Back to Journals » Journal of Multidisciplinary Healthcare » Volume 13

A Multidisciplinary Focus Review of Musculoskeletal Disorders Among Operating Room Personnel

Authors Tavakkol R , Karimi A, Hassanipour S, Gharahzadeh A, Fayzi R

Received 21 April 2020

Accepted for publication 1 July 2020

Published 31 July 2020 Volume 2020:13 Pages 735—741


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Scott Fraser

Reza Tavakkol,1 Ashkan Karimi,2 Soheil Hassanipour,3 Ali Gharahzadeh,4 Reza Fayzi5

1Department of Nursing, School of Nursing, Larestan University of Medical Sciences, Larestan, Iran; 2Operating Room Group, School of Paramedical, Hamadan University of Medical Science, Hamadan, Iran; 3Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran; 4Operating Room Department, North Khorasan University of Medical Science, Bojnord, North Khorasan, Iran; 5Department of Operating Room, School of Paramedical, Kermanshah University of Medical Science, Kermanshah, Iran

Correspondence: Reza Tavakkol
Larestan University of Medical Sciences, Larestan 7431975566, Iran
Tel +9871-52342877
Fax +9871-52344724
Email [email protected]

Abstract: Musculoskeletal disorder is one of the major health issues and is recognized as the second most common occupational disease. The aim of the present study was to investigate the different aspects of musculoskeletal disorders in operating room personnel. The present study was conducted to evaluate the prevalence of MSDs among operating room personnel, in January 2020. In this study, the authors explored 30 articles from five databases including Medline/PubMed, ProQuest, Scopus, Embase, and Google Scholar. The present study found that physical, psychological, and demographic characteristics including age, gender, work experience, and smoking were the most important risk factors for these disorders. Musculoskeletal disorders were also prevalent in different areas of the body, with the highest prevalence being in the lumbar region. In addition, regular exercise and physical activity, the use of stretching and gentle exercise to reduce physical pressure, regard to the principles of ergonomics in the workplace, regular physical examinations, and awareness of the risk factors for these disorders. Therefore, operating room officials need to promote operating room programs focused on reducing musculoskeletal disorders and increase the awareness of the personnel about the risk factors by conducting training courses.

Keywords: musculoskeletal disorders, musculoskeletal injuries, operating room


The increasing development of knowledge in human life has increased the speed of work and increased productivity. These advances have also led to complications such as fatigue, stress, and musculoskeletal disorders (MSDs).1 MSDs are inflammatory and degenerative processes that affect the muscles, tendons, ligaments, joints and peripheral nerves2 And they are often caused by repeated and long-term stresses in these tissues.3 According to the World Health Organization, MSDs are work-related when work activities significantly lead to the development and exacerbation of these disorders.4 These disorders are the most common and costly occupational injuries, accounting for about 7% of total community diseases, 14% of cases referred to physicians, 19% of hospitalized cases,5,6 and 32% of total occupational diseases.7 In addition, MSDs are the most common cause of disability and absenteeism in the Workplace in developing countries.8 They have also been identified as the second leading cause of disability worldwide.9 Among the places where people are at risk of injury due to occupational risk factors are health facilities and hospitals where the prevalence of physical injuries including MSDs is high.10 Health care workers are one of the most important health care providers who are highly exposed to musculoskeletal injuries due to occupational conditions.7

Nurses, which comprise 40% of all hospital staff9 They are at high risk for these disorders due to occupational status and tasks such as moving patients, lifting equipment and bending for a long time. These have been identified as one of the most important sources of occupational injuries and disabilities in the nursing profession.11,12 Prevalence of MSDs among nurses in the United States is 53%13 and in Iran 60–81%.14 Statistics show that about 7.5% of nurses are absent from work each week due to physical disabilities due to activities or mental exhaustion.15 Improving nurses’ performance leads to increased job satisfaction and mental health, But the lack of mental health indicators and consequently MSDs cause burnout and ultimately a decline in health care.16 Operating room nurses are at greater risk of developing MSDs due to specific workplace conditions.17 Operating room personnel due to static pressures, including prolonged standing, Fixed position, and restriction on movement, or inappropriate physical condition during surgery and perform repetitive tasks for a long time and also dynamic stressors, such as activities that require pushing, pulling, or lifting heavy surgical equipment, are most exposed to MSDs.18 Therefore, the present study aimed to investigate the factors associated with MSDs in operating room personnel.


