Temporal patterns of sitting at work are associated with neck–shoulder pain in blue-collar workers

A cross-sectional analysis of accelerometer data in the DPHACTO study
BACKGROUND: Our aim was to examine the extent to which temporal patterns of sitting during occupational work and during leisure-time, assessed using accelerometry, are associated with intense neck-shoulder pain (NSP) in blue-collar workers. METHODS: The population consisted of 659 Danish blue-collar workers. Accelerometers were attached to the thigh, hip, trunk and upper dominant arm to measure sitting time and physical activity across four consecutive days. Temporal sitting patterns were expressed separately for work and leisure by the proportion of total time spent sitting in brief bursts (0-5 min), moderate (>5-20 min) and prolonged (>20 min) periods. The peak NSP intensity during the previous 3 months was assessed using a numerical rating scale (range 0-10) and dichotomized into a lower (4) NSP score. Logistic regression analyses with multiple adjustments for individual and occupational factors were performed to determine the association between brief, moderate and prolonged sitting periods, and NSP intensity. RESULTS: Time in brief bursts of occupational sitting was negatively associated with NSP intensity (adjusted OR 0.68, 95 % CI 0.48-0.98), while time in moderate periods of occupational sitting showed a positive association with NSP (adjusted OR 1.32, 95 % CI 1.04-1.69). Time in prolonged periods of occupational sitting was not associated with NSP (adjusted OR 0.78, 95 % CI 0.78-1.09). We found no significant association between brief, moderate or prolonged sitting periods during leisure, and NSP. CONCLUSION: Our findings indicate that the association between occupational sitting time and intense NSP among blue-collar workers is sensitive to the temporal pattern of sitting.

Source: Hallman DM, Mathiassen SE, Heiden M, et al. International Archieves of Occupational and Environmental Health, 2016.
http://dx.doi.org/10.1007/s00420-016-1123-9

Impact of a Sit-Stand Workstation on Chronic Low Back Pain

Results of a Randomized Trial
Objective: The aim of the study was to determine whether chronic low back pain (LBP) might be attenuated through the introduction of a sit-stand workstation (SSW) in office employees.
Methods: Participants were randomized to receive a SSW at the beginning or at the end of a 3-month study period. Participants responded to a short survey at the end of each workday and a comprehensive survey at weeks 1, 6, and 12. Surveys consisted of a modified brief pain inventory and the Roland Morris Disability Questionnaire.
Results: Forty-six university employees with self-reported chronic LBP were enrolled. Participants who were given access to a SSW reported a significant reduction in current (P?=?0.02) and worst (P?=?0.04) LBP over time.
Conclusions: Our findings support the hypothesis that chronic LBP might be improved by the introduction of a SSW in an office environment.

Source: Ognibene, Grant T.; Torres, Wilson; von Eyben, Rie; Horst, Kathleen C. Journal of Occupational & Environmental Medicine: March 2016, Volume 58, Issue 3, p. 287-293.
http://dx.doi.org/10.1097/JOM.0000000000000615

Une intervention ergonomique dans une entreprise utilisant des nanomatériaux

Cet article présente une intervention ergonomique dans une entreprise du secteur industriel amenée à fabriquer du papier contenant des nanoparticules. Les salariés du laboratoire de recherche et développement de l'entreprise, chargés d'étudier les caractéristiques du produit, ont refusé de le manipuler. À la demande du CHSCT de l'entreprise, l'INRS est intervenu afin de mieux comprendre les pratiques réelles de travail et d'aider à mettre en oeuvre, au cas par cas, une démarche de prévention adaptée au risque potentiel.

Source: L'Allain, C., Caroly, S., Drais, E., Caroly, S., Caroly, S., Landry, A., ... & Casse, C. (2016). Hygiène et Sécurité du Travail, 242, 58-62.
http://www.inrs.fr/dms/inrs/CataloguePapier/HST/TI-EC-14/ec14.pdf

Association of objectively measured occupational walking and standing still with low back pain

A cross-sectional study
Objectives: This cross-sectional study investigated the association of objectively measured walking and standing still time at work with low back pain (LBP) intensity among blue-collar workers. Design: A cross-sectional study. Methods: 187 workers attached two accelerometers for diurnal standing still and walking measurements, which were categorised using tertiles. Workers' self-reported LBP intensity (scale 0–9) was categorised into low (0–5) and high pain (6–9). Results: Of the 187 workers, 17% reported a high level of LBP. Results of the multi-adjusted logistic regression analysis demonstrated a negative association between walking and high LBP intensity (OR 0.24 CL 95% 0.07 to 0.79). The results between standing still and high LBP intensity were mixed and non-significant. Conclusion: Blue-collar workers who walk more at work tend to have low LBP. These results should be verified using objective measures in a prospective design.

