Observatoire des troubles musculo-squelettiques des actifs agricoles

Bilan 2011-2015
Toute démarche de prévention devant nécessairement s'appuyer sur un état des lieux, ce bilan national permet de connaître plus précisément les caractéristiques en France des Troubles Musculo-Squelettiques (TMS) dans le secteur agricole.
Les principaux objectifs de cette étude sont de :
- suivre, sur les cinq dernières années, l'évolution annuelle d'indicateurs spécifiques pour les TMS des actifs agricoles dont les données ou caractéristiques sont connues et consolidées, regrouper ces indicateurs dans des tableaux de bord,
- établir un bilan national sur des grandes tendances, à partir de quelques indicateurs de référence couramment utilisés (nombre de maladies avec et sans arrêt de travail, nombre de maladies graves, indice et taux de fréquence des maladies avec et sans arrêt de travail, coût des maladies, …),
- répondre à l'accord cadre des partenaires sociaux européens en agriculture en centralisant les données relatives aux TMS en agriculture.

Source: http://ssa.msa.fr/lfr/documents/21447876/0/11953%20Observatoire%20des%20TMS%202011%202015/34b585be-8f72-4496-b62e-fa8526710474

Predicting Forearm Physical Exposures During Computer Work Using Self-Reports, Software-Recorded Computer Usage Patterns, and Anthropometric and Workstation Measurements

Objectives: Alternative techniques to assess physical exposures, such as prediction models, could facilitate more efficient epidemiological assessments in future large cohort studies examining physical exposures in relation to work-related musculoskeletal symptoms. The aim of this study was to evaluate two types of models that predict arm-wrist-hand physical exposures (i.e. muscle activity, wrist postures and kinematics, and keyboard and mouse forces) during computer use, which only differed with respect to the candidate predicting variables; (i) a full set of predicting variables, including self-reported factors, software-recorded computer usage patterns, and worksite measurements of anthropometrics and workstation set-up (full models); and (ii) a practical set of predicting variables, only including the self-reported factors and software-recorded computer usage patterns, that are relatively easy to assess (practical models).
Methods: Prediction models were build using data from a field study among 117 office workers who were symptom-free at the time of measurement. Arm-wrist-hand physical exposures were measured for approximately two hours while workers performed their own computer work. Each worker's anthropometry and workstation set-up were measured by an experimenter, computer usage patterns were recorded using software and self-reported factors (including individual factors, job characteristics, computer work behaviours, psychosocial factors, workstation set-up characteristics, and leisure-time activities) were collected by an online questionnaire. We determined the predictive quality of the models in terms of R2 and root mean squared (RMS) values and exposure classification agreement to low-, medium-, and high-exposure categories (in the practical model only).
Results: The full models had R2 values that ranged from 0.16 to 0.80, whereas for the practical models values ranged from 0.05 to 0.43. Interquartile ranges were not that different for the two models, indicating that only for some physical exposures the full models performed better. Relative RMS errors ranged between 5% and 19% for the full models, and between 10% and 19% for the practical model. When the predicted physical exposures were classified into low, medium, and high, classification agreement ranged from 26% to 71%.
Conclusion: The full prediction models, based on self-reported factors, software-recorded computer usage patterns, and additional measurements of anthropometrics and workstation set-up, show a better predictive quality as compared to the practical models based on self-reported factors and recorded computer usage patterns only. However, predictive quality varied largely across different arm-wrist-hand exposure parameters. Future exploration of the relation between predicted physical exposure and symptoms is therefore only recommended for physical exposures that can be reasonably well predicted.

Source: Huysmans, M. A., Eijckelhof, B. H., Garza, J. L. B., Coenen, P., Blatter, B. M., Johnson, P. W., ... & Dennerlein, J. T. (2017). Annals of work exposures and health, 62(1), 124-137.

Accuracy of identification of low or high risk lifting during standardised lifting situations

The aim was to classify lifting activities into low and high risk categories (according to The Danish Working Environment Authority guidelines) based on surface electromyography (sEMG) and trunk inclination (tri-axial accelerometer) measurements. Lifting tasks with different weights, horizontal distance and technique were performed. The lifting tasks were characterised by a feature vector composed of either the 90th, 95th or 99th percentile of sEMG activity level and trunk inclinations during the task. Linear Discriminant Analysis and a subject-specific threshold scheme were applied and lifting tasks were classified with an accuracy of 65.1–65.5%. When lifts were classified based on the subject-specific threshold scheme from low and upper back accelerometers, the accuracy reached 52.1–58.1% and 72.7–78.1%, respectively. In conclusion, the use of subject-specific thresholds from sEMG from upper trapezius and erector spinae as well as inclination of the upper trunk enabled us to identify low and high risk lifts with an acceptable accuracy.