The present study was conducted to evaluate the prevalence of MSDs among operating room personnel, in January 2020. In this study, the authors explored 30 articles from five databases including Medline/PubMed, ProQuest, Scopus, Embase, and Google Scholar. The selected keywords for databases were classified into two categories as follows: 1-related to operating room personnel (operating room staff, operating room nurses), 2- related to MSDs (musculoskeletal diseases, musculoskeletal pain, and occupational injuries).


Risk Factors- Physical Factors

Static Stress

Each group of healthcare workers is exposed to various occupational injuries, especially musculoskeletal disorders, due to their specific occupational activities. Among healthcare workers, operating room personnel have a high prevalence of musculoskeletal disorders due to specific work conditions.19,20 Because operating room personnel are an important member of the surgical team in the operating room, Maintaining and improving their health will improve service quality, job satisfaction, improve patient and community health and reduce costs.

The cause of musculoskeletal disorders is complex and varied.21,22 One of the most important causes of these disorders is work-related physical activity.23,24 Static stress is one of the risk factors that cause musculoskeletal disorders in operating room personnel. Static stress includes activities such as prolonged standing and constant physical posture during surgery and holding equipment such as retractors during surgery. Except for a few surgeries where the surgical team is in a sitting position, in other cases, the team members are in a standing position throughout the surgery.25,26 Standing up for a long time is one of the most important risk factors for musculoskeletal disorders.27 Andersen et al found that prolonged standing may increase back pain and leg pain.28 Movement limitations due to maintaining the sterility of the surgical field and being in a constant position also cause operating room personnel to be at high risk for these disorders. Holding retractors for appropriate exposure in during surgery is one of the common activities of a scrub nurse who can cause musculoskeletal disorders.29,30

In view of the foregoing, such activities are the working nature of operating room personnel and avoiding them is inevitable. On the other hand, working with this condition over time can lead to the incidence or aggravate musculoskeletal disorders. Therefore, it is recommended to prevent these disorders by controlling measures such as wearing medical shoes and exercising.

Manual Handling Activities

Manual activities are another risk factor for work-related physical activity among operating room personnel.29,31 Manual activities mean the manual movement and transfer of surgical instruments and devices that require special attention.28,32 Pulling, pushing or lifting surgical instruments, heavy and specialized surgical equipment and patient displacement are the most common manual activities of operating room personnel.29,33 Doing these activities in the operating room exposes the person to musculoskeletal disorders. Doing these activities in the operating room exposes the person to musculoskeletal disorders, while doing these activities, pay attention to the principles of ergonomics and apply force to the correct position. Transfer equipment also is used to move instruments and patients, and activities should work together if the equipment is not available.

Psychosocial Factors

Mental health, like physical health, is nothing more than the absence of disease. Mental disorders, like other occupational injuries, have become more prevalent in recent years. A major part of these mental disorders is due to the stress that is caused by working conditions.34 Occupational stress is a branch of stress created in the workplace and defined according to the physical and physiological effects of the profession on the individual. These effects can affect one’s mental or physical activities.35 Occupational stress among operating room personnel due to various surgeries and seeing stressful scenes of surgery is common which affects their health.36,37 It can lead to secondary disorders such as fatigue, muscle pain, and bone problems.38 In addition to musculoskeletal injuries, these stresses lead to absence from work and Increasing displacements,39 decreased quality of service provided,40 and increased costs and organizational performance impairment that have become apparent worldwide.41,42

Occupational stressors in nurses and operating room personnel can include overtime,43 low occupational benefits,44 coping with patients’ emotional needs,45 dealing with dead patients,46 lack of resources,47 lack of organizational support,48 disagreements with managers, colleagues, or doctors, unpleasant experiences in the workplace and family problems.49 According to the above, operating room personnel are exposed to occupational stress and consequent injuries due to the workplace. Therefore, the ability to adapt to these stresses is crucial to achieving professional success.50,51 Also by controlling the exacerbations of these conditions such as reducing workloads and communicating effectively in the workplace the secondary effects of these stresses can be reduced.

