were analysed using licensed SPSS 26.0. Descriptive statistics, including frequencies, percentages, means, and standard deviations, were calculated to summarize the data. Inferential statistics, including chi-square tests and Student t-tests, were employed to assess associations between variables, with a significance level set at 0.05. A logistic regression model was used to identify the predictors of WRMSDs. Qualitative data were assigned codes and categories and analysed thematically to identify patterns, themes, and key insights emerging from interviews. RESULTS Quantitative study results: This study included 200 ICU health care providers across seven different ICU in three hospitals of Gujarat. The demographic and occupational characteristics of ICU healthcare providers were examined in relation to the prevalence of WRMSDs. Among the 200 participants, 168 (84%) reported experiencing WRMSDs, while 32 (16%) did not. There were no significant differences observed in the distribution of age (p = 0.56), sex (p = 0.65), or education level (p = 0.29) between the two groups. However, significant associations were found between WRMSDs and marital status (p = 0.003), years working in the ICU (p = 0.000), ICU shift frequency (p = 0.000), number of breaks per shift (p = 0.009), exercise frequency (p = 0.01), and current smoking status (p = 0.02) (Table 1 ). Table 1 Demographics and occupational details of ICU health care providers and its association with WRMSDs Variables WRMSDs Significance Yes (n = 168) No (n = 32) Age in years, n (%) 18–30 60 (35.7) 13 (40.6) p = 0.56 31–40 80 (47.6) 16 (50.0) > 40 28 (16.7) 3 (9.4) Sex, n (%) Male 36 (21.4) 8 (25.0) p = 0.65 Female 132 (78.6) 24 (75.0) Education, n (%) Higher secondary/ diploma 80 (47.6) 12 (37.5) p = 0.29 Graduate and beyond 88 (52.4) 20 (62.5) Marital status, n (%) Unmarried/ Divorce/ separated 66 (39.3) 4 (12.5) p = 0.003 Married 102 (60.7) 28 (87.5) Years working in ICU, n (%) 1–5 60 (35.7) 24 (75.0) p = 0.000 6–10 64 (38.1) 8 (25.0) > 10 44 (26.2) 0 (0) ICU shift frequency (days per week), n (%) ≤ 4 56 (33.4) 22 (68.8) p = 0.000 5–7 112 (66.6) 10 (31.2) Length of breaks, minutes, n (%) ≤ 10 114 26 p = 0.12 10–30 54 6 Number of breaks per shift, n (%) ≤ 1 48 (28.6) 2 (6.2) p = 0.009 2 48 (28.6) 16 (50.0) 3 or more 72 (42.8) 14 (43.8) Exercise, n (%) Never 60 (35.7) 2 (6.2) p = 0.01 Seldom ( 10 days/month) 28 (16.7) 8 (25.0) Current smoking status, n (%) Currently non-smoker 114 (67.9) 28 (87.5) p = 0.02 Currently smoker 54 (32.1) 4 (12.5) Low back pain was the most commonly reported WRMD (77%), followed by neck pain (49%), knee pain (49%) and upper back pain (48%) (Fig. 1 ). The majority of participants with WRMSDs reported experiencing dull ache-type pain (85.9%), with moderate to severe pain intensity being more prevalent. Among those seeking intervention, medication was more commonly sought than physiotherapy (Table 2 ). Table 2 Type of pain, intensity of pain and intervention sought by WRMSDs positive participants (n = 168) Variables No. of participants, n (%) [a] On medications, n (% of a) On physiotherapy, n (% of a) Type of pain Dull ache 144 (85.9) 88 (61.1) 42 (29.1) Sharp pain 24 (14.1) 16 (66.6) 10 (41.6) Intensity of pain Mild 10 (6) 0 (0) 0 (0) Moderate 76 (45.2) 36 (47.3) 14 (18.4) Severe 66 (39.3) 52 (78.8) 28 (42.4) Excruciating 16 (9.5) 16 (100) 10 (62.5) Participants with WRMSDs reported significantly higher mean scores for physical factors (p = 0.000), physical workload (p = 0.001), work environment (p = 0.000), and risk perception (p = 0.000) compared to those without WRMSDs (Table 3 ). Table 3 Association between physical factors, physical workload, work environment and risk perception with WRMSDs Variables WRMSDs Significance Yes (n = 168) No (n = 32) Physical factors (total score 50), mean (SD) 15.1 (6.5) 11.1 (2.0) p = 0.000 Physical workload (total score 20), mean (SD) 12.8 (2.4) 10.7 (1.5) p = 0.001 Work environment (total score 20), mean (SD) 13.1 (3.4) 10.1 (2.7) p = 0.000 Risk perception (total score 20), mean (SD) 11.8 (3.2) 8.9 (3) p = 0.000 The logistic regression analysis revealed several significant risk factors associated with the prevalence of WRMSDs among ICU healthcare providers. Participants with longer tenure in the ICU (OR = 1.4, 95% CI: 1.13–1.66, p = 0.001), working 5–7 days per week (OR = 2.7, 95% CI: 1.27–5.95, p = 0.003), higher physical factor score (OR = 1.2, 95% CI: 1.05–1.42, p = 0.009), higher physical workload score (OR = 1.2, 95% CI: 1.09–1.49, p = 0.04), higher risk perception (OR = 1.3, 95% CI: 1.10–1.78, p = 0.01), and those never exercising (OR = 0.5, 95% CI: 0.27–0.93, p = 0.02) were more likely to report WRMSDs. The logistic regression model was statistically significant and the model explained 58% (Nagelkerke R 2 ) of the variance (Table 4 ). Table 4 Logistic regression analysis to determine risk factors of WRMSDs Risk factors OR (95% CI) Significance Marital status 0.7 (0.33–1.58) 0.42 Smoking status 1.5 (0.72–3.34) 0.26 Years working in ICU 1.4 (1.13–1.66) 0.001 Shift frequency in ICU 2.7 (1.27–5.95) 0.003 Number of breaks per shift 0.5 (0.20–1.20) 0.12 Exercise 0.5 (0.27–0.93) 0.02 Physical factors 1.2 (1.05–1.42) 0.009 Physical workload 1.2 (1.09–1.49) 0.04 Work environment 1.0 (0.45–2.30) 0.95 Risk perception 1.3 (1.10–1.78) 0.01 The REBA scores were used to evaluate risk levels among 200 participants, categorizing them into five risk levels: negligible, low, medium, high, and very high. A score of 1 is negligible risk which needs no necessary action while 11–15 denotes very high risk which needs immediate action. These findings underscore the importance of implementing targeted interventions to mitigate musculoskeletal disorder risks among ICU healthcare providers (Table 5 ). Table 5 REBA score to assess the risk involved REBA score No. of participants Risk level Action needed 1 50 Negligible None necessary 2–3 32 Low May be necessary 4–7 51 Medium Necessary 8–10 49 High Necessary soon 11–15 18 Very high Necessary Now Qualitative results: The median work experience of the fourteen in-depth interviewees, was 7 years. The analysis of the codes and categories from the transcript revealed four primary themes based on the responses of participants: the challenges faced in ICU, coping mechanisms, institutional support and preventive measures. Challenges faced in ICU: Participants commonly mentioned challenges related to heavy patient loads, frequent patient handling, long working hours, and the physical demands of their tasks. They also discussed the emotional toll of caring for critically ill patients and the need for emotional support. "The constant rush, attending to one patient after another, without much time to rest in between, it really takes a toll on your body." "Standing for long hours during procedures is exhausting. Sometimes, it feels like there's no end to it." "The emotional burden is immense, especially when patients are critical. It adds to the physical strain we already face." Coping mechanisms: Healthcare providers described various coping strategies, including seeking social support from colleagues, practicing mindfulness or relaxation techniques during breaks, and finding satisfaction in providing quality patient care despite the challenges. "Talking to my colleagues helps a lot. We share our experiences and have a laugh about it." "Knowing that I'm making a difference in patients' lives keeps me going. Despite the challenges, it's rewarding to see them recover." Institutional support: Participants highlighted the importance of institutional support in addressing WRMSDs. They emphasized the need for ergonomic training, access to ergonomic equipment, and clear communication channels for reporting workplace hazards or injuries. Some also expressed the need for counselling services to address the emotional stress of their work. "We need better training on how to handle patients safely. Patient handling should be ergonomic so that our backs do not hurt." "We need more ergonomic equipment. This would make a big difference." "There should be someone we can talk to about the stress. It's not just about physical health; our mental well-being matters too." Potential preventive measures discussed by participants included implementing ergonomic practices such as proper lifting techniques, adjusting work schedules to allow for adequate rest and recovery, providing regular breaks, and promoting physical exercise or stretching routines. "We need more breaks during shifts. Even just a few minutes to stretch and move around can make a difference." "Proper lifting techniques are crucial. We often lift heavy patients without realizing the strain it puts on our bodies." "Encouraging regular exercise and providing resources for it would be beneficial. It's hard to find time for self-care outside of work." DISCUSSION The present mixed methods study, conducted in Gujarat, aimed to comprehensively investigate the prevalence of work-related musculoskeletal disorders (WRMSDs) and its association with work environment, risk perception and physical workload among 200 healthcare providers working in intensive care units. Utilizing a self-reported survey administered via questionnaire, supplemented by objective assessments using the modified Nordic Musculoskeletal Questionnaire and Rapid Entire Body Assessment (REBA) scales, the study found a high prevalence of WRMSDs, affecting with 84% of participants. The prevalence of WRMDs observed in this study is notably higher compared to similar research conducted in various regions such as Brazil, Italy, India, Nigeria, Ethiopia, and Saudi Arabia. [ 10 , 19 – 22 ] However, it is important to note that while these studies involved healthcare professionals from hospitals, they did not specifically focus on those working in ICUs. When contrasted with investigations targeting healthcare providers in ICUs, even higher prevalence rates of WRMDs have been reported. [ 20 , 23 – 25 ] Notably, all these studies consistently identify the lower back and neck as the most commonly affected body regions, mirroring the findings of our study and emphasizing the widespread nature of musculoskeletal strain among ICU healthcare providers. In this study, several factors were identified as being associated with WRMSDs among ICU healthcare providers such as marital status, years of work in ICU, shift frequency (higher prevalence among those working 5–7 days per week compared to ≤ 4 days), number of breaks (higher prevalence among those taking ≤ 1 break per shift compared to 2 or more), self-exercise (higher prevalence among those who never exercised compared to occasional or frequent exercisers), and smoking habits. Previous evidence support the role of marital status in reporting of WRMDs. [ 26 ] The spouses and families of married nurses may help buffer the effects of injuries [ 27 ], making them less likely to report WRMD symptoms