Ergonomic risks in healthcare workers in acute care; the POSTURE framework

Healthcare workers performing fluoroscopy-guided procedures are at an elevated risk for work-related musculoskeletal disorders (WMSD) due to prolonged, maladaptive postures, further aggravated by the physical burden of lead aprons. Despite growing awareness, few studies have continuously assessed posture risk with task-level contributors to poor ergonomics in surgical settings.

To quantify the proportion of time that healthcare workers spend in medium-to high-risk postures during fluoroscopic procedures in Interventional Cardiology and Orthopaedic Trauma to identify WMSD risk. A secondary aim categorizes specific tasks through qualitative video analysis of the high-risk postures in Orthopaedic Trauma.

A mixed-methods cohort study was conducted for 23 participants over 47 procedures (22 in Interventional Cardiology and 25 in Orthopaedic Trauma). Participants included nurses, physicians and trainees, all of whom wore standard lead aprons during procedures. Postures were continuously assessed using three inertial measurement units attached on the spine to derive real-time Rapid Upper Limb Assessment (RULA) scores. Medium-to high-risk postures were defined as RULA scores ≥5, known to contribute to WMSD risk. For Orthopaedic procedures, synchronized audiovisual data from an Operating Room Black Box® was analyzed using open and focused coding to identify task-related contributors to posture.

Healthcare workers spent more than 50% of procedural time in medium-to high-risk postures. Physicians in Orthopaedics demonstrated the highest risk activity, with 38.9% of time in RULA 6+ postures. Task-based contributions were categorized using the novel POSTURE framework: Pressure, Operations, Sight Technology, Uneven Demographics, Reaching and Exceptions. This framework revealed role-specific ergonomic risks that traditional RULA score alone could not differentiate.

This study highlights a concerning prevalence of high-risk postures among healthcare workers in fluoroscopy-dependent procedures. The integration of continuous IMU-based RULA monitoring with qualitative task analysis offers a scalable and clinically relevant approach to posture assessment. The POSTURE framework extends existing ergonomic tools by contextualizing task-specific risks, providing actionable insights to guide ergonomic interventions, institutional policy, and training aimed at reducing WMSDs in surgical environments.