Source: Nielsen CM, Gupta N, Knudsen LE, et al. Ergonomics, 2016.
http://dx.doi.org/10.1080/00140139.2016.1164901

Associations between biopsychosocial factors and chronic upper limb pain among slaughterhouse workers

Cross sectional study
BACKGROUND: Knowledge of factors associated with chronic pain is necessary for preventive strategies. The present study investigates biopsychosocial differences, with specific focus on rate of force development (RFD) and work ability, between workers with and without chronic upper limb pain. METHODS: Eighty-two male slaughterhouse workers, 49 with chronic upper limb pain and 33 pain-free controls participated in the study. Maximal muscle strength, RFD, and muscle activity was determined from fast and forceful maximal voluntary contractions for the shoulder and hand. Participants filled out a questionnaire on work ability (work ability index), work disability (Work module of DASH questionnaire), fear avoidance, and self-rated health. Additionally, pressure pain threshold (PPT) was measured in muscles of the arm, shoulder and lower leg. RESULTS: Muscle strength and RFD (determined within time intervals of 30, 50, 100, and 200 ms relative to onset of contraction) was 28 % and 58-78 % lower, respectively, in workers with chronic pain compared with pain-free controls, and paralleled by reduced muscle activity (all p < 0.001). Workers with chronic pain had lower PPT of the arm, shoulder and lower leg (p < 0.01), and reported impaired work ability index score and general health along with higher work disability and fear avoidance compared with controls (all p < 0.0001). No differences were observed between the groups in regard to age, BMI, physical activity level, job position and duration of slaughterhouse work (all p > 0.4). CONCLUSIONS: Chronic upper limb pain was paralleled by reduced neuromuscular function of the shoulder and hand along with impaired work ability, work disability and general health. Future studies on chronic pain management at the workplace should carefully consider the biopsychosocial nature of pain when designing and implementing preventive stratégies.

Source: Sundstrup E, Jakobsen MD, Brandt M, et al. BMC Musculoskeletal Disorders, 2016;17(1):104.
http://dx.doi.org/10.1186/s12891-016-0953-7  

La démarche TMS pros

Les troubles musculosquelettiques représentent la première cause de maladies professionnelles reconnues en France. Face à ce constat, l’Assurance maladie-risques professionnels a lancé auprès d’environ 8 000 entreprises une démarche de prévention structurée en quatre étapes, nommée TMS Pros.

Source: Travail et Sécurité, avril 2016, Numéro 771.
http://www.travail-et-securite.fr/ts/dossier/Quatre%20%C3%A9tapes%20pour%20une%20action%20efficace.html

Solutions visant l’amélioration des conditions de santé et de sécurité des poseurs de revêtements de sol

La pose de revêtement de sol se divise en différentes spécialités : céramique, bois et revêtement souple. C'est ce dernier secteur qui nous intéresse, soit la pose de tapis (accrochés ou collés; en rouleau, en tuiles) ou de matériaux résilients (linoléum, vinyle, caoutchouc, gazon synthétique, etc.). Le métier de poseur de revêtement de sol est exigeant sur le plan physique (manutention de rouleaux très lourds, travail à genou prolongé, épandage de colle sur de grandes surfaces), mais aussi en matière de savoir-faire à développer. La pose exige de la précision, entre autres, pour ajuster les motifs et effectuer les raccords. Avec les matériaux résilients, le moindre petit défaut se voit. Présentement, un jeune qui complète son diplôme d'étude professionnelle de poseur débutera comme apprenti; il pourra obtenir le plein statut de compagnon après avoir accompli trois périodes de 2 000 heures dûment déclarées (depuis 2014). Les conditions de travail peuvent aussi être difficiles : chaleur, aires de circulations déficientes, contraintes de temps de fin de chantier, etc. Le milieu éprouve actuellement de la difficulté à recruter de la main-d'oeuvre et il s'inquiète du maintien en activité de ses poseurs vieillissants. Présentement, il y aurait 1 200 à 1 600 travailleurs dont la pose est l'activité principale. Ils travaillent essentiellement au sein de très petites entreprises. Intervenir dans un tel contexte représente un grand défi en SST, car les outils et approches sont le plus souvent développés dans le cadre de grandes et moyennes entreprises. On parle donc d'un milieu dispersé qui dispose de peu de ressources, au sein duquel une multitude d'interlocuteurs-organisations s'entrecroisent (fabricants, détaillants, responsables de chantiers, représentants de la Commission de la construction du Québec, enseignants et intervenants des commissions scolaires, etc.), dont le travail est varié, se transforme rapidement et où les risques de développer des problèmes musculosquelettiques aux genoux, au dos, aux épaules, aux mains, aux poignets et aux chevilles sont réputés élevés. Par contre, le milieu peut compter sur des éléments fédérateurs, comme la Fédération québécoise des revêtements de sol (FQRS) et le GROUPE Agr, mutuelle de prévention.