compared with unmarried nurses. Additionally, years of experience were found to be associated with increased WRMSD prevalence, potentially reflecting prolonged exposure to ergonomic risk factors and age-related declines in muscle strength. [ 7 , 17 ] A comprehensive study involving ICU nurses in China found that the frequency and duration of breaks during shifts, taking breaks in comfortable settings, and the absence of self-exercise were correlated with work-related musculoskeletal disorders (WRMSDs). [ 23 ] Nurses with lower shift frequencies and more breaks may have sufficient time for recovery, potentially resulting in a lower incidence of WRMSDs among them. It has been reported that modifiable risk factors such as tobacco usage is strongly associated with WRMSDs [ 28 ] suggesting that addressing tobacco use could be a key target in preventive strategies aimed at reducing the burden of WRMSDs. The participants with WRMSDs in our study exhibited significantly higher mean scores for physical factors, physical workload, work environment, and risk perception compared to those without WRMSDs, indicating greater frequency of physically demanding tasks, higher perceived workload intensity, greater discomfort with ergonomic conditions, and higher perceived risk of musculoskeletal injury or discomfort associated with their work tasks. The association between physical risk factors and WRMSDs has been supported by previous research. [ 29 , 30 ] It is established that nurses exposed to high physical demands are more susceptible to WRMSDs, [ 31 ] a finding consistent with the present study. Risk perception, a relatively new variable, has gained recognition in behavioural theory studies, highlighting its importance as a modifiable factor in motivating healthy behaviours. [ 32 – 34 ] As an indirect influencer, adequate perception of occupational risk can be regulated and utilized as a tool to mitigate WRMSD occurrence through education and skill training by hospital executives. [ 35 ] It is plausible that the indirect effect of physical factors on WRMSDs is attributed to nurses with heightened awareness of injury risks due to their exposure to high physical demands, leading to the reporting of more severe symptoms. The workplace environment significantly impacts worker health and safety, [ 36 ] although its direct influence on WRMSD occurrence depends largely on individual perceptions and behaviours. [ 37 ] An unsafe workplace environment may negatively impact nurses' ability to work or motivate requests for improvement, underscoring the need for organizational efforts to establish a healthy safety culture and enhance risk consciousness. [ 38 ] After adjusting for covariates, logistic regression analysis revealed that longer tenure in the ICU, working 5–7 days per week, never exercising, and higher physical factor, physical workload, and risk perception scores were significant predictors for WRMSDs among ICU healthcare providers. This analysis underscores the importance of considering various physical and behavioural factors in assessing and addressing the risk of WRMSDs in the ICU setting. There is need for targeted interventions aimed at mitigating the effects of prolonged tenure, demanding work schedules and heightened risk perceptions on the occurrence of WRMSDs among ICU healthcare providers. Further investigation is also warranted into the relationship between exercise habits and WRMSDs among ICU healthcare providers. Insights from qualitative interviews shed light on the multifaceted challenges faced by ICU healthcare providers, including heavy patient loads, long hours, and emotional strain. Coping mechanisms such as seeking social support and finding satisfaction in patient care underscored individual resilience, while institutional support, including ergonomic training and access to equipment, emerged as critical in addressing WRMSDs. Participants also highlighted the importance of preventive measures like ergonomic practices and promoting physical exercise. Overall, the findings from the qualitative interviews complement the quantitative data on WRMSD prevalence and associated factors, providing a nuanced understanding of the challenges and potential solutions in the ICU work environment. Despite its significant contributions, the study is not without limitations. The cross-sectional design precludes the establishment of causal relationships, and reliance on self-reported data may introduce bias. However, author established rapport with participants, clarified the purpose of the study, and assured confidentiality to encourage truthful reporting. Moreover, the study was limited to ICU healthcare providers in public tertiary hospitals, which may restrict the generalizability of the findings to ICUs of other private tertiary hospitals. Future research using longitudinal designs and broader sample populations is needed to validate these findings. More studies are needed to explore links between physical factors, behavioural factors, environmental factors, and WRMSDs. CONCLUSION In conclusion, this mixed methods study sheds light on the high prevalence of WRMSDs among ICU healthcare providers and significant association with longer tenure in ICU, high shift frequency, high score of physical factors, physical demand and risk perception, and low exercise habits. Urgent targeted interventions are needed to address modifiable risk factors, including prolonged tenure, demanding work schedules, and heightened risk perceptions. Institutions should prioritize ergonomic training, workplace modifications, schedule adjustments, and educational programs to enhance risk awareness and preventive behaviours to effectively combat the burden of WRMSDs. Additionally, qualitative insights further highlight the nuanced challenges faced by ICU healthcare providers and offer valuable perspectives into preventive measures. However, the study's limitations, including its cross-sectional design and reliance on self-reported data, should be noted. Future research should focus on designing and testing multidimensional interventions that incorporate physical, psychosocial, and environmental factors, with particular attention to the role of muscle-strengthening exercises in reducing WRMSD incidence. Declarations Ethics approval and consent to participate: Approval for the study was obtained from the Institutional Human Ethics Committee of the B J Medical College and Hospital, Ahmedabad, India. The research was carried out following the Helsinki Declaration. Written informed consent was taken from the participants of the in-depth interviews, which included consent for the audio recording of the interviews. Confidentiality and anonymity of participants were strictly maintained throughout the study process, with data anonymization procedures implemented to safeguard privacy of the participants. Additionally, participants were assured of their right to withdraw from the study at any time without repercussions. Consent for publication: Written informed consent was taken from participants for use of data generated during the interviews for the purpose of publication. It was ensured that the identity of individual participants shall remain confidential and will be not be revealed in any publication. Availability of data and materials: The datasets generated during the current study are not publicly available due to risk of compromise in privacy, but are available from the corresponding author on reasonable request. Competing interests: The authors declare that they have no competing interests. Funding: The author(s) received no financial support for the research, authorship, and/or publication of this article. Authors' contributions: SD, AS and RGM contributed to the study conception and study design. SD and AS contributed to literature search, data collection, data analysis and interpretation, and manuscript draft preparation. RGM contributed to revision of manuscript for intellectual content. All authors read and approved the final version of the manuscript. Acknowledgements: The authors express their sincere gratitude to all the ICU healthcare providers who participated in the study, and the heads of the departments and the ICU in charge for their support and cooperation throughout this study. References Anderson V, Bernard B, Burt SE, Cole LL, Estill C, Fine L et al. Musculoskeletal Disorders and Workplace Factors: A Critical Review of Epidemiologic Evidence for Work-Related Musculoskeletal Disorders of the Neck, Upper Extremity, and Low Back1997. Ribeiro T, Serranheira F, Loureiro H. Work related musculoskeletal disorders in primary health care nurses. Appl Nurs Res. 2017;33:72–7. Lee SJ, Faucett J, Gillen M, Krause N, Landry L. Risk perception of musculoskeletal injury among critical care nurses. Nurs Res. 2013;62(1):36–44. Hoe VC, Kelsall HL, Urquhart DM, Sim MR. Risk factors for musculoskeletal symptoms of the neck or shoulder alone or neck and shoulder among hospital nurses. Occup Environ Med. 2012;69(3):198–204. Heidari M, Borujeni MG, Rezaei P, Kabirian Abyaneh S. Work-Related Musculoskeletal Disorders and Their Associated Factors in Nurses: A Cross-Sectional Study in Iran. Malays J Med Sci. 2019;26(2):122–30. Freimann T, Coggon D, Merisalu E, Animagi L, Paasuke M. Risk factors for musculoskeletal pain amongst nurses in Estonia: a cross-sectional study. BMC Musculoskelet Disord. 2013;14:334. Tinubu BM, Mbada CE, Oyeyemi AL, Fabunmi AA. Work-related musculoskeletal disorders among nurses in Ibadan, South-west Nigeria: a cross-sectional survey. BMC Musculoskelet Disord. 2010;11:12. Munabi IG, Buwembo W, Kitara DL, Ochieng J, Mwaka ES. Musculoskeletal disorder risk factors among nursing professionals in low resource settings: a cross-sectional study in Uganda. BMC Nurs. 2014;13(1):7. Lee SJ, Lee JH, Gershon RR. Musculoskeletal Symptoms in Nurses in the Early Implementation Phase of California's Safe Patient Handling Legislation. Res Nurs Health. 2015;38(3):183–93. Carugno M, Pesatori AC, Ferrario MM, Ferrari AL, Silva FJ, Martins AC, et al. Physical and psychosocial risk factors for musculoskeletal disorders in Brazilian and Italian nurses. Cad Saude Publica. 2012;28(9):1632–42. Liu L, Chen SG, Tang SC, Wang S, He LH, Guo ZH, et al. How Work Organization Affects the Prevalence of WMSDs: A Case-control Study. Biomed Environ Sci. 2015;28(9):627–33. Chang-chun C, Ji-ping W, Ling-ling WU, Ying S, Ke-zhi JIN. Prevalence of musculoskeletal disorders and associated risk factors of healthcare workers in a hospital of Shanghai. J Environ Occup Med. 2017;34(1):15–21. Zhang WQ, Li D, Gui F. Investigation on occupational musculoskeletal injury and its influencing factors among nurses in Wuhan City. Occup Saf Health. 