Source: Brandt, M., Madeleine, P., Samani, A., Jakobsen, M. D., Skals, S., Vinstrup, J., & Andersen, L. L. (2017). Ergonomics, 1-10.

Inter-day reliability of surface electromyography recordings of the lumbar part of erector spinae longissimus and trapezius descendens during box lifting

Background: Low back pain and neck-shoulder pain are the most reported types of work-related musculoskeletal disorders, and performing heavy lifting at work and working with trunk rotation increase the risk of developing work-related musculoskeletal disorders. Surface electromyography (sEMG) provides information about the electrical activity of muscles. Thus it has the potential to retrieve indirect information about the physical exposure of specific muscles of workers during their actual work. This study aimed to investigate the inter-day reliability of absolute and normalized amplitude of sEMG measurements obtained during repeated standardized reference lifts.
Methods: The inter-day reliability of sEMG of the erector spinae longissimus and trapezius descendens muscles was tested during standardized box lifts. The lifts were performed with loads of 3, 15 and 30 kg from floor to table and from table to table in three conditions, i.e., forearm length (short reaching distance), ¾ arm length (long reaching distance) and forearm length with trunk rotation. Absolute and normalized root mean square (absRMS and normRMS) values were extracted. In line with the guidelines for reporting reliability and agreement studies, we reported relative and absolute reliability estimated by intra class correlation (ICC3,K), standard error of measurement (SEM) and minimal detectable change in percent (MDC).
Results: The ICC3,K was higher for absRMS compared with normRMS while SEM and maximal voluntary contraction (MVC) were similar. A total of 50 out of 56, i.e., 89%, and 41 out of 56, i.e., 73%, of the lifting situations were in the range from moderate to almost perfect for absRMS and normRMS, respectively. The SEM and MDC shoved more variation in the lifting situations performed from floor to table and in the trapezius descendens muscle than in the erector spinae longissimus muscle.
Conclusion: This reliability study showed that maximum absRMS and normRMS were found to have a fair to substantial relative inter-day reliability for most lifts but were more reliable when lifting from table to table than from floor to table for both trapezius descendens and erector spinae muscles. The relative inter-day reliability was higher for absolute compared with normalized sEMG amplitudes while the absolute reliability was similar.

Source: Brandt, M., Andersen, L. L., Samani, A., Jakobsen, M. D., & Madeleine, P. (2017). BMC musculoskeletal disorders, 18(1), 519.

Sit-stand workstations and impact on low back discomfort

A systematic review and meta-analysis
Background: Sit-stand workstations are proposed solutions to reduce sedentary time at work. Numerous companies are using them to mitigate health concerns such as musculoskeletal discomfort. Objective: To review the literature on sit-stand workstations and low back discomfort. Method: We conducted a meta-analysis on literature published before 17 November 2016 that addressed the relationship between sit-stand workstations and musculoskeletal discomfort, focusing on the low back. Results: Twelve articles were identified and eight that presented results in means (SD) were included. Among a pain-free population, the standardised mean difference was −0.230 for low back discomfort with use of sit-stand workstations. When applying the SMD to studies using the 10-point pain scale, the effect estimates ranged between −0.30 and −0.51. Conclusion: sit-stand workstations may reduce low back pain among workers. Further research is needed to help quantify dosage parameters and other health outcomes.

Source: Agarwal, S., Steinmaus, C., & Harris-Adamson, C. (2017). Ergonomics, 1-15.

Z412-17 - Office ergonomics - An application standard for workplace ergonomics

This is the third edition of CSA Z412, Office ergonomics — An application standard for workplace ergonomics. It supersedes previous editions published as guidelines in 2000 and 1989 under the title Guideline on Office Ergonomics. The present edition includes updates to reflect new technology and work practices, and is now presented in the form of a standard rather than a guideline.
The objective of this Standard is to apply ergonomics to enhance user health, safety, and well-being and to optimize system performance in order to prevent occupational injuries and illnesses or to reduce the severity of harm related to occupational activities in offices.

