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Prevalence of Musculoskeletal Disorders Among Korean Police Personnel a
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Hak Young Rhee , Jae Hwan Cho , Jong Min Seok , Taek Sang Cho , Woo Jin Jeon , Jin Gu Lee
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& Sung Kyu Kim
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Department of Neurology, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Republic of Korea b
Department of International Radiological Science, Hallym University of Graduate Studies, Seoul, Republic of Korea c
Department of Radiology, National Police Hospital, Seoul, Republic of Korea
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Click for updates
Department of Therapeutic Radiology and Oncology, Yeungnam University, Gyeongsan, Republic of Korea Accepted author version posted online: 14 Jun 2013.
To cite this article: Hak Young Rhee, Jae Hwan Cho, Jong Min Seok, Taek Sang Cho, Woo Jin Jeon, Jin Gu Lee & Sung Kyu Kim (2015) Prevalence of Musculoskeletal Disorders Among Korean Police Personnel, Archives of Environmental & Occupational Health, 70:4, 177-188, DOI: 10.1080/19338244.2013.807762 To link to this article: http://dx.doi.org/10.1080/19338244.2013.807762
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Archives of Environmental & Occupational Health (2015) 70, 177–188 C Taylor & Francis Group, LLC Copyright ISSN: 1933-8244 print / 2154-4700 online DOI: 10.1080/19338244.2013.807762
Prevalence of Musculoskeletal Disorders Among Korean Police Personnel HAK YOUNG RHEE1, JAE HWAN CHO2, JONG MIN SEOK3, TAEK SANG CHO2,3, WOO JIN JEON2,3, JIN GU LEE2,3, and SUNG KYU KIM4 1 Department of Neurology, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Republic of Korea 2 Department of International Radiological Science, Hallym University of Graduate Studies, Seoul, Republic of Korea 3 Department of Radiology, National Police Hospital, Seoul, Republic of Korea 4 Department of Therapeutic Radiology and Oncology, Yeungnam University, Gyeongsan, Republic of Korea
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Received 5 December 2012, Accepted 24 April 2013
This study was conducted to investigate efficient, systematic management of the Korean police and to examine the status and prevention of musculoskeletal disorders in Korean police officers. For police officers in special working environments, the importance of basic data is emphasized for human resources (HR) management and the prevention of industrial hazards from an industrial health care perspective. This study was conducted on police officers who visited the national police hospital and who underwent x-ray, computed tomography (CT), and magnetic resonance imaging (MRI) for the diagnosis of musculoskeletal disorders. The results revealed that examinations for the lower extremities and spine were most frequently conducted using x-ray, CT, and MRI. In particular, knee and lumbar examinations were most frequently conducted among all lower extremity and spine examinations, respectively. Keywords: musculoskeletal disorders, police officers, working type
The police have high possibility of showing musculoskeletal pains due to rough physical activities, including duties, traffic control, driving, security, sports and drills, and handling heavy equipment, and are highly hospitalized or treated. In addition, the musculoskeletal disorders related to the occupation include sprains, tendinitis, bursitis, ligament injuries, entrapment neuropathies, and cartilage and bone damages. The symptom starts with light pains, numbness, stinging, and the development cause signs including deformation, degraded muscular strength, limited or shrunk motion range, and function losses.1 The tasks of police abruptly happen in unexpected circumstances and the situation where the accident was from.2 Therefore, the police shall have high agility and organic cooperation to reasonably solve these abrupt cases,3 and their duties are based on shifts and circulations due to preparedness. The working system of the frontline police was reorganized into the division system in 2003, and the working environment has been changed to the system of double shift of 24-hour work and 24-hour off, but the triple- or quad-shift system has also been under operation.4 However, accidental situations such as emergency standby frequently occur, in which case, office
Address correspondence to Jong-min Seok, PhD, Department of Radiology, National Police Hospital, Republic of Korea, Seoul 712-749, Republic of Korea. E-mail: [email protected]
hours become irregular. Furthermore, due to the exchange of day and nighttime works, their biorhythm gets interrupted, which makes it difficult to maintain a pattern of ordinary life like those of other organizations.5 J. H. Skoinick claimed that dangerousness and authority are particularly significant factors among the environments of the police.6 The aforementioned claims suggest that police officers have a high risk of being exposed to various dangerous factors such as body injury, accident, illness, infection, and poisoning that may occur at any time while on duty, compared with other civil officers.7,8 This working environment of the police has various safetyand health care–related problems. For example, the police officers are believed to be significantly exposed to the risk of musculoskeletal disorders. In particular, the musculoskeletal diseases are serious in that they may cause pains, degrade functions in lives, and be developed to chronic disorder.9 Musculoskeletal disorders are occupational diseases involving body activity-related muscles, tendons, nerves, joints, and adjacent tissues due to the short- and long-term exposure of occupational hazardous factors alone or in combination with personal, sociopsychological factors, including similar diseases of back pain and lower extremities, as well as of upper extremities, such as the neck, shoulder, and arms.10 Musculoskeletal diseases defined in the Occupational Safety and Health Act refer to heath disorders that occur in the neck, shoulder, waist, and upper and lower extremities, and adjacent tissues by hazardous factors, such as repetitive motions,
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178 improper working posture, excessive use of force, physical contact with sharp edges, vibration, and temperature. These occupation-related musculoskeletal diseases have drawn much attention as one of the main occupational diseases in the society.11 In fact, studies on the assessment of relevant risk factors, patients with diseases, and establishment of disease prevention have been actively conducted in various industrial areas. Park et al.12 reported that 77.2% of workers in the dockyard, Kim13 stated that 30% of radiologic technologists in the medical image department, Lee14 showed that 59.3% of dental technicians, and Heo et al.15 reported 44.9% of golf caddies claimed pains in the musculoskeletal system. Recently, a research was performed on the recruits of the marine corps, rather than general and riot police, and it showed that the accumulated rates of musculoskeletal damages for the 6 weeks of the training was 13.4%, and more than half were on the pelvic limbs below the knees.16 The study on local police officers reported the relation between the fatigue and the stress from the officers, but there has been no research on the musculoskeletal system. It seems that there is no systemic approach to the musculoskeletal diseases because there has been no survey on the duties and examination for diseases due to special environment around the police.17 Major diagnostic methods of the musculoskeletal system include simple x-ray, computed tomography (CT), magnetic resonance imaging (MRI), sonogram, and bone scan, and the popular examinations are the simple x-ray, CT, and MRI.18 Accordingly, this study was conducted to investigate the frequency of diseases by musculoskeletal disease type and injury site in police officers who visited the department of radiology at the police hospital and who underwent x-ray, CT, and MRI for the upper and lower extremities and spine during 2009 and 2010. The results of this study could be useful as basic data for the management of police human resources and diseases that frequently occur in the police.
Methods Subjects This study was conducted on police officers who visited the Seoul police hospital as outpatients or inpatients to quantitatively compare their diseases. Data obtained over 2 years from January 1, 2009, to December 31, 2010, were analyzed. The subjects consisted of 27,340 outpatients and 13,623 inpatients from 2009, and 32,571 outpatients and 15,613 inpatients from 2010. Among the police officers who visited the police hospital, those who underwent x-ray, CT, and MRI for musculoskeletal disorders were selected as subjects. Data Collection and Analysis Method This study was conducted on the police officers who underwent x-ray, CT, and MRI during the period from January 1, 2009, to December 31, 2010. Diseases of the subjects were classified into general and musculoskeletal disorders. To determine the characteristics of musculoskeletal diseases by work-
Rhee et al. ing type, body parts that underwent radiologic examinations was classified into the upper extremities, lower extremities, and spine, and further subclassified by examination of body parts, followed by analysis. Differences in the musculoskeletal diseases were comparatively analyzed according to the rank and working type of the police officers. The frequency analysis was performed on the number of police officers for each examination and parts in the statistical analysis and the chi-square test was introduced to compare differences in specific symptoms among musculoskeletal diseases.
Results Classification of the Subjects by Examination Type General Disease The annual radiologic examination conducted on the police officers participating in this study was as follows: 35,148 cases of x-ray, 2,174 cases of CT, and 3,638 cases of MRI in 2009; and 38,091 cases of x-ray, 4,004 cases of CT, and 6,089 cases of MRI in 2010. The frequency of radiologic examinations was shown to increase by 8.37%, 84.17%, and 67.37% for x-ray, CT, and MRI, respectively, in 2010, compared with those of 2009 (p < .05). As for outpatients and inpatients, the 2009 statistics showed 22,436 outpatients and 12,712 inpatients for x-ray, 1,641 outpatients and 533 inpatients for CT, and 3,263 outpatients and 375 inpatients for MRI (Figure 1) (p < .05). Musculoskeletal Disease In 2009, 8,568 subjects who underwent x-ray, 254 subjects who underwent CT, and 1,385 subjects who underwent MRI received radiologic examinations for musculoskeletal diseases. Meanwhile, in 2010, 9,815 subjects who underwent x-ray, 339 subjects who underwent CT, and 1,854 subjects who underwent MRI received radiologic examinations for musculoskeletal diseases. Thus, the numbers of subjects who underwent radiologic examinations for musculoskeletal diseases were increased by 1,247, 85, and 469, for x-ray, CT, and MRI, respectively, in 2010 compared with those in 2009 (p < .05) (Figure 2). Subclassification of Musculoskeletal Diseases by Year In 2009, x-ray included 2,478 cases of the upper extremities, 3,379 cases of the lower extremities, and 2,711 cases of the spine. Meanwhile, in 2010, x-ray included 2,943 cases of the upper extremities, 3,558 cases of the lower extremities, and 3,314 cases of the spine. X-ray for the lower extremities and spine was more frequently conducted in the comparison by year and examination of body parts (p < .05). As for CT, the examination included 48 cases of the upper extremities, 69 cases of the lower extremities, and 137 cases of the spine in 2009, whereas it included 47 cases of the upper extremities, 65 cases of the lower extremities, and 227 cases of the spine in 2010. The numbers of examinations for the upper and lower extremities were similar between 2009 and 2010. Meanwhile, the number of examinations for the spine
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Fig. 1. The annual radiologic examination conducted on the police officers: (a) year-wise comparison of X-ray, CT, and MRI of (b) inpatient and outpatient groups.
was shown to be increased by 65.69% (90 subjects) in 2010 compared with that of 2009 (p < .05). As for MRI, the examination included 157 cases of the upper extremities, 367 cases of the lower extremities, and 861 cases of the spine in 2009, whereas it included 253 cases of the upper extremities, 513 cases of the lower extremities, and 1,088 cases of the spine in 2010. The frequency of examinations for
the spine was shown to be increased by 26.36% (227 subjects) in 2010 compared with that of 2009 (p < .05) (Figure 3). Number of Subjects by Working Type, Rank, Age In 2009, 254 subjects who underwent CT and 1,385 subjects who underwent MRI received radiologic examinations for musculoskeletal diseases. Meanwhile, in 2010, 339 subjects
Fig. 2. Year-wise radiologic examinations for musculoskeletal diseases.
