Avaliação da prevalência de sintomas e da efetividade do exercício físico em ambiente ocupacional para controle da dor musculoesquelética em trabalhadores de enfermagem

Abstract

Musculoskeletal disorders have been recognized as a worldwide health problem being highly prevalent among nursing staff. Pain is one of the most noticeable symptoms and may progress to chronic conditions and loss of function. Workplace exercise programs are among the measures for controlling these disorders. Previous systematic review, based exclusively on randomized controlled trials (RCT) results, reported that this practice can be effective when the programs are performed under specific conditions. However, the conduction of RCT in workplace environment is not always possible. Thus, a systematic review to compare the evidence sinthesized by RCT and non RCT studies regarding the effectiveness of workplace exercise interventions for controlling musculoskeletal pain in active workers was conducted (STUDY I). Results from this study reinforced the evidence already sinthesized by Coury; Moreira; Dias (2009) regarding the effectiveness of exercise in occupational environment, but also t the low methodological quality of non RCT studies which precluded their potential for clinical evidence. On the other hand, the study also provied important scientific recommendations for future research on exercise workplace exercise interventions. These results motivated the conduction of a workplace exercise intervention aiming at musculoskeletal pain control in nursing professionals. The intervention was preceded by an epidemiological survey conducted in the working setting through out a questionnaire developed by the authors wich included the standardized Nordic Questionnaire for musculoskeletal symptoms evaluation (STUDY II). This survey alowed the identification of the lumbar, neck and shoulder regions as the ones presenting the highest musculoskeletal pain prevalence among the professionals evaluated. Given the complexity and multifactorial origin of musculoskeletal pain, it was performed logistic regression analysis wich identified the absence of) physical activity, smoking, carrying out household work, working as a nursing technician and previous history of sick leave due to musculoskeletal problem as the main factors explaining the presence of symptoms among workers evaluated. After this initial evaluation, it was applied an exercise program aiming at musculoskeletal pain control of neck, shoulder and low back regions (STUDY III). The exercise program was apllied in the worplace, during 12 weeks and resulted in the reduction of pain sensivity in all points assessed by the algometry, promoted increased muscle strength of abdominals, besides the improvement of low back symptoms identified through out the functional clinical exam. However, no improvement regarding neck and shoulder joint symptoms was observed. The investigation of musculoskeletal pain under these three different methodological perspectives, allowed a better understanding of the theme.Workplace exercise can be an effective way of controlling musculoskeletal symptoms in workers. However, this approach should not be accepted as the only type of intervention to be performed in the workplace. The addoption of aditional ergonomic interventions to promote overload reduction during working hours are also advisable.