Source: http://shop.csa.ca/en/canada/office-ergonomics/z412-17/invt/27011972017

Frequent Exertion and Frequent Standing at Work, by Industry and Occupation Group - United States, 2015

Repeated exposure to occupational ergonomic hazards, such as frequent exertion (repetitive bending or twisting) and frequent standing, can lead to injuries, most commonly musculoskeletal disorders. Work-related musculoskeletal disorders have been estimated to cost the United States approximately $2.6 billion in annual direct and indirect costs. A recent literature review provided evidence that prolonged standing at work also leads to adverse health outcomes, such as back pain, physical fatigue, and muscle pain. To determine which industry and occupation groups currently have the highest prevalence rates of frequent exertion at work and frequent standing at work, CDC analyzed data from the 2015 National Health Interview Survey (NHIS) Occupational Health Supplement (OHS) regarding currently employed adults in the United States. By industry, the highest prevalence of both frequent exertion and frequent standing at work was among those in the agriculture, forestry, fishing, and hunting industry group (70.9%); by occupation, the highest prevalence was among those in the construction and extraction occupation group (76.9%). Large differences among industry and occupation groups were found with regard to these ergonomic hazards, suggesting a need for targeted interventions designed to reduce workplace exposure.

Source: https://www.cdc.gov/mmwr/volumes/67/wr/mm6701a1.htm

The efficacy of interventions for low back pain in nurses

A systematic review
OBJECTIVES: To investigate the efficacy of interventions for the prevention and treatment of low back pain in nurses.
DESIGN: Systematic review.
DATA SOURCES: The review was registered on the PROSPERO database (CRD42015026941) and followed the PRISMA statement guidelines. A two phase approach was used. In phase one, all randomised controlled trials included in the systematic review of Dawson et al. (2007) which reviewed interventions for low back pain in nurses until 2004 were selected. In phase two, relevant randomised controlled trials and cluster randomised controlled trials published from 2004 until December 2015 were identified by an electronic search of nine databases (Embase, CINAHL, SPORTDiscus, PsycARTICLES, Cochrane Library, Web of Science, PEDro, Scopus and MEDLINE). To be eligible, trials had to examine the efficacy of interventions either for the prevention or treatment of low back pain in nurses. Primary outcomes of interest were any measure of pain and/or disability.
REVIEW METHODS: Three reviewers independently assessed eligibility and two reviewers independently conducted a risk of bias assessment (Cochrane Back and Neck Group).
RESULTS: Four studies were retrieved from phase one. In phase two, 15,628 titles and abstracts were scanned. From these, 150 full-text studies were retrieved and ten were eligible. Fourteen studies (four from phase one, ten from phase two) were eligible for risk of bias assessment. The included trials were highly heterogeneous, differing in pain and disability outcome measures, types of intervention, types of control group and follow-up durations. Only four of the included studies (n=644 subjects) had a low risk of bias (≥6/12). Manual handling training and stress management in isolation were not effective in nurses with and without low back pain (risk of bias, 7/12, n=210); the addition of a stretching exercise intervention was better than only performing usual activities (risk of bias, 6/12, n=127); combining manual handling training and back school was better than passive physiotherapy (risk of bias, 7/12, n=124); and a multidimensional intervention (risk of bias, 7/12, n=183) was not superior to a general exercise program in reducing low back pain in nurses.
CONCLUSIONS: Only four relevant low risk of bias randomised controlled trials were found. At present there is no strong evidence of efficacy for any intervention in preventing or treating low back pain in nurses. Additional high quality randomised controlled trials are required. It may be worth exploring the efficacy of more individualised multidimensional interventions for low back pain in the nursing population.

Source: Van Hoof, W., O'Sullivan, K., O'Keeffe, M., Verschueren, S., O'Sullivan, P., & Dankaerts, W. (2018). International journal of nursing studies, 77, 222-231.

Prediction models to identify workers at risk of sick leave due to low-back pain in the Dutch construction industry

Objective: The aim of this study was to develop a prediction model based on variables measured in occupational health checks to identify non-sick listed workers at risk of sick leave due to non-specific low-back pain (LBP).
Methods: This cohort study comprised manual (N=22 648) and non-manual (N=9735) construction workers who participated in occupational health checks between 2010 and 2013. Occupational health check variables were used as potential predictors and LBP sick leave was recorded during 1-year follow-up. The prediction model was developed with logistic regression analysis among the manual construction workers and validated in non-manual construction workers. The performance of the prediction model was evaluated with explained variances (Nagelkerke's R-square), calibration (Hosmer-Lemeshow test), and discrimination (area under the receiver operating curve, AUC) measures.
Results: During follow-up, 178 (0.79%) manual and 17 (0.17%) non-manual construction workers reported LBP sick leave. Backward selection resulted in a model with pain/stiffness in the back, physician-diagnosed
musculoskeletal disorders/injuries, postural physical demands, feeling healthy, vitality, and organization of work as predictor variables. The Nagelkerke's R-square was 3.6%; calibration was adequate, but discrimination was poor (AUC=0.692; 95% CI 0.568–0.815).
Conclusions: A prediction model based on occupational health check variables does not identify non-sick listed workers at increased risk of LBP sick leave correctly. The model could be used to exclude the workers at the lowest risk on LBP sick leave from costly preventive interventions.