Demographic Characteristics

Various studies have shown that demographic characteristics are effective in the occurrence of musculoskeletal disorders. Age, gender, smoking, and work experience are the most important factors in this category.52


One of the important and effective cases in the development of musculoskeletal disorders is the age factor.19 Increasing age has been identified as a risk factor in the development and exacerbation of these disorders.53

Muscle strength continues to increase in early adulthood but decreases in middle age and thereafter. Also with increasing age, fat tissue weight and consequently muscle and bone density decreased and muscle strength was reduced. In addition, the tensile mechanical strength of the bones, muscles, and joints is also significantly reduced.54 The peak of musculoskeletal disorders, especially low back pain, is in the third decade of life, with the incidence increasing to 65–60 years and then gradually decreasing.55

According to the above, it can be concluded that the exacerbation of age-related musculoskeletal disorders is normal due to physiological and anatomical changes. For this reason, it is recommended to reduce workload as you get older and avoid the risk factors related to physical activity as much as possible.


In general, among healthcare workers, the prevalence of musculoskeletal disorders is higher in women than in men.5658 About age 40, muscle strength decreases and this decrease is greater in women than in men.54 The prevalence of musculoskeletal disorders in operating room personnel is higher in women than in men.27 Women in the operating room are 2.69 times more likely than men to develop musculoskeletal disorders59 and that is especially increased after menopause in women.60 A study by Classen et al found that there was a statistically significant difference in the prevalence of musculoskeletal disorders in women with men and women were 1.61 times more likely to have these disorders.61 According to studies and identification of female gender as a risk factor for musculoskeletal disorders, it is recommended that women pay more attention to the principles of care and preventive factors.

Work Experience

Another risk factor for musculoskeletal disorders is work experience.19 Increased work experience as a result of increasing age and increasing workload, Identified as a risk factor for musculoskeletal disorders in operating room personnel. Various studies have shown that Operating room personnel have been exposed to increased risk factors for increased work experience. Therefore, these disorders are more common in people with more work experience. Operating room personnel are more exposed to these disorders due to operating in a high-risk environment.27,33 A study by Wiitavaara et al found that nurses and operating room personnel with 10 years or more of work experience a higher prevalence of these disorders than those with less work experience.57 According to the above, there is a direct relationship between musculoskeletal disorders and work experience. Therefore, it is recommended that the principle of ergonomics be further adhered to with increasing work experience and prevent further spread of these injuries by awareness of other risk factors associated with these disorders.


Smoking can cause muscle weakness by reducing the amount of oxygen needed by the body.62 Various studies have suggested the association between smoking and musculoskeletal disorders and their impact on the occurrence of these disorders. Smoking with adverse effects on muscles, tendons, cartilage, and ligaments has been identified as a risk factor for musculoskeletal disorders.20,63

From the above-mentioned content, it can be concluded that smoking with oxygen deprivation leads to musculoskeletal disorders. Therefore, it is recommended that smoking needs to minimize to reduce the prevalence of these disorders.

Prevalence of MSDs in Different Areas

Operating room personnel are most affected by musculoskeletal pain (58–90%) due to difficult working conditions.20 Musculoskeletal disorders can occur in different parts of the body. The most common areas of involvement include the neck, shoulder, elbows, wrists, and hands, upper and lower back, hip and thighs, knees, ankles, and feet. Among the musculoskeletal disorders, low back pain has the highest prevalence.53

