Musculoskeletal Disorders and Related Risk Factors in Iranian Military Personnel: A Systematic Review and Meta-Analysis
-
Mehdi Raei
,
Mehran Maleki Roveshti
,
Amin Babaei Pouya
,
Ali Salehi Sahlabadi
,
Mohsen Poursadeghiyan
,
Firooz Valipour
Abstract
Background: Work-Related Musculoskeletal Disorders (WRMSDs) are prevalent and costly diseases in military occupations. WRMSDs are prevalent and costly diseases in military occupations. We investigated the exposure to ergonomic risk factors and the prevalence of musculoskeletal disorders (MSDs) among military personnel in the workplace.
Methods: We aimed to investigate MSDs by conducting electronic searches on Persian databases such as SID, MagIran, and IranMedex, and English databases like PubMed, Web of Sciences, and Scopus. The search was not restricted by time and was conducted until Dec 20, 2021. Two researchers independently extracted the data, and the quality of the research was evaluated using the STROBE checklist. The results of different studies were merged and incorporated into the analysis using Comprehensive Meta-Analysis (CMA) v3 software.
Results: Eleven qualitative studies found that 92% of the respondents were men (83% to 96%). The mean age was 34.17 ± 0.16 yr, with a confidence interval (of 95% CI:33.85-34.48). The mean BMI was 25±0.39 with a confidence interval of 95% CI:24.28-25.84. The mean work record was 12.89±0.81 yr with a confidence interval of 95% CI:11.30-11.48. The highest outbreak of MSDs is in the knee at 38.1% (95%CI:32.1-44.4), 37.6% of the neck (95% CI:24.8-52.5), and 32.5% of the shoulder. (95%CI:22.5-44.3) was observed.
Conclusion: The wide role of various dimensions of work tasks and repetitive tasks (such as lifting, moving or changing positions, standing for long periods, as well as improper postures) in causing WRMSDs. Additionally, the risk factor in the workplace has financial implications for the military organization. The reduction of physical and psychological demands, as well as the improvement of ergonomic standards in the workplace, should be addressed to decrease MSDs in military centers.
1. Askari A, Poursadeghiyan M, Alinia A, et al.( 2023). Workplace Risk Factors Assessment in North-Azadegan Oil Field Based on Harmful Agents Risk Priority Index (HARPI). Iran J Public Health, 52(10):2157-2168.
2. Majdabadi HA, khadri B, Pirposhteh EA, et al. (2022). Relationship between the status of occupational health management and job satisfaction among farmers: A health promotion approach. J Educ Health Promot, 11:390.
3. Ziaeefar P, Hatami H, Panahi D, et al. (2024). Neck Pain Severity and Work Ability Index: A Study of Tehran Dental Students. Iranian Rehabilitation Journal, 22(2):265-276.
4. Roveshti MM, Pouya AB, Pirposhteh EA, et al. (2024). Work-related musculoskeletal disorders and related risk factors among bakers: A systematic review. Work, 77(2):463-476.
5. Khandan M, Eyni Z, Ataei Manesh L, et al (2016). Relationship between Musculoskeletal Disorders and Job Performance among Nurses and Nursing Aides in Main Educational Hospital in Qom Province, 2014. Research Journal of Medical Sciences, 10(4): 307-312.
6. Khandan M, Ataei manesh L, Eyni Z, et al (2016). Relationship between Job content and Demographic Variables with Musculoskeletal Disorders among Nurses in a University Hospital, Qom Province, 2014. Research Journal of Applied Sciences, 11(7):547-553.
7. Khandan M, Aligol MH, Shamsi M, et al (2017). Occupational health, safety, and ergonomics challenges and opportunities based on the organizational structure analysis: A case study in the selected manufacturing industries in Qom Province, Iran, 2015. Ann Trop Med Public Health, 10(3):606-11.
8. Jari A, Niazmand-Aghdam N, Mazhin SA, et al (2022). Effectiveness of Training Program in Manual Material Handling: A Health Promotion Approach. J Educ Health Promot, 11:81.
9. Poursadeghiyan M, Azrah K, Biglari H, et al (2017). Effects of The Manner of Carrying The Bags on Musculoskeletal Symptoms in School Students in The City of Ilam, Iran. Ann Trop Med Public Health, 10(3):600-5.
