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VOLUME 7, ISSUE 2 

 2024 
 

RESEARCH ARTICLE 

Azizi S, Moradi V, Hajiaghaei B, Babaee T. Prevalence of work-related musculoskeletal disorders among Iranian orthotists and prosthetists: A study on work-

related quality of life. Canadian Prosthetics & Orthotics Journal. 2024; Volume 7, Issue 2, No.6. https://doi.org/10.33137/cpoj.v7i2.44064  

 

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mailto:cpoj@online-publication.com
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https://pmc.ncbi.nlm.nih.gov/journals/?term=%22Canadian+Prosthetics+%26+Orthotics+Journal%22
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https://doi.org/10.33137/cpoj.v7i2.44064


 

1 

Azizi S, Moradi V, Hajiaghaei B, Babaee T. Prevalence of work-related musculoskeletal disorders among Iranian orthotists and prosthetists: A study on work-
related quality of life. Canadian Prosthetics & Orthotics Journal. 2024; Volume 7, Issue 2, No. 6. https://doi.org/10.33137/cpoj.v7i2.44064 

 

 

RESEARCH ARTICLE 

 

PREVALENCE OF WORK-RELATED MUSCULOSKELETAL DISORDERS AMONG IRANIAN 

ORTHOTISTS AND PROSTHETISTS: A STUDY ON WORK-RELATED QUALITY OF LIFE 

Azizi S1, Moradi V2, Hajiaghaei B1, Babaee T.1* 

1 Department of Orthotics and Prosthetics, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran. 
2 Iran-Helal Institute of Applied Science and Technology, Tehran, Iran. 

 
  
 

 

 

 

  

 

 

 

 

 

 

 

 

 

 

 

 

INTRODUCTION   

 

Work-related musculoskeletal injuries are among the most 

severe occupational issues worldwide. Unfavorable body 

position during work is an essential factor in these injuries. 

According to the Health and Safety Executive, 38% of work-

related problems are related to musculoskeletal disorders,1 

the leading cause of more than half of work absences and  

 

 

 

 

 

about 50% of occupational diseases.2 These disorders are 

more frequently observed in occupations that require 

manual work, lifting heavy objects, or performing repetitive 

movements.3 Adjusting work habits, reducing working 

hours, or changing job types can help mitigate these 

issues.4,5 Demographic characteristics such as age, 

gender, and psychosocial factors are some predicting 

variables for musculoskeletal disorders.6 These disorders 

lead to waste of working days, increased costs, and human 

injuries and are the leading cause of disability.7 Work-

related musculoskeletal disorders reduce work efficiency 

and production, affecting work-related quality of life 

 
OPEN  ACCESS 

ABSTRACT 

BACKGROUND: Work-related musculoskeletal injuries are prevalent globally and can impact both work 

efficiency and the quality of services offered to patients.  

OBJECTIVES: This study investigated the prevalence of work-related musculoskeletal disorders among 

Iranian orthotists and prosthetists and its relationship with work-related quality of life. 

METHODOLOGY: In this cross-sectional study, the Persian versions of the Nordic Musculoskeletal 

Questionnaire (NMQ) and Work-Related Quality of Life (WRQoL) scale were used to identify disorders of 

different body parts and occupational quality of life. A group of 263 orthotists and prosthetists were invited to 

complete the questionnaires using a simple random sampling method. The data from 188 respondents were 

analyzed. The association between WRQoL and the following variables: gender, work experience, age, 

presence of musculoskeletal disorder, and income level, was assessed using Spearman’s rho correlation 

coefficient. 

FINDINGS: There was an 82% prevalence of work-related musculoskeletal disorders among the participants. 

The most common areas involved were the lower back (35%) and neck (28%). There was a statistically   

significant relationship between gender (rs(188) = 0.16, p = 0.031) and weight (rs(188) = 0.15, p = 0.045) and 

work-related musculoskeletal disorders, however, the strength of the correlation was very small. Moreover, 

the WRQoL had a statistically significant but small to negligible relationship with gender (rs(188) = 0.17, p = 

0.016), work experience (rs(188) = 0.18, p = 0.011), age (rs(188) = 0.15, p = 0.039), and income (rs(178) = 

0.17, p = 0.025). There was no significant relationship between work-related musculoskeletal disorders and 

the total score of WRQoL scale. 

 

CONCLUSION: While the prevalence of work-related musculoskeletal disorders is high among Iranian 

orthotists and prosthetists, the average WRQoL presents an opportunity for improvement. The findings 

indicate associations between work-related disorders and factors such as gender, work experience, age, and 

income, emphasizing the need for plans to improve working conditions and prevent these disorders. 