This disorder is defined as a pain or discomfort in the space between the 12th rib and the lower gluteal folds,64,65 It ranks eighth among all physical injuries and is the second most commonly diagnosed in the United States.66,67 In previous studies, the prevalence of back pain in the upper and lower back was evaluated separately, with reported rates of 46–84%31,34 and 32.7–54.6%25,33 for the lower and upper back respectively. In addition to back pain, which was most prevalent in operating room personnel, the discomfort was significant in other areas. Various studies have reported pain and discomfort in the ankles and feet, knees and hip in 55.8–74%, 22–60.5%, and 23.8–52% respectively.31,33,68 The prevalence of these disorders in the upper limbs was also affected by shoulder, elbow and wrist and hands areas 33–74.3%, 19–52%, and 55.8–74% respectively.33,68 The high prevalence of these disorders in the upper limbs is related to the physical condition of the personnel in the operating room. Because of the movement of the heavy instruments, the traction required during surgery and holding retractors have an important role in exacerbating musculoskeletal disorders. Various studies have reported neck discomfort in operating room personnel 38.4% −71.4%.20,68 Various causes can be involved in this disorder, including prolonged bending and focusing on the surgical area, which may be one of the possible causes of injuries in this area. The above shows that the prevalence of musculoskeletal disorders is high in operating room personnel. This high prevalence indicates that there are many risk factors in the operating room environment. Therefore, can only reduce the prevalence of these disorders by observing the control principles.

Preventive Methods

According to the evidence, musculoskeletal disorders are responsible for a significant portion of the costs in the healthcare system.69 The Canadian Occupational Safety and Health Center recommends the use of flooring, Suitable shoes, and ergonomic chairs to prevent prolonged standing risks as an appropriate way to prevent musculoskeletal disorders.32 Other preventive strategies include regular exercise and physical activity, the use of stretching and gentle exercise to reduce physical pressure,70 regard to the principles of ergonomics in the workplace, regular physical examinations,71 yoga,72 using laterally-tilting operating room tables and friction-reducing devices for patient lateral transfers,73 and awareness of the risk factors for these disorders.71 In addition to the above, Karahan and Bayraktar introduced teaching patient transfer techniques as one of the most effective and cost-effective ways to prevent musculoskeletal disorders.74 In another study, Tamminen-Peter et al revealed that the education scheme can both teaches how to work ergonomically and safely, and applies the basic know-how of the physical load and risk assessment and the ergonomic principles in the prevention of musculoskeletal strain and disorders.75


Due to the difficult working conditions in the operating room, musculoskeletal disorders are common among the personnel in this ward. Since the operating room is called the most sensitive part of any hospital and the so-called heart of the hospital, therefore, special attention needs to paid to personnel working in this ward. Because any disorder to the personnel is not only harmful to them, it will also have many detrimental effects on patients and the health system. Therefore, operating room officials need to promote operating room programs focused on reducing musculoskeletal disorders and by identification of risk factors, preventive measures, and diagnostic and therapeutic methods, prevent the progression of these disorders. It is also possible to improve the awareness of the operating room personnel about the mentioned cases by conducting training courses, which is considered as an important factor in reducing the prevalence of musculoskeletal disorders.

Operating room officials need to promote operating room programs focused on reducing musculoskeletal disorders and Increase the awareness of the personnel about the risk factors by conducting training courses.


The authors of this study are grateful to Dr. Abdullah Poor who guided the authors at various stages.


The authors report no conflict of interests in this work.


1. Tirgar A, Aghalari Z, Salari F. Somatic disorders and ergonomic considerations in computer use among the employees of a University of Medical Sciences. J Health Res Community. 2015;1(3):53–60.

2. Wiitavaara B, Fahlström M, Djupsjöbacka M. Prevalence, diagnostics and management of musculoskeletal disorders in primary health care in Sweden–an investigation of 2000 randomly selected patient records. J Eval Clin Pract. 2017;23(2):325–332. doi:10.1111/jep.12614

3. Haghdoost AA, Hajihosseini F, Hojjati H. Relationship between the musculoskeletal disorders with the ergonomic factors in nurses. Koomesh. 2011;12(4).

4. Abi Aad L. Musculoskeletal disorders among Lebanese dentists-Trend evolution. J Oral Med Toxicol. 2016;1(1):1–5.

5. Aghalari Z, Hosseini SR, Ashrafian Amiri H, Gholinia H, Rahimi D, Jafarian S. Evaluation of musculoskeletal disorders in the personnel of health centers in Babol, Iran. Health Dev J. 2019;8(3):258–266.

