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Year : 2017  |  Volume : 10  |  Issue : 6  |  Page : 1729-1734
Using of Cornell measuring tool(Cornell musculoskeletal discomfort questionnaires) for assessment of the musculoskeletal disorders prevalence among Ilam teaching hospitals nurses: Cross-sectional study in 2016

1 Department of Occupational Health Engineering, Faculty of Health, Ilam University of Medical Sciences, Ilam, Iran
2 Department of Public Health, Ilam University of Medical Science, Ilam, Iran

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Date of Web Publication11-Jan-2018


Introduction: Nurses in compare of other health practitioners have a greater risk for musculoskeletal injuries due to high physical activity together with bending, twisting, prolonged standing, patient moving, and lifting heavy objects. Therefore, the aim of this study was to evaluate musculoskeletal disorders by Cornell measuring tool among Ilam teaching hospitals nurses. Materials and Methods: This study was a cross-sectional analysis in 2016. Atotal of 120 people of Ilam teaching hospitals nurses randomly interred the study. Participants completed the questionnaire set for assess demographic characteristics(employment, working hours, shift work, and work experience) and musculoskeletal disorders(Cornell musculoskeletal discomfort questionnaires). Data collected were analyzed using SPSS version21 software and with the conduct of Pearson's correlation test and independent sample t test. Results: The results showed that 52cases(3.43%) of participants were male and 68(7.56%) were female. The highest discomfort incidence was reported to the lower back(70%) and neck(69.2%), respectively. Pearson's correlation test showed statistically significant relationship between the age, gender, and work experience with discomfort(P<0.05) and no significant relationship between powers working and discomfort(P>0.05). Discussion: According to the high prevalence of musculoskeletal disorders in the lower back and neck in the population studied, ergonomic interventions suggested. Conclusion: The use of appropriate educational programs, ergonomic intervention, and the use of health and safety equipment can reduce MSDs and increase productivity of nurses.

Keywords: Cornell measuring tool, hospital nurse, musculoskeletal disorders

How to cite this article:
Omidi M, Jalilian M, Kazemi M, Kamalvandi M, Jamshidzad M, Kurd N. Using of Cornell measuring tool(Cornell musculoskeletal discomfort questionnaires) for assessment of the musculoskeletal disorders prevalence among Ilam teaching hospitals nurses: Cross-sectional study in 2016. Ann Trop Med Public Health 2017;10:1729-34

How to cite this URL:
Omidi M, Jalilian M, Kazemi M, Kamalvandi M, Jamshidzad M, Kurd N. Using of Cornell measuring tool(Cornell musculoskeletal discomfort questionnaires) for assessment of the musculoskeletal disorders prevalence among Ilam teaching hospitals nurses: Cross-sectional study in 2016. Ann Trop Med Public Health [serial online] 2017 [cited 2020 Feb 17];10:1729-34. Available from:

   Introduction Top

Musculoskeletal disorders(MSDs) are disorders of muscles, tendons, tendon sheaths, peripheral nerves, joints, bones, ligaments, and blood vessels created as the result of repetitive blows over time or a sudden or acute one. According to the research, job-related MSDs are the most common cause of loss of work time, increase in costs, and human damage and are of the world's largest occupational health problems.[1],[2] According to the survey by the World Health Organization and documentation provided by this organization in 2013, among occupational diseases, MSDs comprise about 48% of total diseases caused by work. Several factors play a role in creating these disorders, of which occupational factors such as unfavorable working conditions in terms of ergonomics, manual tasks, lifting heavy objects, and repetitive and heavy tasks can be pointed out.[3],[4],[5] Working people in all areas are not safe of MSDs, but in some jobs due to certain working situations, these damages becomes more pronounced. Studies have shown that health-care workers compared to workers in the construction industry, mining, and manufacturing have higher risk of MSDs and nurses have the highest prevalence of this disorder.[6],[7],[8],[9],[10] The nursing profession has high risk of developing MSDs among health professions due to high physical activity along with bending, twisting, prolonged standing, moving, and lifting heavy objects and patient.[4],[11],[12] In this regard, Hedge writes that>40% of injuries reported in nurses are related to moving patients, of which 75.9% results in back injuries.[13] In some investigations, it is found that back pain with 30%–60% prevalence is the most common type of MSDs among nurses.[14],[15] MSD is a common cause of disability, occupational injuries, and withdrawal from work in nurses.[16],[17],[18] Statistics show that 66% of nurses working in Iran suffer from back pain due to long-term shifts in health centers and hospitals, as well as prolonged standing at the bedside of patients.[19] Therefore, given the importance of prevention of MSDs and their consequences among the nurses, the present study was conducted to determine the severity of MSDs in different organs of the body with the help of Cornell musculoskeletal discomfort 2(CMDQ 2) in hospital nurses in Ilam, Iran.