2016;32(11):1469–72. van Dam K, Meewis M, van der Heijden BI. Securing intensive care: towards a better understanding of intensive care nurses' perceived work pressure and turnover intention. J Adv Nurs. 2013;69(1):31–40. Patil SJ, Ambulkar R, Kulkarni AP. Patient Safety in Intensive Care Unit: What can We Do Better? Indian J Crit Care Med. 2023;27(3):163–5. Ghorbanzadeh K, Ebadi A, Hosseini M, Madah SSB, Khankeh H. Challenges of the patient transition process from the intensive care unit: a qualitative study. Acute Crit Care. 2021;36(2):133–42. Chandralekha K, Joseph M, Joseph B. Work-related Musculoskeletal Disorders and Quality of Life Among Staff Nurses in a Tertiary Care Hospital of Bangalore. Indian J Occup Environ Med. 2022;26(3):178–82. Kuorinka I, Jonsson B, Kilbom A, Vinterberg H, Biering-Sorensen F, Andersson G, et al. Standardised Nordic questionnaires for the analysis of musculoskeletal symptoms. Appl Ergon. 1987;18(3):233–7. Yasobant S, Rajkumar P. Work-related musculoskeletal disorders among health care professionals: A cross-sectional assessment of risk factors in a tertiary hospital, India. Indian J Occup Environ Med. 2014;18(2):75–81. Olufemi Bolarinde S, Oyewole I, Felix Abobarin A. Work-related musculoskeletal disorders among nurses in various specialty areas in a Nigerian tertiary health institution. J Emerg Pract Trauma. 2019;5(2):41–6. Yizengaw MA, Mustofa SY, Ashagrie HE, Zeleke TG. Prevalence and factors associated with work-related musculoskeletal disorder among health care providers working in the operation room. Annals Med Surg. 2021;72:102989. Alwabli Y, Almatroudi MA, Alharbi MA, Alharbi MY, Alreshood S, Althwiny FA. Work-Related Musculoskeletal Disorders Among Medical Practitioners in the Hospitals of Al'Qassim Region, Saudi Arabia. Cureus. 2020;12(5):e8382. Yang S, Lu J, Zeng J, Wang L, Li Y. Prevalence and Risk Factors of Work-Related Musculoskeletal Disorders Among Intensive Care Unit Nurses in China. Workplace Health Saf. 2019;67(6):275–87. Yang S, Li L, Wang L, Zeng J, Li Y. Risk Factors for Work-Related Musculoskeletal Disorders Among Intensive Care Unit Nurses in China: A Structural Equation Model Approach. Asian Nurs Res. 2020;14(4):241–8. El-Soud AMA, El-Najjar AR, El-Fattah NA, Hassan AA. Prevalence of low back pain in working nurses in Zagazig University Hospitals: an epidemiological study. Egypt Rheumatol Rehabilitation. 2014;41(3):109–15. Smith DR, Wei N, Zhao L, Wang RS. Musculoskeletal complaints and psychosocial risk factors among Chinese hospital nurses. Occup Med (Lond). 2004;54(8):579–82. Lee C-YS, Dik BJ. Associations among stress, gender, sources of social support, and health in emerging adults. Stress Health. 2017;33(4):378–88. Sheth A, Pagdhune A, Viramgami A. Prevalence of work-related musculoskeletal disorders (WRMSDs) and its association with modifiable risk factors in metropolitan bus transit drivers: A cross-sectional comparison. J Family Med Prim Care. 2023;12(8):1673–8. Burdorf A, Koppelaar E, Evanoff B. Assessment of the impact of lifting device use on low back pain and musculoskeletal injury claims among nurses. Occup Environ Med. 2013;70(7):491–7. Abdul Rahman H, Abdul-Mumin K, Naing L. Psychosocial Work Stressors, Work Fatigue, and Musculoskeletal Disorders: Comparison between Emergency and Critical Care Nurses in Brunei Public Hospitals. Asian Nurs Res (Korean Soc Nurs Sci). 2017;11(1):13–8. Mehralizadeh S, Dehdashti A, Motalebi Kashani M. Structural equation model of interactions between risk factors and work-related musculoskeletal complaints among Iranian hospital nurses. Work. 2017;57(1):137–46. Ogbuanya TC, Eseadi C, Orji CT, Ede MO, Ohanu IB, Bakare J. Effects of rational emotive occupational health therapy intervention on the perceptions of organizational climate and occupational risk management practices among electronics technology employees in Nigeria. Medicine. 2017;96(18):e6765. Lee S-J, Faucett J, Gillen M, Krause N, Landry L. Factors associated with safe patient handling behaviors among critical care nurses. Am J Ind Med. 2010;53(9):886–97. Rogers RW. A Protection Motivation Theory of Fear Appeals and Attitude Change1. J Psychol. 1975;91(1):93–114. Giurgiu DI, Jeoffrion C, Roland-Lévy C, Grasset B, Dessomme BK, Moret L, et al. Wellbeing and occupational risk perception among health care workers: a multicenter study in Morocco and France. J Occup Med Toxicol. 2016;11(1):20. Gershon RRM, Stone PW, Zeltser M, Faucett J, Macdavitt K, Chou S-S. Organizational Climate and Nurse Health Outcomes in the United States: A Systematic Review. Ind Health. 2007;45(5):622–36. Eriksen W, Bruusgaard D, Knardahl S. Work factors as predictors of intense or disabling low back pain; a prospective study of nurses’ aides. Occup Environ Med. 2004;61(5):398–404. Vendittelli D, Penprase B, Pittiglio L. Musculoskeletal Injury Prevention for New Nurses. Workplace Health Saf. 2016;64(12):573–85. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 07 Feb, 2025 Read the published version in BMC Musculoskeletal Disorders → Version 1 posted Editorial decision: Revision requested 21 May, 2024 Submission checks completed at journal 18 May, 2024 Editor assigned by journal 18 May, 2024 First submitted to journal 09 May, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4394065","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":305112461,"identity":"bbcee09a-c18c-41a2-8452-2c67cca65955","order_by":0,"name":"Sonali Detroja","email":"","orcid":"","institution":"B J Medical College and Civil Hospital","correspondingAuthor":false,"prefix":"","firstName":"Sonali","middleName":"","lastName":"Detroja","suffix":""},{"id":305112462,"identity":"4b09eaea-a3e1-4fb2-a939-e5e2ba086f04","order_by":1,"name":"Rajkumar Mahajan","email":"","orcid":"","institution":"B J Medical College and Civil Hospital","correspondingAuthor":false,"prefix":"","firstName":"Rajkumar","middleName":"","lastName":"Mahajan","suffix":""},{"id":305112463,"identity":"4793d391-438c-450d-9142-44e1194eb3f0","order_by":2,"name":"Ankit Sheth","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA90lEQVRIiWNgGAWjYFACNoYDQDKBgYGH8UECXNSAgJYDIC1sPMwGRGthgGphkyDKWfyz2xIPf2Coy+OX7z1W8aBmWz4D/+JjEgwFd3Bqkbhz7ADQYYeLJdv40m4kHLtt2SDxLE2CweAZbmtupDcAtRxI3HCMx+xGYsNtAwaJM8YGDAaHceqQh2ipS9wP1FJAlBaDG2kghzEnbmDjMWMAa+HvMXyAT4vhjbSEA2cMDifOOJZjLAH0iwGbBFvigwQ8WuRupBl/qKioS+xvPmP48UfNbQN+/sMHDnz4g1sL1HlIbDaJBHBiIAXwHyBN/SgYBaNgFAx7AADRLlpOFAPfpwAAAABJRU5ErkJggg==","orcid":"","institution":"ICMR – National Institute of Occupational Health","correspondingAuthor":true,"prefix":"","firstName":"Ankit","middleName":"","lastName":"Sheth","suffix":""}],"badges":[],"createdAt":"2024-05-09 09:23:41","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4394065/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4394065/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12891-025-08379-4","type":"published","date":"2025-02-07T15:58:10+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":57721158,"identity":"39538508-9c7d-4e00-9816-46ee56a27cfa","added_by":"auto","created_at":"2024-06-04 18:56:29","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":65916,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003ePrevalence of WRMSDs according to body region among participants\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4394065/v1/6c0cf4b75020a4e49e7f9148.jpg"},{"id":57721159,"identity":"5024119e-8684-483c-a94e-1e1c43b83097","added_by":"auto","created_at":"2024-06-04 18:56:29","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":94260,"visible":true,"origin":"","legend":"\u003cp\u003eUnnumbered image in the Result section.\u003c/p\u003e","description":"","filename":"UnnumberFigure.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4394065/v1/1436c48256fdb45c1000271f.jpg"},{"id":75930513,"identity":"69e5c241-d650-479f-a1ab-d6f1039e5b17","added_by":"auto","created_at":"2025-02-10 16:12:40","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1050956,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4394065/v1/82d28bc2-dfdd-4bc1-9910-f11fea86d12d.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Comprehensive Investigation of Ergonomic Challenges and Work-related Musculoskeletal Disorders among Intensive Care Unit Healthcare Providers of Western India through Mixed Methods Study","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eWork-related musculoskeletal disorders (WRMSDs) are conditions in which the work environment and performance of work contribute significantly to the condition and/or the condition is made worse or persists longer due to work conditions. [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e] Work-related musculoskeletal disorders (WRMSDs) are a prevalent and significant concern within the healthcare sector. These disorders arise due to various factors inherent to the nature of the work performed in these settings, including prolonged duty hours, demanding tasks, repetitive movements [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e] and unsafe working conditions. [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e] WRMSDs encompass a range of conditions affecting muscles, tendons, intervertebral discs, nerves, joints, and cartilage, [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e] leading to debilitating symptoms such as lower back pain, neck discomfort, and shoulder issues. [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eFor nurses, musculoskeletal disorders (MSDs) are a significant occupational health problem, with a substantial global prevalence. Worldwide, the annual prevalence of work-related musculoskeletal disorders (WRMDs) among nurses is reported to range from 40\u0026ndash;85% in studies from various countries including Brazil, Italy, Estonia, Uganda, Nigeria, and California. [\u003cspan additionalcitationids=\"CR7 CR8 CR9\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e] Similarly, in China, WRMDs among nurses have been reported to have a prevalence ranging from 56\u0026ndash;92%. [\u003cspan additionalcitationids=\"CR12\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] These disorders commonly manifest as pain in the lower back, neck, and shoulders, reflecting the physically demanding nature of nursing work. Differences in the estimated prevalence of WRMDs across countries may reflect differences in working environments, facilities, and the nature of the work, resulting in inconsistent reporting of risk factors.