6. Tavakol R, Kavi E, Hassanipour S, Rabiei H, Malakoutikhah M. The global prevalence of musculoskeletal disorders among operating room personnel: a systematic review and meta-analysis. Clin Epidemiol Glob Health. 2020. doi:10.1016/j.cegh.2020.03.019

7. Palmer KT, Harris EC, Linaker C, Cooper C, Coggon D. Optimising case definitions of upper limb disorder for aetiological research and prevention: a review. Occup Environ Med. 2012;69(1):71–78. doi:10.1136/oemed-2011-100086

8. Heydari P, Varmazyar S, Hakimi C. Investigation of individual and occupational risk factors on the prevalence and consequence of musculoskeletal disorders among the rescue department employees in Qazvin in year 2016. J Health. 2019;10(1):73–82. doi:10.29252/

9. Ashghali Farahani M, Shahryari M, Saremi M, Mohammadi N, Haghani H. Effectiveness of patient handling training on musculoskeletal disorders of nurses assistance. Iran J Nurs. 2017;30(107):10–19. doi:10.29252/ijn.30.107.10

10. Azhdardor M, Tabatabaei S. Relationship between musculoskeletal disorders and quality of life in employees of selected hospitals in Golestan Province. Iran J Ergonomics. 2019;6(4):30–36. doi:10.30699/jergon.6.4.30

11. 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. doi:10.1186/1472-6955-13-7

12. Hou RJ, Wong -SY-S, Yip BH-K, et al. The effects of mindfulness-based stress reduction program on the mental health of family caregivers: a randomized controlled trial. Psychother Psychosom. 2014;83(1):45–53. doi:10.1159/000353278

13. D’Arcy LP, Sasai Y, Stearns SC. Do assistive devices, training, and workload affect injury incidence? Prevention efforts by nursing homes and back injuries among nursing assistants. J Adv Nurs. 2012;68(4):836–845. doi:10.1111/j.1365-2648.2011.05785.x

14. Index CP. Bureau of labor statistics, US department of labor. Washington, DC; 2012. Available from: http://data bls gov/cgi-bin/surveymost/. Accessed August 14, 2006.

15. Dehdashti A, Mahjoubi Z, Salarinia A. Impact of nurse’s work related body postures on their musculoskeletal disorders. Koomesh. 2015;338–346.

16. Gholami T, Rahnavard N, Sadeghzadeh M, Tahmtan S. Application of MAPO Index and JCQ in Assessing the Risk of Musculoskeletal Disorders and Psychosocial Stressors in Nurse Aids at Fasa Hospital. Iran J Ergonomics. 2018;6(2):24–33. doi:10.30699/jergon.6.2.24

17. Barzideh M, Choobineh A, Tabatabaee H. Job stress dimensions and their relationship to musculoskeletal disorders in Iranian nurses. Work. 2014;47(4):423–429. doi:10.3233/WOR-121585

18. Sadeghian F, Kalalian Moghaddam H, Javanmard M, Khosravi A, Adelnia S. An epidemiological survey of low back pain and its relationship with occupational and personal factors among nursing personnel at hospitals of Shahrood Faculty of Medical Sciences. Iran South Med J. 2005;8(1):75–82.

19. Moscato U, Trinca D, Rega ML, et al. Musculoskeletal injuries among operating room nurses: results from a multicenter survey in Rome, Italy. J Public Health. 2010;18(5):453–459. doi:10.1007/s10389-010-0327-9

20. Nützi M, Koch P, Baur H, Elfering A. Work–Family conflict, task interruptions, and influence at work predict musculoskeletal pain in operating room nurses. Saf Health Work. 2015;6(4):329–337. doi:10.1016/

21. Coluci MZO, Alexandre NMC. Job factors related to musculoskeletal symptoms among nursing personnel–a review. Work. 2012;41(Supplement 1):2516–2520. doi:10.3233/WOR-2012-0492-2516

22. Menzel N, Feng D, Doolen J. Low back pain in student nurses: literature review and prospective cohort study. Int J Nurs Educ Scholarsh. 2016;13:19–25.