   Materials and Methods Top


The study is a descriptive–analytical study that was conducted in cross-sectional form in 2015 on nurses working in 14 districts and in three shifts at Mustafa Khomeini and Imam Khomeini hospitals of Ilam, west of Iran.

Study sample size

In the present study, stratified quota random sampling method was used and each hospital was considered to be a class. According to previous studies [20] and taking into account 95% confidence level and α =0.05 margin of the required sample size was estimated as 107 people and finally by considering loss, the desired sample size increased to 120 people. Equation 1 expresses the statistical formula used to estimate the size of the sample.

Data measurement

To collect the data, two different approaches were used. First, all information related to the work, working hours, shift work, and work experience along with demographic variables such as age, sex, height, and weight were collected through a researcher made checklist.

In the second part of the study, a map of the body 2 called Cornell MSDs measurement tool(CMDQ) was used. The above-mentioned tool is a data collection tool for MSDs that was developed by Professor Haig and colleagues.[13] This tool that is designed for men and women in standing and sitting forms in three stages as follows:(1) the frequency of discomfort,(2) discomfort intensity, and(3) the impact on adjusted operating power, and assesses 12 organs of the body(neck, shoulders, upper back, upper arms, lower back, forearms, wrists, hips, thighs, knees, and lower back and leg) in self-report form. Persian version of CMDQ is an efficient tool in the evaluation of MSDs of Iranian workers that can be used as part of routine health-care ergonomics, prevention of MSDs. Persian version of the questionnaire has a valid certificate of Ergonomics Laboratory at Cornell University in America, and Kashani has approved it. In examining the reliability of the questionnaire using the internal consistency of the tool, Cronbach's alpha coefficient was determined as 0.986. In determining the reliability of each part of the Cornell questionnaire for the presence of pain and discomfort, degree of pain and discomfort, and pain effect on working power, it was calculated, respectively, as 0.955, 0.961, and 0.969.[13]

Data analysis

Reported information on the questionnaires was encoded and entered intospss software version 22 (Armonk, NY: IBM Corp, 2013). Before analyzing the data, using appropriate test, data normality was evaluated. Data analysis was performed using statistical tests include Pearson correlation and independent sample t test. Data were analyzed at 0.95 of confidence level.

   Results Top

The mean age SD of all subjects studied are, respectively, 31.39 and 7.66years. Of the 120 nurses participated in the study, 43.3%, i.e.52 people are men and 56.7% i.e., 68 people, are women and with an average work experience of 8.9years, they are considered to be people with somehow experience. The highest SD is related to the height of the people, which reflects the broad range of height of subjects studied and data dispersion from around the mean. In addition, in the investigation of working shifts of people, it was found that 58 of them were working in the morning shift, 41 people in the evening shift, and 9 people at night shift. Demographic characteristics of hospital nurses are shown in [Table1].
Table 1: Mean and standard deviation of demographic variables of the participants

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The prevalence of pain in nurses during the last working week is presented in [Figure1]. As can be seen during the last working week, the highest incidence of pain and discomfort was in the lower back(70%) and neck(69.2%).
Figure1: Distribution of existing of pain and discomfort in different areas of the body in study participants

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Examining the nurses through CMDQ questionnaire at two levels of the presence of discomfort and impact on the ability to work for men and women showed that 31.59% of men and 48.89% of women have stated the existence of discomfort in one of the organs. In 9.97% of men, this discomfort has affected their work; whereas 49% of women have declared its impact on their work. It was also found that the highest effect on working power was in the neck(33.3%) and lower back(27.5%).

Pearson correlation test showed statistically a significant relationship between age and the discomfort[Table2]. It was also found that there is a significant relationship between gender and work experience with the existence of pain and discomfort(P<0.05). Nevertheless, no significant relationship was found between the intended variables and effect on working power.
Table 2: Simple correlation coefficients between discomfort and demographic variables

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For comparison of gender groups for the presence of discomfort, the intensity of discomfort, and its impact on the working power, independent sample t- test was used. According to [Table3], the study finding was demonstrated a significant difference between men and women in terms of the presence of discomfort and severity of discomfort(P<0.05), but the difference in effect on the power working was not significant(P>0.05).
Table 3: Comparison of discomfort, severity of discomfort and effect on the power working by gender

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The review of the average score of the prevalence of pain and discomfort in shifts: morning, afternoon, and night among the subjects are shown in [Figure2]. As can be seen, evening shift has received higher scores compared to the other two shifts.
Figure2: The prevalence of pain and discomfort in nurses per shift

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Average score of prevalence of pain in various parts of hospitals was identified as follows that pain and discomfort were reported: emergency 43.47, pediatric 90.16, women surgery 48.07, Men surgery 26.5, Intensive Care Unit(ICU) 23.47, neurosurgical ICU 34.07, operating room 36.5, women general 133.5, men internal 20.62, posts for women 86.25, posts for men 28.75, CCU 49.2, dialysis 32.57, and chemotherapy 32.57.

