Démarche de prévention des troubles musculo-squelettiques (TMS)

Le présent document est un guide méthodologique, fondé sur un recueil de pratiques, à destination des employeurs publics et des acteurs de la prévention. Il vise à accompagner les employeurs publics dans la mise en place d'un dispositif de prévention des troubles musculo-squelettiques efficace et durable.

Source: http://www.fonction-publique.gouv.fr/files/files/publications/coll_outils_de_la_GRH/guide_pratique_TMS.pdf

Ergonomic design of crane cabin interior

The path to improved safety
Many procedures in the development process of crane cabins today are still based on the specific experience of manufacturers and historical guidelines. It is not surprising that they fail to meet the needs of a large proportion of operators. Accordingly, the need for more objective, theoretically justified and consistent models, that will minimize crane operators' biomechanical and visual problems through anthropometric characteristic analysis to improve safety and prevent crane related fatalities and injuries, arises. In that aim we firstly identified the critical characteristics of existing crane cabins linked to visibility and posture (seat and armrest problems) using users' opinions and Pareto analysis. We then collected rarely available data on crane operators in Serbian companies (64 in the first and 10 operators in the control sample) and proposed methodology for the ergonomic assessment of crane cabins based on drawing-board mannequins and kinematic modeling. The implemented methodology interval estimate obtains an interior space of 1095 × 1150 × 1865 mm in which is possible to eliminate the critical characteristics of existing crane cabins. The research results fulfill user needs not satisfied in existing crane cabins and suggest certain changes to existing standards on the path to improved safety.

Source: Spasojevic Brkic VK, Klarin MM, Brkic AD. Safety Sci. 2015; 73: 43-51.
http://dx.doi.org/10.1016/j.ssci.2014.11.010

A Tailored Workplace Exercise Program for Women at Risk for Neck and Upper Limb Musculoskeletal Disorders

A Randomized Controlled Trial
Objective: The aim of this study was to evaluate a tailored physical activity protocol performed in a work environment with a group of female workers employed in manual precision tasks to reduce upper limb pain.
Methods: Sixty female subjects were randomly assigned to an intervention group or a control group. The IG was administered of a 6-month, twice-a-week, tailored exercise program, whereas the CG received no intervention.
Results: The IG showed a reduction on shoulder pain accompanied by increases on the range of motion measures. In addition, reductions in upper limb pain and neck disability were detected with concomitant increases in grip strength.
Conclusions: This study indicated positive effects of a tailored workplace exercise protocol in female workers exposed to moderate risk for work-related musculoskeletal disorders, showing clinically meaningful reductions of pain symptoms and disability on upper limb and neck regions.

Source: Rasotto, Chiara; Bergamin, Marco; Sieverdes, John C.; Gobbo, Stefano; Alberton, Cristine L.; Neunhaeuserer, Daniel; Maso, Stefano; Zaccaria, Marco; Ermolao, Andrea. Journal of Occupational & Environmental Medicine: February 2015, Volume 57, Issue 2, p. 178–183.
http://dx.doi.org/10.1097/JOM.0000000000000329

Work-related psychosocial risk factors and musculoskeletal disorders in hospital nurses and nursing aides

A systematic review and meta-analysis
Objectives :To estimate the association between psychosocial risk factors in the workplace and musculoskeletal disorders (MSD) in nurses and aides.
Design : Systematic review and meta-analysis.
Data sources : An electronic search was performed using MEDLINE (Pubmed), Psychinfo, Web of Science, Tripdatabase, Cochrane Central Controlled Trials, NIOSHTIC and Joanna Briggs Institute of Systematic Reviews on Nursing and Midwifery, to identify observational studies assessing the role of psychosocial risk factors on MSD in hospital nurses and nursing aides.
Review methods : Two reviewers independently assessed eligibility and extracted data. Quality assessment was conducted independently by two reviewers using an adapted version of the Standardized Quality Scale. Random-effects meta-analysis was performed by subsets based on specific anatomical site and the exposure to specific psychosocial risk factors. Heterogeneity for each subset of meta-analysis was assessed and meta-regressions were conducted to examine the source of heterogeneity among studies.
Results : Twenty-four articles were included in the review, seventeen of which were selected for meta-analysis. An association was identified between high psychosocial demands–low job control with prevalent and incident low back pain (OR 1.56; 95% CI 1.22–1.99 and OR 1.52; 95% CI 1.14–2.01, respectively), prevalent shoulder pain (OR 1.89; 95% CI 1.53–2.34), prevalent knee pain (OR 2.21; 95% CI 1.07–4.54), and prevalent pain at any anatomical site (OR 1.38; 95% CI 1.09–1.75). Effort-reward imbalance was associated with prevalent MSD at any anatomical site (OR 6.13; 95% CI 5.32–7.07) and low social support with incident back pain (OR 1.82; 95% CI 1.43–2.32). Heterogeneity was generally low for most subsets of meta-analysis.
Conclusion : This meta-analysis suggests that psychosocial risk factors at the workplace are associated with MSD in hospital nurses and nursing aides. Although most preventive strategies at the workplace are focused on ergonomic risk factors, improving the psychosocial work environment might have an impact on reducing MSDs.

Source: Bernal, Dinora, Campos-Serna, Javier, Tobias, Aurelio, Vargas-Prada, Sergio, Benavides, Fernando G., Serra, Consol. International Journal of Nursing Studies, 2015, 52(2), 635-648
http://dx.doi.org/10.1016/j.ijnurstu.2014.11.003

Process Evaluation of Workplace Interventions with Physical Exercise to Reduce Musculoskeletal Disorders

Process evaluation is important to explain success or failure of workplace interventions. This study performs a summative process evaluation of workplace interventions with physical exercise. As part of a randomized controlled trial 132 office workers with neck and shoulder pain were to participate in 10 weeks of elastic resistance training five times a week at the workplace; the 2min group performed a single set of lateral raise to failure, and the 12min group performed 5-6 sets with 8–12 repetitions. Participants received a single instructional session together with a training diary and manual at baseline (100% dose delivered and 100% dose received), and 59 and 57 participants, respectively, replied to the process evaluation questionnaire at 10-week follow-up. Results showed that in the 2 and 12min groups, respectively, 82% and 81% of the participants completed more than 30 training sessions. However, two-thirds of the participants would have preferred more than a single exercise to vary between. In the 12 versus 2min group more participants experienced the training sessions as too long (30% versus 5%). Most participants (67–92%) found the training diary and manual helpful, adequacy in a single instructional session, and satisfaction with the type of training. Among those with low adherence, lack of time (51%) and difficulties in starting exercising after illness (26%) were common barriers for regular training. Among those with low adherence, 52% felt that five training sessions per week were too much, and 29% would rather have trained a completely different kind of exercise. In conclusion, resistance training at the workplace is generally well received among office workers with neck-shoulder pain, but a one-size-fits-all approach is not feasible for all employees.

Source: Lars L. Andersen, Mette K. Zebis. Int J Rheumatol, 2014.
http://dx.doi.org/10.1155/2014/761363

Effect of horizontal pick and place locations on shoulder kinematics

In this study the effects of horizontal bin locations in an order picking workstation on upper arm elevation, trunk inclination and hand use were investigated. Eight subjects moved (self-paced) light or heavy products (0.2 and 3.0 kg) from a central product bin to an inner or outer order bin (at 60 or 150 cm) on the left or right side of the workstation, while movements were recorded. The outer compared to inner bin location resulted in more upper arm elevation and trunk inclination per work cycle, both in terms of number of peak values and in terms of time integrals of angles (which is a dose measure over time). Considering the peak values and time integrals per minute (instead of per work cycle), these effects are reduced, due to the higher cycle times for outer bins. Hand use (left, right or both) was not affected by order bin locations.

