Prevention and rehabilitation of musculoskeletal pain among abdominal and pelvic surgeons with intelligent physical exercise training (IPET) and intraoperative ergonomic recommendations (ERGO): study protocol for a multicenter open-label randomized controlled trial in Denmark and North America (USA).

BACKGROUND: Surgeons are in high demand due to the ageing population's increased need for surgery. However, the high prevalence of musculoskeletal pain (MSP) threatens their career longevity. While improving intraoperative ergonomics is crucial, physical exercise training is also widely used in managing MSP. The objective is to investigate the added effectiveness of intelligent physical exercise training (IPET) when combined with intraoperative ergonomic recommendations (ERGO), compared to ERGO alone, in reducing MSP among abdominal and pelvic surgeons. METHODS: This pragmatic, multicenter, 20-week, superiority, open-label randomized controlled trial (RCT) is conducted in two phases. Phase 1 is a 3-month ergonomic educational period (ERGO) delivered to all participants. Phase 2 is the RCT, where participants are randomized 1:1 to ERGO (control) or ERGO + IPET (intervention). ERGO provides recommendations for operating room (OR) ergonomics, including posture and microbreaks, displayed in and around ORs. IPET prescribes 50 min of individualized weekly exercise, tailored to MSP, job profile (sedentary, walking/standing, or heavy work), physical capacity, and health risk indicators, and is delivered via a mobile application. Eligible surgeons specialize in gynecology, urology, and colorectal surgery and perform ≥ 4 h/week of abdominal or pelvic surgery (robot-assisted, laparoscopic, or open, excluding vaginal surgery), and complete the Phase 1 questionnaire. Surgeons advised against exercise by their GP are excluded. Participants are recruited from regional and academic hospitals in Denmark and North America. Enrollment begins with completion of the ERGO survey and consent in the baseline questionnaire. Recruitment started 13 December 2023, with a target sample size of 83. The primary effect of interest is the between-group difference in MSP intensity (0-10 numeric rating scale) at 20 weeks in the body part reported as most painful at baseline, analyzed using a linear mixed model with baseline MSP as covariate. Harms include increases in MSP or injury, though these will not be systematically collected. Participants and research staff are not blinded. Outcome interpretation will be blinded to group allocation. DISCUSSION: This trial addresses a gap in strategies to mitigate MSP among surgeons by combining ergonomics recommendations with app-delivered IPET. Findings may inform strategies to improve surgeon well-being and reduce future workforce shortages. TRIAL REGISTRATION: Clinicaltrials.gov, NCT06112106. Registered on October 4, 2023.