A cross-sectional survey of reported musculoskeletal pain, disorders, work volume and employment situation among sign language interpreters

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Abstract

This research sought to determine the prevalence of pain and musculoskeletal disorders (MSDs) among sign language interpreters registered with the Association of Visual Language Interpreters of Canada (AVLIC). Additionally, we sought to measure weekly work volume (durations of exposure to interpreting) and employment situation (salaried or freelance) to understand if work volumes or employment situations impacted reported pain or MSD prevalence.

Over 68% of the AVLIC membership responded to the survey (314 respondents), and 38% of respondents reported being previously medically diagnosed with carpal tunnel syndrome, arthritis, bursitis, thoracic outlet syndrome or tendonitis. At the time of filling out the survey 25% of interpreters reported feeling pain at a level greater than 3 on a 10-point visual-analog scale. Most respondents identified the neck, upper back, and right upper limb as being the location of the pain. In terms of work volume, interpreters working primarily in salaried roles worked significantly more (24.7 ± 9.5 h per week) than those working primarily in freelance roles (21.7 ± 10.9); however there was no difference in pain or MSD reporting between the two groups. These results support previous research identifying that sign language interpreters are at an elevated risk of musculoskeletal problems. In addition, these findings demonstrate that both freelance and salaried interpreters are equally at risk, although salaried interpreters are exposed to a greater weekly dose of interpreting. Therefore intervention efforts should focus on factors present in both employment situations, such as total weekly exposure time or work–rest relationships.

Relevance to industry

Intervention is needed to help curb the pronounced MSD rates among sign language interpreters. Administrative controls to manage weekly exposures and work-rest ratios (similar to little league pitchers) may be beneficial for both salaried and freelance interpreters.

Highlights

► Interpreters were surveyed about their work demands, pain and past injuries. ► Salaried interpreters work more hours per week than freelance interpreters. ► Salaried interpreters work more time in solo roles than freelance interpreters. ► Despite work volume differences both groups share a similar prevalence of MSD. ► Freelance and salaried interpreters are likely both overexposed.

Introduction

Sign language interpreters play a key role assisting the participation of Deaf people within a society where most rely on verbal communication. However there is a growing body of literature that shows a high prevalence of pain amongst sign language interpreters (Stedt, 1992, Sweeney et al., 1994, Feuerstein et al., 1997, Cohn et al., 1990, Scheuerle et al., 2000). Although a systematic review of the literature (Fischer et al., in press) revealed that most of the research was of a low to moderate quality, there was consistency in the observation that sign language interpreters are susceptible to work-related musculoskeletal injury.

For example, the National Institute for Occupational Safety and Health (NIOSH) in the USA reported that 92% of surveyed interpreters reported pain within the previous year, where 20% of respondents met their symptom case definition for a work-related upper extremity musculoskeletal disorder (MSD) (Sweeney et al., 1994). Similarly, Feuerstein et al. (1997), found that 32 and 29% of the interpreters surveyed met the NIOSH symptom case definition, for the hand and shoulder respectively. Cohn et al. (1990) reported on the medical diagnoses for fourteen interpreters who sought medical attention for their symptoms. They found that most interpreters suffered from myofasciitis or tendonitis in the right upper limb, at the fingers, wrist, elbow or shoulder, which the authors attributed to repetitive use and fatigue (Cohn et al., 1990). Research has consistently shown that interpreters are at a high risk for pain and MSDs, particularly in the neck, and right upper limb.

Research investigating why interpreters have an increased prevalence of MSD and injury is more limited (Fischer et al., in press). Few studies were able to identify specific pain and MSD risk factors for sign language interpreters. However, three factors from the literature had at least limited support, including mechanical exposure, stress, and speaker’s pace (which directly impacts mechanical exposures). In terms of mechanical exposures, two studies (Delisle et al., 2005, Qin et al., 2008) have demonstrated that sign language interpreters are exposed to wrist motions well in excess of the high-risk thresholds reported by Marras and Schoenmarklin (1993). Although stress has also been identified, research demonstrating how stress influences exposure, pain and MSD is sparse, and interventions focused on stress reducing techniques among interpreters have shown mixed results (Delisle et al., 2007).

The challenge in understanding risk factors for MSD during interpreting is further complicated by the employment situations of interpreters. Sign language interpreters are divided into either salaried (employed by a company or institution) or freelance (self-employed, or short-term contracts) employment. To date, existing research has either treated interpreters as a singular group (Sweeney et al., 1994, Feuerstein et al., 1997), or has focused on salaried interpreters (Cohn et al., 1990, Delisle et al., 2005, Qin et al., 2008). Important insights may be gained by understanding how their exposures differ, and if these differences are reflected in their reporting of pain and injury.

The purpose of this research was three-fold: first, we aimed to quantify the prevalence of pain and MSD among Canadian sign language interpreters. Second, by classifying interpreters based on their employment situation, we aimed to understand if freelance and salaried interpreters were exposed to different work volumes. Third, whether or not work volumes were different, we aimed to determine if pain and MSD experience differed. Based on anecdotal communications with senior members in the Association of Canadian Visual Language Interpreters of Canada (AVLIC), we expected salaried interpreters to have greater work volumes and consequently be more likely to report pain and MSDs than freelance interpreters who have control over their work volume.

Section snippets

Participants

Participants were recruited from the AVLIC membership. Members were contacted for participation through an advertisement in their quarterly newsletter. Additional contact was made by having local chapter representatives advertise the study at regional meetings to ensure participation from respondents all across Canada. Interested participants were directed to an internet web-link allowing them to fill in the survey at their own convenience. The questionnaire was administered using a platform

Demographics

The questionnaire received 314 responses, 68% of the 465 members of AVLIC at the time of administering the survey in 2007. Since that time AVLIC’s membership has grown to over 600 members across Canada, demonstrating the growth of the profession. Of those responding 287 (92%) were female, with an average age of 37.2 ± 9.2 years and an average body mass index (BMI) of 26.2 ± 6.1 kg/m2, while male interpreters had an average age of 38.4 ± 7.9 years and an average BMI of 31.9 ± 3.7 kg/m2. More

Discussion

Sign language interpreters collectively reported a high prevalence of pain and MSD, consistent with our hypothesis and the previous literature. In addition, salaried interpreters were exposed to longer single and weekly durations of interpreting, also consistent with the anecdotal evidence. However, contrary to our expectation, the exposure differences between employment categories were not reflected in pain and MSD reporting. Either pain and MSD prevalence among sign language interpreters is

Conclusion

Interpreters registered with the Association of Visual Language Interpreters of Canada have a high prevalence of MSDs and report pain predominantly in their neck, upper back and right upper limb. Although salaried interpreters worked 12% more hours per week, 43% more time in solo interpreting situations and 30% longer maximum bouts of solo interpreting than freelance interpreters, MSD prevalence and pain intensity remained consistent between the groups. In the context of previous literature,

Acknowledgements

We are grateful for the immense practical assistance of the Association of Visual Language Interpreters of Canada (AVLIC), and the financial support of the Bridging the Gap program of the Ontario WSIB Research Advisory Council.

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