王思逸, 吴玲玲, 程长春, 沈英, 金克峙. 上海某医院护理人员肌肉骨骼疾患模式与危险因素[J]. 环境与职业医学, 2019, 36(2): 112-120. DOI: 10.13213/j.cnki.jeom.2019.18420
引用本文: 王思逸, 吴玲玲, 程长春, 沈英, 金克峙. 上海某医院护理人员肌肉骨骼疾患模式与危险因素[J]. 环境与职业医学, 2019, 36(2): 112-120. DOI: 10.13213/j.cnki.jeom.2019.18420
WANG Si-yi, WU Ling-ling, CHENG Chang-chun, SHEN Ying, JIN Ke-zhi. Patterns of musculoskeletal disorders and associated risk factors of healthcare workers in a hospital of Shanghai[J]. Journal of Environmental and Occupational Medicine, 2019, 36(2): 112-120. DOI: 10.13213/j.cnki.jeom.2019.18420
Citation: WANG Si-yi, WU Ling-ling, CHENG Chang-chun, SHEN Ying, JIN Ke-zhi. Patterns of musculoskeletal disorders and associated risk factors of healthcare workers in a hospital of Shanghai[J]. Journal of Environmental and Occupational Medicine, 2019, 36(2): 112-120. DOI: 10.13213/j.cnki.jeom.2019.18420

上海某医院护理人员肌肉骨骼疾患模式与危险因素

Patterns of musculoskeletal disorders and associated risk factors of healthcare workers in a hospital of Shanghai

  • 摘要: 目的 肌肉骨骼疾患(MSDs)患者同质性的增加可能可以增强治疗的有效性,也有利于MSDs发生机制的探索。本研究拟应用潜在类别分析(LCA)识别上海某医院护理人员MSDs的分类模式,以提高分组对象的同质性,并探讨相关危险因素与模式之间的联系。

    方法 运用横断面调查方法,收集护理工作量数据,并结合前期研究问卷数据,包括研究对象个体信息,各部位MSDs患病情况以及职业因素等,运用LCA识别肌肉骨骼疾患模式及相关危险因素。

    结果 经潜在类别分析,该医院护理人员MSDs模式最优模型为6分类,分别为:上半身疼痛组(潜在类别概率γ=0.208)、仅腰部疼痛组(γ=0.182)、轻微疼痛组(γ=0.169)、颈肩腰疼痛组(γ=0.152)、各部位均疼痛组(γ=0.152)、上半身及下肢疼痛组(γ=0.138)。职业因素进入模型,发现"休息不足"普遍存在于各类别中(条件概率ρ > 0.7),上半身及下肢疼痛组的所有样本均报告工作中"搬运重物"(ρ=1.000)。以工作量值分组后,最佳拟合结果均为4个分类,轻工作量组分别为仅腰部疼痛组1(γ=0.155)、仅腰部疼痛组2(γ=0.183)、各部位均疼痛组(γ=0.257)、上半身疼痛组(γ=0.405);中等工作量组分别为颈及踝足疼痛组(γ=0.151)、轻微疼痛组(γ=0.270)、各部位均疼痛组(γ=0.156)、上半身疼痛组(γ=0.422);重工作量组分别为仅腰部疼痛组(γ=0.390)、颈肩腰疼痛组(γ=0.195)、各部位均疼痛组(γ=0.131)、上半身及下肢疼痛组(γ=0.284)。工龄分析中,各分类工龄OR > 1.000,除重工作量组中"颈肩腰疼痛组""上半身疼痛组"外,其余均有统计学意义(P < 0.05)。

    结论 该医院护理人员MSDs存在一定疼痛模式。护理人员暴露于不同的职业危险因素,将会进入不同MSDs类别中,如常搬运重物的护理人员更易分入上半身及下肢疼痛组。科室工作量不同,护理人员MSDs模式不同。随着工龄增大,护理人员更易出现多部位疼痛模式。

     

    Abstract: Objective Higher homogeneity of patients with musculoskeletal disorders (MSDs) may enhance curative effects and facilitate understanding the mechanism of MSDs. The purpose of the article is to identify the patterns of MSDs and associated risk factors in healthcare workers in a hospital of Shanghai by latent class analysis (LCA).

    Methods A cross-sectional study was conducted by collecting nursing workload data. Combined with previous questionnaire data, including study subjects' information, body part-specific MSDs prevalence, and occupational factors, LCA was used to identify MSDs patterns and risk factors.

    Results The result of LCA showed six best clusters for MSDs:upper body pain group (γ=0.208), only low back pain group (γ=0.182), minor pain group (γ=0.169), neck-shoulder-waist pain group (γ=0. 152), pain in all sites group (γ=0.152), and upper body-lower limb pain group (γ=0.138). When occupational factors entered the model, "lack of rest" was found in each pattern (ρ > 0.7), and "moving heavy objects" was in the "upper body-lower limb pain group" (ρ=1.000). After grouping by workload, the best-fit results were 4 categories in each workload group. The light workload group included only low back pain group 1 (γ=0.155), only low back pain group 2 (γ=0.183), pain in all sites group (γ=0.257), and upper body pain group (γ=0.405). The medium workload group included neck-anklefoot pain group (γ=0.151), minor pain group (γ=0.270), pain in all sites group (γ=0.156), and upper body pain group (γ=0.422). The heavy workload group included only low back pain group (γ=0.390), neck-shoulder-waist pain group (γ=0.195), pain in all sites group (γ=0.131), and upper body and lower limb pain group (γ=0.284). In the career length analysis, all ORs were greater than 1.000, and except the neckshoulder-waist pain group and the upper body pain group of the heavy workload group, the rest were statistically significant (P < 0.05).

    Conclusion The patterns of MSDs in the studied healthcare workers are identified. Being exposed to different occupational risk factors would lead to different MSDs patterns. The healthcare workers who move heavy objects, for instance, are more likely to be found in the upper body-lower limb pain group. Different workloads would also lead to different MSDs patterns. Higher age and work age would be associated with pain in multiple body sites.

     

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