Source: http://www.irsst.qc.ca/publications-et-outils/publication/i/100858/n/amelioration-sante-securite-poseurs-revetements-sol

Sedentary Work

Summary of the Literature Review Evidence on an Emergent Work Health and Safety Issue
Overall exposure to sedentary behaviour (especially prolonged, unbroken sitting time) is associated with a range of poor health outcomes, including musculoskeletal problems, cardiovascular disease, diabetes, obesity, some cancers and premature mortality.
The majority of these associations remain even after allowing for the impact of physical inactivity, thereby highlighting that sedentary behaviour and physical inactivity need to be considered as separate health hazards.
While most of the evidence to date relates to the health effects of overall sedentary behaviour, a high proportion of workers are exposed to prolonged sitting at work and there is a growing amount of evidence on adverse health effects associated with sedentary work.  Sedentary work may occur in both office-based occupations as well as other occupations which may have less scope for changed postures, such as call centre staff, crane operators and truck drivers.

Source: http://www.safeworkaustralia.gov.au/sites/swa/about/publications/pages/literature-review-into-sedentary-work

Workplace interventions for reducing sitting at work

Background: Office work has changed considerably over the previous couple of decades and has become sedentary in nature. Physical inactivity at workplaces and particularly increased sitting has been linked to increase in cardiovascular disease, obesity and overall mortality.
Objectives: To evaluate the effects of workplace interventions to reduce sitting at work compared to no intervention or alternative interventions.
Main results: We included 20 studies, two cross-over RCTs, 11 RCTs, three cRCTs and four CBAs, with a total of 2180 participants from high income nations. The studies evaluated physical workplace changes (nine studies), policy changes (two studies), information and counselling (seven studies) and interventions from multiple categories (two studies). One study had both physical workplace changes and information and counselling components. We did not find any studies that had investigated the effect of periodic breaks or standing or walking meetings.

Source: Shrestha N, Kukkonen-Harjula KT, Verbeek JH, Ijaz S, Hermans V, Bhaumik S. Cochrane Database of Systematic Reviews, 2016, Issue 3.  http://dx.doi.org/10.1002/14651858.CD010912.pub3

Estimation du chargement au dos

Développement d'une méthode ambulatoire intégrant la cinématique du dos et de l'électromyographie
De nombreux travailleurs1 sont atteints de maux de dos chaque année. La région lombaire est de loin celle qui est la plus fréquemment atteinte, et ce type de troubles musculosquelettiques est principalement occasionné par des efforts excessifs, surtout en soulevant quelque chose, et les chargements aux tissus de la colonne qu'ils engendrent. Il n'existe pas de méthode de mesure directe de ces chargements qui puisse être utilisée en milieu de travail, d'où la nécessité de recourir à des modèles biomécaniques pour les estimer. Or, jusqu'à présent, les modèles biomécaniques existants ne permettent pas l'estimation des chargements de manière satisfaisante.
Ce projet s'inscrit en continuité des nombreux travaux subventionnés par l'Institut de recherche Robert-Sauvé en santé et en sécurité du travail (IRSST) visant l'élaboration d'une méthode ambulatoire pouvant estimer les chargements au bas du dos en continu, soit le moment à l'articulation lombo-sacrée (L5/S1). L'approche préconisée vise l'intégration de la mesure de l'électromyographie (EMG) d'un nombre minimal de muscles à la surface du dos et de la cinématique du dos provenant de deux senseurs inertiels pour estimer le chargement au bas du dos. Cette idée n'est pas nouvelle en soi, mais la manière d'y arriver l'est. En effet, l'utilisation d'un calibrage dynamique pour établir la relation EMG et cinématique au moment en L5/S1 est novatrice.