Source: R. Könemann, T. Bosch, I. Kingma, J.H. Van Dieën & M.P. De Looze. Ergonomics, Volume 58,  Issue 2, 2015.
http://dx.doi.org/10.1080/00140139.2014.968636

Manual handling: differences in perceived effort, success rate and kinematics between three different pushing techniques

This study examined the perceived effort, success rates and kinematics for three push strategies in a simulated lateral patient transfer (horizontal slide). Thirteen healthy subjects (four males) completed three repetition pushing loads of 6, 10 and 14 kg in random order; with a spontaneous push strategy, then with a straight-back bent-knees (squat) strategy and the preparatory pelvic movement (‘rockback') strategy in random order. Perceived effort and kinematic parameters measured at the onset of movement and at maximum push excursion were compared between strategies and between loads with repeated measures ANOVA. The spontaneous and ‘rockback' strategies achieved the pushing task with less perceived effort across all loads than the squat push (P < 0.001). Only 3/13 participants were successful on all attempts at pushing the 14 kg load using a squat strategy, which contrasted with 12/13 participants when the spontaneous strategy or the ‘rockback' strategy was used. Forward movement of the pelvis and forward trunk inclination may be positively associated with lower perceived effort in the push task.

Source: Lynn Varcin, Andrew Claus, Wolbert van den Hoorn & Paul Hodges. Ergonomics, Volume 58,  Issue 2, 2015.
http://dx.doi.org/10.1080/00140139.2014.970586

A frequency–duty cycle equation for the ACGIH hand activity level

A new equation for predicting the hand activity level (HAL) used in the American Conference for Government Industrial Hygienists threshold limit value (TLV) was based on exertion frequency (F) and percentage duty cycle (D). The TLV includes a table for estimating HAL from F and D originating from data in Latko et al. (Latko WA, Armstrong TJ, Foulke JA, Herrin GD, Rabourn RA, Ulin SS, Development and evaluation of an observational method for assessing repetition in hand tasks. American Industrial Hygiene Association Journal, 58(4):278–285, 1997) and post hoc adjustments that include extrapolations outside of the data range. Multimedia video task analysis determined D for two additional jobs from Latko's study not in the original data-set, and a new nonlinear regression equation was developed to better fit the data and create a more accurate table. The equation, HAL = 6.56 ln D[F 1.31/1 + 3.18 F1.31], generally matches the TLV HAL lookup table, and is a substantial improvement over the linear model, particularly for F > 1.25 Hz and D > 60% jobs. The equation more closely fits the data and applies the TLVw using a continuous function.

Source: Robert G. Radwin, David P. Azari, Mary J. Lindstrom, Sheryl S. Ulinc, Thomas J. Armstrong and David Rempel. Ergonomics, 2015, Vol. 58, No. 2, 173–183. http://dx.doi.org/10.1080/00140139.2014.966154

Chantiers de construction

Prévention des risques, logistique et avantage économique
Cette brochure est destinée aux différents acteurs d'un projet de construction, notamment aux maîtres d'oeuvre, aux coordonnateurs SPS et aux maîtres d'ouvrage. Ces différents acteurs ont pour obligation de prendre en compte la sécurité et la protection de la santé des travailleurs lors de la conception et de la réalisation des ouvrages. Mais on constate que les aspects économiques des conditions de travail sont généralement peu pris en compte par les donneurs d'ordre, et, lorsqu'ils sont abordés, c'est souvent à travers des idées reçues : l'amélioration des conditions de travail coûterait cher et ses retombées seraient difficilement chiffrables. Cette brochure vise à montrer qu'au contraire la mise en oeuvre d'une organisation logistique contribue à prévenir les accidents du travail et les pathologies liées aux manutentions manuelles tout en améliorant le bilan économique d'une opération.