Conducting ergonomic assessments of workstations, increasing employee income, and implementing 

training programs that focus on proper lifting techniques, posture, and the use of ergonomic tools may help 

reduce work-related musculoskeletal disorders in orthotists and prosthetists. 

 

 

 

ARTICLE INFO 

Received: October 8, 2024 

Accepted: January 27, 2025 

Published: February 2, 2025 
 

CITATION 

Azizi S, Moradi V, Hajiaghaei B, 

Babaee T. Prevalence of work-

related musculoskeletal disorders 

among Iranian orthotists and 

prosthetists: A study on work-

related quality of life. Canadian 

Prosthetics & Orthotics Journal. 

2024; Volume 7, Issue 2, No. 6. 

https://doi.org/10.33137/cpoj.v7i2

.44064 

KEYWORDS 

Musculoskeletal Disorder, Work, 

Quality of Life, Orthotist, WRQoL, 

Rehabilitation, Musculoskeletal, 

Prosthetist, Iranian  

 

* CORRESPONDING AUTHOR: 

Dr. Taher Babaee, PhD, CPO 
Affiliation: Department of Orthotics and Prosthetics, School of 
Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran. 

E-Mail: babaee.t@iums.ac.ir  

ORCID ID: https://orcid.org/0000-0002-1487-2374 

 

Journal Homepage: https://jps.library.utoronto.ca/index.php/cpoj/index 

Volume 7, Issue 2, Article No. 6, 2024 

 

 

https://doi.org/10.33137/cpoj.v7i2.44064
https://doi.org/10.33137/cpoj.v7i2.44064
https://doi.org/10.33137/cpoj.v7i2.44064
mailto:babaee.t@iums.ac.ir
https://orcid.org/0000-0002-1487-2374
https://jps.library.utoronto.ca/index.php/cpoj/index


 

2 

Azizi S, Moradi V, Hajiaghaei B, Babaee T. Prevalence of work-related musculoskeletal disorders among Iranian orthotists and prosthetists: A study on work-
related quality of life. Canadian Prosthetics & Orthotics Journal. 2024; Volume 7, Issue 2, No. 6. https://doi.org/10.33137/cpoj.v7i2.44064 

CANADIAN PROSTHETICS & ORTHOTICS JOURNAL 

ISSN: 2561-987X MUSCULOSKELETAL DISORDERS AMONG IRANIAN ORTHOTISTS AND PROSTHETISTS 

Azizi et al., 2024 

(WRQoL).8 Issues related to WRQoL of employees affect 

their job satisfaction and their intention to stay on the job.9 

Quality of Working Life (QoWL) focuses on different factors 

that affect a person's work experience and overall well-

being. These include the physical work environment, the 

social atmosphere within the organization, conflicts related 

to work roles, job enrichment, fair compensation, flexible 

work hours, reward systems, the balance between work and 

family life, job security, and overall productivity and health.10 

The connection between work-related stress and the 

broader idea of QoWL has been examined, revealing a link 

between job stress and burnout as significant negative 

factors affecting overall quality of life.11 

Orthotists and prosthetists, as well as medical personnel, 

are at a higher risk of suffering from musculoskeletal 

disorders due to repetitive tasks, high workload, poor 

working conditions, psychological factors such as 

occupational stress, and work shifts.12 Manual handling of 

heavy plaster casts (sometimes more than 25 kg), limited 

resting time between activities, working in a limited 

workspace, and not having a helping hand to lift heavy 

objects imposes a high physical load on the 

musculoskeletal structure of these people.13,14 Therefore, 

the possibility of musculoskeletal disorders is high among 

orthotists and prosthetists due to long hours and heavy 

work, use of inappropriate and non-standard tools and 

machines, and lack of knowledge of the correct physical 

position.15 It has been reported that the prevalence of back 

disorders in manual labor is eight times higher than in 

occupations that do not involve manual work.16 In their study 

of 173 orthotists and prosthetists, Anderson et al. found that 

76% of participants experienced musculoskeletal pain 

within the previous six months.17 Concerns related to 

workload, tight deadlines, and a poorly designed physical 

environment can increase fatigue and stress levels.9 

Prosthetists and orthotists reported that the demands 

imposed by other healthcare staff and patients not only 

added to their workloads but also created unrealistic time 

constraints for task completion.13 

Occupational pressures and injuries can negatively affect 

the services provided by healthcare personnel for society. 

