Le Programme de prévention des TMS liés au travail du Réseau de santé publique en santé au travail (RSPSAT) a été mis en place en avril 2008, suite à la publication d'un document de réflexion sur le rôle de la santé publique en prévention des TMS liés au travail et de proposition des orientations de la Table de concertation nationale en santé au travail (TCNSAT) et de l'Institut national de santé publique du Québec (INSPQ) (Stock et coll., 2005). Ce programme vise l'identification de la présence de TMS liés au travail et des facteurs de risque professionnels associés aux TMS et l'intégration des risques TMS aux programmes de santé spécifiques aux entreprises (PSSE), au même titre que les autres risques à la santé au travail. Il vise également la mobilisation des entreprises ayant des facteurs de risque de TMS importants à s'engager dans des activités de prévention. Un programme à quatre blocs a été proposé. Les membres de la TCNSAT ont décidé de lancer le Programme Réseau de prévention des TMS par étape à travers la province. Ils favorisaient d'abord l'implantation des deux premiers blocs du Programme, en tant qu'offre de service minimal aux établissements concernés lors de l'élaboration ou la mise à jour des PSSE.
OBJECTIVES: Epidemiological studies have shown that musculoskeletal symptoms are frequent occupational injury and disability among nurses in developing countries. Preventive measures were not able to reduce musculoskeletal disorders significantly in nursing profession. This study was performed to provide a comprehensive assessment of the association among risk factors in developing musculoskeletal symptoms.
METHOD: A structural equation model was applied to describe and analyse complex causal relationships from sets of occupational variables involved in musculoskeletal symptoms. A questionnaire was applied to nurses at hospitals affiliated to Semnan Medical Sciences University to collect data on personal and occupational factors and musculoskeletal symptoms. An ergonomic rapid entire body assessment measured work posture risks.
RESULTS: Physical work demand and mental pressure increased the risk of musculoskeletal disorders significantly. Musculoskeletal symptoms increased in nurses who worked for extended hours and experienced frequent unstable work posture. Structural equation model showed that musculoskeletal symptoms were associated directly and indirectly by physical and mental job variables, employment status, age and lifestyle.
CONCLUSIONS: Covarience structural analysis is useful to describe and understand both the direct and indirect effects of variables with complex relationship between risk factors on the prediction of musculoskeletal symptoms.
Source: Dehdashti A. Occup. Environ. Med. 2014; 71(Suppl 1): A68-A68.
This leaflet includes the Manual Handling Assessment Charts (MAC). MAC is a tool developed to help users identify high-risk workplace manual handling activities.
Employers and safety representatives can use the tool to assess the risks posed by lifting, carrying and team manual handling activities. It will help them understand, interpret and categorise the level of risk of the various known risk factors associated with manual handling activities. MAC has a numerical and colour coding score system to highlight high-risk manual handling tasks.
Order picking can be defined as the retrieval of stock keeping units from a warehouse according to a pick list generated from a customer order prior to the despatch of the completed order to the customer.
There is a variety of order picking systems that are used in warehouses and distribution centres and the choice of system will determine the amount and type of manual handling that occurs within those locations. In order to understand the factors that influence the design of order picking systems a literature review was undertaken and telephone interviews were conducted with six industry stakeholders. The stakeholders included were two retailers with distribution networks operating across the UK, two specifiers who design order picking systems of different types and complexity for the end users, and two major suppliers of order picking systems.
The factors that influence the amount of manual handling within warehouses and distribution centres are complex and inter-locking. The key factor is the design of the order picking system, particularly how much automation is used and whether pickers travel between pick slots or whether items are automatically delivered to them. It also depends on the nature of the goods that the warehouse handles. There are financial trade-offs between high capital costs of automated systems, and increased labour costs in manual systems.
This work was commissioned to examine more closely the nature of the forces exerted during manual pushing and pulling operations and to provide a pushing and pulling risk assessment tool that aids identification of key workplace risk factors and measures for control of the risks that they present. It builds on the work reported in RR562 (HSE 2007).