23. Johnson OE, Edward E. Prevalence and risk factors of low back pain among workers in a health facility in South-South Nigeria. Br J Med Med Res. 2016;11(8):1. doi:10.9734/BJMMR/2016/20785

24. Wong T, Teo N, Kyaw M. Prevalence and risk factors associated with low back pain among health care providers in a District Hospital. Malays Orthop J. 2010;4(2):23–28. doi:10.5704/MOJ.1007.004

25. Choobineh A, Movahed M, Tabatabaie SH, Kumashiro M. Perceived demands and musculoskeletal disorders in operating room nurses of Shiraz city hospitals. Ind Health. 2010;48(1):74–84. doi:10.2486/indhealth.48.74

26. Bos E, Krol B, van der Star L, Groothoff J. Risk factors and musculoskeletal complaints in non-specialized nurses, IC nurses, operation room nurses, and X-ray technologists. Int Arch Occup Environ Health. 2007;80(3):198–206. doi:10.1007/s00420-006-0121-8

27. Aljeesh YI, Nawajha S. Determinants of low back pain among operating room nurses in gaza governmental hospitals. J Al Azhar Univ Gaza. 2011;14:41–54.

28. Andersen JH, Haahr JP, Frost P. Risk factors for more severe regional musculoskeletal symptoms: a two‐year prospective study of a general working population. Arthritis Rheum. 2007;56(4):1355–1364. doi:10.1002/art.22513

29. Sievert DM, Ricks P, Edwards JR, et al. Antimicrobial-resistant pathogens associated with healthcare-associated infections summary of data reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2009–2010. Infect Control Hosp Epidemiol. 2013;34(1):1–14. doi:10.1086/668770

30. Lin P-H, Tsai Y-A, Chen W-C, Huang S-F. Prevalence, characteristics, and work-related risk factors of low back pain among hospital nurses in Taiwan: a cross-sectional survey. Int J Occup Med Environ Health. 2012;25(1):41–50. doi:10.2478/s13382-012-0008-8

31. Meijsen P, Knibbe HJ. Work-related musculoskeletal disorders of perioperative personnel in the Netherlands. AORN J. 2007;86(2):193–208. doi:10.1016/j.aorn.2007.07.011

32. Bank HSD. Canadian centre for occupational health and safety. Q-1. 1998.

33. Asghari E, Dianat I, Abdollahzadeh F, et al. Musculoskeletal pain in operating room nurses: associations with quality of work life, working posture, socio-demographic and job characteristics. Int J Ind Ergon. 2019;72:330–337. doi:10.1016/j.ergon.2019.06.009

34. Jeyakumar AK, Segaran F. Prevalence and risk factors of low back pain and disability index among operating room nurses. J Perioper Nurs. 2018;31(3):21–24. doi:10.26550/2209-1092.1030

35. Bao M, Liu Y, Wu J. Study on job stressors and coping ways of bachelor nurses (Article in Chinese). Chin J Dis Control Prev. 2011;16:937–939.

36. Wanzer M, Booth-Butterfield M, Booth-Butterfield S. “If we didn’t use humor, we’d cry”: humorous coping communication in health care settings. J Health Commun. 2005;10(2):105–125. doi:10.1080/10810730590915092

37. Lambert VA, Lambert CE, Ito M. Workplace stressors, ways of coping and demographic characteristics as predictors of physical and mental health of Japanese hospital nurses. Int J Nurs Stud. 2004;41(1):85–97. doi:10.1016/S0020-7489(03)00080-4

38. Zhao FF, Lei XL, He W, Gu YH, Li DW. The study of perceived stress, coping strategy and self‐efficacy of Chinese undergraduate nursing students in clinical practice. Int J Nurs Pract. 2015;21(4):401–409. doi:10.1111/ijn.12273

39. Hasnzadeh H, Hashemi M, MaddiNeshat M. Stress and coping strategies in clinical education of nursing students of North Khorasan University of Medical Sciences. J North Khorasan Univ Med Sci. 2015;6(4):797–806. doi:10.29252/jnkums.6.4.797

