口腔医生颈部工作相关肌肉骨骼疾患影响因素及预测模型构建

Influencing factors and prediction model of neck pain in dentists

  • 摘要:
    背景 口腔医生是工作相关肌肉骨骼疾患(WMSDs)的高发人群,颈部是发生率最高的部位。
    目的 分析口腔医生颈部WMSDs症状发生的相关因素,探讨口腔医生颈部WMSDs预测模型。
    方法 选择福州市的口腔医生作为研究对象,采用分层整群抽样,按医院性质(口腔专科医院、综合性医院和口腔诊所/门诊部)进行分层。采用“中国肌肉骨骼疾患问卷”和“主观负荷评价技术量表”调查口腔医生基本信息、WMSDs症状发生情况及其影响因素。本次研究共回收问卷655份,其中有效问卷603份,有效率92.1%。应用多因素logistic回归分析口腔医生颈部WMSDs的影响因素;应用神经网络模型构建口腔医生颈部WMSDs预测模型,评价模型的预测效能。
    结果 口腔医生WMSDs症状发生率最高的部位是颈部,为43.8%(264/603)。多因素logistic回归分析结果显示:女性(OR=2.709,95%CI:1.852~3.962,P<0.001)、工龄10~<20年(与<10年相比,OR=3.836,95%CI:2.471~5.957,P<0.001)、长时间保持头部后仰或低头(OR=8.492,95%CI:2.203~32.731,P=0.002)、长时间保持侧头(OR=2.210,95%CI:1.376~3.550,P<0.001)、长时间坐在同一位置(OR=4.336,95%CI:2.192~8.579,P<0.001)、心理负荷值≥70(与心理负荷值<40相比,OR=1.901,95%CI:1.038~3.480,P=0.037)的口腔医生颈部WMSDs症状发生风险升高,操作空间够用(OR=0.507,95%CI:0.302~0.850,P=0.010)和工间运动(OR=0.670,95%CI:0.453~0.991,P=0.045)的口腔医生颈部WMSDs症状发生风险降低。构建口腔医生颈部WMSDs神经网络预测模型,得到一个隐含层数为1,隐含层神经元个数为6的模型。训练集预测正确率百分比89.6%,测试集预测正确率百分比83.9%。模型自变量重要性排序依次为工龄、长时间保持侧头、心理负荷等。口腔医生颈部WMSDs神经网络模型预测结果为:受试者工作特性曲线(ROC)的曲线下面积为0.940(95%CI:0.922~0.958,P<0.001);ROC曲线取最大诊断分界值时的灵敏度为84.8%,特异性为91.2%,约登指数为0.760。
    结论 口腔医生颈部WMSDs的发生受个体因素(如性别、工龄)、工效学因素(如长时间保持各种姿势和操作、操作空间等)、心理因素(不同程度的心理负荷)等多种因素影响。神经网络模型可作为探讨口腔医生颈部WMSDs发生风险的预测工具。

     

    Abstract:
    Background Dentists are a high-risk population of work-related musculoskeletal disorders (WMSDs), where the body part with the highest prevalence is the neck.
    Objective To analyze potential influencing factors of neck pain among dentists, and explore a prediction model of neck pain in dentists.
    Methods Dentists from different hospitals in Fuzhou were selected as study subjects by stratified cluster sampling according to hospital characteristics (dental hospitals, general hospitals, and dental clinics). The basic information, presentation of WMSDs, and its influencing factors were investigated by using the Chinese version of Musculoskeletal Disorders Questionnaire and the Subjective Workload Assessment Technique. A total of 655 questionnaires were collected, of which 603 were valid, with an effective rate of 92.1%. Multiple logistic regression was used to analyze potential influencing factors of neck pain in dentists. A prediction model of neck pain of dentists was constructed by using neural network model, and the prediction efficiency of the model was evaluated.
    Results The neck was the body part with the highest prevalence (43.8%, 264/603) of WMSDs among dentists. The results of multiple logistic regression analysis showed that female (OR=2.709, 95%CI: 1.852-3.962, P <0.001), working age of 10-<20 years (versus <10 years, OR=3.836, 95%CI: 2.471-5.957, P<0.001), keeping head up or down for a long time (OR=8.492, 95%CI: 2.203-32.731, P=0.002), holding head sideways for a long time (OR=2.210, 95%CI: 1.376-3.550, P<0.001), maintaining the same sitting spot for a long time (OR=4.336, 95%CI: 2.192-8.579, P<0.001), and psychological load value ≥70 (versus <40, OR=1.901, 95%CI: 1.038-3.480, P=0.037) increased the risk of neck pain in dentists. Sufficient operating space (OR=0.507, 95%CI: 0.302-0.850, P=0.010) and doing some exercise during work break (OR=0.670, 95%CI: 0.453-0.991, P=0.045) reduced the risk of reporting neck pain among dentists. A neural network prediction model of dentists' neck pain was constructed with 1 hidden layer and 6 hidden layer neurons. The percentage of correct prediction of training set was 89.6%, and the percentage of correct prediction of test set was 83.9%. The order of importance of the independent variables included in the model were working age, holding head sideways for a long time, psychological load, etc. The result of neural network model of neck pain among dentists showed that the area under the curve of receiver operator characteristic (ROC) was 0.940 (95%CI: 0.922-0.958, P<0.001). When the maximum diagnostic value was determined by the ROC curve, the sensitivity was 84.8%, the specificity was 91.2%, and the Youden Index was 0.760.
    Conclusion Neck pain of dentists is affected by many factors, such as individual factors (gender and working age), ergonomic factors (keeping various postures and operations for a long time, operating space, etc.), psychological factors (different levels of psychological load) and so on. The neural network model can be used as a prediction tool to explore the risk of reporting neck pain among dentists.

     

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