10. Azizi A, Dargahi A, Amirian F, et al (2016). Investigation the prevalence of work-related musculoskeletal disorders (WRMSDs) among factories packaging workers in Kermanshah (2015). Research Journal of Medical Sciences, 10(4): 319-324.
11. Parno A, Sayehmiri K, Nabi Amjad R, et al (2020). Meta-analysis Study of Work-related Musculoskeletal Disorders in Iran. Archives of Rehabilitation, 21(2) :182-205.
12. Khandan M, Koohpaei A, Kohansal Aghchay M, et al (2017). Assessing the Factors Predicting Work-Related Musculoskeletal Disorders Among Iranian Port’s Personnel Using Regression Model. Iranian Rehabilitation Journal, 15 (4) :309-316.
13. Valipour F, Mohamadian M, Yahyayi E, et al (2016). Assessment of the Staff Working Posture Using REBA, ROSA Methods in a Military Hospital. Health Research Journal, 1(3):171-177.
14. Yarmohammadi H, Niksima S H, Yarmohammadi S ( 2019). Evaluating the Prevalence of Musculoskeletal Disorders in Drivers Systematic Review and Meta-analysis. J Health Saf Work, 9 (3) :221-230.
15. Zambraski E, Yancosek K (2012). Prevention and Rehabilitation of Musculoskeletal Injuries During Military Operations and Training. J Strength Cond Res, 26 Suppl 2:S101-6.
16. Yancosek K, Roy T, Erickson M (2012). Rehabilitation programs for musculoskeletal injuries in military personnel. Curr Opin Rheumatol, 24:232-6.
17. Hauret K, Jones B, Bullock S, Canham-Chervak M, Canada S (2010). Musculoskeletal Injuries Description of an Under-Recognized Injury Problem Among Military Personnel. Am J Prev Med, 38(1 Suppl):S61-70.
18. Lovalekar M, Hauret K, Roy T, et al (2021). Musculoskeletal injuries in military personnel—Descriptive epidemiology, risk factor identification, and prevention. J Sci Med Sport, 24 (10):963-969.
19. Huedo-Medina T, Sanchez-Meca J, Marín-Martínez F, Botella J (2006). Assessing heterogeneity in meta-analysis: Q statistic or I 2 Index? Psychol Methods, 11(2):193-206.
20. Saadatian A, Mirafzal SF, Mirzaei M (2021). Prevalence of Postural Abnormalities and Musculoskeletal Disorders in a military center. Sport Science and Battle Ability, 1 (2):57-67.
21. Sadeghi Yarandi M, Ghasemi M, Ghanjal A (2021). Investigating the Relationship Between Mental Workload, Occupational Stress and Demographic Factors with the Prevalence of Musculoskeletal Disorders and its Disabilities in Flight Security Employees. Journal of Military Medicine, 23 (1):46-57.
22. Piri H, Mirafzal SF, Zavar MR, Rahimi M (2020). Prevalence of Postural Abnormalities and Musculoskeletal Disorders in Ships Staff. Journal Military Medicine, 22 (4):80-6.
23. Alizadeh R, Shariat A, Hakakzadeh A, et al (2020). A comprehensive screening protocol to identify incidence of lower back pain in military office workers. J Pain Manage, 13(1):35-40
24. Golgoli E, Mottaghian H, Roshandel Hesari A (2018). Study of Musculoskeletal Disorders and Pain Prevalence in Computer Operators in Bojnoord. Paramedical Sciences and Military Health, 13 (1):41-46.
25. Yazdanian M, Moradi K, Sobhani V, et al (2018). Assessing the prevalence of musculoskeletal disorders and posture conditions during work time of dentists in a dentistry clinic affiliated to a military college in Tehran in 2017. Journal of Military Medicine, 20(2):222-230.
26. SHokati b, YektaKooshali MH, Zareiyan A, et al (2018). The prevalence of Work-Related Musculoskeletal Disorders among X-ray radiographers those working in Radiology Centers of the hospitals affiliated in AJA University of Medical Sciences: A Cross-Sectional Study. Military Caring Sciences, 4 (3):198-206.
27. Ashnagar M, Mohammadi Z, Ghanbary Sartang A (2017). Relationship between Body Mass Index and Musculoskeletal Disorders and General Health in Military Personnel. Journal of Police Medicine, 6 (2):127-133.