Source: http://www.inrs.fr/accueil/produits/mediatheque/doc/publications.html?refINRS=ED%206186

Multisite musculoskeletal pain predicts medically certified disability retirement among Finns

BACKGROUND: Musculoskeletal pain at several sites (multisite pain) is more common than single-site pain. Little is known on its effects on disability pension (DP) retirement. METHODS: A nationally representative sample comprised 4071 Finns in the workforce aged 30 to 63. Data (questionnaire, interview, clinical examination) were gathered in 2000-2001 and linked with national DP registers for 2000-2011. Pain during the preceding month in 18 locations was combined into four sites (neck, upper limbs, low back, lower limbs). Hazard ratios (HR) of DP were estimated by Cox regression. RESULTS: The HR of any DP (n = 477) was 1.6 (95% confidence interval 1.2-2.1) for one, 2.5 (1.9-3.3) for two, 3.1 (2.3-4.3) for three and 5.6 (4.0-7.8) for four pain sites, when adjusted for age and gender. When additionally adjusted for clinically assessed chronic diseases, the HRs varied from 1.4 (1.0-1.8) to 3.5 (2.5-4.9), respectively. When further adjusted for physical and psychosocial workload, education, body mass index, smoking, exercise and sleep disorders, the HRs were 1.3 (0.9-1.7), 1.6 (1.2-2.2), 1.8 (1.3-2.5) and 2.5 (1.8-3.6). The number of pain sites was especially strong in predicting DPs due to musculoskeletal diseases (HRs in the full model; 3.1 to 4.3), but it also predicted DPs due to other somatic diseases (respective HRs 1.3 to 2.3); pain in all four sites was also predictive of DPs due to mental disorders (full model HR 2.2). CONCLUSIONS: The number of pain sites independently predicted DP retirement. Employees with multisite pain may need specific support to maintain their work ability.

Source: Haukka E, Kaila-Kangas L, Ojajarvi A, et al. European Journal of Pain, 2014.
http://dx.doi.org/10.1002/ejp.635

Prevalence of work-related musculoskeletal symptoms of the neck and upper extremity among dentists in China

OBJECTIVES: Studies from western countries show that dentists are vulnerable to work-related musculoskeletal disorders (WMSDs) of the neck and upper extremities, but little is known about their epidemiology among members of this rapidly growing profession in China. This study aims to investigate the prevalence of WMSDs and identify potential risk factors associated with their occurrence in the dental profession in China.
SETTING AND PARTICIPANTS: A cross-sectional survey was carried out in 52 different hospitals in a large metropolitan city in China. A total of 304 questionnaires were distributed to respondents identified via stratified random sampling and 272 dentists (121 females and 151 males) completed the survey. The response rate was 89.5%.
OUTCOMES: Visual analogue score was used to record neck and upper limb musculoskeletal symptoms on a body chart. Work-related risk factors, including physical and psychosocial factors, were accounted for in the regression analysis.
RESULTS: 88% of the dentists reported at least one musculoskeletal disorder and 83.8% suffered from neck pain. In the multivariate analyses, working hours per day were associated with neck pain (OR=1.43; 95% CI 1.03 to 1.98). Inability to select the appropriate size of dental instrument was associated with shoulder (OR=2.07; 95% CI 1.00 to 4.32) and wrist/hand (OR=2.47; 95% CI 1.15 to 5.32) pain. As for psychosocial factors, high job demand was associated with symptoms in the shoulder (OR=1.09; 95% CI 1.00 to 1.18), elbow (OR=1.11; 95% CI 1.03 to 1.19) and wrist/hand (OR=1.09; 95% CI 1.02 to 1.17). Regular physical exercise was associated with decreased neck pain (OR=0.37; 95% CI 0.14 to 1.00).
CONCLUSIONS: The prevalence of WMSDs among Chinese dentists is high. Specifically, long working hours, inability to select the appropriate size of dental instrument and high job demand are the most significant risk factors.

Source: Beibei Feng, Qi Liang, Yuling Wang, Lars L Andersen, Grace Szeto. BMJ, 2014; 4 (12).
http://dx.doi.org/10.1136/bmjopen-2014-006451

Validation of the HSE manual handling assessment charts as predictors of work-related low back pain

The aim of this research was to ascertain whether HSE's ‘Manual handling Assessment Charts' (MAC tool) could be used to predict workers losing time from work due to low back pain (LBP). Results from the study suggest that as the ‘Hand distance from the lower back' increased, the risk of lost time due to LBP increased. For each 10 cm increase, the rate of lost time increased by approximately 20%. No evidence of relationships between other risk factors in the MAC and lost time was found. There was no evidence that the rate of lost time due to LBP increased with either increasing total MAC lifting score or total MAC carrying score.
Due to imprecision in the model estimates (wide confidence intervals), the lack of statistically significant results, and the limitations of the data, it was decided that it would not be appropriate to alter the scoring system currently used in the MAC based on these data. Duty holders should be confident in carrying on using the MAC tool as the risk factors for LBP included were identified as important by earlier studies.

Source: http://www.hse.gov.uk/research/rrhtm/rr1026.htm

Evaluation of the use of the pushing and pulling operations risk assessment tool by dutyholders

This report describes the usability testing of a prototype tool for assessing the manual handling risks associated with tasks involving pushing or pulling of loads. It builds on earlier work by HSL to develop Pushing and Pulling Operations Assessment Charts (PPAC) (Research Report 998). Feedback on the assessment of typical operations in the field indicated that the risk factors included in the tool are relevant, useful, relatively easy to identify and that they covered most of the conditions found in workplaces.
Duty holders who took part in the study were able to differentiate between categories of risk for most of the factors, they were also able to argue and justify their choices. The findings indicate that the tool is sufficiently usable and reliable, and it is useful for increasing duty holder confidence in assessing pushing and pulling operations.

Source: http://www.hse.gov.uk/research/rrhtm/rr999.htm

Conditions préalables à l’implantation de la rotation chez une population d’assembleurs-monteurs du secteur de l’aéronautique

L'impact des exigences de qualité sur le développement de la polyvalence et sur l'apprentissage
Une grande entreprise du secteur de l'aéronautique désire développer la polyvalence de ses assembleurs-monteurs par l'instauration de la rotation de postes. Convenant qu'il s'agit d'une problématique complexe, l'expertise de l'Institut de recherche Robert-Sauvé en santé et en sécurité du travail (IRSST) est sollicitée. La demande formulée consiste à identifier les conditions requises pour implanter la rotation des postes, souhaitant ainsi prévenir les TMS qui affectent cette population de travailleurs. Le département où sont assemblés les cabines de pilotage de deux des avions-phares de l'entreprise est ciblé à la fois de par les exigences physiques qui le caractérisent, sa position stratégique dans le cycle de production optimisée (lean production) et le haut niveau d'expertise requis pour y effectuer les tâches d'assemblage. On y retrouve quatre stations d'assemblage dans lesquelles se répartissent plus d'une vingtaine d'assembleurs sous la supervision de trois chefs d'équipe. Le travail se caractérise entre autres par des cycles longs – puisque l'assemblage complet d'une cabine s'échelonne sur plusieurs jours – et par des exigences élevées de qualité.

Source: http://www.irsst.qc.ca/-publication-irsst-rotation-secteur-de-aeronautique-r-853.html

Are elderly construction workers sufficiently fit for heavy manual labour?

This study analysed the work ability of elderly construction workers. Forty male construction workers, 20 young (age < 33 yrs) and 20 senior (age>44 yrs) workers, were tested regarding aerobic power (VO2max) and muscle strength. The aerobic demand of a number of tasks in construction work was measured and compared with the workers' aerobic power. VO2max was higher for the young, and they performed better on most muscle strength tests. The measurements showed that about half of the senior workers had to use more than 30% of their maximum oxygen uptake on some tasks. In conclusion, because elderly construction workers decline in physical fitness, they are more exposed to overload when performing heavy manual work than are their younger peers. Increasing their individual fitness or adjusting their workload may be important for staying in the workforce for such workers.

Source: Jebens E, Mamen A, Medbø JI, Knudsen O, Veiersted KB. Ergonomics, 2014.
http://dx.doi.org/10.1080/00140139.2014.977828

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