40. Lambert V, Lambert C, Petrini M, Li X, Zhang Y. Predictors of physical and mental health in hospital nurses within the People’s Republic of China. Int Nurs Rev. 2007;54(1):85–91. doi:10.1111/j.1466-7657.2007.00512.x

41. Callaghan P, Tak‐Ying SA, Wyatt PA. Factors related to stress and coping among Chinese nurses in Hong Kong. J Adv Nurs. 2000;31(6):1518–1527. doi:10.1046/j.1365-2648.2000.01434.x

42. Hillhouse JJ, Adler CM. Investigating stress effect patterns in hospital staff nurses: results of a cluster analysis. Soc Sci Med. 1997;45(12):1781–1788. doi:10.1016/S0277-9536(97)00109-3

43. Li J, Lambert VA. Workplace stressors, coping, demographics and job satisfaction in Chinese intensive care nurses. Nurs Crit Care. 2008;13(1):12–24. doi:10.1111/j.1478-5153.2007.00252.x

44. Xianyu Y, Lambert VA. Investigation of the relationships among workplace stressors, ways of coping, and the mental health of Chinese head nurses. Nurs Health Sci. 2006;8(3):147–155. doi:10.1111/j.1442-2018.2006.00281.x

45. Wu H, Chi TS, Chen L, Wang L, Jin YP. Occupational stress among hospital nurses: cross‐sectional survey. J Adv Nurs. 2010;66(3):627–634. doi:10.1111/j.1365-2648.2009.05203.x

46. Mann S, Cowburn J. Emotional labour and stress within mental health nursing. J Psychiatr Ment Health Nurs. 2005;12(2):154–162. doi:10.1111/j.1365-2850.2004.00807.x

47. Tholdy Doncevic S, Romelsjö A, Theorell T. Comparison of stress, job satisfaction, perception of control, and health among district nurses in Stockholm and prewar Zagreb. Scand J Soc Med. 1998;26(2):106–114. doi:10.1177/14034948980260021001

48. Tyson PD, Pongruengphant R, Aggarwal B. Coping with organizational stress among hospital nurses in Southern Ontario. Int J Nurs Stud. 2002;39(4):453–459. doi:10.1016/S0020-7489(01)00047-5

49. Cheng Y, Kawachi I, Coakley EH, Schwartz J, Colditz G. Association between psychosocial work characteristics and health functioning in American women: prospective study. BMJ. 2000;320(7247):1432–1436. doi:10.1136/bmj.320.7247.1432

50. Edwards D, Burnard P, Bennett K, Hebden U. A longitudinal study of stress and self-esteem in student nurses. Nurse Educ Today. 2010;30(1):78–84. doi:10.1016/j.nedt.2009.06.008

51. Lambert VA, Lambert CE. Nurses’ workplace stressors and coping strategies. Indian J Palliat Care. 2008;14(1):38. doi:10.4103/0973-1075.41934

52. Burdorf A, Sorock G. Positive and negative evidence of risk factors for back disorders. Scand J Work Environ Health. 1997;23(4):243–256. doi:10.5271/sjweh.217

53. Bin Homaid M, Abdelmoety D, Alshareef W, et al. Prevalence and risk factors of low back pain among operation room staff at a tertiary care center, Makkah, Saudi Arabia: a cross-sectional study. Ann Occup Environ Med. 2016;28:1. doi:10.1186/s40557-016-0089-0

54. Health Monitor Journal of the Iranian Institute for Health Sciences Research. 2007;6(2).

55. Clark DK Professional values: a study of education and experience in nursing students and nurses: Capella university. 2009.

56. Homaid MB, Abdelmoety D, Alshareef W, et al. Prevalence and risk factors of low back pain among operation room staff at a Tertiary Care Center, Makkah, Saudi Arabia: a cross-sectional study. Ann Occup Environ Med. 2016;28:1.