28. Ghanbary Sartang. A, Ashnagar M, Habibi E, Rezaei N (2017). Relationship between Anxiety and Depression with Musculoskeletal Disorders in Military Personnel. Military Caring Sciences, 4 (2):95-101.
29. Pourtaghi G, Karimi Zarchi A, Valipour F, et al (2015). Ergonomic Assessment Using RULA Technique in Determining the Relationship between Musculoskeletal Disorders and Ergonomic Conditions for Administrative Jobs in a Military Center. Journal of Military Medicine, 17(3):155-162.
30. Aghilinezhad M, Ghiasvand M, Heshmat R, et al (2008). Comparison of musculoskeletal complaints between helicopter and aero plane pilots. Journal of Army University of Medical Sciences, 5(4):1391–4.
31. Asadi ZS, Afshari M, Moradinia M, et al (2021). The Effect of Educational Intervention on the Level of Risk of Musculoskeletal Disorders in Different Parts of a Military Unit. Journal of Military Medicine, 23 (6):489-498.
32. Jafari B, Yousef Pour AR, Naji M (2020). The Effect of a Corrective Exercise Course on the Musculoskeletal Disorders of a Military Unit Soldiers. Journal of Military Medicine, 22 (3):235-243.
33. Pourtaghi G, Valipour F, Jabbari M, et al (2020). Investigation of musculoskeletal disorders and its relationship with ergonomic working conditions in small marine personnel. Journal of Military Health Promotion, 1 (1):42-49.
34. Ahmadi Ma, Fakourian A, Kashfi Sm, et al (2020). The Relationship between Temperament, Somatotype and Some Anthropometric Variables and Prevalence of Musculoskeletal Injuries in Military Pilots: A Cross-Sectional Study. Jorjani Biomedicine Journal, 8 (4):42-53.
35. Bahiraei S, Sharbatzadeh R, Fouladi J (2020). Study of Functional Movement Screening Scores and some Damaging Risk Factors in AJA Staff. Sport Science and Battle Ability, 1 (1):11-24.
36. Yasi E, Saffari M, Ghasemi M, et al (2018). The effect of educational intervention on low back pain among air force personnel in a military organization. Journal of Military Medicine, 20(5):519-526.
37. Zarei M (2017). Risk factors for musculoskeletal injuries after basic combat training among Iranian cadets. EBNESINA, 19 (1):36-44.
38. Beyranvand R, Sani M, Azargoun M (2018). The Assessment of Musculoskeletal Condition and Its Relationship with Years of Service and Level of Physical and Mental Health in NEDAJA Submarine Crews of Bandar Abbas in 2016. Journal of Rafsanjan University of Medical Sciences, 17 (1):15-26.
39. Majidi S, Nezami-Asl A, Mokhtarzadeh M (2015). The study of essential factors in designing a military backpack with a focus on mid-sized backpack. EBNESINA, 17 (1):45-55.
40. Shokoohi H, Khoshroo MR (2011). Fitness Measurement of the Combat Troops to Prevent the Skleton and Muscular Disorders due to Inappropriate Design of the Military Equipments. Annals of Military and Health Sciences Research, 9(3):177–172.
41. Jahani MR, Motevalian SA, Asgari AR (2002). Musculoskeletal disabilities among police force personnel of the Islamic Republic of Iran. Mil Med, 167 (10):850-852.
42. Jannesari M, SH A, Sadeghi M, Mohebi H (2005). Causes of Health Care Referals During Military Training. Journal of Military Medicine, 7 (3):187-192.
43. Ghanjal A, Ghanjal M, Meskarpour_Amiri M (2019). Measuring and valuing the lost productivity due to knee osteoarthritis and its effective factors among military personnel. Journal of Military Medicine, 21 (3):234-242.
44. Rezaee Moghaddam F, Azma K, Raeissadat S, et al (2007). Effect of basic military training on knee pain and muscular flexibility of lower limbs. Journal of Military Medicine, 8 (4):255-260.
45. Khosravani H, Ezazi L, Bagheri S (2017). Surveying etiologies of probable sports-combat injuries in female police students. Journal of Police Medicine, 5 (5):379-388.
46. Ghanjal A, Motaqhey M, Sadigh N (2008). The relation between job and field of work with spine discopathies in male military personnel. Journal of Military Medicine, 10 (2):107-112.