Source: http://www.irsst.qc.ca/publications-et-outils/publication/i/100857/n/chargement-dos-methode-ambulatoire-cinematique-electromyographie

Wearable Exoskeletons to Reduce Physical Load at Work

Robotic-like suits which provide powered assist and increase human strength may conjure thoughts of sci-fi and superhero film genres. But these wearable exoskeleton devices are now a reality and the market for their applications in the workplace is projected to increase significantly in the next five years.  As with any technologic innovation some of the pros and cons and barriers to adoption are not completely understood.  In this blog our objectives are to:  (1) describe wearable exoskeletons in the context of workplace safety and health control strategies; (2) highlight current and projected trends related to industrial applications of these technologies; and (3) invite input from our stakeholders on workplace health and safety experiences, positive or negative, with these devices.

Source: http://blogs.cdc.gov/niosh-science-blog/2016/03/04/exoskeletons/

Cortisol, Health, and Coping in Patients with Nonspecific Low Back Pain

Subjective health complaints (SHC), including nonspecific low back pain (LBP) as the most common single complaint, are the main reasons for long-term sick leave in many western countries. These complaints are often attributed to “stress”. Cortisol has frequently been considered a biomarker reflecting sustained physiological HPA-axis activity, and is characterized by a high cortisol awakening response (CAR) and low evening values. The aim of the study was to investigate whether LBP patients had a normal characteristic cortisol profile, and whether possible deviations were related to coping and health. 305 patients on long-term sick leave for LBP participated in the study, and saliva cortisol profiles were compared to a reference population consisting of Danish workers. Cortisol was measured upon awakening, after 30 min, and in the evening. Additionally, patients answered questionnaires about SHC, fatigue, pain, coping, and social support. The patients showed a seemingly normal cortisol profile. However, CAR was larger among patients compared to the reference population. Patients with low cortisol reactivity had more SHC, pain, and fatigue, and those with higher evening cortisol reported higher scores on coping. The results are discussed in terms of theory, practical considerations, and possible mechanisms for the association between cortisol, health, and coping.

Source: Sveinsdottir V, Eriksen HR, Ursin H, et al. Applied Psychophysiology and Biofeedback, March 2016, Volume 41, Issue 1, p.p 9-16.
http://dx.doi.org/10.1007/s10484-015-9300-2

Physical workload and risk of long-term sickness absence in the general working population and among blue-collar workers

Prospective cohort study with register follow-up
Objective: To determine the prospective association between physical workload—in terms of specific physical exposures and the number of exposures—and long-term sickness absence (LTSA).
Methods: Using cox-regression analyses, we estimated the risk of register-based incident LTSA (at least 3 consecutive weeks) from self-reported exposure to different physical workloads among 11 908 wage earners from the general working population (Danish Work Environment Cohort Study year 2000 and 2005).
Results: The incidence of LTSA was 8.9% during two-year follow-up. Spending 25% or more of the total work time with a bent or twisted back (HR 1.59 (95% CI 1.39 to 1.83)), arms above shoulder height (HR 1.35 (95% CI 1.14 to 1.59)), squatting or kneeling (HR 1.30 (95% CI 1.09 to 1.54)), pushing/pulling or lifting/carrying (HR 1.40 (95% CI 1.22 to 1.62)) and standing in the same place for 50% or more of total work time (HR 1.19 (95% CI 1.00 to 1.42), were risk factors for LTSA when adjusted for baseline age, gender, psychosocial work environment, lifestyle, musculoskeletal and mental disorders, and socioeconomic status. HR increased from 1.25 (95% CI 1.04 to 1.51) for one to 1.94 (95% CI 1.56 to 2.41) for four combined physical workloads. Results largely remained stable in subgroup analyses including only blue-collar workers (n=5055). Population attributable risks for LTSA from one or more physical workloads were 26% and 40% in the general working population and among blue-collar workers, respectively.
Conclusions: Several of the investigated types of physical workload were risk factors for LTSA when exceeding 25% of the work time. A higher number of combined physical workloads was associated with progressively increased risk. Our study underscores the importance of physical workload as risk factors for LTSA in the general working population as well as among blue-collar workers.