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Fig. 3. Year-wise subclassification of musculoskeletal diseases (x-ray, CT, MRI).
who underwent CT and 1,854 subjects who underwent MRI underwent radiologic examinations for musculoskeletal diseases. As for the comparison by working type, 84 (33.07%) and 110 (32.44%) subjects of public safety underwent CT in 2009 and 2010, respectively, whereas 410 (29.60%) and 595 (32.1%) subjects of public safety underwent MRI in 2009 and 2010, respectively. The major frequencies of the subjects who underwent CT were as follows: Guard 64 (25.2%) and Traffic 33 (13.0%) in 2009, and Guard 52 (15.34%) and Police Affairs 37 (10.91%) in 2010. Meanwhile, the major frequencies of the subjects who underwent MRI were as follows: Guard 206 (14.87%) and Investigation 165 (11.91%) in 2009, and Guard 236 (12.73%) and Investigation 192 (10.35%) in 2010 (p < .05). The major frequencies of musculoskeletal disease by rank position were as follows: Sergeant (2009 39.37%, 2010 37.46%), Lieutenant (2009 36.22%, 2010 33.63%), and Corporal (2009 11.81%, 2010 12.39%) for CT, and Lieutenant (2009 35.81%, 2010 41.58%), Sergeant (2009 35.52%, 2010 32.79%), and Corporal (2009 12.06%, 2010 10.03%) for MRI (p < .05). As for the frequency of musculoskeletal disease by age, subjects in their 40s accounted for 38.42% and 39.16% of the subjects who underwent x-ray in 2009 and 2010, respectively, constituting the highest portions. Meanwhile, subjects in their 50s accounted for 41.08% and 43.69% of the subjects who underwent MRI in 2009 and 2010, respectively, constituting the highest portions (p < .05) (Figure 4).
Number of the Subjects by Examination of Body Parts Musculoskeletal Disease As for x-ray, the frequency of examinations of the lower extremities was shown to be 39.44% and 36.25% in 2009 and 2010, respectively, which were the highest portions. The frequency of examinations of the spine was shown to be 31.64% and 33.76% in 2009 and 2010, respectively (p < .05). As for CT, the frequency of examinations for the spine was shown to be 59.93% and 66.96% in 2009 and 2010, respectively, accounting for the highest portions. The frequency of examinations for the lower extremities was shown to be 27.16% and 19.18% in 2009 and 2010, respectively (p < .05). As for MRI, the frequency of examinations for the spine was shown to be 62.16% and 58.68% in 2009 and 2010, respectively, accounting for the highest portions. Next to the frequency of the spine, that for the lower extremities was shown to be 26.50% and 27.67% in 2009 and 2010, respectively (p < .05) (Table 1). As for x-ray for musculoskeletal diseases, 51.05% were examinations of the shoulder and 57.86% were examinations of the upper extremities in 2009 and 2010, respectively, accounting for the highest portions. Next to shoulder examinations, 14.86% and 12.16% were examinations of the fingers and the upper extremities in 2009 and 2010, respectively (p < .05).
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Fig. 4. Year-wise number of subjects by working type, rank, and age. Table 1. Classification of Radiologic Examinations by Examination of Body Parts Upper extremities
Lower extremities
Spine
Examination
Year
n
%
n
%
n
%
Total
X-ray
2009 2010 2009 2010 2009 2010
2,478 2,943 48 47 157 253
28.92 29.98 18.90 13.86 11.34 13.65
3,379 3,558 69 65 367 513
39.44 36.25 27.16 19.18 26.50 27.67
2,711 3,314 137 227 861 1,088
31.64 33.76 53.93 66.96 62.16 58.86
8,568 9,815 254 339 1,385 1,854
CT MRI
As for CT for musculoskeletal diseases, 47.91% and 34.04% were examinations of the wrist and the upper extremities in 2009 and 2010, respectively, accounting for the highest portions. Next to examinations of the wrist, shoulder, and elbow, 18.75% were examinations of the upper extremities in 2009, and 29.78% were examination of the upper extremities in 2010 (p < .05). As for MRI for musculoskeletal diseases, shoulder examination constituted 77.07% and 75.89% of MRI for the upper extremities in 2009 and 2010, respectively, accounting for the highest portions. Next to examinations of the shoulder, wrist examinations constituted 10.19% and upper extremity examinations constituted 14.23% of MRI examinations in 2009 and 2010, respectively (p < .05) (Table 2). As for x-ray for musculoskeletal diseases, 56.78% and 60.37% were examinations of the knee and the lower extremities in 2009 and 2010, respectively, accounting for the highest portions. Next to knee examinations, ankle examinations constituted 15.42% and lower extremity examinations constituted
14.64% of x-ray examinations in 2009 and 2010, respectively (p < .05). As for CT for musculoskeletal diseases, ankle examinations constituted 36.23% and lower examinations constituted 23.07% in 2009 and 2010, respectively, accounting for the highest portions. Next to ankle examinations came pelvis examination (18.84%) lower extremity examinations (21.54%) in 2009 and 2010, respectively (p < .05). As for MRI for musculoskeletal diseases, 74.66% were knee examinations and 72.90% lower extremity examinations in 2009 and 2010, respectively, accounting for the highest portions. Next to knee examinations, ankle examinations constituted 11.44% and lower extremity examinations constituted 13.26% of MRI examinations in 2009 and 2010, respectively (p < .05) (Table 3). As for x-ray for musculoskeletal diseases, L-spine (lumbar spine) examinations constituted 55.44% and spine examinations constituted 53.80% in 2009 and 2010, respectively, accounting for the highest portions. Next to L-spine
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Table 2. Radiologic Examination Results of the Upper Extremities 2009 Examination
Classification
X-ray
Finger Hand Wrist Forearm Elbow Humerus Shoulder Total (%) Hand Wrist Elbow Humerus Shoulder Total (%) Hand Wrist Forearm Elbow Humerus Shoulder Total (%)
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CT
MRI
2010
n
%
n
%
368 259 255 66 244 21 1,265 2,478 7 23 9
14.86 10.45 10.3 2.66 9.702 0.847 51.05 100 14.58 47.91 18.75
9 48 13 16 1 6
18.75 100 8.28 10.19 0.64 %
121 157
77.07 100
358 282 273 35 260 32 1,703 2,943 12 16 3 2 14 47 9 36 2 12 2 192 253
12.16 9.582 9.28 1.19 8.83 1.087 57.86 100 25.53 34.04 6.38 4.26 29.78 100 3.56 14.23 0.79 4.74 0.79 75.89 100
Table 3. Radiologic Examination Results of the Lower Extremities 2009 Examination
Classification
X-ray
Toe Foot Ankle Calcaneus Leg Knee Femur Hip Total (%) Foot Ankle Calcaneus Leg Knee Femur Hip Pelvis Total (%) Foot Ankle Leg Knee Femur Hip Pelvis Total (%)
CT
MRI
2010
n
%
n
%
48 332 521 57 165 1,917 54 285 3,379 12 25 1 6 10 2 — 13 69 6 42 7 274 4 31 3 367
1.42 9.83 15.42 1.67 4.88 56.73 1.06 8.43 100 17.39 36.23 1.45 8.70 14.49 2.90
40 294 521 57 160 2,148 57 281 3,558 5 15 4 13 6 5 3 14 65 13 68 13 374 7 28 10 513
1.12 8.26 14.64 1.60 4.49 60.37 1.60 7.89 100 7.69 23.07 6.15 20.0 9.23 7.69 4.61 21.54 100 2.53 13.26 2.53 72.90 1.36 5.46 1.95 100
18.84 100 1.63 11.44 1.90 74.66 1.09 8.44 0.817 100
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Table 4. Radiologic Examination Results of the Spine 2009 Examination
Classification
n
%
n
%
X-ray
Cervical spine Thoracic spine Lumbar spine Total (%) Cervical spine Thoracic spine Lumbar spine Total (%) Cervical spine Thoracic spine Lumbar spine C+T+L-spine Myelogrm Total (%)
1,137 71 1,503 2,711 60 1 76 137 375 10 469 4 3 861
41.94 2.62 55.44 100 43.80 0.73 55.47 100 43.55 1.16 54.47 0.46 0.35 100
1,438 93 1,783 3,314 86 4 137 227 464 20 594 8 2 1,088
43.40 2.80 53.80 100 37.88 1.76 60.35 100 42.66 1.84 54.60 0.73 0.18 100
CT
MRI
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2010
examinations, C-spine examinations constituted 41.94% and spine constituted 43.40%% in 2009 and 2010, respectively (p < .05). As for CT for musculoskeletal diseases, 55.47% were Lspine examinations and 60.35% spine examinations in 2009 and 2010, respectively, accounting for the highest portions. Next to L-spine examinations, C-spine (cervical spine) examinations constituted 43.80% and spine examinations constituted 37.88% in 2009 and 2010, respectively (p < .05). As for MRI for musculoskeletal diseases, 54.47% were Lspine examinations and 54.60% were spine examinations in 2009 and 2010, respectively, accounting for the highest portions. Next to L-spine examinations, C-spine examinations constituted 43.55%, followed by 42.65% spine examinations in 2009 and 2010, respectively (p < .05) (Table 4). As for CT of the upper extremities by working type, the subjects who belonged to public safety were shown to account for 35.41% and 42.5% of the subjects who underwent CT, in 2009 and 2010, respectively, making up the highest portions. Next to public safety, guard accounted for 25% and 25.5% of CT in 2009 and 2010, respectively (p < .05). As for MRI of the upper extremities by working type, subjects who belonged to public safety were shown to account for 33.97% and 35.97% of the subjects who underwent MRI in 2009 and 2010, respectively, constituting the highest portions. Next to public safety, no response accounted for 22.43% and 26.87% in 2009 and 2010, respectively. If no response was excluded, guard accounted for 25% and 25.5% in 2009 and 2010, respectively (p < .05) (Table 5). As for CT of the lower extremities by working type, subjects who belonged to public safety accounted for 36.2% and 35.38% of the subjects who underwent CT in 2009 and 2010, respectively, making up the highest portions. Next to public safety, guard was shown to account for 29% and 18.46% of CT in 2009 and 2010, respectively (p < .05). As for MRI of the lower extremities by working type, subjects who belonged to public safety were shown to account
for 29% and 32.16% of the subjects who underwent MRI in 2009 and 2010, respectively, making up the highest portions. Next to public safety, no response accounted for 23.63% and 19.1% in 2009 and 2010, respectively. If no response was excluded, guard accounted for 18.2% and 16.96% in 2009 and 2010, respectively (p < .05) (Table 6). As for CT of the spine by working type, subjects who belonged to public safety accounted for 30.66% and 29.5% of the subjects who underwent CT in 2009 and 2010, respectively, constituting the highest portions. Next to public safety, guard in 2009, and no response and police affairs in 2010 were shown to account for 23.36%, 17.18%, and 12.33%, respectively (p < .05). As for MRI of the spine by working type, subjects who belonged to public safety accounted for 29.03% and 31.1% of the subjects who underwent MRI in 2009 and 2010, respectively, constituting the highest portions. Next to public safety, no response accounted for 27.75% and 23.1% in 2009 and 2010, respectively. If no response was excluded, guard accounted for 13.12% and 11.58% in 2009 and 2010, respectively (p < .05) (Table 7).