\u003c/p\u003e \u003cp\u003eDespite the attention given to WRMSDs among nurses, there remains a notable gap in understanding its prevalence and ergonomic challenges faced by ICU healthcare providers specifically. The patients in intensive care units (ICUs) are often immobile with severe physical weakness and little ability to care for themselves. The demands of the ICU setting differ significantly from other healthcare settings, with healthcare providers facing distinct challenges such as frequent patient handling, complex medical procedures, and prolonged periods of standing or exertion. [\u003cspan additionalcitationids=\"CR15\" citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e] In India, where staff shortages and a high patient volume are prevalent, heavy workload and repetitive movements emerge as the most common risk factors contributing to WRMSDs among ICU healthcare providers. [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eExisting literature primarily emphasizes the prevalence and risk factors of WRMSDs among nurses in general healthcare settings, with few studies addressing the distinct challenges faced by ICU healthcare providers. Moreover, the few studies that have examined WRMSDs in the ICU setting often lack comprehensive assessments of ergonomic factors and fail to consider the unique environmental and workload-related challenges specific to ICU care.\u003c/p\u003e \u003cp\u003eGiven the critical role of ICU healthcare providers in delivering care to critically ill patients, it is imperative to address these gaps in knowledge. This study aims to investigate the prevalence of WRMSDs among ICU healthcare providers in India and explore the underlying work environment and job-related factors contributing to these disorders. Additionally, the study seeks to identify perceived ergonomic challenges within the ICU environment and propose potential strategies to mitigate them. By shedding light on these issues, this research endeavours to inform targeted interventions and policies aimed at promoting the occupational health and well-being of ICU healthcare providers.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Design and Setting:\u003c/h2\u003e \u003cp\u003e This cross-sectional mixed-method study was conducted in Gujarat, India, focusing on assessing musculoskeletal symptoms and associated factors among registered doctors, nurses, and other healthcare providers working in the intensive care units (ICUs) of three tertiary care hospitals. These ICUs admitted critically ill patients from various departments of the hospital. By employing both qualitative and quantitative components, the study aimed to comprehensively explore the prevalence and determinants of work-related musculoskeletal disorders (WRMSDs) in ICU health care providers.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eParticipants and Sampling:\u003c/h2\u003e \u003cp\u003eThe study utilized a simple random sampling technique to select 200 healthcare providers from seven ICUs across the three tertiary care hospitals in Gujarat. Inclusion criteria required participants to have at least one year of ICU experience and be actively involved daily in patient care duties. Individuals diagnosed with genetic musculoskeletal disorders or recent viral infections which may lead to viral myalgias were excluded to minimize potential confounding factors.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eData collection tools:\u003c/h2\u003e \u003cp\u003eQuantitative data were collected using a structured questionnaire designed to capture a comprehensive range of variables related to musculoskeletal symptoms and associated factors. The questionnaire covered sociodemographic details, including age, sex, marital status, and highest education level, as well as occupational details such as years of experience, job title, duty hours, and frequency of breaks. Physical factors, including patient handling frequency and physical workload, were assessed using Likert scale-based questions. Environmental factors, ergonomic habits, and risk perception were also evaluated using structured items. The Modified Nordic Musculoskeletal Questionnaire (NMQ) [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] was employed to accurately locate musculoskeletal pain sites and assess pain severity among participants.\u003c/p\u003e \u003cp\u003eQualitative data were collected through in-depth interviews to gain deeper insights into the challenges faced by healthcare providers in ICUs, their coping mechanisms, institutional support, and potential preventive measures for WRMSDs. Interviews and discussions continued until saturation of responses was achieved, ensuring a comprehensive understanding of participants' perspectives.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eStudy Variables and Measures:\u003c/h2\u003e \u003cp\u003eThe primary dependent variable was musculoskeletal symptoms, defined as symptoms lasting\u0026thinsp;\u0026ge;\u0026thinsp;1 week, occurring\u0026thinsp;\u0026ge;\u0026thinsp;1 per month, of at least moderate intensity, and attributed to work-related events. The symptoms were measured using modified NMQ in which diagram of the body was depicted to help participants accurately locate the region and duration of pain by author herself. Participants were then asked to rate the intensity of their pain on a Likert scale ranging from 1 (excruciating) to 4 (mild), describe the type of pain experienced, and indicate whether they sought medical intervention for symptom management.\u003c/p\u003e \u003cp\u003eIndependent variables included demographics, physical factors, job and workplace-related factors, environmental factors, and risk perception.\u003c/p\u003e \u003cp\u003e \u003cem\u003eDemographic details\u003c/em\u003e included age, sex, marital status and highest education level. \u003cem\u003eOccupational details\u003c/em\u003e comprised years of experience, job title, and specifics regarding duty hours, breaks, and frequency of patient handling activities. \u003cem\u003ePersonal habits\u003c/em\u003e, such as smoking status, duration, and daily cigarette consumption, were also recorded.\u003c/p\u003e \u003cp\u003e \u003cem\u003ePhysical factors\u003c/em\u003e were assessed through a series of five-point Likert scale-based questions (1\u0026thinsp;=\u0026thinsp;never to 5\u0026thinsp;=\u0026thinsp;very often) regarding the frequency of patient handling tasks, lifting and transferring patients, utilization of lifting aids, and assistance from colleagues during patient shifting from wheelchair to bed and vice versa. Additionally, questions regarding continuous standing, repetitive bending, heavy lifting (\u0026gt;\u0026thinsp;20 kgs), and the frequency of performing repetitive movements were included to gauge the \u003cem\u003ephysical workload/ demand\u003c/em\u003e experienced by participants.\u003c/p\u003e \u003cp\u003e \u003cem\u003eEnvironmental factors and risk perception\u003c/em\u003e were evaluated through inquiries regarding ergonomic training, patient handling techniques, and comfort level in reporting issues to superiors. Engagement of the participants in stretching and exercise activities, sleep disturbances, perceptions of work-related pain causation, and disruptions in personal life due to work were assessed using five-point Likert scale responses (1\u0026thinsp;=\u0026thinsp;never/strongly disagree to 5\u0026thinsp;=\u0026thinsp;very often/strongly agree).\u003c/p\u003e \u003cp\u003eAdditionally, the \u003cem\u003eRapid Entire Body Assessment (REBA) scale\u003c/em\u003e was employed to evaluate the ergonomic challenges associated with specific tasks performed by participants, thereby assessing their potential contribution to the development of work-related musculoskeletal disorders (WRMSDs). REBA provides a single final score based on the posture evaluated, force requirement, type of movement, frequency of movement and coupling observed within the task. A single value ranging from 1 to 15, represents WRMSD risk to the investigator.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eData Analysis:\u003c/h2\u003e \u003cp\u003eQuantitative data were analysed using licensed SPSS 26.0. Descriptive statistics, including frequencies, percentages, means, and standard deviations, were calculated to summarize the data. Inferential statistics, including chi-square tests and Student t-tests, were employed to assess associations between variables, with a significance level set at 0.05. A logistic regression model was used to identify the predictors of WRMSDs. Qualitative data were assigned codes and categories and analysed thematically to identify patterns, themes, and key insights emerging from interviews.\u003c/p\u003e \u003c/div\u003e"},{"header":"RESULTS","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eQuantitative study results:\u003c/h2\u003e \u003cp\u003eThis study included 200 ICU health care providers across seven different ICU in three hospitals of Gujarat. The demographic and occupational characteristics of ICU healthcare providers were examined in relation to the prevalence of WRMSDs. Among the 200 participants, 168 (84%) reported experiencing WRMSDs, while 32 (16%) did not. There were no significant differences observed in the distribution of age (p\u0026thinsp;=\u0026thinsp;0.56), sex (p\u0026thinsp;=\u0026thinsp;0.65), or education level (p\u0026thinsp;=\u0026thinsp;0.29) between the two groups. However, significant associations were found between WRMSDs and marital status (p\u0026thinsp;=\u0026thinsp;0.003), years working in the ICU (p\u0026thinsp;=\u0026thinsp;0.000), ICU shift frequency (p\u0026thinsp;=\u0026thinsp;0.000), number of breaks per shift (p\u0026thinsp;=\u0026thinsp;0.009), exercise frequency (p\u0026thinsp;=\u0026thinsp;0.01), and current smoking status (p\u0026thinsp;=\u0026thinsp;0.02) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographics and occupational details of ICU health care providers and its association with WRMSDs\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eWRMSDs\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSignificance\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;168)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;32)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003eAge in years, n (%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e18\u0026ndash;30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e60 (35.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13 (40.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.56\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e31\u0026ndash;40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e80 (47.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16 (50.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt; 40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e28 (16.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (9.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e36 (21.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8 (25.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.65\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e132 (78.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24 (75.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003eEducation, n (%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigher secondary/ diploma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e80 (47.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12 (37.