This indicates the importance of and needs to consider the 

physical and mental health of the personnel working in 

health and treatment centers.18 Since the workstations in 

orthotics and prosthetics wards are non-adjustable and 

individuals of various heights and body dimensions must 

work at the same workstation, this situation can lead to the 

development of improper postures in the neck, shoulders, 

and back.14 They seem to be the main contributors to 

morbidity and disability in any workforce, affecting 

individuals' quality of life and work capacity.19 To the best of 

our knowledge, no studies have assessed WRQoL among 

orthotists and prosthetists. 

Various studies have been conducted to investigate the 

prevalence of work-related musculoskeletal disorders in 

Iran. However, there are no accurate statistics on the 

prevalence of work-related musculoskeletal disorders and 

the quality of life of people working in this field of 

rehabilitation in Iran. This study aimed to determine the 

prevalence of work-related musculoskeletal disorders 

among orthotists and prosthetists and investigate its 

relationship with WRQoL. 

METHODOLOGY 

This cross-sectional study was conducted from July 2023 to 

November 2023. Data was collected in person and online. 

To increase the generalizability of the study findings, the 

orthotists and prosthetists from all over Iran were invited to 

participate. Consequently, individuals working in Tehran, 

Iran, completed the questionnaires in person, while those 

situated other cities/provinces filled out the questionnaires 

online. It is important to note that the items in the 

questionnaires completed in person and online were exactly 

the same. Before completing the questionnaire, participants 

were given a consent form to sign. For the online version, 

an invitation message was sent via WhatsApp to individuals 

who had smartphones and internet access. The invitation 

included a brief description of the study and a link to the 

questionnaire. Consent was obtained by including a 

statement at the beginning of the online survey. The 

software used (https://porsline.ir) automatically removed 

respondents' phone numbers, ensuring that participants 

remained anonymous during the statistical analyses. The 

study protocol was approved by the research ethics 

committee of Iran University of Medical Sciences (Ref: # 

IR.IUMS.REC.1402.141, date: 24/05/2023). 

The participants were asked to answer the Persian versions 

of the Nordic Musculoskeletal Questionnaire (NMQ)20 and 

the WRQoL scale.21  Completing these questionnaires took 

about seven minutes on average.  

The NMQ is among the most commonly utilized 

questionnaires for evaluating work-related musculoskeletal 

disorders. It has proven to be highly reliable in assessing 

ergonomic hazards across different healthcare 

professionals.22 The WRQoL scale is widely recognized for 

its comprehensive approach to assessing various 

dimensions of factors across both work and non-work life 

domains.23 The NMQ and WRQoL scales are tools that 

broadly assess work-related musculoskeletal disorders and 

the quality of life of individuals across various professions.  

The inclusion criteria included working as an orthotist or 

prosthetist at the time of the study,24 having at least one year 

of clinical work experience,25 having a smartphone, and 

having no previous musculoskeletal injuries during the past 

12 months.14 To assess the participants’ previous 

musculoskeletal injuries, the following question was asked: 

“Have you experienced injuries in your neck, shoulders, 

elbows, wrists, upper back, waist, thighs, knees, or ankles 

https://doi.org/10.33137/cpoj.v7i2.44064
https://porsline.ir/


 

3 

Azizi S, Moradi V, Hajiaghaei B, Babaee T. Prevalence of work-related musculoskeletal disorders among Iranian orthotists and prosthetists: A study on work-
related quality of life. Canadian Prosthetics & Orthotics Journal. 2024; Volume 7, Issue 2, No. 6. https://doi.org/10.33137/cpoj.v7i2.44064 

CANADIAN PROSTHETICS & ORTHOTICS JOURNAL 

ISSN: 2561-987X MUSCULOSKELETAL DISORDERS AMONG IRANIAN ORTHOTISTS AND PROSTHETISTS 

Azizi et al., 2024 

during the past 12 months?”. Those cases who did not 

complete the questionnaires were excluded. 

