Surgical Ergonomic Pilot Study Using a Posture Biofeedback Device in Rhinology: A Multi-Phase Quality Improvement Study

Background: Poor surgical ergonomic practices can result in musculoskeletal strain and chronic injury. Previous studies have demonstrated that wearable devices like the “Upright Go” (UG) can improve posture with real-time feedback among otolaryngologists. Prior studies have not assessed the long-term impact of these devices on posture and musculoskeletal complaints after biofeedback is removed, nor have any studies correlated improvements in posture with changes in musculoskeletal pain. This is the first study to utilize UG to evaluate the long-term impact of biofeedback on ergonomics and pain in rhinologic surgery. Methods: Participants included rhinologists at a tertiary-care center. Participants were excluded if they had a history of whiplash, arthritis, spine surgery, traumatic injury, or chronic pain. The UG was positioned midline on the surgeon’s back between the cervical and thoracic spine via a necklace applicator and was calibrated to each individual’s neutral, upright posture. Maintaining posture within 4 degrees of neutral was recorded as “upright posture” and any tilt beyond this was recorded as “poor posture.” The percentage of time spent in upright posture (PUP) was recorded while participants operated wearing the UG. This study was conducted in three phases, each lasting four weeks in duration. Phase 1 consisted of wearing the UG without biofeedback to record participants’ baseline posture and pain. Phase 2 incorporated biofeedback, which provided gentle vibration to correct poor posture. Phase 3 served as the post-intervention phase, in which the participant’s posture was recorded without biofeedback. In each phase, participants completed the Numeric Pain Rating Scale (NPR) at the end of each operating day, rating current pain, least pain, and worst pain on a scale from 0 (no pain) to 10 (severe pain) over the past 24 hours postoperatively. The NPR is reported as a composite score, which is the average of these three scores for each day. Results: Three rhinologists completed all three phases of the study. One rhinologist preferred operating while seated, and two preferred standing. PUP increased from 83.82 ± 4.83% to 96.71 ± 0.36% between Phase 1 and Phase 3, with a statistically significant positive correlation with trial phase (r=0.37, p = 0.05). The average composite NPR score was 2.73 ± 0.44 points in Phase 1, 2.80 ± 0.79 points in Phase 2 and 2.90 ± 1.09 points in Phase 3 out of 10 points maximum, with no statistical difference between phases ( p = 0.373). At the end of the trial, two of three endorsed a subjective improvement in posture from Phase 1 to Phase 3 of the trial. Discussion: This three-phase study of rhinologists characterized conditioned effects of the “Upright Go” (UG) device on posture and pain. This study found that the UG device improved posture with real-time vibrotactile biofeedback and demonstrated a sustained effect when biofeedback was subsequently absent. Improved upright posture did not correlate with improved pain. Though pain was not improved, this unique study highlights the potential for conditioning proper surgical posture, while promoting ergonomic sustainability and limiting posing risks. Publication History Article published online: 05 February 2024 © 2024. Thieme. All rights reserved. Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany