The Impact of Intraoperative Stretching Microbreaks on Otolaryngologists
Phase: NA
Conditions: Postural; Strain
Sponsor: George Washington University

1 
 
Cover Page 
 
● Official title of the study 
The impact of intraoperative stretching microbreaks on otolaryngologists 
 
• IRB number 
NCR203032 
 
• Date of the document 
January 21, 2021 
 
 
 

2 
 
 
 
 
 
 
 
 
 
 
Ergonomics in ENT 
 
 
 

3 
 
Table of Contents 
Protocol 
3 
Preliminary Questionnaire 
6 
Pre-surgery questionnaire 
10 
Post-surgery Control 
11 
Post-surgery Intervention 
13 
Exit Questionnaire 
16 
 
 
 

4 
 
Protocol 
 
● Principal Investigator 
Name: Philip E. Zapanta, M.D., F.A.C.S. 
Department: Otolaryngology  
 
● Co-investigators 
Name: Daniel A. Benito, M.D. 
Department: Otolaryngology 
 
Name: Weston Niermeyer, M.D. 
Department: Otolaryngology 
 
Name: Keith Cole, Ph.D. 
Department: Physical therapy program 
 
● Student investigator 
Name: Esther Lee 
Department: Otolaryngology 
 
● Purpose of the study 
- 
To gather baseline data on the prevalence and impact of musculoskeletal symptoms 
among otolaryngologists in George Washington University Hospital network. 
- 
To examine the influence of otolaryngology stretching micro-breaks (OSMB) on their 
physical performance, mental focus, and self-reported pain and discomfort among 
otolaryngologists in George Washington University Hospital network.  
 
● Enrollment Criteria 
- 
Age: 18-80 
- 
Attending physicians, residents, and fellows affiliated with The George Washington 
University and Children’s National Medical Center Division of Otolaryngology-Head & 
Neck Surgery.  
 
● Sample size 
- 
N= 26  
▪ 
9 attending physicians and 8 residents at GWU 
▪ 
9 attending physicians at Children’s National Medical Center  
 
● Recruitment Methods 
- 
An E-mail will be sent out to attending physicians and residents affiliated at GWU and 
Children’s National inviting them to participate in the study.  
 

5 
 
● Research Locations 
- 
George Washington University Hospital 
- 
Children’s National Medical Center  
 
● Methods 
- 
Intervention 
▪ 
Otolaryngology stretching micro-breaks (OSMB)= standardized microbreak 
stretch that is designed to perform intraoperatively within the sterile field at 
medically convenient 20-40 min intervals throughout each procedure.  
 
- 
Assessment tools (see the table of content to view survey) 
▪ 
Preliminary questionnaire- given at the beginning of the study 
● Assess demographic information, ergonomic questions, and 
musculoskeletal symptom questions  
▪ 
Pre-surgery questionnaire (baseline)- given prior to each surgery to establish a 
baseline 
● Body part discomfort (validated survey with 0-5 score on the neck, 
shoulder R/L, hand R/L, lower/upper back, knee R/L, foot R/L)  
 
- 
Post-surgery questionnaire for CONTROL day- given after each surgery 
▪ 
Surg-TLX and GOAL questionnaire- assess the degree of difficulty of the surgery 
▪ 
Body part discomfort sore 
- 
Post-surgery questionnaire for INTERVENTION day- - given after each surgery 
▪ 
Surg-TLX and GOAL questionnaire- assess the degree of difficulty of the surgery 
▪ 
Body part discomfort sore 
▪ 
Questions on OSMB  
- 
Exit questionnaire after the study is completed 
▪ 
2 questions asking whether the participant would incorporate OSMB in their 
routine OR cases, and would recommend OSMB to colleagues. 
 

6 
 
● Study design 
- 
Crossover study design 
- 
Control: 3 Non-OSMB surgical days  
- 
Intervention: 3 OSMB surgical days 
- 
In order to reduce confounding variables, study will focus on open neck cases. (e.g. 
thyroidectomy, parathyroidectomy, neck dissection, etc)  
- 
We will adjust for surgical duration, and use Surg-TLX, and GOAL questionnaires to 
show no statistically significant difference between control and intervention surgical 
cases.  
- 
Outcome measures 
▪ 
Primary outcome= difference between self-reported body part discomfort 
score from before/after surgery  
● Control the surgical environment and difficulty using Surg-TLX and GOAL 
questionnaires. The score should be statistically insignificant among 
various surgeries. 
▪ 
Secondary outcome= impact of OSMB on physical performance, 
discomfort/pain, fatigue, and mental focus 
▪ 
Tertiary outcome= distraction and workflow interruption of OSMB 
 
● Statistics 
- 
Descriptive statistics to calculate the prevalence and impact of musculoskeletal 
symptoms  
- 
Descriptive statistics to characterize demographic information on participants 
- 
Linear mixed models: Used to test for an association between pain and the targeted 
micro-break intervention 
- 
Statistical significance is set at 0.05 (Bonferroni adjustment for measurement on 11 body 
parts.) 

7 
 
Preliminary Questionnaire 
 
 
 
 

8 
 
 

9 
 
 

10 
 
 
 

11 
 
Pre-surgery questionnaire 
 
 
 
 

12 
 
Post-surgery Control 
 

13 
 
 

14 
 
Post-surgery Intervention 
 
 
 
 

15 
 
 

16 
 
 

17 
 
Exit Questionnaire