The association between musculoskeletal disorders and lead apron use in healthcare workers: A systematic review and meta-analysis

Background: Radiation protective garments, commonly called lead aprons, are required to be worn by healthcare workers to reduce radiation exposure. There is growing evidence that wearing lead aprons may be associated with increased prevalence of musculoskeletal disorders, which can result in ended careers or reduced capacities. Methods: Keywords were identified using the PICO method and combined in searches using Boolean operators. Literature searches were conducted in PubMed, Scopus, Web of Science, and using Ovid. Additional literature was identified using academic search engines and reference reviews. The PRISMA 2020 Statement guidelines were followed for article selection. Quality reviews were conducted on included studies using the LEGEND Evidence Evaluation System. A meta-analysis was then performed using calculated odds-ratios comparing musculoskeletal disorder prevalence in lead apron wearers against a baseline population prevalence. Results: 1,873 articles were identified in initial searches, which resulted in thirty-one included studies after screening. Included studies contained 8,280 participants with over 4,500 occurrences of musculoskeletal pain. The overall body of evidence quality was low. Four of six non-cross-sectional studies found a negative consequence of wearing lead aprons. Meta-analysis of cross-sectional studies resulted in a combined odds ratio of 3.83 (95 % CI: 2.67-5.48, p < 0.01), with I-2 at 90 %. Studies from Asian countries indicated higher odds ratios than other regions. There were no statistical differences between the rate of individuals who felt that lead apron use caused their musculoskeletal disorder and the mean prevalence of musculoskeletal disorders in lead apron wearers. Conclusions: A significant potential of injury is associated with wearing lead aprons in healthcare settings. Ergonomic interventions, training, and strategies like those implemented by organizations that require body armor to be utilized, such as reduced wear times and reduced weight, should be considered to reduce the potential of injury.