47. Mohammadyari S, Aslani M, Zohrabi A (2022). The effect of eight weeks of injury prevention program on performance and musculoskeletal pain in Imam Ali Military University students. Journal of Military Medicine, 23 (5):444-455.
48. Kangar LH, Malekzadeh S, Alizadeh K, et al (2006). The Prevalence of Musculoskeletal Causes of Disability Retirement among Air Force Personnel during 1371-1382. Annals of Military and Health Sciences Research,14(4):813–8.
49. Sanaeinasab H, Saffari M, Valipour F, et al (2018). The effectiveness of a model-based health education intervention to improve ergonomic posture in office computer workers: a randomized controlled trial. Int Arch Occup Environ Health, 91:951-962.
50. Najafi Mehri S, Sadeghian M, Tayyebi A, et al (2010). Epidemiology of physical injuries resulted from military training course. Journal of Military Medicine, 12 (2):89-92.
2. Majdabadi HA, khadri B, Pirposhteh EA, et al. (2022). Relationship between the status of occupational health management and job satisfaction among farmers: A health promotion approach. J Educ Health Promot, 11:390.
3. Ziaeefar P, Hatami H, Panahi D, et al. (2024). Neck Pain Severity and Work Ability Index: A Study of Tehran Dental Students. Iranian Rehabilitation Journal, 22(2):265-276.
4. Roveshti MM, Pouya AB, Pirposhteh EA, et al. (2024). Work-related musculoskeletal disorders and related risk factors among bakers: A systematic review. Work, 77(2):463-476.
5. Khandan M, Eyni Z, Ataei Manesh L, et al (2016). Relationship between Musculoskeletal Disorders and Job Performance among Nurses and Nursing Aides in Main Educational Hospital in Qom Province, 2014. Research Journal of Medical Sciences, 10(4): 307-312.
6. Khandan M, Ataei manesh L, Eyni Z, et al (2016). Relationship between Job content and Demographic Variables with Musculoskeletal Disorders among Nurses in a University Hospital, Qom Province, 2014. Research Journal of Applied Sciences, 11(7):547-553.
7. Khandan M, Aligol MH, Shamsi M, et al (2017). Occupational health, safety, and ergonomics challenges and opportunities based on the organizational structure analysis: A case study in the selected manufacturing industries in Qom Province, Iran, 2015. Ann Trop Med Public Health, 10(3):606-11.
8. Jari A, Niazmand-Aghdam N, Mazhin SA, et al (2022). Effectiveness of Training Program in Manual Material Handling: A Health Promotion Approach. J Educ Health Promot, 11:81.
9. Poursadeghiyan M, Azrah K, Biglari H, et al (2017). Effects of The Manner of Carrying The Bags on Musculoskeletal Symptoms in School Students in The City of Ilam, Iran. Ann Trop Med Public Health, 10(3):600-5.
10. Azizi A, Dargahi A, Amirian F, et al (2016). Investigation the prevalence of work-related musculoskeletal disorders (WRMSDs) among factories packaging workers in Kermanshah (2015). Research Journal of Medical Sciences, 10(4): 319-324.
11. Parno A, Sayehmiri K, Nabi Amjad R, et al (2020). Meta-analysis Study of Work-related Musculoskeletal Disorders in Iran. Archives of Rehabilitation, 21(2) :182-205.
12. Khandan M, Koohpaei A, Kohansal Aghchay M, et al (2017). Assessing the Factors Predicting Work-Related Musculoskeletal Disorders Among Iranian Port’s Personnel Using Regression Model. Iranian Rehabilitation Journal, 15 (4) :309-316.
13. Valipour F, Mohamadian M, Yahyayi E, et al (2016). Assessment of the Staff Working Posture Using REBA, ROSA Methods in a Military Hospital. Health Research Journal, 1(3):171-177.
14. Yarmohammadi H, Niksima S H, Yarmohammadi S ( 2019). Evaluating the Prevalence of Musculoskeletal Disorders in Drivers Systematic Review and Meta-analysis. J Health Saf Work, 9 (3) :221-230.
15. Zambraski E, Yancosek K (2012). Prevention and Rehabilitation of Musculoskeletal Injuries During Military Operations and Training. J Strength Cond Res, 26 Suppl 2:S101-6.
