SURGICAL RESEARCH

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

Published on

Feb 6, 2026

Injury

William R Bonin, Samuel Brost, Portia Kalun, Sebastian Tomescu, Bradley H Strauss, Cari M Whyne, Qingguo Li

Overview

This mixed-methods cohort study examined ergonomic risk among healthcare workers performing fluoroscopy-guided procedures in Interventional Cardiology and Orthopaedic Trauma. Recognizing the elevated risk of work-related musculoskeletal disorders (WMSDs) associated with prolonged maladaptive postures and the added burden of 5–10 kg lead aprons, the authors aimed to quantify time spent in medium-to high-risk postures and identify task-level contributors to these risks. Twenty-three participants (nurses, trainees, and physicians) were observed across 47 procedures using wearable inertial measurement units (IMUs) placed on the spine to generate continuous Rapid Upper Limb Assessment (RULA) scores. Medium-to high-risk postures were defined as RULA ≥5.

In Orthopaedic Trauma cases, synchronized video from the OR Black Box® was analyzed to contextualize high-risk postures and develop a task-based classification system. This led to the creation of the POSTURE framework—Pressure, Operations, Sight, Technology, Uneven Demographics, Reaching, and Exceptions—which categorizes specific intraoperative stressors contributing to poor ergonomics. By integrating quantitative posture monitoring with qualitative task analysis, the study provides a scalable model for ergonomic surveillance in surgical settings.

Results

Across both specialties and all roles, healthcare workers spent more than 50% of procedural time in medium-to high-risk postures (RULA ≥5), indicating substantial WMSD risk. Orthopaedic physicians demonstrated the highest exposure, spending 55.2% of operating time in RULA ≥5 positions and 38.9% in the highest risk category (RULA 6+). Physicians in both specialties consistently accumulated more time in RULA 6+ postures than nurses, underscoring role-based differences in ergonomic strain.

Task-level analysis in Orthopaedics revealed distinct risk patterns by role using the POSTURE framework. Nurses’ high-risk postures were most frequently associated with Operations (34.8%), Reaching (17.4%), and Exceptions (15.6%), reflecting tool handling, preparation tasks, and constrained environments. Physicians’ risks were driven primarily by Sight (25.8%), Pressure (19.8%), and Operations (19.6%), highlighting visual obstruction, forceful maneuvers (e.g., drilling), and procedural tasks as key contributors. These findings demonstrate that continuous IMU-based RULA monitoring, combined with contextual task categorization, reveals role-specific ergonomic vulnerabilities not captured by posture scoring alone.