Les problèmes chroniques de douleur et de perte de fonction de l'épaule touchent jusqu'à 20 % des adultes (Pope, Croft et coll., 1997). La proportion serait encore plus élevée chez les adultes âgés de plus de 50 ans. Au Québec, la Commission de la santé et de la sécurité au travail du Québec (CSST) rapporte que, pour les années 2003 à 2006, les lésions à l'épaule représentaient 39% des 32 549 lésions inflammatoires dues à un travail répétitif ou à un traumatisme. Les lésions à l'épaule ont requis en moyenne 75,4 jours d'absence du travail et 4 533 $ en indemnités de remplacement du revenu (IRR) par travailleur. En comparaison, les lésions au membre inférieur représentaient moins de 10 % des lésions rapportées et ont requis en moyenne 39,5 jours d'absence et des IRR de 2 439 $ par travailleur (CSST, 2007). Ces chiffres montrent non seulement l'importance du problème, mais aussi que les lésions à l'épaule nécessitent proportionnellement plus de temps pour retrouver une fonction adéquate et permettre un retour durable au travail. Ceci témoigne de l'importance d'identifier rapidement les personnes à risque de développer des problèmes de fonction à l'épaule afin de les orienter vers des programmes de réadaptation efficaces et adaptés.
A systematic review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration
Purpose We conducted a systematic review to critically appraise and synthesize literature on the effectiveness of work disability prevention (WDP) interventions in workers with neck pain, whiplash-associated disorders (WAD), or upper extremity disorders. Methods We searched electronic databases from 1990 to 2012. Random pairs of independent reviewers critically appraised eligible studies using the Scottish Intercollegiate Guidelines Network criteria. Scientifically admissible studies were summarized and synthesized following best-evidence synthesis methodology. Results Of the 6,359 articles retrieved, 16 randomized controlled trials were eligible for critical appraisal and five were admissible. We found that a return-to-work coordination program (including workplace-based work hardening) was superior to clinic-based work hardening for persistent rotator cuff tendinitis. Workplace high-intensity strength training and workplace advice had similar outcomes for neck and shoulder pain. Mensendieck/Cesar postural exercises and strength and fitness exercises had similar outcomes for non-specific work-related upper limb complaints. Adding a brief job stress education program to a workplace ergonomic intervention was not beneficial for persistent upper extremity symptoms. Adding computer-prompted work breaks to ergonomic adjustments and workplace education benefited workers' recovery from recent work-related neck and upper extremity complaints. Conclusions At present, no firm conclusions can be drawn regarding the effectiveness of WDP interventions for managing neck pain, WAD, and upper extremity disorders. Our review suggests a return-to-work coordination program is more effective than clinic-based work hardening. Also, adding computer-prompted breaks to ergonomic and workplace interventions benefits workers' recovery. The current quality of evidence does not allow for a definitive evaluation of the effectiveness of ergonomic interventions.
Source: Varatharajan S, Côté P, Shearer HM, Loisel P, Wong JJ, Southerst D, Yu H, Randhawa K, Sutton D, van der Velde G, Mior S, Carroll LJ, Jacobs C, Taylor-Vaisey A. J. Occup. Rehabil. 2014.
A Review and Meta-Analysis
Objective: A meta-analysis on epidemiological studies was undertaken to assess association between carpal tunnel syndrome (CTS) and computer work.
Methods: Four databases (PubMed, Embase, Web of Science, and Base de Donnees de Sante Publique) were searched with cross-references from published reviews. We included recent studies, original epidemiological studies for which the association was assessed with blind reviewing with control group. Relevant associations were extracted, and a metarisk was calculated using the generic variance approach (meta–odds ratio [meta-OR]).
Results: Six studies met the criteria for inclusion. Results are contradictory because of heterogeneous work exposure. The meta-OR for computer use was 1.67 (95% confidence interval [CI], 0.79 to 3.55). The meta-OR for keyboarding was 1.11 (95% CI, 0.62 to 1.98) and for mouse 1.94 (95% CI, 0.90 to 4.21).
Conclusion: It was not possible to show an association between computer use and CTS, although some particular work circumstances may be associated with CTS.
Source: Mediouni, Zakia MD; de Roquemaurel, Alexis MD; Dumontier, Christian MD; Becour, Bertrand MD; Garrabe, Hélène; Roquelaure, Yves MD, PhD; Descatha, Alexis MD, PhD. Journal of Occupational & Environmental Medicine: February 2014, Volume, Issue 2, p. 204–208.
Manual handling solutions for the food and drink industries
This book is aimed at employers and dutyholders within the food and drink industry. It discusses manual handling risks and solutions.
