Development of a multidimensional scale for discomfort related to personal protective equipment and its exploratory association with musculoskeletal symptoms among Korean healthcare workers during the COVID-19 pandemic

Abstract

The COVID-19 pandemic required healthcare workers (HCWs) to use personal protective equipment (PPE) for prolonged periods, raising concerns about its possible relationship with musculoskeletal disorders (MSDs). PPE-related discomfort, however, is multidimensional, encompassing both direct wearing burden and organisational aspects of its deployment. How these two dimensions relate to MSDs has rarely been examined. This cross-sectional study analysed 565 Korean physicians, nurses and medical technicians who had directly cared for patients with COVID-19. A 17-item PPE Discomfort Scale was developed and its factor structure was examined using exploratory factor analysis with oblique rotation. As an exploratory objective, cross-sectional associations between PPE-related discomfort and MSDs were examined using hierarchical modified Poisson regression, adjusting sequentially for demographic, occupational, ergonomic and psychosocial covariates. Exploratory factor analysis yielded two factors; direct wearing burden (Factor 1) and organisational vulnerability (Factor 2). The prevalence of MSDs was 37.2%, with the lower back most frequently affected (19.5%). Greater total PPE discomfort was associated with MSDs (adjusted prevalence ratio 1.60, 95% CI 1.18–2.16 in the ergonomic-adjusted model). When the two subscales were entered simultaneously, the association was observed for organisational vulnerability (1.48, 95% CI 1.14–1.93), but not for direct wearing burden (0.98, 95% CI 0.67–1.44). Sleep disturbance, traumatic experience, current smoking and ergonomic exposure were independently associated with MSDs. After further adjustment for current smoking, sleep disturbance and traumatic experience, these associations were attenuated and no longer statistically significant (total score 1.28, 95% CI 0.95–1.74; organisational vulnerability 1.25, 95% CI 0.96–1.62), whereas ergonomic exposure remained associated with MSDs. The PPE Discomfort Scale identified two dimensions: direct wearing burden and organisational vulnerability, supporting a multidimensional conceptualisation of PPE-related discomfort. In exploratory analyses, organisational vulnerability showed a stronger association with MSDs, although this association was attenuated after additional adjustment. Further studies are needed to confirm the factor structure and evaluate the scale in other healthcare settings.