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Patient Positioning During In-Office Otologic Procedures Impacts Physician Ergonomics.
Otol Neurotol. 2018 10; 39(9):e883-e888.ON

Abstract

OBJECTIVE

The purpose of this study was to evaluate the impact of patient positioning on physician ergonomics during in-office otologic procedures. A previous simulation study suggested that placing patients supine during in-office otology procedures is ergonomically favorable. This study aims to substantiate these findings during the routine care of patients in an otolaryngology practice setting.

STUDY DESIGN

Observational study.

SETTING

Outpatient otology clinic within tertiary care facility.

STUDY SUBJECTS

Two neurotology attending physicians.

INTERVENTIONS

Physicians performed cerumen removal procedures in the office with patients either in the seated position (n = 24) or supine position (n = 24).

MAIN OUTCOME MEASURES

The rapid upper limb assessment (RULA), a validated instrument that measures body positioning with a focus on the upper arm, was used to measure ergonomic positioning. RULA scores correlate occupational body positioning with a numeric representation of musculoskeletal injury risk ranging from 1 (minimal risk) to 7 (very high risk).

RESULTS

Overall median RULA scores were 4.5 (medium risk) with patients in the seated position, and 2 (low risk) with patients in the supine position (p < 0.0001). Similarly, RULA scores were significantly lower with patients in the supine position when each physician was evaluated independently (p < 0.0001, for both).

CONCLUSIONS

Placing patients in a supine position for cerumen removal results in more favorable ergonomic positioning for the physician, thus reducing risk for work-related musculoskeletal disorders. This suggests that physicians should consider placing patients in the supine position for in-office otologic procedures. Further study is needed to investigate optimal ergonomic positioning for other common otolaryngology procedures.

Authors+Show Affiliations

Department of Otolaryngology.Division of Otology/Neurotology, Department of Otolaryngology, University of Pittsburgh Medical Center, Eye and Ear Institute, Pittsburgh, Pennsylvania.Department of Otolaryngology. Division of Otology/Neurotology, Department of Otolaryngology, University of Pittsburgh Medical Center, Eye and Ear Institute, Pittsburgh, Pennsylvania.Department of Otolaryngology. Division of Otology/Neurotology, Department of Otolaryngology, University of Pittsburgh Medical Center, Eye and Ear Institute, Pittsburgh, Pennsylvania.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

30106851

Citation

Govil, Nandini, et al. "Patient Positioning During In-Office Otologic Procedures Impacts Physician Ergonomics." Otology & Neurotology : Official Publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology, vol. 39, no. 9, 2018, pp. e883-e888.
Govil N, DeMayo WM, Hirsch BE, et al. Patient Positioning During In-Office Otologic Procedures Impacts Physician Ergonomics. Otol Neurotol. 2018;39(9):e883-e888.
Govil, N., DeMayo, W. M., Hirsch, B. E., & McCall, A. A. (2018). Patient Positioning During In-Office Otologic Procedures Impacts Physician Ergonomics. Otology & Neurotology : Official Publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology, 39(9), e883-e888. https://doi.org/10.1097/MAO.0000000000001961
Govil N, et al. Patient Positioning During In-Office Otologic Procedures Impacts Physician Ergonomics. Otol Neurotol. 2018;39(9):e883-e888. PubMed PMID: 30106851.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Patient Positioning During In-Office Otologic Procedures Impacts Physician Ergonomics. AU - Govil,Nandini, AU - DeMayo,William M, AU - Hirsch,Barry E, AU - McCall,Andrew A, PY - 2018/8/15/pubmed PY - 2019/11/8/medline PY - 2018/8/15/entrez SP - e883 EP - e888 JF - Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology JO - Otol Neurotol VL - 39 IS - 9 N2 - OBJECTIVE: The purpose of this study was to evaluate the impact of patient positioning on physician ergonomics during in-office otologic procedures. A previous simulation study suggested that placing patients supine during in-office otology procedures is ergonomically favorable. This study aims to substantiate these findings during the routine care of patients in an otolaryngology practice setting. STUDY DESIGN: Observational study. SETTING: Outpatient otology clinic within tertiary care facility. STUDY SUBJECTS: Two neurotology attending physicians. INTERVENTIONS: Physicians performed cerumen removal procedures in the office with patients either in the seated position (n = 24) or supine position (n = 24). MAIN OUTCOME MEASURES: The rapid upper limb assessment (RULA), a validated instrument that measures body positioning with a focus on the upper arm, was used to measure ergonomic positioning. RULA scores correlate occupational body positioning with a numeric representation of musculoskeletal injury risk ranging from 1 (minimal risk) to 7 (very high risk). RESULTS: Overall median RULA scores were 4.5 (medium risk) with patients in the seated position, and 2 (low risk) with patients in the supine position (p < 0.0001). Similarly, RULA scores were significantly lower with patients in the supine position when each physician was evaluated independently (p < 0.0001, for both). CONCLUSIONS: Placing patients in a supine position for cerumen removal results in more favorable ergonomic positioning for the physician, thus reducing risk for work-related musculoskeletal disorders. This suggests that physicians should consider placing patients in the supine position for in-office otologic procedures. Further study is needed to investigate optimal ergonomic positioning for other common otolaryngology procedures. SN - 1537-4505 UR - https://www.unboundmedicine.com/medline/citation/30106851/Patient_Positioning_During_In_Office_Otologic_Procedures_Impacts_Physician_Ergonomics_ DB - PRIME DP - Unbound Medicine ER -