Nordic Musculoskeletal Questionnaire  

This questionnaire is used in work-related healthcare 

studies to evaluate the prevalence of musculoskeletal 

disorders. The first part includes nine questions about pain 

and discomfort experienced in the past 12 months, the 

second part consists of nine questions about pain and 

discomfort experienced in the last seven days, and the third 

part consists of nine questions about reducing working 

hours and leaving the workplace due to pain and discomfort 

experienced in the past 12 months. All items are answered 

with "yes” or “no". If participants answered "yes," they were 

then asked whether the musculoskeletal pain had been 

present in the past 7 days (yes or no) and whether the 

musculoskeletal pain had hindered their ability to engage in 

regular work and daily activities over the past 12 months 

(yes or no). It is used to collect information on pain or 

discomfort in nine body parts: neck, shoulder, elbow, wrist, 

upper back, waist, thigh, knee, and ankle.18,26 The validity 

and reliability of its Persian version have been evaluated by 

Namnik et al. showing an acceptable internal consistency of 

more than 0.7, a standard error of measurement ranging 

0.56 to 1.76, and a Kappa coefficient ranging 0.78 to 1).20 

The WRQoL scale  

This questionnaire, designed by Van Laar and Easton in 

2007, measures the QoWL.27 It consists of 24 items 

distributed into six subgroups to evaluate WRQoL. The 

scoring is based on a 5-point Likert scale. Twenty-three 

items evaluate six subgroups: general well-being, home-

work interface, job-career satisfaction, control at work 

(referring to the degree of autonomy and influence an 

employee has over their work environment and tasks), 

working conditions, and stress at work. Item 24 evaluates 

satisfaction with the work-related quality of work. The full 

scale score of this questionnaire is obtained by calculating 

the average score from these six areas, ranging from 1 to 

110, where a score of 1 to 71 indicates the lowest level of 

WRQoL and a score of 85 to 110 shows the highest level of 

WRQoL.27 Percentile equivalents of each WRQoL subscale 

are also categorized as low QoWL (score range of 10-30), 

medium QoWL (score ranges of 40-60), and high QoWL 

(score range of 70-99). Higher percentiles indicate a better 

QoWL. The validity and reliability of its Persian version have 

been investigated by Shabaninejad et al.21   

Sampling method and sample size 

A simple random sampling method was employed to include 

potential participants. The following formula28 was 

considered for sample size calculation: 

 𝑛 =
𝑍2P(1−P)

𝑑2
 

where n is the sample size, Z is the statistic corresponding 

to the level of confidence (99%), P is expected prevalence 

(60%),29 and d is precision (0.1); at least 159 participants 

were required. Considering that the average response rate 

for surveys among healthcare professionals is 53.3%,30 a 

total of 263 orthotists and prosthetists were invited to 

participate in this study. 

Statistical Analysis 

Descriptive data (means and standard deviations) and 

frequencies were reported for continuous and categorical 

variables, respectively. To check the normality of the data, 

the Kolmogorov-Smirnov test was run. The association 

between WRQoL and the following variables: gender, work 

experience, age, presence of musculoskeletal disorder, and 

income level, was assessed using Spearman’s rho 

correlation coefficient. We considered the relationships as 

good to excellent, moderate to good, small, and small to no 

correlation if the r values were (r > 0.75), (0.50 < r < 0.75), 

(0.25 < r < 0.50), and (r < 0.25), respectively.31 The Mann-

Whitney U test was used for data that did not follow a normal 

distribution, while the independent-sample t-test was 

applied  to normally distributed data. These tests compared 

the mean values of WRQoL parameters between men and 

women. The Chi-square test was used to assess the 

relationships between categorical variables. All data were 

analyzed using the statistical package for social sciences 

(SPSS) software version 20. A threshold of 0.05 was 

considered as significant. 

RESULTS 

A total of 263 orthotists and prosthetists were invited to 

participate in the study, either in-person or online. Of these, 

207 completed the questionnaires, yielding a response rate 

of 78%. After applying the inclusion and exclusion criteria, 

the data from 188 participants (75 men and 113 women) 

were chosen and analyzed. Orthotists and prosthetists from 

various centers across different cities in Iran participated in 

this study. The mean of age, height, and weight of the 

participants were 31.4 ± 8.3 years old (range of 21 to 60 

years old), 173.3 ± 9.5 cm (range of 150 to 197 cm), and 

75.1 ± 14.6 kg (range of 45 to 110 kg). One hundred and 

four people were single, and 84 people were married. Their 

average daily working hours was 7.2 ± 2.8 hours (range of 

1 to 15 hours), the average work experience was 7.4 ± 7.8 

years (range of 1 to 34 years), and the average number of 

visitors per week was 26.2 ± 27.3 (range of 2 to 200 

patients). As shown in Table 1, most participants worked in 

private clinics. Additionally, 40.4% of all participants 

engaged in activities outside of working hours, while 52.7% 

participated in sports activities. 