   Discussion Top

Several studies have shown that nurses are exposed to MSDs more than the staff in other sections due to the nature of the work of nursing, heavy tasks, and interference of effective factors such as individual, organizational, and work-related parameters staff are.[2],[21],[22] The study findings showed that of all nurses participating in the study, 101 people(84.3%), during the last working week have had discomfort or pain at least in one organ of their bodies. Most MSDs were in lower back pain(70%) and neck(69.2%). In their study on 247 nurses in Australia, Smith et al.[14] have reported the prevalence of musculoskeletal problems in all parts of the body as 91.9%. In this study, the highest incidence of discomfort and pain was in the lower back with 82.64%, shoulders 61.1%, and neck 36.8%. Several studies also suggest a high prevalence of pain and discomfort, especially in the waist area for the nursing profession, including: The study by Rokni et al.(most discomfort in the low back area 58.2%),[23] Nasiry Zarrin Ghabaee et al.(most discomfort in the waist area with 60.9%),[24] Abedini et al.(most discomfort in the low back area 71.5%),[25] Choobineh et al.,[21] Raeisi et al.,[26] De Souza Magnago et al.,[8] and Maul et al.[27] In all studies, discomforts related to back and neck have been the highest that may be related to the nature of the work of nurses, especially performing activities associated with moving patient because it requires sudden movements, bending, rotating, moving patients in the bed, patient transfer from bed and abnormal postures.[28],[29] The high standing of nursing staff in different departments can be considered as another possible reason.[30] In the study by Munabi et al. conducted on 880 nurses, the results showed that bending in the waist area that are too long, displacement and pushing heavy loads are of causes of damage to their waist.[31] The use of assistive devices such as hoists for transportation of patients and education of nurses leads to reduction of injuries.[15]

Pearson correlation test showed a statistically significant difference between age, gender, and experience with MSDs in nurses(P<0.05). In the study by Rokni etal.,[23] Nasiry Zarrin Ghabaee etal.,[24] Haghdoost etal.[32] and Zamanian etal.,[33] a significant relationship was observed between age and sex with MSDs problems(P<0.05). This result was also observed in the study by Tezel. In the study by Bahrami etal.,[34] Delpisheh etal.,[20] and Khoshbakht etal.[35] no significant correlation was found between some demographic factors with the final score of the evaluation of MSDs. In a study by Kjellberg etal.[36] showed that increase in age increases the chances of increased shoulder pain, which is justified by lack of education in how to use the body mechanic correctly and natural loss of movement performance by pass of time and aging. Other findings showed that the prevalence of pain in all studied parts is rather high(highest incidence in the pediatric ward with 90.16% and then to 86.25% in posts of women). However, one cannot use an accurate test to identify significant differences between disease prevalence in different parts. In his study, Mohsen band pay reported a significant association between ward of working and lower back pain.[25] He showed that the highest prevalence of lower back pain is in the emergency and the lowest is in the neonatal intensive care and urology. According to articles and reports, so far studying MSDs in different wards and comparing them for differences in the type of tasks and activities have not been carried out.

The review of the average score of the prevalence of pain and discomfort in shifts: morning, afternoon and night among the subjects show that evening shift has received higher scores compared to the other two shifts. In a study by Abedini etal.[25] showed that night workers suffer MSDs significantly more than individuals working during days, which is inconsistent with the results of this study. This is probably due to the lower number of subjects in night shift in the present study.

In terms of intensity of pain, in the limbs studied, lower pain intensity was the most prevalent. This is due to the nature of the pain and its causes, so that often work-related MSDs problems are considered as a category of cumulative trauma disorders.[37] The most important feature of this disorder is that it is cumulative that is the element causing pain and discomfort hits every day and briefly in the body, and hence in this situation, there will not be much pain. This finding is different from the findings by Falaki et al.[37] on the staff of medical diagnostic laboratories where the pain in different organs examined has been reported average. The difference in the population studied, and the methods of measuring the prevalence of MSDs are maybe the reasons for dissimilar results in the two studies. Moreover, the greatest impact of pain on working power of the staff has been in the neck and waist, which can be attributed to the high prevalence of these disorders in these areas.

   Conclusion Top

Since insufficient education in the field of ergonomics and poor working conditions has substantial effects in increasing occupational injuries in nurses, the use of appropriate educational programs, ergonomic intervention, and the use of health and safety equipment can reduce MSDs and increase the productivity of nurses.


The authors would like to thank and appreciate the nurses of Imam Khomeini and Shahid Mustafa Khomeini hospital in Ilam who provided the arrangements for of the study.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

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Correspondence Address:
Nematullah Kurd
Department of Occupational Health Engineering, Faculty of Health, Ilam University of Medical Sciences, Ilam
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ATMPH.ATMPH_619_17

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  [Table1], [Table2], [Table3]


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