Comment Musculoskeletal diseases are one of the major occupational diseases. Various studies have been conducted due to the rising interest in musculoskeletal diseases. Kim reported that 30.8% of radiation technicians of the radiology department suffered from pain due to musculoskeletal diseases,13 Lee reported that 59.3% of dental technicians suffered from pain due to musculoskeletal diseases,14 Go et al. reported that 3.1/1000 of workers of the ship building industry suffered from pain due to musculoskeletal diseases,19 and Son et al reported that 26.1% of workers of the meat and fish processing industries suffered from pain due to musculoskeletal diseases.20 Recently, a research was performed on the recruits of the marine corps, rather than general and riot police, and it showed that the accumulated rates of musculoskeletal
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Table 5. Radiologic Examination by Working Type (Upper Extremities) Total Year
Classification
Hand
Wrist
Forearm
Elbow
Humerus
Shoulder
n
%
2 2 1
12 5 17 1 1 15 51 4 13 2 20 3 1 4 47
25 10.41 35.41 2.08 2.08 25
8 26 8 2 53 19 2 3 35 156 22 23 12 8 91 19 7 3 68
5.12 16.7 5.13 1.28 33.97 12.17 1.28 1.92 22.43
CT 2009
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2010
Guard Traffic Public safety Investigation Marine No response Police affairs Guard Traffic Public safety Investigation Information No response
2 1 3
5 2 10
3
1
6
2
1 3 1 6
2 5 1 6 2
3 1
1 3 1 5
2
1
1
1
5 1 1 2
8.51 25.5 4.25 42.5 6.4 2.12 8.51
MRI 2009
2010
Police affairs Guard Traffic Security Public safety Investigation Information Marine No response Police affairs Guard Traffic Security Public safety Investigation Information Marine No response
1 3
3 1
1
4 3
4 2
3
2
6
2
2 4
4 1 3 12 1
1
15
1
1
2
7 19 7 2 42 14 2 3 25
1 2
4 1
damages for the 6 weeks of the training was 13.4%, and more than half were on the pelvic limbs below the knees.16 The study on local police officers reported the relation between the fatigue and the stress from the officers, but there has been no research on the musculoskeletal system. It seems that there is no systemic approach to the musculoskeletal diseases because there has been no survey on the duties and examination for diseases due to special environment around the police. The working environment of the police generally consists of triple- or quad-shift working system. However, restroom or standby room is insufficient. Furthermore, police officers of local divisions have protective equipments, such as 38-caliber pistol, three baton, stun gun, and handcuffs, around their waist, which equal a total weight of 7 kg including a radio.21
4
2
21 15 7 4 72 17 7 3 46
8.69 9.09 4.74 3.16 35.97 7.51 2.76 1.18 26.87 253
In addition, the results of a study on factors affecting stress of workers in the manufacturing industry showed that working under the shift system contributed to significant stress.22 Although job satisfaction and stress of the police have been actively studied, few systematic studies on musculoskeletal diseases have been conducted compared with overload or dangerousness of police duties. Kim et al. conducted a study on the distribution of patients with occupational diseases defined by the Industrial Accident Compensation and Insurance Act from 1998 to 2000, and reported that hazardous works increased from 72 in 1998 to 393 in 2000, and lumbar pain increased from 51 in 1998 to 421 in 2000.25 A previous study that analyzed compensated cases due to occupational diseases from January 1999 to December
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Table 6. Radiologic Examination by Working Type (Lower Extremities) Total Year
Classification
Foot
Ankle
Calcaneus
Leg
Knee
Femur
Hip
Pelvis
n
%
3 4 4 1
20 9 25 2 1 12 69 5 12 6 4 23 7 3 1 4 65
29 13 36.2 2.89 1.45 17.4 100 7.69 18.46 9.23 6.15 35.38 10.76 4.6 1.54 6.15
22 67 22 9 107 40 8 6 87 368 33 87 22 22 165 53 14 19 98
5.98 18.2 5.98 2.44 29 10.8 2.17 1.63 23.6
CT 2009
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2010
Guard Traffic Public safety Investigation Information No response Police affairs Guard Traffic Security Public safety Investigation Information Marine No response
3 4 1 1 3
9 1 12
1
3
1 3
5 3 1
2
1
1 1 1 2 1
3 2 2 5 2
2 1
1 3
2 5 2 2
1
2 1 2
1 1
2 1 1
2 4 1 5 1 1
1
1
2 MRI
2009
2010
Police affairs Guard Traffic Security Public safety Investigation Information Marine No response Police affairs Guard Traffic Security Public safety Investigation Information Marine No response
1
1 3
2
2
4
7
2 12 2
1
18 3 1
3 2
4
1
4 16 2 2 19 5 3 4 13
3 2 1
1999 showed that men accounted for 75.6% of the total 410 subjects with musculoskeletal diseases, with 219 cases involving the lumbar spine, 170 cases the neck and upper extremities, 7 cases the lower extremities, and 14 cases involving 2 or more examination of body parts.23 The report on Occupational Accident Causes by the KOSHA, which analyzed causes of diseases for 8,011 subjects with musculoskeletal diseases for 3 consecutive years from 2003 to 2005, showed that subjects with musculoskeletal diseases due to repetitive motions, improper working posture, and excessive use of force accounted for 95.9% (7,688 subjects) of the total subjects.24 In the present study, the data were collected from police officers
4 1
2
17 51 16 8 74 29 7 6 66 24 59 18 17 121 40 11 13 71
1
1 3 3
1 1
8 5
1
11
3 1 2 1
1
2
2 3 1 2 13 3
2 3
1 3
1 2
2
6.43 16.96 4.29 4.29 32.16 10.3 2.72 3.7 19.1 513
who underwent radiologic examinations for musculoskeletal disorders from January 1, 2009, to December 31, 2010. As for x-ray for musculoskeletal diseases, lower extremity examinations accounted for 39.43% and 36.25% in 2009 and 2010, respectively. With regard to the examination of body parts, the most frequently examined site was shoulder in the examinations for the upper extremities, which accounted for 14.76% and 17.35% in 2009 and 2010, respectively; knee in the examinations for the lower extremities, which accounted for 22.37% and 21.88% in 2009 and 2010, respectively; and lumbar spine in the examinations for the spine, which accounted for 17.54% and 18.16% in 2009 and 2010, respectively. As for CT for
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Table 7. Radiologic Examination by Working Type (Spine) Total Year
Classification
Cervical spine
Thoracic spine
Lumbar spine
C+T+L-spine
Myelogram
n
%
6 32 19 1 42 4 3 5 25 137 28 27 19 9 67 25 1 12 39 227
4.38 23.35 13.86 0.73 30.66 3.65 2.91 3.65 18.25 100 12.33 11.9 8.37 3.96 29.5 11 0.44 5.28 17.18
56 113 35 20 250 106 17 25 239 861 85 126 46 54 339 121 34 33 251
6.5 13.12 4.06 2.33 29.03 12.31 1.97 2.9 27.75
CT 2009
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2010
Police affairs Guard Traffic Security Public safety Investigation Information Marine No response
3 11 10 18 1 2 4 11
1
Police affairs Guard Traffic Security Public safety Investigation Information Marine No response
13 12 8 1 23 9 1 4 15
1 1
1 1
3 21 9 1 23 3 1 1 14 14 15 10 8 44 15 7 24 MRI
2009
2010
Police affairs Guard Traffic Security Public safety Investigation Information Marine No response
25 51 18 7 116 45 8 10 95
2 1
1
29 57 16 13 128 59 9 15 143
Police affairs Guard Traffic Security Public safety Investigation Information Marine No response
42 39 23 16 160 57 14 9 104
2 1 2 2 4 1 2 4 2
41 86 21 36 171 61 18 20 140
4
musculoskeletal diseases, spine examinations accounted for 53.94% and 66.96% in 2009 and 2010, respectively. Regarding the examination of body parts, the most frequently examination of body parts was the wrist for the upper extremities, which accounted for 9.06% and 4.72% in 2009 and 2010, respectively; the ankle for the lower extremities, which accounted for 9.84% and 4.42%, in 2009 and 2010, respectively; and the lumbar spine for the spine, which accounted for 29.92% and 40.41% in 2009 and 2010, respectively. As for MRI for musculoskeletal diseases, spine examinations accounted for 62.16%
3 1
1
2 2
3 1
1
4
1
7.81 11.58 4.22 4.96 31.1 11 3.12 3.03 23.1 1,088
and 58.68% in 2009 and 2010, respectively. As for the examination of body parts, the most frequently examined site was the shoulder for the upper extremities, which accounted for 8.74% and 10.35% in 2009 and 2010, respectively; the knee for the lower extremities, which accounted for 19.78% and 20.17% in 2009 and 2010, respectively; and the lumbar spine for the spine, which accounted for 33.86% and 32.03% in 2009 and 2010, respectively. Compared with other groups, Park et al.25 reported that hair dressers claimed musculoskeletal pains on the shoulders