A total of 141 orthotists and 47 prosthetists participated in 

the study. The prevalence rates of musculoskeletal 

disorders among the studied orthotists and prosthetists 

were 82% and 81%, respectively. 123 people (65.4%) 

stated that they felt pain, discomfort, burning, or numbness 

in different body parts during the last seven days.  

https://doi.org/10.33137/cpoj.v7i2.44064


 

4 

Azizi S, Moradi V, Hajiaghaei B, Babaee T. Prevalence of work-related musculoskeletal disorders among Iranian orthotists and prosthetists: A study on work-
related quality of life. Canadian Prosthetics & Orthotics Journal. 2024; Volume 7, Issue 2, No. 6. https://doi.org/10.33137/cpoj.v7i2.44064 

CANADIAN PROSTHETICS & ORTHOTICS JOURNAL 

ISSN: 2561-987X MUSCULOSKELETAL DISORDERS AMONG IRANIAN ORTHOTISTS AND PROSTHETISTS 

Azizi et al., 2024 

 

Table 1: Percentage of participants by out-of-work activities and workplace type.  

Sport activities 
Activities out of working 

hours 
Workplace 

Yes No Yes No 
Private 
clinic 

Government 
work 

environment 

Both government 
work environment  
and private clinic 

Personal practice 

52.7% 44.7% 40.4% 59.6% 68.1% 8.5% 9.6% 26.8% 

 
Table 2: Prevalence of musculoskeletal disorders in the past 12 months and 7 days, and the percentage of individuals requiring reduced activity 

or workplace leave. 

Musculoskeletal disorders 
frequency, 

 n (%), in last 12 months 

Musculoskeletal disorders 
frequency,  

n (%), in last 7 days 

Reduced activity or leave the 
workplace frequency, 

 n (%), in last 12 months 
Body segments 

53 (28.2%) 40 (21.3%) 14 (7.4%) Neck 

23 (12.2%) 17 (9%) 8 (4.3%) Right shoulder 

12 (6.4%) 11 (5.9%) 5 (2.7%) Left shoulder 

17 (9%) 11 (5.9%) 3 (1.6%) Both shoulders 

13 (6.9%) 11 (5.9%) 2 (1.1%) Right elbow 

1 (0.5%) 0 (0%) 0 (0%) Left elbow 

3 (1.6%) 2 (1.1%) 1 (0.5%) Both elbows 

30 (16%) 16 (8.5%) 9 (4.8%) Right wrist/hand 

6 (3.2%) 4 (2.1%) 1 (0.5%) Left wrist/hand 

21 (11.2%) 12 (6.4%) 2 (1.1%) Both wrists/hands 

33 (17.6%) 21 (11.2%) 7 (3.7%) Upper back 

66 (35.1%) 45 (23.9%) 14 (7.4%) Lower back 

8 (4.3%) 4 (2.1%) 6 (3.2%) Right hip and thigh 

8 (4.3%) 3 (1.6%) 8 (4.3%) Left hip and thigh 

7 (3.7%) 5 (2.7%) 11 (5.8%) Both hips and thighs 

8 (4.3%) 2 (1.1%) 3 (1.6%) Right knee 

10 (5.3%) 4 (2.1%) 2 (1.1%) Left knee 

23 (12.3%) 10 (5.3%) 6 (3.2%) Both knees 

6 (3.2%) 2 (1.1%) 0 (0%) Right ankle and foot 

10 (5.3%) 5 (2.7%) 2 (1.1%) Left ankle and foot 

40 (21.3%) 30 (16%) 9 (4.8%) Both ankles and feet 

 

Table 3: Subscales scores of work-related quality of life scale in studied population. 

Full-scale 

WRQoL 

General well-

being 

Home-work 

interface 

Job-career 

satisfaction 

Control at 

work 

Working 

conditions 

Stress at 

work 

Work related 

quality of life 

subscales 

79.44 ± 10.70 19.41 ± 3.47 9.62 ± 2.53 20.41 ± 4.06 14.22 ± 1.88 9.84 ± 2.45 5.92 ± 1.94 Mean ± SD 

Medium Low Low  Medium High  Low  Medium  Percentile 

equivalents*  
 

* The percentile ranges for low, medium, and high QoWL is 10-30, 40-60, and 70-99, respectively. 

 

Table 4: Relationship between work-related quality of life subscales and parameters of interest. 