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.29\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGraduate and beyond\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e88 (52.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20 (62.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003eMarital status, n (%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnmarried/ Divorce/ separated\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e66 (39.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (12.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003ep\u003c/b\u003e\u0026thinsp;\u003cb\u003e=\u0026thinsp;0.003\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e102 (60.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28 (87.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003eYears working in ICU, n (%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u0026ndash;5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e60 (35.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24 (75.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003ep\u003c/b\u003e\u0026thinsp;\u003cb\u003e=\u0026thinsp;0.000\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6\u0026ndash;10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e64 (38.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8 (25.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt; 10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e44 (26.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003eICU shift frequency (days per week), n (%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026le; 4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e56 (33.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22 (68.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003ep\u003c/b\u003e\u0026thinsp;\u003cb\u003e=\u0026thinsp;0.000\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5\u0026ndash;7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e112 (66.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10 (31.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003eLength of breaks, minutes, n (%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026le; 10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e114\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.12\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10\u0026ndash;30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003eNumber of breaks per shift, n (%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026le; 1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e48 (28.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (6.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003ep\u003c/b\u003e\u0026thinsp;\u003cb\u003e=\u0026thinsp;0.009\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e48 (28.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16 (50.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3 or more\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e72 (42.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14 (43.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003eExercise, n (%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNever\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e60 (35.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (6.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003ep\u003c/b\u003e\u0026thinsp;\u003cb\u003e=\u0026thinsp;0.01\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSeldom (\u0026lt;\u0026thinsp;5 days/ month)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e56 (33.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6 (18.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOccasional (6\u0026ndash;10 days/ month)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24 (14.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8 (25.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOften (\u0026gt;\u0026thinsp;10 days/month)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e28 (16.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8 (25.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003eCurrent smoking status, n (%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCurrently non-smoker\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e114 (67.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28 (87.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003ep\u003c/b\u003e\u0026thinsp;\u003cb\u003e=\u0026thinsp;0.02\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCurrently smoker\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e54 (32.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (12.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eLow back pain was the most commonly reported WRMD (77%), followed by neck pain (49%), knee pain (49%) and upper back pain (48%) (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The majority of participants with WRMSDs reported experiencing dull ache-type pain (85.9%), with moderate to severe pain intensity being more prevalent. Among those seeking intervention, medication was more commonly sought than physiotherapy (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eType of pain, intensity of pain and intervention sought by WRMSDs positive participants (n\u0026thinsp;=\u0026thinsp;168)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo. of participants,\u003c/p\u003e \u003cp\u003en (%)\u003c/p\u003e \u003cp\u003e[a]\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eOn medications,\u003c/p\u003e \u003cp\u003en (% of a)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eOn physiotherapy,\u003c/p\u003e \u003cp\u003en (% of a)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eType of pain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDull ache\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e144 (85.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e88 (61.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e42 (29.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSharp pain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24 (14.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16 (66.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10 (41.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntensity of pain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMild\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10 (6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e76 (45.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36 (47.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14 (18.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSevere\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e66 (39.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e52 (78.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e28 (42.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExcruciating\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16 (9.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10 (62.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eParticipants with WRMSDs reported significantly higher mean scores for physical factors (p\u0026thinsp;=\u0026thinsp;0.000), physical workload (p\u0026thinsp;=\u0026thinsp;0.001), work environment (p\u0026thinsp;=\u0026thinsp;0.000), and risk perception (p\u0026thinsp;=\u0026thinsp;0.000) compared to those without WRMSDs (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAssociation between physical factors, physical workload, work environment and risk perception with WRMSDs\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eWRMSDs\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSignificance\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;168)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;32)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePhysical factors (total score 50), mean (SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e15.1 (6.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11.1 (2.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePhysical workload (total score 20), mean (SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e12.8 (2.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10.7 (1.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWork environment (total score 20), mean (SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e13.1 (3.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10.1 (2.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRisk perception (total score 20), mean (SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e11.8 (3.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8.9 (3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe logistic regression analysis revealed several significant risk factors associated with the prevalence of WRMSDs among ICU healthcare providers. Participants with longer tenure in the ICU (OR\u0026thinsp;=\u0026thinsp;1.4, 95% CI: 1.13\u0026ndash;1.66, p\u0026thinsp;=\u0026thinsp;0.001), working 5\u0026ndash;7 days per week (OR\u0026thinsp;=\u0026thinsp;2.7, 95% CI: 1.27\u0026ndash;5.95, p\u0026thinsp;=\u0026thinsp;0.003), higher physical factor score (OR\u0026thinsp;=\u0026thinsp;1.2, 95% CI: 1.05\u0026ndash;1.42, p\u0026thinsp;=\u0026thinsp;0.009), higher physical workload score (OR\u0026thinsp;=\u0026thinsp;1.2, 95% CI: 1.09\u0026ndash;1.49, p\u0026thinsp;=\u0026thinsp;0.04), higher risk perception (OR\u0026thinsp;=\u0026thinsp;1.3, 95% CI: 1.10\u0026ndash;1.78, p\u0026thinsp;=\u0026thinsp;0.01), and those never exercising (OR\u0026thinsp;=\u0026thinsp;0.5, 95% CI: 0.27\u0026ndash;0.93, p\u0026thinsp;=\u0026thinsp;0.02) were more likely to report WRMSDs. The logistic regression model was statistically significant and the model explained 58% (Nagelkerke R\u003csup\u003e2\u003c/sup\u003e) of the variance (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eLogistic regression analysis to determine risk factors of WRMSDs\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRisk factors\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOR (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSignificance\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarital status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.7 (0.33\u0026ndash;1.58)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.42\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSmoking status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.5 (0.72\u0026ndash;3.34)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.26\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYears working in ICU\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.4 (1.13\u0026ndash;1.66)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eShift frequency in ICU\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.7 (1.27\u0026ndash;5.95)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.003\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber of breaks per shift\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.5 (0.20\u0026ndash;1.20)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.12\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExercise\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.5 (0.27\u0026ndash;0.93)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.02\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePhysical factors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.2 (1.05\u0026ndash;1.42)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.009\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePhysical workload\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.2 (1.09\u0026ndash;1.49)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.04\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWork environment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.0 (0.45\u0026ndash;2.30)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.95\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRisk perception\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.3 (1.10\u0026ndash;1.78)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.01\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe REBA scores were used to evaluate risk levels among 200 participants, categorizing them into five risk levels: negligible, low, medium, high, and very high. A score of 1 is negligible risk which needs no necessary action while 11\u0026ndash;15 denotes very high risk which needs immediate action. These findings underscore the importance of implementing targeted interventions to mitigate musculoskeletal disorder risks among ICU healthcare providers (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eREBA score to assess the risk involved\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eREBA score\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo. of participants\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRisk level\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAction needed\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNegligible\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNone necessary\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u0026ndash;3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLow\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMay be necessary\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4\u0026ndash;7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMedium\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNecessary\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8\u0026ndash;10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eHigh\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNecessary soon\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e11\u0026ndash;15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eVery high\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003eNecessary Now\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eQualitative results:\u003c/h2\u003e \u003cp\u003eThe median work experience of the fourteen in-depth interviewees, was 7 years. The analysis of the codes and categories from the transcript revealed four primary themes based on the responses of participants: the challenges faced in ICU, coping mechanisms, institutional support and preventive measures.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e Challenges faced in ICU: Participants commonly mentioned challenges related to heavy patient loads, frequent patient handling, long working hours, and the physical demands of their tasks. They also discussed the emotional toll of caring for critically ill patients and the need for emotional support.\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003e \u003cem\u003e\"The constant rush, attending to one patient after another, without much time to rest in between, it really takes a toll on your body.\"\u003c/em\u003e \u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cem\u003e\"Standing for long hours during procedures is exhausting. Sometimes, it feels like there's no end to it.\"\u003c/em\u003e \u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cem\u003e\"The emotional burden is immense, especially when patients are critical. It adds to the physical strain we already face.\"\u003c/em\u003e \u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003e Coping mechanisms: Healthcare providers described various coping strategies, including seeking social support from colleagues, practicing mindfulness or relaxation techniques during breaks, and finding satisfaction in providing quality patient care despite the challenges.\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003e \u003cem\u003e\"Talking to my colleagues helps a lot. We share our experiences and have a laugh about it.\"\u003c/em\u003e \u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cem\u003e\"Knowing that I'm making a difference in patients' lives keeps me going. Despite the challenges, it's rewarding to see them recover.\"\u003c/em\u003e \u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003e Institutional support: Participants highlighted the importance of institutional support in addressing WRMSDs. They emphasized the need for ergonomic training, access to ergonomic equipment, and clear communication channels for reporting workplace hazards or injuries. Some also expressed the need for counselling services to address the emotional stress of their work.\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003e \u003cem\u003e\"We need better training on how to handle patients safely. Patient handling should be ergonomic so that our backs do not hurt.\"\u003c/em\u003e \u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cem\u003e\"We need more ergonomic equipment. This would make a big difference.\"\u003c/em\u003e \u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cem\u003e\"There should be someone we can talk to about the stress. It's not just about physical health; our mental well-being matters too.\"\u003c/em\u003e \u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003ePotential preventive measures discussed by participants included implementing ergonomic practices such as proper lifting techniques, adjusting work schedules to allow for adequate rest and recovery, providing regular breaks, and promoting physical exercise or stretching routines.\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003e \u003cem\u003e\"We need more breaks during shifts. Even just a few minutes to stretch and move around can make a difference.\"\u003c/em\u003e \u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cem\u003e\"Proper lifting techniques are crucial. We often lift heavy patients without realizing the strain it puts on our bodies.\"\u003c/em\u003e \u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cem\u003e\"Encouraging regular exercise and providing resources for it would be beneficial. It's hard to find time for self-care outside of work.\"\u003c/em\u003e \u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThe present mixed methods study, conducted in Gujarat, aimed to comprehensively investigate the prevalence of work-related musculoskeletal disorders (WRMSDs) and its association with work environment, risk perception and physical workload among 200 healthcare providers working in intensive care units. Utilizing a self-reported survey administered via questionnaire, supplemented by objective assessments using the modified Nordic Musculoskeletal Questionnaire and Rapid Entire Body Assessment (REBA) scales, the study found a high prevalence of WRMSDs, affecting with 84% of participants. The prevalence of WRMDs observed in this study is notably higher compared to similar research conducted in various regions such as Brazil, Italy, India, Nigeria, Ethiopia, and Saudi Arabia. [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan additionalcitationids=\"CR20 CR21\" citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e] However, it is important to note that while these studies involved healthcare professionals from hospitals, they did not specifically focus on those working in ICUs. When contrasted with investigations targeting healthcare providers in ICUs, even higher prevalence rates of WRMDs have been reported. [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan additionalcitationids=\"CR24\" citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e] Notably, all these studies consistently identify the lower back and neck as the most commonly affected body regions, mirroring the findings of our study and emphasizing the widespread nature of musculoskeletal strain among ICU healthcare providers.\u003c/p\u003e \u003cp\u003eIn this study, several factors were identified as being associated with WRMSDs among ICU healthcare providers such as marital status, years of work in ICU, shift frequency (higher prevalence among those working 5\u0026ndash;7 days per week compared to \u0026le;\u0026thinsp;4 days), number of breaks (higher prevalence among those taking\u0026thinsp;\u0026le;\u0026thinsp;1 break per shift compared to 2 or more), self-exercise (higher prevalence among those who never exercised compared to occasional or frequent exercisers), and smoking habits.\u003c/p\u003e \u003cp\u003ePrevious evidence support the role of marital status in reporting of WRMDs. [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e] The spouses and families of married nurses may help buffer the effects of injuries [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e], making them less likely to report WRMD symptoms compared with unmarried nurses. Additionally, years of experience were found to be associated with increased WRMSD prevalence, potentially reflecting prolonged exposure to ergonomic risk factors and age-related declines in muscle strength. [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e] A comprehensive study involving ICU nurses in China found that the frequency and duration of breaks during shifts, taking breaks in comfortable settings, and the absence of self-exercise were correlated with work-related musculoskeletal disorders (WRMSDs). [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e] Nurses with lower shift frequencies and more breaks may have sufficient time for recovery, potentially resulting in a lower incidence of WRMSDs among them. It has been reported that modifiable risk factors such as tobacco usage is strongly associated with WRMSDs [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e] suggesting that addressing tobacco use could be a key target in preventive strategies aimed at reducing the burden of WRMSDs.\u003c/p\u003e \u003cp\u003eThe participants with WRMSDs in our study exhibited significantly higher mean scores for physical factors, physical workload, work environment, and risk perception compared to those without WRMSDs, indicating greater frequency of physically demanding tasks, higher perceived workload intensity, greater discomfort with ergonomic conditions, and higher perceived risk of musculoskeletal injury or discomfort associated with their work tasks.