Magnitude of exerted force is one of several factors that may precipitate injury to the musculoskeletal system during pushing and pulling operations, but the force demands in any pushing and pulling operation are not an independent aspect; they are a direct consequence of workplace factors that are present. Practical problems associated with workplace measurement of the task forces are encouraging risk assessment procedures that preclude measurement of the task forces. With input from groups of ergonomists, and potential users (regulatory inspectors and duty holders), it was possible to develop a prototype pushing and pulling operations assessment tool that is user-friendly, reduces/eliminates the need for measurement of force, requires minimal expert knowledge to apply, identifies high-risk operations and intuitively indicates good practice.
Further work in field trialling is now required with the potential users (regulatory inspectors and duty holders) to clarify its usability and effectiveness in real task situations.
De récentes revues de la littérature épidémiologique montrent que travailler avec les bras en position levée augmente la probabilité de développer des troubles musculosquelettiques (TMS) aux épaules. Bien que l’origine et les mécanismes de TMS à l’épaule manquent d’évidence dans la littérature scientifique, réaliser une tâche avec les bras en position levée cause un chargement de la musculature de l’épaule plus important. Cependant, peu d’éléments permettent d’expliquer les raisons pour lesquelles cette posture avec les bras élevés est gênante, et comment celle-ci affecte le membre supérieur en mouvement. La modélisation musculosquelettique du corps humain est aujourd’hui un moyen efficace et non invasif pour obtenir des informations sur les efforts internes qui sont appliqués aux muscles, aux tendons et aux os.
The literature on upper limb musculoskeletal disorders (UL-MSD) in different groups of healthcare workers was reviewed: 65 relevant studies were collected. In dentists, the neck was the most frequently affected segment, with prevalences up to 73% and exceeding 50% in 7 out of 12 studies. In dental hygienists and in laboratory technicians, the hand/wrist had the highest prevalence in the majority of the studies. In nurses, the most seriously affected anatomic sites were the neck and shoulders. Physiotherapists had the lowest prevalence of UL-MSD. A high prevalence of upper limb disease, mainly carpal tunnel syndrome, was reported in dentists, dental hygienists, anesthesia nurses and endoscopists. The high prevalence of upper limb disorders/diseases reported in health personnel supports the hypothesis of a significant risk in these workers. However, the possible role of biomechanical overload, as much as that of stress or other personal factors, cannot be currently assessed.
Practitioner Summary: Published studies support the hypothesis of a significant risk of upper limb musculoskeletal disorders in healthcare activities. The neck was the most frequently affected segment in dentists, the hand/wrist in dental hygienists and in laboratory technicians, and the neck and shoulders in nurses. Lower prevalence was reported in physiotherapists. A high prevalence of carpal tunnel syndrome was also observed in various healthcare activities.
Source: Occhionero V, Korpinen L, Gobba F. Ergonomics. 2014 May 20:1-26.
Cette publication vise à documenter les lésions attribuables aux TMS en milieu de travail sous les aspects administratif, médical et socio-économique, dans un souci de qualité et d'uniformité des informations transmises sur le sujet. Les données qu'elle contient sont tirées des banques informationnelles de la CSST.
En 2011, une nouvelle définition des lésions de type TMS a été adoptée, de concert avec l'IRSST et l'Institut national de santé publique du Québec, afin de faciliter la cohérence et l'interprétation des données.
Sur le plan médical, les lésions de type troubles musculo-squelettiques sont des atteintes inflammatoires ou dégénératives aux structures musculo-squelettiques, causées par une sursollicitation articulaire (application d'une force excessive, répétitive ou continue, parfois combinée à une posture contraignante, à l'exposition aux vibrations ou au froid).
Objective: To describe the proportions of workers with upper extremity (UE) symptoms and work limitations because of symptoms in a newly hired working population over a 3-year study period and to describe transitions between various outcome states.