Work experience Age Income 
The average number of visits per 

week 
WRQoL subscales 

r p r p r p r p  

0.24 0.01 0.26 0.01 0.21 0.77 0.13 0.04 General well-being 

0.06 0.39 0.07 0.29 0.16 0.02 -0.06 0.41 Home-work interface 

0.15 0.04 0.11 0.12 0.09 0.20 -0.09 0.21 Job- career satisfaction 

-0.04 0.95 -0.01 0.85 0.09 0.22 0.03 0.66 Control at work 

0.15 0.03 0.09 0.21 0.07 0.33 0.01 0.83 Working conditions 

-0.15 0.03 -0.15 0.03 0.08 0.28 0.06 0.4 Stress at work 

0.18 0.01 0.15 0.03 0.16 0.02 0.03 0.63 Full scale WRQoL 

 

 

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5 

Azizi S, Moradi V, Hajiaghaei B, Babaee T. Prevalence of work-related musculoskeletal disorders among Iranian orthotists and prosthetists: A study on work-
related quality of life. Canadian Prosthetics & Orthotics Journal. 2024; Volume 7, Issue 2, No. 6. https://doi.org/10.33137/cpoj.v7i2.44064 

CANADIAN PROSTHETICS & ORTHOTICS JOURNAL 

ISSN: 2561-987X MUSCULOSKELETAL DISORDERS AMONG IRANIAN ORTHOTISTS AND PROSTHETISTS 

Azizi et al., 2024 

Also, 77 people (41%) were forced to rest, reduce work 

activity, leave the workplace, or could not perform their 

activities at work or home during the past 12 months due to 

pain or discomfort (Table 2). 

Results of Chi-square test revealed that there was a 

significant relationship between the participants' gender and 

musculoskeletal disorders in the last 12 months (Phi = 

0.157, p = 0.031). There was a small to no relationship 

between participants’ weight and musculoskeletal disorders 

in the last 12 months (rs(188) = 0.14, p = 0.045). The 

prevalence of these disorders was higher in men than 

women (89% versus 76%) and people with more weight. 

Decreased work activity, leaving the workplace, or being 

unable to perform activities at home or the workplace during 

the last 12 months had a statistically significant yet small to 

negligible relationship with the number of daily working 

hours (rs(188) = 0.22, p = 0.002). 

Among the different areas of WRQoL, control at work (14.22 

± 1.88) had the highest mean, home-work interface (9.62 ± 

2.53), and working conditions (9.84 ± 2.45) had the lowest 

mean, and the mean of WRQoL was 79.44 ± 10.70 (Table 

3). 

The WRQoL had a small to negligible but significant 

relationship with gender (rs(188) = 0.17, p = 0.016), work 

experience (rs(188) = 0.18, p = 0.011), age (rs(188) = 0.15, 

p = 0.039), and income (rs(178)= 0.17, p =0.025) (Table 4).  

The WRQoL was higher in women than in men. All areas of 

the quality of work life had a higher mean in women than 

men, except stress at work (Table 5). 

There was no statistically significant relationship between 

general musculoskeletal disorders and overall WRQoL. 

Still, these disorders were significantly related to general 

well-being (rs(188) = 0.16, p= 0.023). 

DISCUSSION 

This study investigated the prevalence of work-related 

musculoskeletal disorders among Iranian orthotists and 

prosthetists and its relationship with WRQoL. The results 

showed a high prevalence of work-related musculoskeletal 

disorders among Iranian orthotists and prosthetists who had 

a minimum one year of clinical experience. 82% of the 

studied orthotists and prosthetists had experienced pain in 

different body parts during the past 12 months. This was in 

line with Anderson et al.'s study on Australian orthotists and 

prosthetists (80%).24 Still, the prevalence of 

musculoskeletal pain found in this study was higher than 

that reported by Farahmand et al., who noted that 60% of 

orthotists experienced pain in their shoulders, elbows, and 

wrists over the last year. In contrast, the prevalence of 

musculoskeletal pain among prosthetists was 33%.29 

Notably, this study found that the prevalence of 

musculoskeletal pain was the same for both orthotists and 

prosthetists. 

Some factors contributing to musculoskeletal disorders in 

orthotists and prosthetists include the poor design of tools 

and machinery, long working hours using  them, manual 

lifting and moving of heavy objects (such as molded plaster) 

without assistance, working with vibrating devices (like 

milling machines and drills) and performing repetitive 

tasks.29 Findings from this study showed that pain is most 

prevalent in the back (35.1%), neck (28.2%), and ankles 

and feet (21.3%), with lower back pain being the most 

common musculoskeletal disorder among orthotists and 

prosthetists. In the study by Anderson et al.,16 it was 

reported that the prevalence of disorders in the lumbar 

region is eight times higher in jobs involving manual activity 

compared to jobs that do not require manual activity. The 

manual handling of heavy plaster molds for various 

processes such as mold correction, lamination, 

thermoplastic mold production, and the preparation of 

negative and positive plaster molds, as well as filling the 

molds, is common in orthotic and prosthetic fabrication 

facilities. These factors may explain the high prevalence of 

back pain among orthotists and prosthetists.  

