Document Type : Original Article



BACKGROUND: Musculoskeletal disorders (MSDs) were known as one of the main occupational
problems among health‑care workers. However, we had some limitations and difficulties for
transferring ergonomic concepts to the health‑care workers, especially nurses due to heavy work
task and insufficient time for that. This study compares the impacts of two ergonomic training
methods (lecture and pamphlet) in nurses of an Iranian tertiary hospital on prevalence of their upper
and lower extremity complaints.
MATERIALS AND METHODS: In the present randomized clinical trial with parallel groups, 1140 nurses
were randomly selected and allocated to the control and two interventional groups. In the interventional
groups, nurses revived a training program and pamphlet as ergonomic training methods about
work‑related MSDs and related ergonomic concept to MSDs prevention and nurses in the control group,
did not receive any ergonomic training methods. Upper and lower extremity complaints measure among
study nurses with Nordic MSDs before 6 months and 1 year after trial intervention. Statistical analysis
including the Kolmogorov–Smirnov goodness‑of‑fit, Chi‑square test, and independent sample t‑test
was performed using SPSS version 22. A two‑tailed P ≤ 0.05 was considered statistically significant.
RESULTS: At the first and second parts of the study follow‑up, the prevalence of upper and lower
extremities significantly improved in the interventional groups in comparison with the control group.
Moreover, between the two trial groups, the frequency of MSDs in upper and lower extremities
significantly improved among nurses of the pamphlet group in comparison with the lecture group.
CONCLUSION: Findings of the study showed that we can use pamphlet as a suitable tool for
describing ergonomic concepts in comparison with lecture among nurses.


  1. Kaila‑Kangas L, Haukka E, Miranda H, Kivekäs T, Ahola K,
    Luukkonen R, et al. Common mental and musculoskeletal
    disorders as predictors of disability retirement among Finns.
    J Affect Disord 2014;165:38‑44.
    2. RibeiroT, Serranheira F, Loureiro H. Work related musculoskeletal
    disorders in primary health care nurses. Appl Nurs Res
    3. Khammar A, Poursadeghiyan M, Marioryad H, Nabi Amjad R,
    Alimohammadi M, Khandan M. Patient safety climate and
    its affecting factors among rehabilitation health care staff of
    hospitals and rehabilitation centers in Iran‑Tehran. Iran. Rehabil.
    J. 2019;17:39‑48.
    4. Dehghan N, Aghilinejad M, Nassiri‑Kashani MH, Amiri Z,
    Talebi A. The effect of a multifaceted ergonomic intervention
    program on reducing musculoskeletal disorders in dentists. Med
    J Islam Repub Iran 2016;30:472.
  2. 5. Passali C, Maniopoulou D, Apostolakis I, Varlamis I. Work‑related
    musculoskeletal disorders among Greek hospital nursing
    professionals: A cross‑sectional observational study. Work
    6. 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;6:329‑37.
    7. Duhig S, Shield AJ, Opar D, Gabbett TJ, Ferguson C, Williams M.
    Effect of high‑speed running on hamstring strain injury risk. Br J
    Sports Med 2016;50:1536‑40.
    8. Suarez R, Agbonifo N, Hittle B, Davis K, Freeman A. Frequency
    and risk of occupational health and safety hazards for
    home healthcare workers. Home Health Care Manag Pract
    9. Nastasia I, Coutu MF, Tcaciuc R. Topics and trends in
    research on non‑clinical interventions aimed at preventing
    prolonged work disability in workers compensated for
    work‑related musculoskeletal disorders (WRMSDs): A systematic,
    comprehensive literature review. Disabil Rehabil 2014;36:1841‑56.
    10. Mouatt B, Kamper SJ. Common challenges in managing neck and
    upper limb pain in office workers. Aust J Gen Pract 2019;48:746‑50.
    11. Aghilinejad M, Kabir‑Mokamelkhah E, Talebi A, Soleimani R,
    Dehghan N. The effect of magnification lenses on reducing
    musculoskeletal discomfort among dentists. Med J Islam Repub
    Iran 2016;30:473.
    12. Gilliaux M, Renders A, Dispa D, Holvoet D, Sapin J, Dehez B,
    et al. Upper limb robot‑assisted therapy in cerebral palsy:
    A single‑blind randomized controlled trial. Neurorehabil Neural
    Repair 2015;29:183‑92.
    13. Lassen AD, Fagt S, Lennernäs M, Nyberg M, Haapalar I,
    Thorsen AV, et al. The impact of worksite interventions promoting
    healthier food and/or physical activity habits among employees
    working ‘around the clock’ hours: A systematic review. Food Nutr
    Res 2018; 62:1‑13.