\u003c/p\u003e \u003cp\u003eThe association between physical risk factors and WRMSDs has been supported by previous research. [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e] It is established that nurses exposed to high physical demands are more susceptible to WRMSDs, [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e] a finding consistent with the present study. Risk perception, a relatively new variable, has gained recognition in behavioural theory studies, highlighting its importance as a modifiable factor in motivating healthy behaviours. [\u003cspan additionalcitationids=\"CR33\" citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e] As an indirect influencer, adequate perception of occupational risk can be regulated and utilized as a tool to mitigate WRMSD occurrence through education and skill training by hospital executives. [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e] It is plausible that the indirect effect of physical factors on WRMSDs is attributed to nurses with heightened awareness of injury risks due to their exposure to high physical demands, leading to the reporting of more severe symptoms. The workplace environment significantly impacts worker health and safety, [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e] although its direct influence on WRMSD occurrence depends largely on individual perceptions and behaviours. [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e] An unsafe workplace environment may negatively impact nurses' ability to work or motivate requests for improvement, underscoring the need for organizational efforts to establish a healthy safety culture and enhance risk consciousness. [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eAfter adjusting for covariates, logistic regression analysis revealed that longer tenure in the ICU, working 5\u0026ndash;7 days per week, never exercising, and higher physical factor, physical workload, and risk perception scores were significant predictors for WRMSDs among ICU healthcare providers. This analysis underscores the importance of considering various physical and behavioural factors in assessing and addressing the risk of WRMSDs in the ICU setting. There is need for targeted interventions aimed at mitigating the effects of prolonged tenure, demanding work schedules and heightened risk perceptions on the occurrence of WRMSDs among ICU healthcare providers. Further investigation is also warranted into the relationship between exercise habits and WRMSDs among ICU healthcare providers.\u003c/p\u003e \u003cp\u003eInsights from qualitative interviews shed light on the multifaceted challenges faced by ICU healthcare providers, including heavy patient loads, long hours, and emotional strain. Coping mechanisms such as seeking social support and finding satisfaction in patient care underscored individual resilience, while institutional support, including ergonomic training and access to equipment, emerged as critical in addressing WRMSDs. Participants also highlighted the importance of preventive measures like ergonomic practices and promoting physical exercise. Overall, the findings from the qualitative interviews complement the quantitative data on WRMSD prevalence and associated factors, providing a nuanced understanding of the challenges and potential solutions in the ICU work environment.\u003c/p\u003e \u003cp\u003eDespite its significant contributions, the study is not without limitations. The cross-sectional design precludes the establishment of causal relationships, and reliance on self-reported data may introduce bias. However, author established rapport with participants, clarified the purpose of the study, and assured confidentiality to encourage truthful reporting. Moreover, the study was limited to ICU healthcare providers in public tertiary hospitals, which may restrict the generalizability of the findings to ICUs of other private tertiary hospitals. Future research using longitudinal designs and broader sample populations is needed to validate these findings. More studies are needed to explore links between physical factors, behavioural factors, environmental factors, and WRMSDs.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eIn conclusion, this mixed methods study sheds light on the high prevalence of WRMSDs among ICU healthcare providers and significant association with longer tenure in ICU, high shift frequency, high score of physical factors, physical demand and risk perception, and low exercise habits. Urgent targeted interventions are needed to address modifiable risk factors, including prolonged tenure, demanding work schedules, and heightened risk perceptions. Institutions should prioritize ergonomic training, workplace modifications, schedule adjustments, and educational programs to enhance risk awareness and preventive behaviours to effectively combat the burden of WRMSDs. Additionally, qualitative insights further highlight the nuanced challenges faced by ICU healthcare providers and offer valuable perspectives into preventive measures. However, the study's limitations, including its cross-sectional design and reliance on self-reported data, should be noted. Future research should focus on designing and testing multidimensional interventions that incorporate physical, psychosocial, and environmental factors, with particular attention to the role of muscle-strengthening exercises in reducing WRMSD incidence.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eApproval for the study was obtained from the Institutional Human Ethics Committee of the B J Medical College and Hospital, Ahmedabad, India. The research was carried out following the Helsinki Declaration. Written informed consent was taken from the participants of the in-depth interviews, which included consent for the audio recording of the interviews. Confidentiality and anonymity of participants were strictly maintained throughout the study process, with data anonymization procedures implemented to safeguard privacy of the participants. Additionally, participants were assured of their right to withdraw from the study at any time without repercussions.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u0026nbsp;\u003c/strong\u003eWritten informed consent was taken from participants for use of data generated during the interviews for the purpose of publication. It was ensured that the identity of individual participants shall remain confidential and will be not be revealed in any publication.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials:\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe datasets generated during the current study are not publicly available due to risk of compromise in privacy, but are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe author(s) received no financial support for the research, authorship, and/or publication of this article. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSD, AS and RGM contributed to the study conception and study design. SD and AS contributed to literature search, data collection, data analysis and interpretation, and manuscript draft preparation. RGM contributed to revision of manuscript for intellectual content. All authors read and approved the final version of the manuscript.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe authors express their sincere gratitude to all the ICU healthcare providers who participated in the study, and the heads of the departments and the ICU in charge for their support and cooperation throughout this study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAnderson V, Bernard B, Burt SE, Cole LL, Estill C, Fine L et al. Musculoskeletal Disorders and Workplace Factors: A Critical Review of Epidemiologic Evidence for Work-Related Musculoskeletal Disorders of the Neck, Upper Extremity, and Low Back1997.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRibeiro T, Serranheira F, Loureiro H. Work related musculoskeletal disorders in primary health care nurses. Appl Nurs Res. 2017;33:72\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLee SJ, Faucett J, Gillen M, Krause N, Landry L. Risk perception of musculoskeletal injury among critical care nurses. Nurs Res. 2013;62(1):36\u0026ndash;44.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHoe VC, Kelsall HL, Urquhart DM, Sim MR. Risk factors for musculoskeletal symptoms of the neck or shoulder alone or neck and shoulder among hospital nurses. Occup Environ Med. 2012;69(3):198\u0026ndash;204.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHeidari M, Borujeni MG, Rezaei P, Kabirian Abyaneh S. Work-Related Musculoskeletal Disorders and Their Associated Factors in Nurses: A Cross-Sectional Study in Iran. Malays J Med Sci. 2019;26(2):122\u0026ndash;30.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFreimann T, Coggon D, Merisalu E, Animagi L, Paasuke M. Risk factors for musculoskeletal pain amongst nurses in Estonia: a cross-sectional study. BMC Musculoskelet Disord. 2013;14:334.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTinubu BM, Mbada CE, Oyeyemi AL, Fabunmi AA. Work-related musculoskeletal disorders among nurses in Ibadan, South-west Nigeria: a cross-sectional survey. BMC Musculoskelet Disord. 2010;11:12.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMunabi IG, Buwembo W, Kitara DL, Ochieng J, Mwaka ES. Musculoskeletal disorder risk factors among nursing professionals in low resource settings: a cross-sectional study in Uganda. BMC Nurs. 2014;13(1):7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLee SJ, Lee JH, Gershon RR. Musculoskeletal Symptoms in Nurses in the Early Implementation Phase of California's Safe Patient Handling Legislation. Res Nurs Health. 2015;38(3):183\u0026ndash;93.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCarugno M, Pesatori AC, Ferrario MM, Ferrari AL, Silva FJ, Martins AC, et al. Physical and psychosocial risk factors for musculoskeletal disorders in Brazilian and Italian nurses. Cad Saude Publica. 2012;28(9):1632\u0026ndash;42.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLiu L, Chen SG, Tang SC, Wang S, He LH, Guo ZH, et al. How Work Organization Affects the Prevalence of WMSDs: A Case-control Study. Biomed Environ Sci. 2015;28(9):627\u0026ndash;33.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChang-chun C, Ji-ping W, Ling-ling WU, Ying S, Ke-zhi JIN. Prevalence of musculoskeletal disorders and associated risk factors of healthcare workers in a hospital of Shanghai. J Environ Occup Med. 2017;34(1):15\u0026ndash;21.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhang WQ, Li D, Gui F. Investigation on occupational musculoskeletal injury and its influencing factors among nurses in Wuhan City. Occup Saf Health. 2016;32(11):1469\u0026ndash;72.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003evan Dam K, Meewis M, van der Heijden BI. Securing intensive care: towards a better understanding of intensive care nurses' perceived work pressure and turnover intention. J Adv Nurs. 2013;69(1):31\u0026ndash;40.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePatil SJ, Ambulkar R, Kulkarni AP. Patient Safety in Intensive Care Unit: What can We Do Better? Indian J Crit Care Med. 2023;27(3):163\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGhorbanzadeh K, Ebadi A, Hosseini M, Madah SSB, Khankeh H. Challenges of the patient transition process from the intensive care unit: a qualitative study. Acute Crit Care. 2021;36(2):133\u0026ndash;42.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChandralekha K, Joseph M, Joseph B. Work-related Musculoskeletal Disorders and Quality of Life Among Staff Nurses in a Tertiary Care Hospital of Bangalore. Indian J Occup Environ Med. 2022;26(3):178\u0026ndash;82.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKuorinka I, Jonsson B, Kilbom A, Vinterberg H, Biering-Sorensen F, Andersson G, et al. Standardised Nordic questionnaires for the analysis of musculoskeletal symptoms. Appl Ergon. 1987;18(3):233\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYasobant S, Rajkumar P. Work-related musculoskeletal disorders among health care professionals: A cross-sectional assessment of risk factors in a tertiary hospital, India. Indian J Occup Environ Med. 2014;18(2):75\u0026ndash;81.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOlufemi Bolarinde S, Oyewole I, Felix Abobarin A. Work-related musculoskeletal disorders among nurses in various specialty areas in a Nigerian tertiary health institution. J Emerg Pract Trauma. 2019;5(2):41\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYizengaw MA, Mustofa SY, Ashagrie HE, Zeleke TG. Prevalence and factors associated with work-related musculoskeletal disorder among health care providers working in the operation room. Annals Med Surg. 2021;72:102989.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlwabli Y, Almatroudi MA, Alharbi MA, Alharbi MY, Alreshood S, Althwiny FA. Work-Related Musculoskeletal Disorders Among Medical Practitioners in the Hospitals of Al'Qassim Region, Saudi Arabia. Cureus. 2020;12(5):e8382.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYang S, Lu J, Zeng J, Wang L, Li Y. Prevalence and Risk Factors of Work-Related Musculoskeletal Disorders Among Intensive Care Unit Nurses in China. Workplace Health Saf. 2019;67(6):275\u0026ndash;87.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYang S, Li L, Wang L, Zeng J, Li Y. Risk Factors for Work-Related Musculoskeletal Disorders Among Intensive Care Unit Nurses in China: A Structural Equation Model Approach. Asian Nurs Res. 2020;14(4):241\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEl-Soud AMA, El-Najjar AR, El-Fattah NA, Hassan AA. Prevalence of low back pain in working nurses in Zagazig University Hospitals: an epidemiological study. Egypt Rheumatol Rehabilitation. 2014;41(3):109\u0026ndash;15.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSmith DR, Wei N, Zhao L, Wang RS. Musculoskeletal complaints and psychosocial risk factors among Chinese hospital nurses. Occup Med (Lond). 2004;54(8):579\u0026ndash;82.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLee C-YS, Dik BJ. Associations among stress, gender, sources of social support, and health in emerging adults. Stress Health. 2017;33(4):378\u0026ndash;88.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSheth A, Pagdhune A, Viramgami A. Prevalence of work-related musculoskeletal disorders (WRMSDs) and its association with modifiable risk factors in metropolitan bus transit drivers: A cross-sectional comparison. J Family Med Prim Care. 2023;12(8):1673\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBurdorf A, Koppelaar E, Evanoff B. Assessment of the impact of lifting device use on low back pain and musculoskeletal injury claims among nurses. Occup Environ Med. 2013;70(7):491\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAbdul Rahman H, Abdul-Mumin K, Naing L. Psychosocial Work Stressors, Work Fatigue, and Musculoskeletal Disorders: Comparison between Emergency and Critical Care Nurses in Brunei Public Hospitals. Asian Nurs Res (Korean Soc Nurs Sci). 2017;11(1):13\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMehralizadeh S, Dehdashti A, Motalebi Kashani M. Structural equation model of interactions between risk factors and work-related musculoskeletal complaints among Iranian hospital nurses. Work. 2017;57(1):137\u0026ndash;46.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOgbuanya TC, Eseadi C, Orji CT, Ede MO, Ohanu IB, Bakare J. Effects of rational emotive occupational health therapy intervention on the perceptions of organizational climate and occupational risk management practices among electronics technology employees in Nigeria. Medicine. 2017;96(18):e6765.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLee S-J, Faucett J, Gillen M, Krause N, Landry L. Factors associated with safe patient handling behaviors among critical care nurses. Am J Ind Med. 2010;53(9):886\u0026ndash;97.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRogers RW. A Protection Motivation Theory of Fear Appeals and Attitude Change1. J Psychol. 1975;91(1):93\u0026ndash;114.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGiurgiu DI, Jeoffrion C, Roland-L\u0026eacute;vy C, Grasset B, Dessomme BK, Moret L, et al. Wellbeing and occupational risk perception among health care workers: a multicenter study in Morocco and France. J Occup Med Toxicol. 2016;11(1):20.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGershon RRM, Stone PW, Zeltser M, Faucett J, Macdavitt K, Chou S-S. Organizational Climate and Nurse Health Outcomes in the United States: A Systematic Review. Ind Health. 2007;45(5):622\u0026ndash;36.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEriksen W, Bruusgaard D, Knardahl S. Work factors as predictors of intense or disabling low back pain; a prospective study of nurses\u0026rsquo; aides. Occup Environ Med. 2004;61(5):398\u0026ndash;404.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVendittelli D, Penprase B, Pittiglio L. Musculoskeletal Injury Prevention for New Nurses. Workplace Health Saf. 2016;64(12):573\u0026ndash;85.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-musculoskeletal-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmsd","sideBox":"Learn more about [BMC Musculoskeletal Disorders](http://bmcmusculoskeletdisord.biomedcentral.com/)","snPcode":"","submissionUrl":"https://author-welcome.nature.com/12891","title":"BMC Musculoskeletal Disorders","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Work-related musculoskeletal disorders (WRMSDs), intensive care units (ICUs), healthcare providers, ergonomic factors, risk perception.","lastPublishedDoi":"10.21203/rs.3.rs-4394065/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4394065/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e Work-related musculoskeletal disorders (WRMSDs) are significant concern in healthcare sector, specifically intensive care units (ICUs) due to distinct work environment. This study aims to comprehensively investigate determinants of WRMSDs and ergonomic challenges, specific to ICU healthcare providers, providing valuable insights for targeted interventions.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e In this mixed methods study, 200 consenting healthcare providers from seven ICUs participated. Structured questionnaires were used to collect details of socio-demographics, occupation, physical and workplace factors, risk perception, and musculoskeletal pain through modified Nordic Musculoskeletal Questinnaire. Qualitative insights were obtained through in-depth interviews until saturation of responses. Statistical analyses included inferential statistics, logistic regression, and thematic analysis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e Study revealed a high prevalence of WRMSDs (84%), with low back pain and neck reported to be most affected regions. Logistic regression analysis identified longer tenure in the ICU, high shift frequency, high physical workload and risk perception, and low exercise habits as significant predictors of WRMSDs among ICU healthcare providers. Qualitative study underscored challenges of heavy patient loads, long hours, and emotional strain faced by ICU healthcare providers, while also highlighting institutional support strategies for prevention of WRMSDs.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eThis study offers valuable insights into the multifaceted challenges faced by ICU healthcare providers and underscores the importance of multidimensional interventions incorporating physical, behavioural, and environmental factors. There is urgent need to address modifiable risk factors, including ergonomic training, workplace modifications, schedule adjustments, and educational programs to enhance risk awareness and preventive behaviours to effectively combat the burden of WRMSDs.\u003c/p\u003e","manuscriptTitle":"Comprehensive Investigation of Ergonomic Challenges and Work-related Musculoskeletal Disorders among Intensive Care Unit Healthcare Providers of Western India through Mixed Methods Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-06-04 18:56:24","doi":"10.21203/rs.3.rs-4394065/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-05-21T15:30:50+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-05-18T12:51:59+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-05-18T12:51:59+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Musculoskeletal Disorders","date":"2024-05-09T09:22:28+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-musculoskeletal-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmsd","sideBox":"Learn more about [BMC Musculoskeletal Disorders](http://bmcmusculoskeletdisord.biomedcentral.com/)","snPcode":"","submissionUrl":"https://author-welcome.nature.com/12891","title":"BMC Musculoskeletal Disorders","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"6dc3bfd5-a3e7-4638-a0e2-e66871f53fce","owner":[],"postedDate":"June 4th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-02-10T16:05:03+00:00","versionOfRecord":{"articleIdentity":"rs-4394065","link":"https://doi.org/10.1186/s12891-025-08379-4","journal":{"identity":"bmc-musculoskeletal-disorders","isVorOnly":false,"title":"BMC Musculoskeletal Disorders"},"publishedOn":"2025-02-07 15:58:10","publishedOnDateReadable":"February 7th, 2025"},"versionCreatedAt":"2024-06-04 18:56:24","video":"","vorDoi":"10.1186/s12891-025-08379-4","vorDoiUrl":"https://doi.org/10.1186/s12891-025-08379-4","workflowStages":[]},"version":"v1","identity":"rs-4394065","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4394065","identity":"rs-4394065","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}