RULA method in the ergonomic analysis of an ophthalmic surgeon’s work: a case study
DOI:
https://doi.org/10.15343/0104-7809.202549e17212025PKeywords:
Musculoskeletal Diseases, Ophthalmologic Surgical Procedures, Occupational Health Nursing, ErgonomicsAbstract
Work-related musculoskeletal disorders (WRMSDs) represent a widespread occupational health issue across many countries, leading to high organizational costs and constituting one of the main causes of work disability. Ophthalmic surgery requires a high level of concentration, precision, and physical effort, often associated with the adoption of static and inadequate postures, which predispose these professionals to the development of WRMSDs. This study aimed to characterize the posture of an ophthalmic surgeon in the operating room using the RULA (Rapid Upper Limb Assessment) method. This is a descriptive case study conducted according to the Case Report (CARE) guidelines. The results revealed that the surgeon remains seated and static for extended periods, adopting potentially harmful postures. The application of the RULA method indicated an urgent need for ergonomic intervention, with recommendations including seat adjustments, arm support, and workspace reorganization. The importance of implementing regular breaks, stretching exercises, and strategies to reduce visual fatigue is also emphasized. The use of more comprehensive, complementary ergonomic assessment methods is recommended for a more complete analysis. It is concluded that ergonomic adaptation of the workstation is essential for promoting the surgeon’s health, safety, and performance, and that the RULA method is a valuable tool for identifying risks associated with WRMSDs.
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Mota M, Pires G, Silva DS e, Lopes AS, Henriques S. Bloco operatório – O que podemos fazer para evitar lesões? In: Perguntas e Respostas em Ergoftalmologia. Lisboa; 2018. p. 64–7.
Dzhodzhua V, Serranheira F, Leite ES, Grillo MM, Sousa Uva A. Exigências visuais e fadiga visual em médicos oftalmologistas. Rev Bras Med Trab. 2017;15(3):209–16.
Alrashed WA. Ergonomics and work-related musculoskeletal disorders in ophthalmic practice. Imam J Appl Sci. 2017;1:48–63.
Schechet SA, DeVience E, DeVience S, Shukla S, Kaleem M. Survey of musculoskeletal disorders among US ophthalmologists. Digit J Ophthalmol. 2020;26(4):36–45.
Honavar SG. Head up, heels down, posture perfect: Ergonomics for an ophthalmologist. Indian J Ophthalmol. 2017;65(8):647–50.
European Agency for Safety and Health at Work. Work-related musculoskeletal disorders: prevalence, costs and demographics in the EU [Internet]. 2019 [citado 2025 Jun 12]. Disponível em: https://osha.europa.eu/en/publications/work-related-musculoskeletal-disorders prevalence-costs-and-demographics-eu/view
Fan X, Straube S. Reporting on work-related low back pain: data sources, discrepancies and the art of discovering truths. Pain Manag. 2016;6(6):553–9.
Lynn M, Corlett N. RULA: A survey method for the investigation of work-related upper limb disorders. Appl Ergon. 1993;24(2):91–9.
Dwyer A, Huckleby J, Kabbani M, Delano A, De Sutter M, Crawford D. Ergonomic assessment of robotic general surgeons: a pilot study. J Robot Surg. 2020;14(3):387–92.
Hignett S, McAtamney L. Rapid Entire Body Assessment (REBA). Appl Ergon. 2000;31(2):201–5.
Suo M, Zhou L, Wang J, Huang H, Zhang J, Sun T, et al. The application of surface electromyography technology in evaluating paraspinal muscle function. Diagnostics. 2024;14(11):1–23.
Wang G, Cui Y. Meta-analysis of visual fatigue based on visual display terminals. BMC Ophthalmol. 2024;24(1):1–13.
Supian N, Munajat M, Saiful B. The effects of workplace office ergonomic intervention on work-related posture and musculoskeletal symptoms: A systematic review. Int J Allied Health Sci [Internet]. 2023 [citado 2025 Jun 12];7(5):589–605. Disponível em: https://journals.iium. edu.my/ijahs/index.php/IJAHS/article/view/883
Markatia Z, Al-Khersan H, Kalavar M, Watane A, Yannuzzi N, Sridhar J. Ergonomics of ophthalmic surgery: Evaluating the effect of a posture trainer on trainee intraoperative back posture. J Acad Ophthalmol. 2023;15(2):e276–9.
Yousif I, Jibreel K, Mohammed M. Surgical ergonomics among ophthalmologists at Alsaim Eye Hospital, Wad Madani, Sudan: A clinical audit. Discov Public Health [Internet]. 2025 [citado 2025 Jun 12];22(1). Disponível em: https://doi.org/10.1186/s12982-025-00407-x
Simon S, Dully J, Dindorf C, Bartaguiz E, Walle O, Roschlock-Sachs I, et al. Inertial motion capturing in ergonomic workplace analysis: Assessing the correlation between RULA, upper-body posture deviations and musculoskeletal discomfort. Safety. 2024;10(1):1–17.
Kee D. Comparison of LEBA and RULA based on postural load criteria and epidemiological data on musculoskeletal disorders. Int J Environ Res Public Health. 2022;19(7):1–14.
Merbah J, Caré BR, Gorce P, Gadea F, Prince F. A new approach to quantifying muscular fatigue using wearable EMG sensors during surgery: An ergonomic case study. Sensors. 2023;23(3):1–11.
Korkmaz ÖA. The ergonomic posture assessment by comparing REBA with RULA & OWAS: A case study in a gas springs factory. Sigma J Eng Nat Sci. 2023;(Jan):1–12.
Soares C, Shimano SGN, Marcacine PR, Martinho Fernandes LFR, de Castro LLPT, de Walsh IAP. Ergonomic interventions for work in a sitting position: An integrative review. Rev Bras Med Trab. 2023;21(1):1–10.
Suh Y, Shin S, Kim BY, Jeong J, Kim TI. Comparison of neck angle and musculoskeletal discomfort of surgeon in cataract surgery between three-dimensional heads-up display system and conventional microscope. Sci Rep [Internet]. 2024 [citado 2025 Jun 12];14(1):22681. Disponível em: https://doi.org/10.1038/s41598-024-68630-1
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. 2016;30(1):1–7.
Kaur K, Gurnani B, Nayak S, Deori N, Kaur S, Jethani J, et al. Digital eye strain: A comprehensive review. Ophthalmol Ther [Internet]. 2022 [citado 2025 Jun 12];11(5):1655–80. Disponível em: https://doi.org/10.1007/s40123-022-00540-9
Sheppard AL, Wolffsohn JS. Digital eye strain: Prevalence, measurement and amelioration. BMJ Open Ophthalmol. 2018;3(1):1–10.
Feng Y, Grooten W, Wretenberg P, Arborelius UP. Effects of arm support on shoulder and arm muscle activity during sedentary work. Ergonomics. 1997;40(8):834–48.
Milerad E, Ericson MO. Effects of precision and force demands, grip diameter, and arm support during manual work: An electromyographic study. Ergonomics. 1994;37(2):255–64.
Quinn D, Moohan J. Optimal laparoscopic ergonomics in gynaecology. Obstet Gynaecol. 2015;17(2):77–82.
Kaup S, Shivalli S, Kulkarni U, Arunachalam C. Ergonomic practices and musculoskeletal disorders among ophthalmologists in India: An online appraisal. Eur J Ophthalmol. 2020;30(1):196–200.
Ordem dos Enfermeiros. Regulamento n.º 372/2018. Diário da República, 2.ª série — N.º 114 — 15 de junho de 2018. p. 16804–10.
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