Specifically, it covers:
- the main causes of injuries
- handling raw materials
- packing into containers
- stacking and moving containers
- handling equipment
- off-site delivery
The introduction in this new edition has been revised but the case studies remain unchanged.
BACKGROUND: This analysis examines the associations of work organization attributes among Latino women in manual occupations with musculoskeletal and neurological injuries. METHODS: Participants included 234 women in western North Carolina. Outcome measures included epicondylitis, rotator cuff syndrome, back pain, and carpal tunnel syndrome. Independent measures included indicators of job demand, job control, and job support, as well as personal characteristics. RESULTS: Latina workers commonly experienced epicondylitis, rotator cuff syndrome, back pain, and CTS. Awkward posture and decision latitude were associated with epicondylitis. Rotator cuff syndrome was associated with awkward posture and psychological demand. Awkward posture and psychological demand, and decreased skill variety and job control were related to CTS. CONCLUSIONS: Work organization factors are potentially important for musculoskeletal and neurological injury among vulnerable workers. Research is required to understand the associations of work and health outcomes of these women. Policy initiatives need to consider how work organization affects health.
Source : Arcury TA, Cartwright MS, Chen H, Rosenbaum DA, Walker FO, Mora DC, Quandt SA. Am. J. Ind. Med. 2014.
Objectives : This study compared the cost efficiency of observation and inclinometer assessment of trunk and upper-arm inclination in a population of flight baggage handlers, as an illustration of a general procedure for addressing the trade-off between resource consumption and statistical performance in occupational epidemiology.
Methods : Trunk and upper-arm inclination with respect to the line of gravity were assessed for three days on each of 27 airport baggage handlers using simultaneous inclinometer and video recordings. Labor and equipment costs associated with data collection and processing were tracked throughout. Statistical performance was computed from the variance components within and between workers and bias (with inclinometer assumed to produce “correct” inclination angles). The behavior of the trade-off between cost and efficiency with changed sample size, as well as with changed logistics for data collection and processing, was investigated using simulations.
Results : At similar total costs, time spent at trunk and arm inclination angles >60 ° as well as 90th percentile arm inclination were estimated at higher precision using inclinometers, while median inclination and 90th percentile trunk inclination was determined more precisely using observation. This hierarchy remained when the study was reproduced in another population, while inclinometry was more cost-efficient than observation for all three posture variables in a scenario where data were already collected and only needed to be processed.
Conclusions : When statistical performance was measured only in terms of precision, inclinometers were more cost-efficient than observation for two out of three posture metrics investigated. Since observations were biased, inclinometers consistently outperformed observation when both bias and precision were included in statistical performance. This general model for assessing cost efficiency may be used for designing exposure assessment strategies with considerations not only of statistical but also cost criteria. The empirical data provide a specific basis for planning assessments of working postures in occupational groups.
Source : Trask C, Mathiassen SE, Wahlström J, Forsman M. Scand J Work Environ Health. 2014.
A two-year follow-up study of workers in municipal kitchens
Objective : We studied predictors of sickness absences (SA) due to musculoskeletal pain over two years among 386 municipal female kitchen workers.
Methods : Pain and SA periods (no/yes) due to pain in seven sites during the past three months were assessed at 3-month intervals over two years by questionnaire. Age, musculoskeletal pain, multisite pain (pain in ≥3 sites), musculoskeletal and other somatic diseases, depressive symptoms, physical and psychosocial workload, body mass index, smoking, and leisure-time physical activity (LTPA) at baseline were considered as predictors. Trajectory analysis and multinomial logistic regression were used.
Results : Three trajectories of SA emerged, labelled as “none” (41% of the subjects), “intermediate” (48%), and “high” (11%). With the “none” trajectory (no SA) as reference, pain in all musculoskeletal sites excepting the low back predicted belonging to the “intermediate” [odds ratio (OR) 1.82–2.48] or “high” (OR 2.56–3.74) trajectory adjusted for age; multisite pain predicted membership of the “intermediate” [OR 2.15, 95% confidence interval (95% CI) 1.38–3.34] or “high” (OR 4.66, 95% CI 2.10–10.3) trajectories. In a mutually adjusted final model, smoking (OR 2.12, 95% CI 1.22–3.69), multisite pain (OR 1.87, 95% CI 1.15–3.02), and overweight/obesity (OR 1.71, 95% CI 1.08–2.72) predicted belonging to the “intermediate” trajectory, while depressive symptoms (OR 3.57, 95% CI 1.57–8.10), musculoskeletal diseases (OR 3.18, 95% CI 1.37–7.37), and multisite pain (OR 2.72, 95% CI 1.15–6.40) were associated with the “high” trajectory.
Conclusion : Along with the number of pain sites and musculoskeletal diseases, attention to depressive symptoms, smoking, and overweight/obesity is needed to tackle SA related to musculoskeletal pain.
Source : Haukka E, Kaila-Kangas L, Luukkonen R, Takala E-P, Viikari-Juntura E, Leino-Arjas P. Scand J Work Environ Health. 2014.
Prospective cohort study on the risk for occupational back injury among healthcare workers
Objectives : This prospective cohort study investigates work-related risk factors for occupational back injury among healthcare workers.
Methods : The study comprised 5017 female healthcare workers in eldercare from 36 municipalities in Denmark who responded to a baseline and follow-up questionnaire in 2005 and 2006, respectively. Using logistic regression, the odds for occupational back injury (ie, sudden onset episodes) in 2006 from patient transfers in 2005 was modeled.
Results : In the total study population, 3.9% experienced back injury during follow-up, of which 0.5% were recurrent events. When adjusting for lifestyle (body mass index, leisure-time physical activity, smoking), work-related characteristics (seniority and perceived influence at work), and history of back pain and injury, daily patient transfers increased the risk for back injury (trend, P=0.03): odds ratio (OR) 1.75 [95% confidence interval (95% CI) 1.05–2.93] for 1–2 transfers per day, OR 1.81 (95% CI 1.14–2.85) for 3–10 transfers per day, and OR 1.56 (95% CI 0.96–2.54) for >10 transfers per day, referencing those with <1 patient transfer on average per day. The population attributable fraction of daily patient transfer for back injury was estimated to be 36%. Among those with daily patient transfer (N=3820), using an assistive device decreased the risk for back injury for “often” and “very often” use [OR 0.59 (95% CI 0.36–0.98) and OR 0.62 (95% CI 0.38–1.00), respectively] referencing those who “seldom” use assistive devices.
Conclusion : Daily patient transfer was associated with increased risk for back injury among healthcare workers. Persistent use of an assistive device was associated with reduced risk for back injury among healthcare workers with daily patient transfers.
Source : Andersen LL, Burdorf A, Fallentin N, Persson R, Jakobsen MD, Mortensen OS, Clausen T, Holtermann A. Scand J Work Environ Health. 2014; 40 (1): 74-81.
Work-related upper limb disorder (WRULD), repetitive strain injury (RSI), occupational overuse syndrome (OOS) and work-related complaints of the arm, neck or shoulder (CANS) are the most frequently used umbrella terms for disorders that develop as a result of repetitive movements, awkward postures and impact of external forces such as those associated with operating vibrating tools. Work-related CANS, which is the term we use in this review, severely hampers the working population.
Source : http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD008742.pub2/abstract
Objective: To test the feasibility of a multicomponent pilot intervention to improve worker safety and wellness in two Boston hospitals.
Methods: A 3-month intervention was conducted on seven hospital units. Pre- (374 workers) and postsurveys (303 workers) assessed changes in safety/ergonomic behaviors and practices, and social support. Wellness outcomes included self-reported pain/aching in specific body areas (musculoskeletal disorders or MSDs) and physical activity (PA).
Results: Pain was reported frequently (81%), and PA averaged 4 hours per week. There was a postintervention increase in safe patient handling (P < 0.0001), safety practices (P = 0.0004), ergonomics (P = 0.009), and supervisor support (P = 0.01), but no changes in MSDs or PA.
Conclusions: Safe patient handling, ergonomics, and safety practices are good targets for worker safety and wellness interventions; longer intervention periods may reduce the risk of MSDs.
Source : Caspi, Caitlin Eicher, Dennerlein, Jack T., Kenwwod, Christopher, Stoddard, Anne, Hopcia, Karen, Hashimoto, Dean, et Sorensen, Glorian. (2013). Journal of Occupational & Environmental Medicine, 55(12), 1449-1455.
Dynamic trunk motion assessment at the workplace
Many paramedics' work accidents are related to physical aspects of the job, and the most affected body part is the low back. This study documents the trunk motion exposure of paramedics on the job. Nine paramedics were observed over 12 shifts (120 h). Trunk postures were recorded with the computer-assisted CUELA measurement system worn on the back like a knapsack. Average duration of an emergency call was 23.5 min. Sagittal trunk flexion of >40° and twisting rotation of >24° were observed in 21% and 17% of time-sampled postures. Medical care on the scene (44% of total time) involved prolonged flexed and twisted postures (∼10 s). The highest extreme sagittal trunk flexion (63°) and twisting rotation (40°) were observed during lifting activities, which lasted 2% of the total time. Paramedics adopted trunk motions that may significantly increase the risk of low back disorders during medical care and patient-handling activities.
Source : Prairie, Jérôme, et Corbeil, Philippe (2013). Applied Ergonomics.