There seems to be a small to negligible yet statistically 

significant relationship between gender and 

musculoskeletal disorders, as the findings of this study 

show that the prevalence of these disorders is higher in 

men. This may be due to the fact that men tend to be more 

inclined to perform heavier lifts. The results of this study are 

in line with Farahmand et al.'s findings.29 However, in other 

studies, such as those by Anderson et al. on Australian 

orthotists and prosthetists,24 Rahimi et al. on Iranian 

physiotherapists,32 Nazari et al. on occupation therapists,33 

Table 5: Comparing the results of work-related quality of life subscales between men and women. 

p 

Women Men 

WRQoL subscales 

Mean ± SD Quality of work life Mean ± SD Quality of work life 

0.04 19.83  ± 3.31 Medium 18.78  ± 3.64 Low General well-being 

0.51 9.67  ± 2.35 Low 9.54  ± 2.80 Low Home-work interface 

0.01 21.00  ± 3.64 Medium 19.52  ± 4.50 Medium Job-career satisfaction 

0.01 14.53  ± 1.57 High 13.77  ± 2.20 High Control at work 

0.26 10.02  ± 2.15 Low 9.56  ± 2.83 Low Working conditions 

0.47 5.88  ± 1.99 Medium 5.98  ± 1.87 Medium Stress at work 

0.01 80.95  ± 9.12 Medium 77.17  ± 12.45 Medium Full scale WRQoL 

 

https://doi.org/10.33137/cpoj.v7i2.44064


 

6 

Azizi S, Moradi V, Hajiaghaei B, Babaee T. Prevalence of work-related musculoskeletal disorders among Iranian orthotists and prosthetists: A study on work-
related quality of life. Canadian Prosthetics & Orthotics Journal. 2024; Volume 7, Issue 2, No. 6. https://doi.org/10.33137/cpoj.v7i2.44064 

CANADIAN PROSTHETICS & ORTHOTICS JOURNAL 

ISSN: 2561-987X MUSCULOSKELETAL DISORDERS AMONG IRANIAN ORTHOTISTS AND PROSTHETISTS 

Azizi et al., 2024 

and Keyhani et al. on Iranian dentists,34 the prevalence of 

work-related musculoskeletal disorders was higher in 

women. Additionally, there was a small to negligible but 

significant relationship between weight and feeling pain and 

discomfort due to musculoskeletal disorders over the past 

12 months. Still, this study did not find a significant 

relationship between these disorders and other 

demographic characteristics such as age, height, work 

experience, income, and working hours. It is important to 

note that, due to the small to negligible relationship between 

gender and musculoskeletal disorders, these results should 

be interpreted with caution. 

Only 52.7% of the studied orthotists and prosthetists 

engaged in regular sports activities and showed little 

tendency to reduce their activity or take rest when they felt 

pain and discomfort. Additionally, about 48% of people who 

experienced pain and discomfort in the last 12 months 

reduced their activity during work. Decreased work activity, 

leaving the workplace, or an inability to perform tasks at 

home or the workplace during the last 12 months was more 

common in women (57%), although this difference was not 

significant. These results are similar to those found in 

Rahimi et al.’s study on Iranian physiotherapists.32 

The total score of the WRQoL questionnaire among the 

studied orthotists and prosthetists was 79.44, which, based 

on the proposed percentile equivalents, falls within the 

average range. Among its different aspects, control at the 

workplace was more favorable, and working conditions and 

the relationship between home and work were less 

favorable. Also, the mean WRQoL score was significantly 

related to gender and was higher in women. The average 

quality of life for female orthotists and prosthetists was 

higher than that of their men counterparts in all aspects 

except stress at work. There was a significant difference in 

general well-being, control at work, and job-career 

satisfaction between men and women.  

Regarding the demographic characteristics and WRQoL, 

there was a small to negligible but significant relationship 

between age, gender, work experience, income, and overall 

quality of life. The WRQoL was higher in women and 

participants of older ages, higher income, and greater work 

experience. The reasons for this could include increased job 

satisfaction, better control of the work environment, and 

reduced stress because of more work experience, age, and 

income. Arab et al. found no significant difference between 

age, sex, employment status, working hours, and WRQoL. 