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Archives of Environmental & Occupational Health (61.0%), waist (53.2%), legs/knees (36.7%), and feet/ankles (34.8%), and Sung et al.26 wrote that performers in orchestras showed pains on the shoulders (59.6%), neck (43.6%), waist (48.1%), wrists (24.4%), and arms and elbows (23.1%). The reason why the examinees claimed different parts of pains is the fact that they had differences in jobs, including using different parts depending on their jobs, heavy or light use of muscles, and the environment. Unlike other fields, conscripted and riot police officers showed that the lower extremities took the highest rank from simple x-ray, CT, and MRI examinations, and it suggests that the officers showed the most severe pains on their legs due to special tasks of standing up for a long time. In addition, the knee examination rates showed the highest value among the lower extremities. Generally, the musculoskeletal diseases on the knees are mainly pain while walking and walking limit, and damaging cartilages is the most representing occupational musculoskeletal disease.27 In conclusion, it suggests that the conscripted and riot police officers claimed pains on the knees due to repetitive movement of knees. In addition, the CT and the MRI examinations showed the highest rates for the spine and the lumbar spine, respectively. Cartilage injury of the knee joint, a typical occupational musculoskeletal disease, is mainly caused by rotational force exerted on the partial curvature. Lumbar pain is caused by degenerative change of the disc and subsequent change of the ligament and posterior joint, which are facilitated by improper posture or work-derived excessive force applied to the lumbar spine.28 As for CT according to working type, public safety accounted for 33.07% and 32.44% in 2009 and 2010, respectively. Public safety also accounted for 29.60% and 32.10% in 2009 and 2010, respectively, in MRI. As for the examination of body parts, the most frequently examined site was the spine, which accounted for 18.05% and 18.28% in 2009 and 2010, respectively, of which the lumbar spine accounted for 9.24% and 9.22% in 2009 and 2010, respectively. As for the distribution by age, subjects in their 40s accounted for 38.42% and 39.16% in 2009 and 2010, respectively, in x-ray, and 39.16% and 39.82% in 2009 and 2010, respectively, in CT. Meanwhile, subjects in their 50s accounted for 41.08% and 43.69% in 2009 and 2010, respectively, in MRI. As for the distribution by rank position, sergeants accounted for 39.37% and 37.46% in 2009 and 2010, respectively, in CT, which was the highest proportion. Lieutenants accounted for 35.81% and 41.58% in 2009 and 2010, respectively, in MRI, which was the highest proportion. Unlike other occupations, the results of this study conducted on police officers showed that knee examinations among all x-ray examinations of the lower extremities accounted for the highest proportion, whereas lumbar spine examinations among all CT and MRI examinations of the spine accounted for the highest proportion. The results of analysis of the subject distribution by working type, rank position, and age showed that public safety, lieutenant, and age range of 40–50s accounted for the highest portions in 2009 and 2010. Knee and lumbar spine examinations accounted for the majority of radiologic examinations conducted on the police, and the causes of lumbar spine disorders were due to wearing of police equipments, working under the triple- or quad-shift system that involve long-term burden on the spine,
187 emergency standby, traffic, patrol activities, and investigation. The musculoskeletal diseases of the police shown in this study are likely to be attributable to the fact that police officers conduct their duties under special working environments, such as triple- or quad-shift system, emergency standby, or stakeout, which entail burden on the knee and waist for a long time. An epidemiologic study is essentially required for a further understanding of musculoskeletal diseases in this particular group of patients. However, in the present study, the 2-year data of radiologic examinations were used due to approach limitation caused by special working environments of police officers. Thus, a further study is required with more sufficient data.
Conclusion The results of this study could be useful as basic data for improvement of police welfare, specialized treatment for the health safety of the police, and efficient management of police resources.
References 1. Kim JS, Lee YS. Causal relationship between military activities and musculoskeletal injuries. J Korea Inst Mil Sci Technol. 2008;11:142–147. 2. Choi EL. Police Administration. Seoul, Korea: The Police Mutual Aid Association; 2006. 3. Lee HW. Police Administration. Seoul, Korea: Bobmunsa; 2007. 4. Hwang HK. Job satisfaction among police officers in centralized patrol bureaus of urban area: the effect of demographics, perceptions of the role of police, and perceptions of internal and external environments. Korean Police Stud Rev. 2008;7:147–180. 5. Lee HM, Kim JS. Effects of influence of working environment and recognition on the exam-promotion stress. J Korea Contents. 2009;3:256–261. 6. Skolnick, Jerome H. Justice Without Trial: Law Enforcement in Democratic Society. New York: John Wiley & Sons; 1966. 7. Choi SW. An approach to the theory of co-production in police service. Korean Assoc Public Saf Crim Justice. 2001;11:378–379. 8. Jamal M. Job stress and job performance controversy. Organ Behav Hum Perform. 1984;33:1–21. 9. Kaufman KR, Brodine S, Shaffer R. Military training-related injuries: surveillance, research, and prevention. Am J Prevent Med. 2000;18:54–63. 10. Kang DM, Kim YK, Kim JE. Job stress and musculoskeletal diseases. J Korean Med Assoc. 54;851–858:2011. 11. Chang SR, Kim YS, Lee KS, Kim YC, Bae DC. A study on managerial system of work-related musculoskeletal disorders. J Korean Inst Intell Systems. 2003;18:149–153. 12. Park BC, Cheong HK, Kim SK. Risk factors related to musculoskeletal symptoms in shipyard workers. Korean J Occup Environ Med. 2003;15:373–387. 13. Kim TS. A Study on the Musculoskeletal Symptoms of Radiologists in Diagnostic Radiology [master thesis]. Seoul, Korea: Yonsei University; 2003. 14. Lee JS. Factors on Prevalence of Musculoskeletal Disorders Among Dental Technicians in Korea [master thesis]. Seoul, Korea: Yonsei University; 2001. 15. Heo KH, Han YS, Jung HS, Koo JW. Musculoskeletal symptoms and related factors of golf caddies. Korean J Occup Environ Med. 2003;16:92–102.
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Downloaded by [UQ Library] at 09:51 13 July 2015
16. Choi SW, Park JS, Jung SO. Risk factors of musculoskeletal injuries among the marine corps enlisted trainees. Korean J Occup Environ Med. 2010;22:146–153. 17. Cho JH, Kang MG, Seok JM, et al. Survey of the musculoskeletal disorders of riot police and conscripted policeman in radiologic examination. J Korean Soc Radiol. 2011;5:315–324. 18. Jung YH, Koo JW. Medical approach of work-related musculoskeletal diseases. J Ergon Soc Korea. 2010;29:473–478. 19. Koh SB, Kim HS, Choi HR, et al. Incidence and risk factors for occupational low back pain among shipyard workers. Korean J Occup Environ Med. 2000;12:1–11. 20. Son JE, Jang TW, Kim YK, et al. Survey on the prevalence of carpal tunnel syndrome in simple repetitive workers who use upper extremities. Korean J Occup Environ Med. 2001;13:209–219. 21. Choi ER, Jeong SM. A study on the problems and improvement for the police patrol division system. Korean J Criminol. 2004;59:81–123. 22. Noh DH, Wang JH, Choi HR, et al. The effect of shift work on the level of self-rated health. Korean J Occup Environ Med. 2010;22:200–209.
Rhee et al. 23. Kim BK, Kim JY. Status of musculoskeletal disorders in Korea. Korean J Occup Environ Med. 2003;9:7–12. 24. Kwon BH, Park KH, Kim W, Kim YM, Choi HK. Analysis of the epidemiology of musculoskeletal illness in Korea. J Ergon Soc Korea. 2008;9:28–33. 25. Park SK, Choi YJ, Moon DH, Chun JH, Lee JT, Shon HS. Work related musculoskeletal disorders of hairdresser. Korean J Occup Environ Med. 2003;12:395–404. 26. Sung NK, Sakong J, Chung JH. Musculoskeletal disorders and related factors of symphony orchestra players. Korean J Occup Environ Med. 2000;12:48–58. 27. Baker P, Coggon D, Reading I. Barrett D, McLaren M, Cooper C. Sports injury, occupational physical activity, joint laxity and meniscal damage. J Rheumatol. 2002;29: 557–563. 28. Kim KM, Chun CH, Jeong KJ. Meniscal allograft transplantation—clinical results and recovery of sports activity. Korean J Sports Med. 2011;29:15–20.