Methods: A total of 827 subjects completed repeat self-reported questionnaires including demographics, medical and work history, symptoms, and work status. Outcomes of interest were UE symptoms and work limitations because of symptoms.
Results: Up to 72% of workers reported symptoms at least once during the study, with 12% reporting persistent symptoms and 27% reporting fluctuating symptoms; 31% reported work limitations at least once, with 3% reporting consistent work limitations and 8% reporting fluctuating limitations.
Conclusions: UE symptoms and work limitations are common among workers and dynamic in their course. A better understanding of the natural course of symptoms is necessary for targeted interventions.
Source: Gardner, Bethany T.; Dale, Ann Marie; Descatha, Alexis; Evanoff, Bradley. Journal of Occupational & Environmental Medicine: June 2014 - Volume 56 - Issue 6 - p 588–594
Toward Improvement in the Patient's Journey
Objective: To assess the cost outcomes of treatment approaches to care for back problems in a major self-insured workforce, using published guidelines to focus on low back pain.
Methods: Longitudinally tracked episodes of three types of International Classification of Diseases, Ninth Revision diagnosis code–identified back problems (n = 14,787) during 2001 to 2009. Identified five patterns of care on the basis of the first 6 weeks of claims and compared their total costs per episode with tests that included splits by episode type and duration, use of guidelines, and propensity-derived adjustments.
Results: Care congruent with 10 of 11 guidelines was linked to lower total costs. Of the five patterns, complex medical management and chiropractic reported the highest and lowest rates, respectively, of guideline-incongruent use of imaging, surgeries, and medications, and the highest and lowest total costs.
Conclusions: Approaches marked by higher resource utilization and lower guideline congruence are linked to greater low back pain total costs. Total cost is a needed input for guideline development.
Source: Allen, Harris; Wright, Marcia; Craig, Terri; Mardekian, Jack; Cheung, Raymond; Sanchez, Robert; Bunn, William B.; Rogers, William. Journal of Occupational & Environmental Medicine: June 2014 - Volume 56 - Issue 6 - p 604–620.
Objectives: The study examined the course of neck and shoulder pain among a cohort of technical school students entering working life. We also aimed to identify work-related and individual risk factors for neck and shoulder pain during this transition period.
Methods: The study was designed as a prospective cohort study following 420 technical school students (167 student hairdressers, 118 student electricians, and 135 media/design students) from school, through their apprenticeship and into working life. Every 4th month over a 6.5 year period (2002–2009), the participant`s neck and shoulder pain for the preceding four weeks was assessed. Mechanical and psychosocial workplace factors as well as individual factors were evaluated at baseline and/or during the follow-up period. Data were analyzed by generalized estimating equations (GEE).
Results: We found a significant increase in neck and shoulder pain over time in the transition from technical school to working life. High mechanical workload was associated with neck and shoulder pain among women, while a high level of shoulder muscle endurance capacity was associated with lower rates of neck and shoulder pain among men. Perceived muscle tension and ethnicity were the most consistent predictors for neck and shoulder pain, found among both women and men.
Conclusion: Increased neck and shoulder pain was found in the transition from technical school to working life, and both work-related and individual factors were associated with pain development.
Source: Hanvold TN, Wærsted M, Mengshoel AM, Bjertness E, Twisk J, Veiersted KB. Scand J Work Environ Health. 2014.
This experimental study investigated the effect of lifting task parameters (i.e., lifting weight, frequency, coupling, asymmetric angle, and vertical, horizontal, and travel distances) for various dynamic human lifting activities on the ground reaction forces of workers. Ten male workers loaded containers from different levels asymmetrically during experimental trials. The experimental design evolved using Taguchi's Fractional Factorial Experiments. Three factors (lifting weight, frequency, and vertical distance) were observed to be significant. The results showed that vertical reaction forces increase when workers lift weight from floor to shoulder height frequently. It was also observed that instantaneous loading rate increases with more weight, vertical distance, and frequency; a significant extra loading rate is required to change the lower level of load, frequency, and vertical distance to higher levels. Safe limits for significant factors were determined to result in optimal performance of the manual lifting task.