Source: Bosman LC, Dijkstra L, Joling CI, Heymans MW, Twisk JWR, Roelen CAM. (2018). Scand J Work Environ Health.

Développement du monoripage et conditions de travail

Depuis quelques années se développe la pratique du monoripage, c'est-à-dire la collecte des déchets par un équipage constitué d'un opérateur de collecte et d'un chauffeur. Une étude menée par l'INRS révèle que dans les conditions observées une telle collecte est physiquement plus intense que celle réalisée en biripage.
Elle présente alors un risque plus élevé de troubles musculosquelettiques et une astreinte cardiaque excessive. L'étude montre qu'il est possible, pour une collectivité territoriale, d'imposer dans le cahier des charges d'un marché de collecte, les conditions sous lesquelles les entreprises sont autorisées à proposer des collectes en monoripage, de façon à préserver la santé et la sécurité des opérateurs.

Source: Delecroix, B., Salmon, I., Desbrosses, K., Vieira, M., Adam, B. (2017). Références en santé au travail (152), 53-63.

Economic evaluations of ergonomic interventions preventing work-related musculoskeletal disorders

A systematic review of organizational-level interventions
Background: Work-related musculoskeletal disorders (WMSD) represent a major public health problem and economic burden to employers, workers and health insurance systems. This systematic review had two objectives: (1) to analyze the cost-benefit results of organizational-level ergonomic workplace-based interventions aimed at preventing WMSD, (2) to explore factors related to the implementation process of these interventions (obstacles and facilitating factors) in order to identify whether economic results may be due to a successful or unsuccessful implementation.
Methods: Systematic review. Studies were searched in eight electronic databases and in reference lists of included studies. Companion papers were identified through backward and forward citation tracking. A quality assessment tool was developed following guidelines available in the literature. An integration of quantitative economic results and qualitative implementation data was conducted following an explanatory sequential design.
Results: Out of 189 records, nine studies met selection criteria and were included in our review. Out of nine included studies, grouped into four types of interventions, seven yielded positive economic results, one produced a negative result and one mixed results (negative cost-effectiveness and positive net benefit). However, the level of evidence was limited for the four types of interventions given the quality and the limited number of studies identified. Our review shows that among the nine included studies, negative and mixed economic results were observed when the dose delivered and received by participants was low, when the support from top and/or middle management was limited either due to limited participation of supervisors in training sessions or a lack of financial resources and when adequacy of intervention to workers' needs was low. In studies where economic results were positive, implementation data showed strong support from supervisors and a high rate of employee participation.
Conclusion: Studies investigating the determinants of financial outcomes of prevention related to implementation process are very seldom. We recommend that in future research economic evaluation should include information on the implementation process in order to permit the interpretation of economic results and enhance the generalizability of results. This is also necessary for knowledge transfer and utilization of research results for prevention-oriented decision-making in occupational health and safety.

Source: Sultan-Taïeb, H., Parent-Lamarche, A., Gaillard, A., Stock, S., Nicolakakis, N., Hong, Q. N., ... et Berthelette, D. (2017). BMC public health, 17(1), 935.