Archives of Environmental & Occupational Health Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/vaeh20
Prevalence of Musculoskeletal Disorders Among Korean Police Personnel a
b
c
bc
bc
Hak Young Rhee , Jae Hwan Cho , Jong Min Seok , Taek Sang Cho , Woo Jin Jeon , Jin Gu Lee
bc
& Sung Kyu Kim
d
a
Department of Neurology, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Republic of Korea b
Department of International Radiological Science, Hallym University of Graduate Studies, Seoul, Republic of Korea c
Department of Radiology, National Police Hospital, Seoul, Republic of Korea
d
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Department of Therapeutic Radiology and Oncology, Yeungnam University, Gyeongsan, Republic of Korea Accepted author version posted online: 14 Jun 2013.
To cite this article: Hak Young Rhee, Jae Hwan Cho, Jong Min Seok, Taek Sang Cho, Woo Jin Jeon, Jin Gu Lee & Sung Kyu Kim (2015) Prevalence of Musculoskeletal Disorders Among Korean Police Personnel, Archives of Environmental & Occupational Health, 70:4, 177-188, DOI: 10.1080/19338244.2013.807762 To link to this article: http://dx.doi.org/10.1080/19338244.2013.807762
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Archives of Environmental & Occupational Health (2015) 70, 177–188 C Taylor & Francis Group, LLC Copyright ISSN: 1933-8244 print / 2154-4700 online DOI: 10.1080/19338244.2013.807762
Prevalence of Musculoskeletal Disorders Among Korean Police Personnel HAK YOUNG RHEE1, JAE HWAN CHO2, JONG MIN SEOK3, TAEK SANG CHO2,3, WOO JIN JEON2,3, JIN GU LEE2,3, and SUNG KYU KIM4 1 Department of Neurology, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Republic of Korea 2 Department of International Radiological Science, Hallym University of Graduate Studies, Seoul, Republic of Korea 3 Department of Radiology, National Police Hospital, Seoul, Republic of Korea 4 Department of Therapeutic Radiology and Oncology, Yeungnam University, Gyeongsan, Republic of Korea
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Received 5 December 2012, Accepted 24 April 2013
This study was conducted to investigate efficient, systematic management of the Korean police and to examine the status and prevention of musculoskeletal disorders in Korean police officers. For police officers in special working environments, the importance of basic data is emphasized for human resources (HR) management and the prevention of industrial hazards from an industrial health care perspective. This study was conducted on police officers who visited the national police hospital and who underwent x-ray, computed tomography (CT), and magnetic resonance imaging (MRI) for the diagnosis of musculoskeletal disorders. The results revealed that examinations for the lower extremities and spine were most frequently conducted using x-ray, CT, and MRI. In particular, knee and lumbar examinations were most frequently conducted among all lower extremity and spine examinations, respectively. Keywords: musculoskeletal disorders, police officers, working type
The police have high possibility of showing musculoskeletal pains due to rough physical activities, including duties, traffic control, driving, security, sports and drills, and handling heavy equipment, and are highly hospitalized or treated. In addition, the musculoskeletal disorders related to the occupation include sprains, tendinitis, bursitis, ligament injuries, entrapment neuropathies, and cartilage and bone damages. The symptom starts with light pains, numbness, stinging, and the development cause signs including deformation, degraded muscular strength, limited or shrunk motion range, and function losses.1 The tasks of police abruptly happen in unexpected circumstances and the situation where the accident was from.2 Therefore, the police shall have high agility and organic cooperation to reasonably solve these abrupt cases,3 and their duties are based on shifts and circulations due to preparedness. The working system of the frontline police was reorganized into the division system in 2003, and the working environment has been changed to the system of double shift of 24-hour work and 24-hour off, but the triple- or quad-shift system has also been under operation.4 However, accidental situations such as emergency standby frequently occur, in which case, office
Address correspondence to Jong-min Seok, PhD, Department of Radiology, National Police Hospital, Republic of Korea, Seoul 712-749, Republic of Korea. E-mail: [email protected]
hours become irregular. Furthermore, due to the exchange of day and nighttime works, their biorhythm gets interrupted, which makes it difficult to maintain a pattern of ordinary life like those of other organizations.5 J. H. Skoinick claimed that dangerousness and authority are particularly significant factors among the environments of the police.6 The aforementioned claims suggest that police officers have a high risk of being exposed to various dangerous factors such as body injury, accident, illness, infection, and poisoning that may occur at any time while on duty, compared with other civil officers.7,8 This working environment of the police has various safetyand health care–related problems. For example, the police officers are believed to be significantly exposed to the risk of musculoskeletal disorders. In particular, the musculoskeletal diseases are serious in that they may cause pains, degrade functions in lives, and be developed to chronic disorder.9 Musculoskeletal disorders are occupational diseases involving body activity-related muscles, tendons, nerves, joints, and adjacent tissues due to the short- and long-term exposure of occupational hazardous factors alone or in combination with personal, sociopsychological factors, including similar diseases of back pain and lower extremities, as well as of upper extremities, such as the neck, shoulder, and arms.10 Musculoskeletal diseases defined in the Occupational Safety and Health Act refer to heath disorders that occur in the neck, shoulder, waist, and upper and lower extremities, and adjacent tissues by hazardous factors, such as repetitive motions,
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178 improper working posture, excessive use of force, physical contact with sharp edges, vibration, and temperature. These occupation-related musculoskeletal diseases have drawn much attention as one of the main occupational diseases in the society.11 In fact, studies on the assessment of relevant risk factors, patients with diseases, and establishment of disease prevention have been actively conducted in various industrial areas. Park et al.12 reported that 77.2% of workers in the dockyard, Kim13 stated that 30% of radiologic technologists in the medical image department, Lee14 showed that 59.3% of dental technicians, and Heo et al.15 reported 44.9% of golf caddies claimed pains in the musculoskeletal system. Recently, a research was performed on the recruits of the marine corps, rather than general and riot police, and it showed that the accumulated rates of musculoskeletal damages for the 6 weeks of the training was 13.4%, and more than half were on the pelvic limbs below the knees.16 The study on local police officers reported the relation between the fatigue and the stress from the officers, but there has been no research on the musculoskeletal system. It seems that there is no systemic approach to the musculoskeletal diseases because there has been no survey on the duties and examination for diseases due to special environment around the police.17 Major diagnostic methods of the musculoskeletal system include simple x-ray, computed tomography (CT), magnetic resonance imaging (MRI), sonogram, and bone scan, and the popular examinations are the simple x-ray, CT, and MRI.18 Accordingly, this study was conducted to investigate the frequency of diseases by musculoskeletal disease type and injury site in police officers who visited the department of radiology at the police hospital and who underwent x-ray, CT, and MRI for the upper and lower extremities and spine during 2009 and 2010. The results of this study could be useful as basic data for the management of police human resources and diseases that frequently occur in the police.
Methods Subjects This study was conducted on police officers who visited the Seoul police hospital as outpatients or inpatients to quantitatively compare their diseases. Data obtained over 2 years from January 1, 2009, to December 31, 2010, were analyzed. The subjects consisted of 27,340 outpatients and 13,623 inpatients from 2009, and 32,571 outpatients and 15,613 inpatients from 2010. Among the police officers who visited the police hospital, those who underwent x-ray, CT, and MRI for musculoskeletal disorders were selected as subjects. Data Collection and Analysis Method This study was conducted on the police officers who underwent x-ray, CT, and MRI during the period from January 1, 2009, to December 31, 2010. Diseases of the subjects were classified into general and musculoskeletal disorders. To determine the characteristics of musculoskeletal diseases by work-
Rhee et al. ing type, body parts that underwent radiologic examinations was classified into the upper extremities, lower extremities, and spine, and further subclassified by examination of body parts, followed by analysis. Differences in the musculoskeletal diseases were comparatively analyzed according to the rank and working type of the police officers. The frequency analysis was performed on the number of police officers for each examination and parts in the statistical analysis and the chi-square test was introduced to compare differences in specific symptoms among musculoskeletal diseases.
Results Classification of the Subjects by Examination Type General Disease The annual radiologic examination conducted on the police officers participating in this study was as follows: 35,148 cases of x-ray, 2,174 cases of CT, and 3,638 cases of MRI in 2009; and 38,091 cases of x-ray, 4,004 cases of CT, and 6,089 cases of MRI in 2010. The frequency of radiologic examinations was shown to increase by 8.37%, 84.17%, and 67.37% for x-ray, CT, and MRI, respectively, in 2010, compared with those of 2009 (p < .05). As for outpatients and inpatients, the 2009 statistics showed 22,436 outpatients and 12,712 inpatients for x-ray, 1,641 outpatients and 533 inpatients for CT, and 3,263 outpatients and 375 inpatients for MRI (Figure 1) (p < .05). Musculoskeletal Disease In 2009, 8,568 subjects who underwent x-ray, 254 subjects who underwent CT, and 1,385 subjects who underwent MRI received radiologic examinations for musculoskeletal diseases. Meanwhile, in 2010, 9,815 subjects who underwent x-ray, 339 subjects who underwent CT, and 1,854 subjects who underwent MRI received radiologic examinations for musculoskeletal diseases. Thus, the numbers of subjects who underwent radiologic examinations for musculoskeletal diseases were increased by 1,247, 85, and 469, for x-ray, CT, and MRI, respectively, in 2010 compared with those in 2009 (p < .05) (Figure 2). Subclassification of Musculoskeletal Diseases by Year In 2009, x-ray included 2,478 cases of the upper extremities, 3,379 cases of the lower extremities, and 2,711 cases of the spine. Meanwhile, in 2010, x-ray included 2,943 cases of the upper extremities, 3,558 cases of the lower extremities, and 3,314 cases of the spine. X-ray for the lower extremities and spine was more frequently conducted in the comparison by year and examination of body parts (p < .05). As for CT, the examination included 48 cases of the upper extremities, 69 cases of the lower extremities, and 137 cases of the spine in 2009, whereas it included 47 cases of the upper extremities, 65 cases of the lower extremities, and 227 cases of the spine in 2010. The numbers of examinations for the upper and lower extremities were similar between 2009 and 2010. Meanwhile, the number of examinations for the spine
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Fig. 1. The annual radiologic examination conducted on the police officers: (a) year-wise comparison of X-ray, CT, and MRI of (b) inpatient and outpatient groups.
was shown to be increased by 65.69% (90 subjects) in 2010 compared with that of 2009 (p < .05). As for MRI, the examination included 157 cases of the upper extremities, 367 cases of the lower extremities, and 861 cases of the spine in 2009, whereas it included 253 cases of the upper extremities, 513 cases of the lower extremities, and 1,088 cases of the spine in 2010. The frequency of examinations for
the spine was shown to be increased by 26.36% (227 subjects) in 2010 compared with that of 2009 (p < .05) (Figure 3). Number of Subjects by Working Type, Rank, Age In 2009, 254 subjects who underwent CT and 1,385 subjects who underwent MRI received radiologic examinations for musculoskeletal diseases. Meanwhile, in 2010, 339 subjects
Fig. 2. Year-wise radiologic examinations for musculoskeletal diseases.