57. Wiitavaara B, Barnekow-Bergkvist M, Brulin C. Striving for balance: a grounded theory study of health experiences of nurses with musculoskeletal problems. Int J Nurs Stud. 2007;44(8):1379–1390. doi:10.1016/j.ijnurstu.2006.07.009

58. Akbari M, Bagheri A, Fathollahi A, Darvish M. Job satisfaction among nurses in Iran: does gender matter? J Multidiscip Healthc. 2020;13:71–78. doi:10.2147/JMDH.S215288

59. Raeisi S, Hosseini M, Attarchi MS, Golabadi M, Rezaei MS, Namvar M. The association between job type and ward of service of nursing personnel and prevalence of musculoskeletal disorders. Razi J Med Sci. 2013;20(108):1–10.

60. Karimi S, Afkhaminia F, Talebpour Amiri F. Association between low back pain and lifestyle among the staff in Mazandaran University of Medical Sciences. J Mazandaran Univ Med Sci. 2018;28(162):141–148.

61. Classen DC, Resar R, Griffin F, et al. ‘Global trigger tool’shows that adverse events in hospitals may be ten times greater than previously measured. Health Aff. 2011;30(4):581–589. doi:10.1377/hlthaff.2011.0190

62. Lincoln AE, Smith GS, Amoroso PJ, Bell NS. The effect of cigarette smoking on musculoskeletal‐related disability. Am J Ind Med. 2003;43(4):337–349. doi:10.1002/ajim.10195

63. Abate M, Vanni D, Pantalone A, Salini V. Cigarette smoking and musculoskeletal disorders. Muscles Ligaments Tendons J. 2013;3(2):63. doi:10.32098/mltj.02.2013.03

64. Woolf AD, Erwin J, March L. The need to address the burden of musculoskeletal conditions. Best Pract Res Clin Rheumatol. 2012;26(2):183–224. doi:10.1016/j.berh.2012.03.005

65. Bhandary AK, Chimes GP, Malanga GA. Investigational pharmacology for low back pain. J Pain Res. 2010;3:169.

66. Vos T, Flaxman AD, Naghavi M, et al. Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380(9859):2163–2196. doi:10.1016/S0140-6736(12)61729-2

67. Starkweather AR, Ramesh D, Lyon DE, et al. Acute low back pain: differential somatosensory function and gene expression compared to healthy no-pain controls. Clin J Pain. 2016;32(11):933. doi:10.1097/AJP.0000000000000347

68. Sheikhzadeh A, Gore C, Zuckerman JD, Nordin M. Perioperating nurses and technicians’ perceptions of ergonomic risk factors in the surgical environment. Appl Ergon. 2009;40(5):833–839. doi:10.1016/j.apergo.2008.09.012

69. Waehrer G, Leigh JP, Miller TR. Costs of occupational injury and illness within the health services sector. Int J Health Serv. 2005;35(2):343–359. doi:10.2190/RNQ3-0C13-U09M-TENP

70. Attar SM. Frequency and risk factors of musculoskeletal pain in nurses at a tertiary centre in Jeddah, Saudi Arabia: a cross sectional study. BMC Res Notes. 2014;7(1):61. doi:10.1186/1756-0500-7-61

71. Samaei SE, Mostafaee M, Jafarpoor H, Hosseinabadi MB. Effects of patient-handling and individual factors on the prevalence of low back pain among nursing personnel. Work. 2017;56(4):551–561. doi:10.3233/WOR-172526

72. Monson AL, Chismark AM, Cooper BR, Krenik-Matejcek TM. Effects of yoga on musculoskeletal pain. Am Dent Hyg Assoc. 2017;91(2):15–22.

73. Al-Qaisi SK, El Tannir A, Younan LA, Kaddoum RN. An ergonomic assessment of using laterally-tilting operating room tables and friction reducing devices for patient lateral transfers. Appl Ergon. 2020;87:103122. doi:10.1016/j.apergo.2020.103122

74. Karahan A, Bayraktar N. Effectiveness of an education program to prevent nurses’ low back pain: an interventional study in Turkey. Workplace Health Saf. 2013;61(2):73–78.

75. Tamminen-Peter L, Nygren K. Development of an education scheme for improving perioperative nurses’ competence in ergonomics. Work. 2019;64(3):661–667. doi:10.3233/WOR-193002

Creative Commons License This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at and incorporate the Creative Commons Attribution - Non Commercial (unported, v3.0) License. By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms.