Working posture assessment using the RULA: methodological framework and pilot application among surgeons

Introduction. Working posture assessment is important in occupational health and occupational medicine because unfavorable positions of body segments form postural load associated with musculoskeletal disorders. The RULA method provides sequential assessment of the upper limb and hand, neck, trunk, and lower limbs, as well as muscle work and external load. The lack of a unified Russian-language algorithm limits standardized use of the method.

The aim of the study is to present the methodological framework for working posture assessment using the RULA method in Russian and to pilot the method among surgeons.

Materials and methods. The study included a methodological description of the RULA algorithm with preservation of the original calculation structure and pilot application in the analysis of 28 operations. The most unfavorable working posture during the main stage of the intervention was assessed. Operations were grouped by variants of surgical work organization: microscope-assisted, laparoscopic, open, and endovascular procedures. The final RULA score, group A and group B scores, and the ΔA — B index were determined. The Kruskal–Wallis and Wilcoxon tests were used.

Results. In all variants of surgical work, the final RULA score reached 7. In microscope-assisted, laparoscopic, and open operations, group A scores exceeded group B scores (p=0,031; p=0,031; p=0,002), indicating the leading contribution of upper limb and hand position. In endovascular operations, a tendency toward predominance of group B was observed, reflecting a greater contribution of neck, trunk, and lower limb position (p=0,063). Intergroup differences in the component profile were significant (p<0,001).

Limitations. The study was observational, included a limited number of observations, and involved heterogeneous operations within the groups.

Conclusion. The Russian-language presentation of RULA can be used as a standardized tool for ergonomic assessment of working posture. Analysis of the balance between groups A and B makes it possible to clarify the mechanisms of unfavorable posture formation and substantiate targeted preventive measures.

Ethics. The study was approved by the Local Ethics Committee of the East-Siberian Institute of Medical and Ecological Research (Protocol No. 3 dated March 24, 2025) and was conducted in accordance with the principles of the Declaration of Helsinki of the World Medical Association, as revised in 2013. All participants provided voluntary informed consent.

Contributions:
Budaev A.E. — study concept and design, manuscript drafting, editing;
Lakhman O.L. — study concept and design, editing.

Use of AI. During manuscript preparation, ChatGPT, GPT-5.5 Thinking (OpenAI), was used for text editing and searching for additional literature sources; date of use: June 9, 2026.

Funding. The study was performed within the funds allocated for the state assignment of the East-Siberian Institute of Medical and Ecological Research.

Conflict of interest. The authors declare no conflict of interest.

Received: 31.07.2026 / Accepted: 31.08.2026 / Published: 11.09.2026

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