Source: Lars Louis Andersen, Nils Fallentin, Sannie Vester Thorsen, Andreas Holtermann. Occup Environ Med, 2016. 
http://dx.doi.org/10.1136/oemed-2015-103314

Prevention of Low Back Pain

A Systematic Review and Meta-analysis
IMPORTANCE: Existing guidelines and systematic reviews lack clear recommendations for prevention of low back pain (LBP).
OBJECTIVE: To investigate the effectiveness of interventions for prevention of LBP.
DATA SOURCES: MEDLINE, EMBASE, Physiotherapy Evidence Database Scale, and Cochrane Central Register of Controlled Trials from inception to November 22, 2014.
STUDY SELECTION: Randomized clinical trials of prevention strategies for nonspecific LBP.
DATA EXTRACTION AND SYNTHESIS: Two independent reviewers extracted data and assessed the risk of bias. The Physiotherapy Evidence Database Scale was used to evaluate the risk-of-bias. The Grading of Recommendations Assessment, Development, and Evaluation system was used to describe the quality of evidence.
MAIN OUTCOMES AND MEASURES: The primary outcome measure was an episode of LBP, and the secondary outcome measure was an episode of sick leave associated with LBP. We calculated relative risks (RRs) and 95% CIs using random-effects models.
RESULTS: The literature search identified 6133 potentially eligible studies; of these, 23 published reports (on 21 different randomized clinical trials including 30?850 unique participants) met the inclusion criteria. With results presented as RRs (95% CIs), there was moderate-quality evidence that exercise combined with education reduces the risk of an episode of LBP (0.55 [0.41-0.74]) and low-quality evidence of no effect on sick leave (0.74 [0.44-1.26]). Low- to very low-quality evidence suggested that exercise alone may reduce the risk of both an LBP episode (0.65 [0.50-0.86]) and use of sick leave (0.22 [0.06-0.76]). For education alone, there was moderate- to very low-quality evidence of no effect on LBP (1.03 [0.83-1.27]) or sick leave (0.87 [0.47-1.60]). There was low- to very low-quality evidence that back belts do not reduce the risk of LBP episodes (1.01 [0.71-1.44]) or sick leave (0.87 [0.47-1.60]). There was low-quality evidence of no protective effect of shoe insoles on LBP (1.01 [0.74-1.40]).
CONCLUSION AND RELEVANCE: The current evidence suggests that exercise alone or in combination with education is effective for preventing LBP. Other interventions, including education alone, back belts, and shoe insoles, do not appear to prevent LBP. Whether education, training, or ergonomic adjustments prevent sick leave is uncertain because the quality of evidence is low.

Source: Steffens D, Maher CG, Pereira LS, Stevens ML2, Oliveira VC, Chapple M, Teixeira-Salmela LF, Hancock MJ. JAMA Intern Med. 2016 Feb 1; 176 (2): 199-208.
http://dx.doi.org/10.1001/jamainternmed.2015.7431

Social support modifies association between forward bending of the trunk and low-back pain

Cross-sectional field study of blue-collar workers
Objectives: This study aimed to investigate the association between forward bending of the trunk and low-back pain intensity (LBPi) among blue-collar workers in Denmark as well as whether the level of social support modifies the association.
Methods: In total, 457 workers were included in the study. The forward bending of ≥30° was computed from accelerometer recordings for several consecutive days during work, categorized into long (highest tertile) and short–moderate (remaining tertiles) duration. LBPi was measured on a 0–10 scale and categorized into low (≤5) and high (>5) pain. Self-reported social support was categorized into low, moderate, and high levels. Multi-adjusted logistic regressions estimated the association between forward bending and LBPi and the effect modification by social support.
Results: Forward bending and LBPi were not significantly associated but modified by social support. Workers with low social support and long duration of forward bending had higher likelihood of high LBPi [odds ratio (OR) 2.97, 95% confidence interval (95% CI) 1.11–7.95] compared to workers with high social support and long duration of forward bending. Among workers with low social support, workers with long duration of forward bending had higher likelihood of high LBPi (OR 3.28, 95% CI 0.99–10.90) compared to workers with short–moderate duration of forward bending. Among workers with high social support, workers with short duration of forward bending had reduced likelihood of high LBPi (OR 0.39, 95% CI 0.16–0.95) compared to workers with short–moderate duration of forward bending.
Conclusions: Social support modifies the association between objectively measured forward bending and LBPi among blue-collar workers.

Source: Villumsen M, Holtermann A, Samani A, Madeleine P, Jørgensen MB. Scand J Work Environ Health, 2016.
http://dx.doi.org/10.5271/sjweh.3549

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