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Fig. 3. Year-wise subclassification of musculoskeletal diseases (x-ray, CT, MRI).
who underwent CT and 1,854 subjects who underwent MRI underwent radiologic examinations for musculoskeletal diseases. As for the comparison by working type, 84 (33.07%) and 110 (32.44%) subjects of public safety underwent CT in 2009 and 2010, respectively, whereas 410 (29.60%) and 595 (32.1%) subjects of public safety underwent MRI in 2009 and 2010, respectively. The major frequencies of the subjects who underwent CT were as follows: Guard 64 (25.2%) and Traffic 33 (13.0%) in 2009, and Guard 52 (15.34%) and Police Affairs 37 (10.91%) in 2010. Meanwhile, the major frequencies of the subjects who underwent MRI were as follows: Guard 206 (14.87%) and Investigation 165 (11.91%) in 2009, and Guard 236 (12.73%) and Investigation 192 (10.35%) in 2010 (p < .05). The major frequencies of musculoskeletal disease by rank position were as follows: Sergeant (2009 39.37%, 2010 37.46%), Lieutenant (2009 36.22%, 2010 33.63%), and Corporal (2009 11.81%, 2010 12.39%) for CT, and Lieutenant (2009 35.81%, 2010 41.58%), Sergeant (2009 35.52%, 2010 32.79%), and Corporal (2009 12.06%, 2010 10.03%) for MRI (p < .05). As for the frequency of musculoskeletal disease by age, subjects in their 40s accounted for 38.42% and 39.16% of the subjects who underwent x-ray in 2009 and 2010, respectively, constituting the highest portions. Meanwhile, subjects in their 50s accounted for 41.08% and 43.69% of the subjects who underwent MRI in 2009 and 2010, respectively, constituting the highest portions (p < .05) (Figure 4).
Number of the Subjects by Examination of Body Parts Musculoskeletal Disease As for x-ray, the frequency of examinations of the lower extremities was shown to be 39.44% and 36.25% in 2009 and 2010, respectively, which were the highest portions. The frequency of examinations of the spine was shown to be 31.64% and 33.76% in 2009 and 2010, respectively (p < .05). As for CT, the frequency of examinations for the spine was shown to be 59.93% and 66.96% in 2009 and 2010, respectively, accounting for the highest portions. The frequency of examinations for the lower extremities was shown to be 27.16% and 19.18% in 2009 and 2010, respectively (p < .05). As for MRI, the frequency of examinations for the spine was shown to be 62.16% and 58.68% in 2009 and 2010, respectively, accounting for the highest portions. Next to the frequency of the spine, that for the lower extremities was shown to be 26.50% and 27.67% in 2009 and 2010, respectively (p < .05) (Table 1). As for x-ray for musculoskeletal diseases, 51.05% were examinations of the shoulder and 57.86% were examinations of the upper extremities in 2009 and 2010, respectively, accounting for the highest portions. Next to shoulder examinations, 14.86% and 12.16% were examinations of the fingers and the upper extremities in 2009 and 2010, respectively (p < .05).
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Fig. 4. Year-wise number of subjects by working type, rank, and age. Table 1. Classification of Radiologic Examinations by Examination of Body Parts Upper extremities
Lower extremities
Spine
Examination
Year
n
%
n
%
n
%
Total
X-ray
2009 2010 2009 2010 2009 2010
2,478 2,943 48 47 157 253
28.92 29.98 18.90 13.86 11.34 13.65
3,379 3,558 69 65 367 513
39.44 36.25 27.16 19.18 26.50 27.67
2,711 3,314 137 227 861 1,088
31.64 33.76 53.93 66.96 62.16 58.86
8,568 9,815 254 339 1,385 1,854
CT MRI
As for CT for musculoskeletal diseases, 47.91% and 34.04% were examinations of the wrist and the upper extremities in 2009 and 2010, respectively, accounting for the highest portions. Next to examinations of the wrist, shoulder, and elbow, 18.75% were examinations of the upper extremities in 2009, and 29.78% were examination of the upper extremities in 2010 (p < .05). As for MRI for musculoskeletal diseases, shoulder examination constituted 77.07% and 75.89% of MRI for the upper extremities in 2009 and 2010, respectively, accounting for the highest portions. Next to examinations of the shoulder, wrist examinations constituted 10.19% and upper extremity examinations constituted 14.23% of MRI examinations in 2009 and 2010, respectively (p < .05) (Table 2). As for x-ray for musculoskeletal diseases, 56.78% and 60.37% were examinations of the knee and the lower extremities in 2009 and 2010, respectively, accounting for the highest portions. Next to knee examinations, ankle examinations constituted 15.42% and lower extremity examinations constituted
14.64% of x-ray examinations in 2009 and 2010, respectively (p < .05). As for CT for musculoskeletal diseases, ankle examinations constituted 36.23% and lower examinations constituted 23.07% in 2009 and 2010, respectively, accounting for the highest portions. Next to ankle examinations came pelvis examination (18.84%) lower extremity examinations (21.54%) in 2009 and 2010, respectively (p < .05). As for MRI for musculoskeletal diseases, 74.66% were knee examinations and 72.90% lower extremity examinations in 2009 and 2010, respectively, accounting for the highest portions. Next to knee examinations, ankle examinations constituted 11.44% and lower extremity examinations constituted 13.26% of MRI examinations in 2009 and 2010, respectively (p < .05) (Table 3). As for x-ray for musculoskeletal diseases, L-spine (lumbar spine) examinations constituted 55.44% and spine examinations constituted 53.80% in 2009 and 2010, respectively, accounting for the highest portions. Next to L-spine
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Table 2. Radiologic Examination Results of the Upper Extremities 2009 Examination
Classification
X-ray
Finger Hand Wrist Forearm Elbow Humerus Shoulder Total (%) Hand Wrist Elbow Humerus Shoulder Total (%) Hand Wrist Forearm Elbow Humerus Shoulder Total (%)
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CT
MRI
2010
n
%
n
%
368 259 255 66 244 21 1,265 2,478 7 23 9
14.86 10.45 10.3 2.66 9.702 0.847 51.05 100 14.58 47.91 18.75
9 48 13 16 1 6
18.75 100 8.28 10.19 0.64 %
121 157
77.07 100
358 282 273 35 260 32 1,703 2,943 12 16 3 2 14 47 9 36 2 12 2 192 253
12.16 9.582 9.28 1.19 8.83 1.087 57.86 100 25.53 34.04 6.38 4.26 29.78 100 3.56 14.23 0.79 4.74 0.79 75.89 100
Table 3. Radiologic Examination Results of the Lower Extremities 2009 Examination
Classification
X-ray
Toe Foot Ankle Calcaneus Leg Knee Femur Hip Total (%) Foot Ankle Calcaneus Leg Knee Femur Hip Pelvis Total (%) Foot Ankle Leg Knee Femur Hip Pelvis Total (%)
CT
MRI
2010
n
%
n
%
48 332 521 57 165 1,917 54 285 3,379 12 25 1 6 10 2 — 13 69 6 42 7 274 4 31 3 367
1.42 9.83 15.42 1.67 4.88 56.73 1.06 8.43 100 17.39 36.23 1.45 8.70 14.49 2.90
40 294 521 57 160 2,148 57 281 3,558 5 15 4 13 6 5 3 14 65 13 68 13 374 7 28 10 513
1.12 8.26 14.64 1.60 4.49 60.37 1.60 7.89 100 7.69 23.07 6.15 20.0 9.23 7.69 4.61 21.54 100 2.53 13.26 2.53 72.90 1.36 5.46 1.95 100
18.84 100 1.63 11.44 1.90 74.66 1.09 8.44 0.817 100
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Table 4. Radiologic Examination Results of the Spine 2009 Examination
Classification
n
%
n
%
X-ray
Cervical spine Thoracic spine Lumbar spine Total (%) Cervical spine Thoracic spine Lumbar spine Total (%) Cervical spine Thoracic spine Lumbar spine C+T+L-spine Myelogrm Total (%)
1,137 71 1,503 2,711 60 1 76 137 375 10 469 4 3 861
41.94 2.62 55.44 100 43.80 0.73 55.47 100 43.55 1.16 54.47 0.46 0.35 100
1,438 93 1,783 3,314 86 4 137 227 464 20 594 8 2 1,088
43.40 2.80 53.80 100 37.88 1.76 60.35 100 42.66 1.84 54.60 0.73 0.18 100
CT
MRI
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2010
examinations, C-spine examinations constituted 41.94% and spine constituted 43.40%% in 2009 and 2010, respectively (p < .05). As for CT for musculoskeletal diseases, 55.47% were Lspine examinations and 60.35% spine examinations in 2009 and 2010, respectively, accounting for the highest portions. Next to L-spine examinations, C-spine (cervical spine) examinations constituted 43.80% and spine examinations constituted 37.88% in 2009 and 2010, respectively (p < .05). As for MRI for musculoskeletal diseases, 54.47% were Lspine examinations and 54.60% were spine examinations in 2009 and 2010, respectively, accounting for the highest portions. Next to L-spine examinations, C-spine examinations constituted 43.55%, followed by 42.65% spine examinations in 2009 and 2010, respectively (p < .05) (Table 4). As for CT of the upper extremities by working type, the subjects who belonged to public safety were shown to account for 35.41% and 42.5% of the subjects who underwent CT, in 2009 and 2010, respectively, making up the highest portions. Next to public safety, guard accounted for 25% and 25.5% of CT in 2009 and 2010, respectively (p < .05). As for MRI of the upper extremities by working type, subjects who belonged to public safety were shown to account for 33.97% and 35.97% of the subjects who underwent MRI in 2009 and 2010, respectively, constituting the highest portions. Next to public safety, no response accounted for 22.43% and 26.87% in 2009 and 2010, respectively. If no response was excluded, guard accounted for 25% and 25.5% in 2009 and 2010, respectively (p < .05) (Table 5). As for CT of the lower extremities by working type, subjects who belonged to public safety accounted for 36.2% and 35.38% of the subjects who underwent CT in 2009 and 2010, respectively, making up the highest portions. Next to public safety, guard was shown to account for 29% and 18.46% of CT in 2009 and 2010, respectively (p < .05). As for MRI of the lower extremities by working type, subjects who belonged to public safety were shown to account
for 29% and 32.16% of the subjects who underwent MRI in 2009 and 2010, respectively, making up the highest portions. Next to public safety, no response accounted for 23.63% and 19.1% in 2009 and 2010, respectively. If no response was excluded, guard accounted for 18.2% and 16.96% in 2009 and 2010, respectively (p < .05) (Table 6). As for CT of the spine by working type, subjects who belonged to public safety accounted for 30.66% and 29.5% of the subjects who underwent CT in 2009 and 2010, respectively, constituting the highest portions. Next to public safety, guard in 2009, and no response and police affairs in 2010 were shown to account for 23.36%, 17.18%, and 12.33%, respectively (p < .05). As for MRI of the spine by working type, subjects who belonged to public safety accounted for 29.03% and 31.1% of the subjects who underwent MRI in 2009 and 2010, respectively, constituting the highest portions. Next to public safety, no response accounted for 27.75% and 23.1% in 2009 and 2010, respectively. If no response was excluded, guard accounted for 13.12% and 11.58% in 2009 and 2010, respectively (p < .05) (Table 7).
Comment Musculoskeletal diseases are one of the major occupational diseases. Various studies have been conducted due to the rising interest in musculoskeletal diseases. Kim reported that 30.8% of radiation technicians of the radiology department suffered from pain due to musculoskeletal diseases,13 Lee reported that 59.3% of dental technicians suffered from pain due to musculoskeletal diseases,14 Go et al. reported that 3.1/1000 of workers of the ship building industry suffered from pain due to musculoskeletal diseases,19 and Son et al reported that 26.1% of workers of the meat and fish processing industries suffered from pain due to musculoskeletal diseases.20 Recently, a research was performed on the recruits of the marine corps, rather than general and riot police, and it showed that the accumulated rates of musculoskeletal
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Table 5. Radiologic Examination by Working Type (Upper Extremities) Total Year
Classification
Hand
Wrist
Forearm
Elbow
Humerus
Shoulder
n
%
2 2 1
12 5 17 1 1 15 51 4 13 2 20 3 1 4 47
25 10.41 35.41 2.08 2.08 25
8 26 8 2 53 19 2 3 35 156 22 23 12 8 91 19 7 3 68
5.12 16.7 5.13 1.28 33.97 12.17 1.28 1.92 22.43
CT 2009
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Guard Traffic Public safety Investigation Marine No response Police affairs Guard Traffic Public safety Investigation Information No response
2 1 3
5 2 10
3
1
6
2
1 3 1 6
2 5 1 6 2
3 1
1 3 1 5
2
1
1
1
5 1 1 2
8.51 25.5 4.25 42.5 6.4 2.12 8.51
MRI 2009
2010
Police affairs Guard Traffic Security Public safety Investigation Information Marine No response Police affairs Guard Traffic Security Public safety Investigation Information Marine No response
1 3
3 1
1
4 3
4 2
3
2
6
2
2 4
4 1 3 12 1
1
15
1
1
2
7 19 7 2 42 14 2 3 25
1 2
4 1
damages for the 6 weeks of the training was 13.4%, and more than half were on the pelvic limbs below the knees.16 The study on local police officers reported the relation between the fatigue and the stress from the officers, but there has been no research on the musculoskeletal system. It seems that there is no systemic approach to the musculoskeletal diseases because there has been no survey on the duties and examination for diseases due to special environment around the police. The working environment of the police generally consists of triple- or quad-shift working system. However, restroom or standby room is insufficient. Furthermore, police officers of local divisions have protective equipments, such as 38-caliber pistol, three baton, stun gun, and handcuffs, around their waist, which equal a total weight of 7 kg including a radio.21
4
2
21 15 7 4 72 17 7 3 46
8.69 9.09 4.74 3.16 35.97 7.51 2.76 1.18 26.87 253
In addition, the results of a study on factors affecting stress of workers in the manufacturing industry showed that working under the shift system contributed to significant stress.22 Although job satisfaction and stress of the police have been actively studied, few systematic studies on musculoskeletal diseases have been conducted compared with overload or dangerousness of police duties. Kim et al. conducted a study on the distribution of patients with occupational diseases defined by the Industrial Accident Compensation and Insurance Act from 1998 to 2000, and reported that hazardous works increased from 72 in 1998 to 393 in 2000, and lumbar pain increased from 51 in 1998 to 421 in 2000.25 A previous study that analyzed compensated cases due to occupational diseases from January 1999 to December
Archives of Environmental & Occupational Health
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Table 6. Radiologic Examination by Working Type (Lower Extremities) Total Year
Classification
Foot
Ankle
Calcaneus
Leg
Knee
Femur
Hip
Pelvis
n
%
3 4 4 1
20 9 25 2 1 12 69 5 12 6 4 23 7 3 1 4 65
29 13 36.2 2.89 1.45 17.4 100 7.69 18.46 9.23 6.15 35.38 10.76 4.6 1.54 6.15
22 67 22 9 107 40 8 6 87 368 33 87 22 22 165 53 14 19 98
5.98 18.2 5.98 2.44 29 10.8 2.17 1.63 23.6
CT 2009
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Guard Traffic Public safety Investigation Information No response Police affairs Guard Traffic Security Public safety Investigation Information Marine No response
3 4 1 1 3
9 1 12
1
3
1 3
5 3 1
2
1
1 1 1 2 1
3 2 2 5 2
2 1
1 3
2 5 2 2
1
2 1 2
1 1
2 1 1
2 4 1 5 1 1
1
1
2 MRI
2009
2010
Police affairs Guard Traffic Security Public safety Investigation Information Marine No response Police affairs Guard Traffic Security Public safety Investigation Information Marine No response
1
1 3
2
2
4
7
2 12 2
1
18 3 1
3 2
4
1
4 16 2 2 19 5 3 4 13
3 2 1
1999 showed that men accounted for 75.6% of the total 410 subjects with musculoskeletal diseases, with 219 cases involving the lumbar spine, 170 cases the neck and upper extremities, 7 cases the lower extremities, and 14 cases involving 2 or more examination of body parts.23 The report on Occupational Accident Causes by the KOSHA, which analyzed causes of diseases for 8,011 subjects with musculoskeletal diseases for 3 consecutive years from 2003 to 2005, showed that subjects with musculoskeletal diseases due to repetitive motions, improper working posture, and excessive use of force accounted for 95.9% (7,688 subjects) of the total subjects.24 In the present study, the data were collected from police officers
4 1
2
17 51 16 8 74 29 7 6 66 24 59 18 17 121 40 11 13 71
1
1 3 3
1 1
8 5
1
11
3 1 2 1
1
2
2 3 1 2 13 3
2 3
1 3
1 2
2
6.43 16.96 4.29 4.29 32.16 10.3 2.72 3.7 19.1 513
who underwent radiologic examinations for musculoskeletal disorders from January 1, 2009, to December 31, 2010. As for x-ray for musculoskeletal diseases, lower extremity examinations accounted for 39.43% and 36.25% in 2009 and 2010, respectively. With regard to the examination of body parts, the most frequently examined site was shoulder in the examinations for the upper extremities, which accounted for 14.76% and 17.35% in 2009 and 2010, respectively; knee in the examinations for the lower extremities, which accounted for 22.37% and 21.88% in 2009 and 2010, respectively; and lumbar spine in the examinations for the spine, which accounted for 17.54% and 18.16% in 2009 and 2010, respectively. As for CT for
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Table 7. Radiologic Examination by Working Type (Spine) Total Year
Classification
Cervical spine
Thoracic spine
Lumbar spine
C+T+L-spine
Myelogram
n
%
6 32 19 1 42 4 3 5 25 137 28 27 19 9 67 25 1 12 39 227
4.38 23.35 13.86 0.73 30.66 3.65 2.91 3.65 18.25 100 12.33 11.9 8.37 3.96 29.5 11 0.44 5.28 17.18
56 113 35 20 250 106 17 25 239 861 85 126 46 54 339 121 34 33 251
6.5 13.12 4.06 2.33 29.03 12.31 1.97 2.9 27.75
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Police affairs Guard Traffic Security Public safety Investigation Information Marine No response
3 11 10 18 1 2 4 11
1
Police affairs Guard Traffic Security Public safety Investigation Information Marine No response
13 12 8 1 23 9 1 4 15
1 1
1 1
3 21 9 1 23 3 1 1 14 14 15 10 8 44 15 7 24 MRI
2009
2010
Police affairs Guard Traffic Security Public safety Investigation Information Marine No response
25 51 18 7 116 45 8 10 95
2 1
1
29 57 16 13 128 59 9 15 143
Police affairs Guard Traffic Security Public safety Investigation Information Marine No response
42 39 23 16 160 57 14 9 104
2 1 2 2 4 1 2 4 2
41 86 21 36 171 61 18 20 140
4
musculoskeletal diseases, spine examinations accounted for 53.94% and 66.96% in 2009 and 2010, respectively. Regarding the examination of body parts, the most frequently examination of body parts was the wrist for the upper extremities, which accounted for 9.06% and 4.72% in 2009 and 2010, respectively; the ankle for the lower extremities, which accounted for 9.84% and 4.42%, in 2009 and 2010, respectively; and the lumbar spine for the spine, which accounted for 29.92% and 40.41% in 2009 and 2010, respectively. As for MRI for musculoskeletal diseases, spine examinations accounted for 62.16%
3 1
1
2 2
3 1
1
4
1
7.81 11.58 4.22 4.96 31.1 11 3.12 3.03 23.1 1,088
and 58.68% in 2009 and 2010, respectively. As for the examination of body parts, the most frequently examined site was the shoulder for the upper extremities, which accounted for 8.74% and 10.35% in 2009 and 2010, respectively; the knee for the lower extremities, which accounted for 19.78% and 20.17% in 2009 and 2010, respectively; and the lumbar spine for the spine, which accounted for 33.86% and 32.03% in 2009 and 2010, respectively. Compared with other groups, Park et al.25 reported that hair dressers claimed musculoskeletal pains on the shoulders