Usage de données quantitatives dans une grande entreprise
Cet article se base sur la partie quantitative d'une recherche en ergonomie dont le but est de comprendre comment des évolutions du travail ont favorisé ou limité la survenue et la persistance de troubles musculo-squelettiques (TMS) chez des opérateurs d'un groupe industriel aéronautique, avec une approche diachronique des faits étudiés. Un observatoire, fondé sur le recueil systématique de données quantitatives auprès des opérateurs (dispositif Evrest), permet de mettre en relation les facteurs de risque TMS passés et présents de ces opérateurs avec leur santé ostéo-articulaire. Sur cette base, sont explorés les mécanismes de régulation, d'usure et de sélection éventuellement à l'œuvre. Pour ces deux derniers mécanismes, l'analyse repose sur l'étude de « séquences d'astreinte » et de « cumuls d'astreinte », l'astreinte étant définie à partir d'une combinaison de questions sur les contraintes physiques, la pression temporelle et les possibilités de choisir la façon de procéder dans son travail.
Source : Céline Mardon, Willy Buchmann et Serge Volkoff. Pistes, vol. 15, no. 3. 2013.
Quelles conséquences pour la santé ?
Réponse de l'INRS à une question posée par un médecin du travail.
L'utilisation de ces écrans de petite taille est de plus en plus répandue. Elle peut être source de contrainte posturale et de fatigue visuelle.
Source : http://www.rst-sante-travail.fr/rst/pages-article/ArticleRST.html?ref=RST.QR%2079
Improved work safety or shifting of care?
INTRODUCTION: Construction workers are at high risk of work-related musculoskeletal back disorders, and research suggests medical care and costs associated with these conditions may be covered by sources other than workers' compensation (WC). Little is known about the back injury experience and care seeking behavior among drywall installers, a high-risk workgroup regularly exposed to repetitive activities, awkward postures, and handling heavy building materials. METHODS: Among a cohort of 24,830 Washington State union carpenters (1989-2008), including 5,073 drywall installers, we identified WC claims, visits for health care covered through union-provided health insurance and time at risk. Rates of work-related overexertion back injuries (defined using WC claims data) and health care utilization for musculoskeletal back disorders covered by private health insurance were examined and contrasted over time and by worker characteristics, stratified by type of work (drywall installation, other carpentry). RESULTS: Drywall installers' work-related overexertion back injury rates exceeded those of other carpenters (adjusted IRR 1.63, 95% CI 1.48-1.78). For both carpentry groups, rates declined significantly over time. In contrast, rates of private healthcare utilization for musculoskeletal back disorders were similar for drywall installers compared to other carpenters; they increased over time (after the mid-1990s), with increasing years in the union, and with increasing numbers of work-related overexertion back injuries. CONCLUSIONS: Observed declines over time in the rate of work-related overexertion back injury, as based on WC claims data, is encouraging. However, results add to the growing literature suggesting care for work-related conditions may be being sought outside of the WC system.
Source : Schoenfisch AL, Lipscomb HJ, Marshall SW, Casteel C, Richardson DB, Brookhart MA, Cameron W. Am. J. Ind. Med. 2013.
OBJECTIVES: To estimate the contribution of preexisting chronic conditions on age differences in health care expenditures for the management of work-related musculoskeletal injuries in British Columbia. METHODS: A secondary analysis of workers' compensation claims submitted over the 5-year period between January 1, 2002 and December 31, 2006 (N=55,827 claims among men and 32,141 claims among women). Path models examined the relationships between age and health care expenditures, and the extent to which age differences in health care expenditures were mediated by preexisting chronic conditions. Models were adjusted for individual, injury, occupational, and industrial covariates. RESULTS: The relationship between age and health care expenditures differed for men and women, with a stronger age gradient observed among men. Preexisting osteoarthritis and coronary heart disease were associated with elevated health care expenditures among men and women. Diabetes was associated with elevated health care expenditures among men only, and depression was associated with elevated health care expenditures among women only. The percentage of the age effect on health care expenditures that was mediated through preexisting chronic conditions increased from 12.4% among 25-34-year-old men (compared with 15-24 y) to 26.6% among 55+-year-old men; and 14.6% among 25-34-year-old women to 35.9% among women 55 and older. CONCLUSIONS: The results of this study demonstrate that differences in preexisting chronic conditions have an impact on the relationship between older age and greater health care expenditures after a work-related musculoskeletal injury. The differing prevalence of preexisting osteoarthritis, coronary heart disease, and to a lesser extent diabetes (among men) and depression (among women) across age groups explain a nontrivial proportion of the age effect in health care expenditures after injury. However, approximately two thirds or more of the age effect in health care expenditures remains unexplained.
Source : Smith PM, Bielecky A, Ibrahim S, Mustard C, Scott-Marshall H, Saunders R, Beaton D. Med. Care. 2013.
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