16. Yancosek K, Roy T, Erickson M (2012). Rehabilitation programs for musculoskeletal injuries in military personnel. Curr Opin Rheumatol, 24:232-6.
17. Hauret K, Jones B, Bullock S, Canham-Chervak M, Canada S (2010). Musculoskeletal Injuries Description of an Under-Recognized Injury Problem Among Military Personnel. Am J Prev Med, 38(1 Suppl):S61-70.
18. Lovalekar M, Hauret K, Roy T, et al (2021). Musculoskeletal injuries in military personnel—Descriptive epidemiology, risk factor identification, and prevention. J Sci Med Sport, 24 (10):963-969.
19. Huedo-Medina T, Sanchez-Meca J, Marín-Martínez F, Botella J (2006). Assessing heterogeneity in meta-analysis: Q statistic or I 2 Index? Psychol Methods, 11(2):193-206.
20. Saadatian A, Mirafzal SF, Mirzaei M (2021). Prevalence of Postural Abnormalities and Musculoskeletal Disorders in a military center. Sport Science and Battle Ability, 1 (2):57-67.
21. Sadeghi Yarandi M, Ghasemi M, Ghanjal A (2021). Investigating the Relationship Between Mental Workload, Occupational Stress and Demographic Factors with the Prevalence of Musculoskeletal Disorders and its Disabilities in Flight Security Employees. Journal of Military Medicine, 23 (1):46-57.
22. Piri H, Mirafzal SF, Zavar MR, Rahimi M (2020). Prevalence of Postural Abnormalities and Musculoskeletal Disorders in Ships Staff. Journal Military Medicine, 22 (4):80-6.
23. Alizadeh R, Shariat A, Hakakzadeh A, et al (2020). A comprehensive screening protocol to identify incidence of lower back pain in military office workers. J Pain Manage, 13(1):35-40
24. Golgoli E, Mottaghian H, Roshandel Hesari A (2018). Study of Musculoskeletal Disorders and Pain Prevalence in Computer Operators in Bojnoord. Paramedical Sciences and Military Health, 13 (1):41-46.
25. Yazdanian M, Moradi K, Sobhani V, et al (2018). Assessing the prevalence of musculoskeletal disorders and posture conditions during work time of dentists in a dentistry clinic affiliated to a military college in Tehran in 2017. Journal of Military Medicine, 20(2):222-230.
26. SHokati b, YektaKooshali MH, Zareiyan A, et al (2018). The prevalence of Work-Related Musculoskeletal Disorders among X-ray radiographers those working in Radiology Centers of the hospitals affiliated in AJA University of Medical Sciences: A Cross-Sectional Study. Military Caring Sciences, 4 (3):198-206.
27. Ashnagar M, Mohammadi Z, Ghanbary Sartang A (2017). Relationship between Body Mass Index and Musculoskeletal Disorders and General Health in Military Personnel. Journal of Police Medicine, 6 (2):127-133.
28. Ghanbary Sartang. A, Ashnagar M, Habibi E, Rezaei N (2017). Relationship between Anxiety and Depression with Musculoskeletal Disorders in Military Personnel. Military Caring Sciences, 4 (2):95-101.
29. Pourtaghi G, Karimi Zarchi A, Valipour F, et al (2015). Ergonomic Assessment Using RULA Technique in Determining the Relationship between Musculoskeletal Disorders and Ergonomic Conditions for Administrative Jobs in a Military Center. Journal of Military Medicine, 17(3):155-162.
30. Aghilinezhad M, Ghiasvand M, Heshmat R, et al (2008). Comparison of musculoskeletal complaints between helicopter and aero plane pilots. Journal of Army University of Medical Sciences, 5(4):1391–4.
31. Asadi ZS, Afshari M, Moradinia M, et al (2021). The Effect of Educational Intervention on the Level of Risk of Musculoskeletal Disorders in Different Parts of a Military Unit. Journal of Military Medicine, 23 (6):489-498.
32. Jafari B, Yousef Pour AR, Naji M (2020). The Effect of a Corrective Exercise Course on the Musculoskeletal Disorders of a Military Unit Soldiers. Journal of Military Medicine, 22 (3):235-243.
33. Pourtaghi G, Valipour F, Jabbari M, et al (2020). Investigation of musculoskeletal disorders and its relationship with ergonomic working conditions in small marine personnel. Journal of Military Health Promotion, 1 (1):42-49.