Musculoskeletal Symptoms Among Finnish Professional Orchestra Musicians

BACKGROUND: The prevalence of musculoskeletal symptoms is high among professional musicians (73-88%). AIMS: We investigated the prevalence of musculoskeletal symptoms in Finnish symphony orchestra musicians. We compared individual instruments as well as the perceived demands of orchestral programs and difficulties in recovering after performances. METHODS: In this cross-sectional questionnaire 920 of 2,785 members of the Finnish Musicians Union (33%) completed the questionnaire, including 361 full-time members of symphony orchestras. Questions about pain symptoms and frequency were based on the national survey done in 2011. RESULTS: Among the 361 full-time orchestra musicians, those playing all instruments experienced frequent pain, both in the last 30 days and exceeding 30 days in the last 12 months, in their neck or upper extremities. Female musicians experienced significantly more neck (69%), elbow (31%), and wrist (30%) pain than males (neck 52%, elbow 23%, wrist 19%). The profiles varied according to the different instruments and their playing positions. Musculoskeletal symptoms correlated with perceived demand of the orchestral program and difficulties in recovering after performances. Professional musicians experienced nearly twice as often neck pain in the last 30 days (female musicians 69%, male musicians 52%) than persons of the same age in the Finnish working population (female 41%, male 27%). CONCLUSION: Symphony orchestra musicians experience nearly twice as much musculoskeletal symptoms of the neck and upper extremities as others their age. To prevent musicians¿ playing-related problems, special emphasis should be focused on recovery after concerts, including the special demands of different composers and the frequency of rehearsals and performances.

Source: Viljamaa, K., Liira, J., Kaakkola, S. et Savolainen, A. (2017). Medical Problems of Performing Artists, 32(4), 195.

Conception des équipements de travail et prévention des TMS Complémentarités et points d’ancrage des démarches

Après un bref rappel sur les démarches de prévention des TMS et de conception des équipements de travail, cet article présente dans un premier temps les difficultés constatées vis-à-vis de leur articulation. Il propose ensuite des « points d’ancrage » pour accompagner, dans un cadre participatif et multidisciplinaire, les temps de recherche de solutions et de décisions. Les interactions ainsi obtenues favorisent le partage des référentiels et explicitent les processus de décision. Elles fonctionnent à l’identique d’un « moteur méthodologique » qui implante la problématique des TMS à chaque séquence de la conception.
Cette approche doit permettre aux petites et moyennes entreprises (PME) de trouver des réponses à leurs besoins en matière de prévention des TMS très en amont dans le processus de conception d’un équipement de travail. Elle contribue en effet à une meilleure compréhension des leviers favorisant la prise en compte des TMS et à l’élaboration de nouvelles références d’actions vis-à-vis du processus de conception.

Source: Marsot, J. et Atain-Kouadio, J. J. (2017). Perspectives interdisciplinaires sur le travail et la santé, (19-2).

Are work organization interventions effective in preventing or reducing work-related musculoskeletal disorders?

A systematic review of the literature
Objectives: We sought to determine whether interventions that target work organization or the psychosocial work environment are effective in preventing or reducing work-related musculoskeletal disorders (WMSD) compared to usual work.
Methods: We systematically reviewed the 2000–2015 English and French language scientific literature, including studies evaluating the effectiveness of an organizational or psychosocial work intervention on incidence, prevalence or intensity of work-related musculoskeletal pain or disorders in the neck, shoulders, upper limbs and/or back or of work absence due to such problems, among non-sick-listed workers. We excluded rehabilitation and individual-level behavioral interventions and studies with >50% attrition. We analyzed medium- and high-quality studies and synthesized the evidence using the Grading of Recommendations Assessment, Development & Evaluation (GRADE) approach. An analysis of key workplace intervention elements supplemented interpretation of results.
Results: We identified 884 articles; 28 met selection criteria, yielding 2 high-quality, 10 medium-quality and 16 low-quality studies. There was moderate evidence that supplementary breaks, compared to conventional break schedules, are effective in reducing symptom intensity in various body regions. Evidence was low- to very low-quality for other interventions, primarily due to risk of bias related to study design, high attrition rates, co-interventions, and insensitive indicators. Most interventions lacked key intervention elements, such as work activity analysis and ergonomist guidance during implementation, but the relation of these elements to intervention effectiveness or ineffectiveness remains to be demonstrated.
Conclusions: Targeting work–rest cycles may reduce WMSD. Better quality studies are needed to allow definitive conclusions to be drawn on the effectiveness of other work organizational or psychosocial interventions to prevent or reduce WMSD.

Source: Stock, S. R., Nicolakakis, N., Vézina, N., Vézina, M., Gilbert, L., Turcot, A., ... et Beaucage, C. (2017). Scandinavian Journal of Work, Environment & Health.

Can beliefs about musculoskeletal pain and work be changed at the national level?

Prospective evaluation of the Danish national Job & Body campaign
Using a mixture of networking activities, workplace visits and a mass media campaign, the Danish national Job & Body health campaign improved beliefs about musculoskeletal pain and work among public-sector employees in Denmark. Intensive and long-term national campaigns may be a strategically important tool against musculoskeletal disorders and their consequences in the population.

Source: Andersen, L. L., Geisle, N., & Knudsen, B. (2017). Scand J Work Environ Health.

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