    14. Straube S, Harden M, Schröder H, Arendacka B, Fan X,
    Moore RA, et al. Back schools for the treatment of chronic low
    back pain: Possibility of benefit but no convincing evidence after
    47 years of research‑systematic review and meta‑analysis. Pain
    15. Pillastrini P, Mugnai R, Farneti C, Bertozzi L, Bonfiglioli R, Curti S,
    et al. Evaluation of two preventive interventions for reducing
    musculoskeletal complaints in operators of video display
    terminals. Phys Ther 2007;87:536‑44.
    16. Santos AC, Bredemeier M, Rosa KF, Amantéa VA, Xavier RM.
    Impact on the quality of life of an educational program for
    the prevention of work‑related musculoskeletal disorders:
    A randomized controlled trial. BMC Public Health 2011;11:60.
    17. Aghilinejad M, Choobineh AR, Sadeghi Z, Nouri MK, Bahrami
    Ahmadi A. Prevalence of musculoskeletal disorders among
    Iranian steel workers. Iran Red Crescent Med J 2012;14:198‑203.
    18. Daneshmandi H, Kee D, Kamalinia M, Oliaei M, Mohammadi H.
    An ergonomic intervention to relieve musculoskeletal symptoms
    of assembly line workers at an electronic parts manufacturer in
    Iran. Work 2018;61:515‑21.
    19. Andersson K, Karlehagen S, Jonsson B. The importance
    of variations in questionnaire administration. Appl Ergon
    20. Kuorinka I, JonssonB, KilbomA, Vinterberg H, Biering‑Sørensen F,
    Andersson G, et al. Standardised Nordic questionnaires for the
    analysis of musculoskeletal symptoms. Appl Ergon 1987;18:233‑7.
    21. Brisson C, Montreuil S, Punnett L. Effects of an ergonomic training
    program on workers with video display units. Scand J Work
    Environ Health 1999;25(3):255–63.
    22. Mahmud N, Kenny DT, Zein RM, Hassan SN. Ergonomic training
    reduces musculoskeletal disorders among office workers: Results
    from the 6‑month follow‑up. Malays J Med Sci 2011;18:16.
    23. Franasiak J, Ko EM, Kidd J, Secord AA, Bell M, Boggess JF, et al.
    Physical strain and urgent need for ergonomic training among
    gynecologic oncologists who perform minimally invasive surgery.
    Gynecol Oncol 2012;126:437‑42.
    24. Mani K, Provident I, Eckel E. Evidence‑based ergonomics
    education: Promoting risk factor awareness among office
    computer workers. Work 2016;55:913‑22.
    25. Robertson MM, Ciriello VM, Garabet AM. Office ergonomics
    training and a sit‑stand workstation: Effects on musculoskeletal
    and visual symptoms and performance of office workers. Appl
    Ergon 2013;44:73‑85.
    26. Aghilinejad M, Ehsani AA, Talebi A, Koohpayehzadeh J,
    Dehghan N. Ergonomic risk factors and musculoskeletal
    symptoms in surgeons with three types of surgery: Open,
    laparoscopic, and microsurgery. Med J Islam Repub Iran
    27. Nhamrc NH, Council AR, Australia U. National Statement
    on Ethical Conduct in Human Research 2007 (Updated 2018).
    Canberra: National Health and Medical Research Council; 2018.
    28. Khin NA, Francis G, Mulinde J, Grandinetti C, Skeete R, Yu B, et al.
    Data integrity in global clinical trials: Discussions from joint US
    food and drug administration and UK medicines and healthcare
    products regulatory agency good clinical practice workshop. Clin
    Pharmacol Ther 2020;108:949‑63.
    29. Johnsson C, Carlsson R, Lagerström M. Evaluation of training in
    patient handling and moving skills among hospital and home
    care personnel. Ergonomics 2002;45:850‑65.
    30. Poursadeqiyan M, Arefi MF, Khaleghi S, Moghaddam AS,
    Mazloumi E, Raei M, et al. Investigation of the relationship
    between the safety climate and occupational fatigue among the
    nurses of educational hospitals in Zabol. J Educ Health Promot
    31. Karimpour VazifehkhoraniA, KarimzadehM, PoursadeghiyanM,
    Rahmati‑Najarkolaei F. Psychoeducation on improving mental
    health literacy and adjustment to illness in patients with type 2
    diabetes: An experimental stud. Iran. Rehabil. J. 2018;16:395‑404.