However, specialist physicians with the least work 

experience had the highest WRQoL.35 In Abbasi et al.'s 

study on nurses, age and work experience had an inverse 

relationship with WRQoL.36 In light of the small to negligible 

relationship between the demographic characteristics and 

WRQoL in this study, it is important to interpret these results 

cautiously. 

In this study, there was no significant relationship between 

the overall score of the WRQoL and work-related 

musculoskeletal disorders. However, a significant 

relationship existed between WRQoL and musculoskeletal 

disorders in different body areas. Regarding each 

subdomain of WRQoL, results of this study revealed a small 

to no relationship between general well-being and 

musculoskeletal disorder. It should be noted that the overall 

WRQoL score is calculated by summing the values of its six 

subdomains: general well-being, home-work interface, job-

career satisfaction, control at work, working conditions, and 

stress at work. Consequently, the score of each subdomain 

influences the total score of the questionnaire. However, 

general well-being is an independent subdomain; its score 

is not affected by the scores of the other subdomains. This 

independence may explain the lack of a significant 

relationship between overall WRQoL and musculoskeletal 

disorders, as fluctuations in other areas do not impact the 

general well-being score.  

Limitations 

This was a cross-sectional study and, therefore, cannot 

show the conditions of the participants over time. Also, the 

questions were asked about past events to evaluate the 

working conditions of participants (for example, in the past 

12 months or seven days). Thus, they may not have 

answered the questions accurately due to the effects of 

memory over time. The WRQoL scale is designed without a 

distinction between employees and employers, so the 

responses might not be accurate for some questions about 

the work environment and the employer. Moreover, in this 

study, there was no age limit for inclusion. Most participants 

were under 50 years old, with 11 participants aged between 

50 and 60 years. The statistical analysis revealed a small to 

no relationship between WRQoL and participants' age. 

Further research is needed to assess the rate of 

musculoskeletal injuries among orthotists and prosthetists 

across different age classifications and marital statuses, 

utilizing a sufficient sample size. In addition, this study 

included orthotists and prosthetists with at least one year of 

clinical work experience. Future investigations are needed 

to assess the prevalence of work-related musculoskeletal 

disorders among novice orthotists and prosthetists with less 

than one year of clinical experience. 

CONCLUSION 

There appears to be a high prevalence of work-related 

musculoskeletal disorders among Iranian orthotists and 

prosthetists. Symptoms of pain in the back and neck are the 

most common issues. The Iranian orthotists and 

prosthetists seem to have an average WRQoL, which is 

higher in women and individuals with more work 

experience. Addressing the high incidence of 

musculoskeletal disorders and enhancing the WRQoL for 

orthotists and prosthetists may lead to improved health 

https://doi.org/10.33137/cpoj.v7i2.44064


 

7 

Azizi S, Moradi V, Hajiaghaei B, Babaee T. Prevalence of work-related musculoskeletal disorders among Iranian orthotists and prosthetists: A study on work-
related quality of life. Canadian Prosthetics & Orthotics Journal. 2024; Volume 7, Issue 2, No. 6. https://doi.org/10.33137/cpoj.v7i2.44064 

CANADIAN PROSTHETICS & ORTHOTICS JOURNAL 

ISSN: 2561-987X MUSCULOSKELETAL DISORDERS AMONG IRANIAN ORTHOTISTS AND PROSTHETISTS 

Azizi et al., 2024 

outcomes and job performance in this essential healthcare 

sector. 

ACKNOWLEDGEMENTS 

The authors would like to thank the participants for taking part in 

this study. 

DECLARATION OF CONFLICTING INTERESTS 

The authors declare that there is no conflict of interest. 

AUTHORS’ CONTRIBUTION 

• Sarina Azizi: Conception and design; Data acquisition; 

Analysis and interpretation; Drafting the article; Revision and 

final approval of the manuscript. 

 

• Vahideh Moradi: Conception and design; Review and final 

approval of the manuscript. 

 

• Behnam Hajiaghaei: Conception and design; Review and final 

approval of the manuscript. 

 

• Taher Babaee: Conception and design; Analysis and 

interpretation, Revision and final approval of the manuscript. 

SOURCES OF SUPPORT 

No external support was obtained for this project. 

ETHICAL APPROVAL 

The study protocol was approved by the research ethics committee 

of Iran University of Medical Sciences (Ref: # 

IR.IUMS.REC.1402.141, date: 24/05/2023). 

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related quality of life. Canadian Prosthetics & Orthotics Journal. 2024; Volume 7, Issue 2, No. 6. https://doi.org/10.33137/cpoj.v7i2.44064 

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Azizi et al., 2024 

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