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Archives of Environmental & Occupational Health (61.0%), waist (53.2%), legs/knees (36.7%), and feet/ankles (34.8%), and Sung et al.26 wrote that performers in orchestras showed pains on the shoulders (59.6%), neck (43.6%), waist (48.1%), wrists (24.4%), and arms and elbows (23.1%). The reason why the examinees claimed different parts of pains is the fact that they had differences in jobs, including using different parts depending on their jobs, heavy or light use of muscles, and the environment. Unlike other fields, conscripted and riot police officers showed that the lower extremities took the highest rank from simple x-ray, CT, and MRI examinations, and it suggests that the officers showed the most severe pains on their legs due to special tasks of standing up for a long time. In addition, the knee examination rates showed the highest value among the lower extremities. Generally, the musculoskeletal diseases on the knees are mainly pain while walking and walking limit, and damaging cartilages is the most representing occupational musculoskeletal disease.27 In conclusion, it suggests that the conscripted and riot police officers claimed pains on the knees due to repetitive movement of knees. In addition, the CT and the MRI examinations showed the highest rates for the spine and the lumbar spine, respectively. Cartilage injury of the knee joint, a typical occupational musculoskeletal disease, is mainly caused by rotational force exerted on the partial curvature. Lumbar pain is caused by degenerative change of the disc and subsequent change of the ligament and posterior joint, which are facilitated by improper posture or work-derived excessive force applied to the lumbar spine.28 As for CT according to working type, public safety accounted for 33.07% and 32.44% in 2009 and 2010, respectively. Public safety also accounted for 29.60% and 32.10% in 2009 and 2010, respectively, in MRI. As for the examination of body parts, the most frequently examined site was the spine, which accounted for 18.05% and 18.28% in 2009 and 2010, respectively, of which the lumbar spine accounted for 9.24% and 9.22% in 2009 and 2010, respectively. As for the distribution by age, subjects in their 40s accounted for 38.42% and 39.16% in 2009 and 2010, respectively, in x-ray, and 39.16% and 39.82% in 2009 and 2010, respectively, in CT. Meanwhile, subjects in their 50s accounted for 41.08% and 43.69% in 2009 and 2010, respectively, in MRI. As for the distribution by rank position, sergeants accounted for 39.37% and 37.46% in 2009 and 2010, respectively, in CT, which was the highest proportion. Lieutenants accounted for 35.81% and 41.58% in 2009 and 2010, respectively, in MRI, which was the highest proportion. Unlike other occupations, the results of this study conducted on police officers showed that knee examinations among all x-ray examinations of the lower extremities accounted for the highest proportion, whereas lumbar spine examinations among all CT and MRI examinations of the spine accounted for the highest proportion. The results of analysis of the subject distribution by working type, rank position, and age showed that public safety, lieutenant, and age range of 40–50s accounted for the highest portions in 2009 and 2010. Knee and lumbar spine examinations accounted for the majority of radiologic examinations conducted on the police, and the causes of lumbar spine disorders were due to wearing of police equipments, working under the triple- or quad-shift system that involve long-term burden on the spine,
187 emergency standby, traffic, patrol activities, and investigation. The musculoskeletal diseases of the police shown in this study are likely to be attributable to the fact that police officers conduct their duties under special working environments, such as triple- or quad-shift system, emergency standby, or stakeout, which entail burden on the knee and waist for a long time. An epidemiologic study is essentially required for a further understanding of musculoskeletal diseases in this particular group of patients. However, in the present study, the 2-year data of radiologic examinations were used due to approach limitation caused by special working environments of police officers. Thus, a further study is required with more sufficient data.
Conclusion The results of this study could be useful as basic data for improvement of police welfare, specialized treatment for the health safety of the police, and efficient management of police resources.
References 1. Kim JS, Lee YS. Causal relationship between military activities and musculoskeletal injuries. J Korea Inst Mil Sci Technol. 2008;11:142–147. 2. Choi EL. Police Administration. Seoul, Korea: The Police Mutual Aid Association; 2006. 3. Lee HW. Police Administration. Seoul, Korea: Bobmunsa; 2007. 4. Hwang HK. Job satisfaction among police officers in centralized patrol bureaus of urban area: the effect of demographics, perceptions of the role of police, and perceptions of internal and external environments. Korean Police Stud Rev. 2008;7:147–180. 5. Lee HM, Kim JS. Effects of influence of working environment and recognition on the exam-promotion stress. J Korea Contents. 2009;3:256–261. 6. Skolnick, Jerome H. Justice Without Trial: Law Enforcement in Democratic Society. New York: John Wiley & Sons; 1966. 7. Choi SW. An approach to the theory of co-production in police service. Korean Assoc Public Saf Crim Justice. 2001;11:378–379. 8. Jamal M. Job stress and job performance controversy. Organ Behav Hum Perform. 1984;33:1–21. 9. Kaufman KR, Brodine S, Shaffer R. Military training-related injuries: surveillance, research, and prevention. Am J Prevent Med. 2000;18:54–63. 10. Kang DM, Kim YK, Kim JE. Job stress and musculoskeletal diseases. J Korean Med Assoc. 54;851–858:2011. 11. Chang SR, Kim YS, Lee KS, Kim YC, Bae DC. A study on managerial system of work-related musculoskeletal disorders. J Korean Inst Intell Systems. 2003;18:149–153. 12. Park BC, Cheong HK, Kim SK. Risk factors related to musculoskeletal symptoms in shipyard workers. Korean J Occup Environ Med. 2003;15:373–387. 13. Kim TS. A Study on the Musculoskeletal Symptoms of Radiologists in Diagnostic Radiology [master thesis]. Seoul, Korea: Yonsei University; 2003. 14. Lee JS. Factors on Prevalence of Musculoskeletal Disorders Among Dental Technicians in Korea [master thesis]. Seoul, Korea: Yonsei University; 2001. 15. Heo KH, Han YS, Jung HS, Koo JW. Musculoskeletal symptoms and related factors of golf caddies. Korean J Occup Environ Med. 2003;16:92–102.
188
Downloaded by [UQ Library] at 09:51 13 July 2015
16. Choi SW, Park JS, Jung SO. Risk factors of musculoskeletal injuries among the marine corps enlisted trainees. Korean J Occup Environ Med. 2010;22:146–153. 17. Cho JH, Kang MG, Seok JM, et al. Survey of the musculoskeletal disorders of riot police and conscripted policeman in radiologic examination. J Korean Soc Radiol. 2011;5:315–324. 18. Jung YH, Koo JW. Medical approach of work-related musculoskeletal diseases. J Ergon Soc Korea. 2010;29:473–478. 19. Koh SB, Kim HS, Choi HR, et al. Incidence and risk factors for occupational low back pain among shipyard workers. Korean J Occup Environ Med. 2000;12:1–11. 20. Son JE, Jang TW, Kim YK, et al. Survey on the prevalence of carpal tunnel syndrome in simple repetitive workers who use upper extremities. Korean J Occup Environ Med. 2001;13:209–219. 21. Choi ER, Jeong SM. A study on the problems and improvement for the police patrol division system. Korean J Criminol. 2004;59:81–123. 22. Noh DH, Wang JH, Choi HR, et al. The effect of shift work on the level of self-rated health. Korean J Occup Environ Med. 2010;22:200–209.
Rhee et al. 23. Kim BK, Kim JY. Status of musculoskeletal disorders in Korea. Korean J Occup Environ Med. 2003;9:7–12. 24. Kwon BH, Park KH, Kim W, Kim YM, Choi HK. Analysis of the epidemiology of musculoskeletal illness in Korea. J Ergon Soc Korea. 2008;9:28–33. 25. Park SK, Choi YJ, Moon DH, Chun JH, Lee JT, Shon HS. Work related musculoskeletal disorders of hairdresser. Korean J Occup Environ Med. 2003;12:395–404. 26. Sung NK, Sakong J, Chung JH. Musculoskeletal disorders and related factors of symphony orchestra players. Korean J Occup Environ Med. 2000;12:48–58. 27. Baker P, Coggon D, Reading I. Barrett D, McLaren M, Cooper C. Sports injury, occupational physical activity, joint laxity and meniscal damage. J Rheumatol. 2002;29: 557–563. 28. Kim KM, Chun CH, Jeong KJ. Meniscal allograft transplantation—clinical results and recovery of sports activity. Korean J Sports Med. 2011;29:15–20.