34. Ahmadi Ma, Fakourian A, Kashfi Sm, et al (2020). The Relationship between Temperament, Somatotype and Some Anthropometric Variables and Prevalence of Musculoskeletal Injuries in Military Pilots: A Cross-Sectional Study. Jorjani Biomedicine Journal, 8 (4):42-53.
35. Bahiraei S, Sharbatzadeh R, Fouladi J (2020). Study of Functional Movement Screening Scores and some Damaging Risk Factors in AJA Staff. Sport Science and Battle Ability, 1 (1):11-24.
36. Yasi E, Saffari M, Ghasemi M, et al (2018). The effect of educational intervention on low back pain among air force personnel in a military organization. Journal of Military Medicine, 20(5):519-526.
37. Zarei M (2017). Risk factors for musculoskeletal injuries after basic combat training among Iranian cadets. EBNESINA, 19 (1):36-44.
38. Beyranvand R, Sani M, Azargoun M (2018). The Assessment of Musculoskeletal Condition and Its Relationship with Years of Service and Level of Physical and Mental Health in NEDAJA Submarine Crews of Bandar Abbas in 2016. Journal of Rafsanjan University of Medical Sciences, 17 (1):15-26.
39. Majidi S, Nezami-Asl A, Mokhtarzadeh M (2015). The study of essential factors in designing a military backpack with a focus on mid-sized backpack. EBNESINA, 17 (1):45-55.
40. Shokoohi H, Khoshroo MR (2011). Fitness Measurement of the Combat Troops to Prevent the Skleton and Muscular Disorders due to Inappropriate Design of the Military Equipments. Annals of Military and Health Sciences Research, 9(3):177–172.
41. Jahani MR, Motevalian SA, Asgari AR (2002). Musculoskeletal disabilities among police force personnel of the Islamic Republic of Iran. Mil Med, 167 (10):850-852.
42. Jannesari M, SH A, Sadeghi M, Mohebi H (2005). Causes of Health Care Referals During Military Training. Journal of Military Medicine, 7 (3):187-192.
43. Ghanjal A, Ghanjal M, Meskarpour_Amiri M (2019). Measuring and valuing the lost productivity due to knee osteoarthritis and its effective factors among military personnel. Journal of Military Medicine, 21 (3):234-242.
44. Rezaee Moghaddam F, Azma K, Raeissadat S, et al (2007). Effect of basic military training on knee pain and muscular flexibility of lower limbs. Journal of Military Medicine, 8 (4):255-260.
45. Khosravani H, Ezazi L, Bagheri S (2017). Surveying etiologies of probable sports-combat injuries in female police students. Journal of Police Medicine, 5 (5):379-388.
46. Ghanjal A, Motaqhey M, Sadigh N (2008). The relation between job and field of work with spine discopathies in male military personnel. Journal of Military Medicine, 10 (2):107-112.
47. Mohammadyari S, Aslani M, Zohrabi A (2022). The effect of eight weeks of injury prevention program on performance and musculoskeletal pain in Imam Ali Military University students. Journal of Military Medicine, 23 (5):444-455.
48. Kangar LH, Malekzadeh S, Alizadeh K, et al (2006). The Prevalence of Musculoskeletal Causes of Disability Retirement among Air Force Personnel during 1371-1382. Annals of Military and Health Sciences Research,14(4):813–8.
49. Sanaeinasab H, Saffari M, Valipour F, et al (2018). The effectiveness of a model-based health education intervention to improve ergonomic posture in office computer workers: a randomized controlled trial. Int Arch Occup Environ Health, 91:951-962.
50. Najafi Mehri S, Sadeghian M, Tayyebi A, et al (2010). Epidemiology of physical injuries resulted from military training course. Journal of Military Medicine, 12 (2):89-92.
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| Issue | Vol 53 No 11 (2024) | |
| Section | Review Article(s) | |
| Keywords | ||
| Ergonomic risk factors Musculoskeletal disorder Military Occupational disease Meta-analysis | ||
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How to Cite
1.
Raei M, Maleki Roveshti M, Babaei Pouya A, Salehi Sahlabadi A, Poursadeghiyan M, Valipour F. Musculoskeletal Disorders and Related Risk Factors in Iranian Military Personnel: A Systematic Review and Meta-Analysis. Iran J Public Health. 2024;53(11):2419-2431.