Source: Pratrap Singh, Ravindra, Batish, Ajay, et Singh, Tejinder Pal. (2014). Workplace Health & Safety, 62(4), 150-160.
The effects of load handling position on trunk biomechanics
Back injury caused by sudden loading is a significant risk among workers that perform manual handling tasks. The present study investigated the effects of load handling position on trunk biomechanics (flexion angle, L5/S1 joint moment and compression force) during sudden loading. Eleven subjects were exposed to a 6.8 kg sudden loading while standing upright, facing forward and holding load at three different vertical heights in the sagittal plane or 45° left to the sagittal plane (created by arm rotation).
Results showed that the increase of load holding height significantly elevated the peak L5/S1 joint compression force and reduced the magnitude of trunk flexion. Further, experiencing sudden loading from an asymmetric direction resulted in significantly smaller peak L5/S1 joint compression force, trunk flexion angle and L5/S1 joint moment than a symmetric posture. These findings suggest that handling loads in a lower position could work as a protective strategy during sudden loading.
Source: Ning X, Zhou J, Dai B, Jaridi M. Appl. Ergon. 2014.
A high incidence of Musculoskeletal Disorders (MSDs) has been reported in the construction sector. The use of ladders in the workplace has long been identified as a significant risk that can lead to workplace accidents. However, it is unclear if platform types have an effect on the physical risk factors for MSDs in overhead work. The aim of this study is to perform a pilot study on the effects of hand activity on both shoulder muscle loading and task performance while working on ladders versus Mobile Elevated Working Platforms (MEWPs). It is hypothesised that work on ladders would result in greater muscle loading demands, increased levels of discomfort, and reduced performance due to the restrictions on postures that could be adopted. A field study (n = 19) of experienced electricians on a construction site found that workers spent approximately 28% of their working time on ladders versus 6% on MEWPs. However, the durations of individual tasks were higher on MEWPs (153 s) than on ladders (73 s). Additionally, maximum levels of perceived discomfort (on a VAS 0-100) were reported for the shoulders (27), neck (23), and lower regions of the body (22). A simulated study (n = 12) found that task performance and discomfort were not significantly different between platform types (ladder vs. MEWP) when completing either of three tasks: cabling, assembly and drilling. However, platform and task had significant effects (p < 0.05) on median electromyographic (EMG) activity of the anterior deltoid and upper trapezius. EMG amplitudes were higher for the deltoid than the upper trapezius. For the deltoid, the peak amplitudes were, on average, higher for ladder work over MEWP work for the hand intensive cabling (32 vs. 27% Maximal Voluntary Exertion (MVE)) and the assembly task (19 vs. 6% MVE). Conversely, for drilling, the peak EMG amplitudes were marginally lower for ladder compared to the MEWP (3.9 vs. 5.1% MVE). The general implication was that working on the MEWP involved lower shoulder muscle loading for cabling and assembly task. A difference due to platform type was not present for drilling work.
Source: Phelan D, O'Sullivan L. Appl. Ergon. 2014.
The role of perceived injustice
OBJECTIVE: Depressive symptoms complicate patients' recovery following musculoskeletal injury. There is strong evidence to support the utility of multidisciplinary approaches for treating comorbid pain and depressive symptoms. Despite this, a significant proportion of patients may not experience meaningful reductions in depressive symptoms following intervention. The purpose of this study was to identify barriers to change in depressive symptom during multidisciplinary rehabilitation for patients with whiplash injuries.
METHODS: 53 patients with clinically meaningful levels of depressive symptoms prior to participating in a standardized multidisciplinary rehabilitation program participated in this study. Patients completed self-report measures of depressive symptoms, demographic factors, pain intensity, disability, post-traumatic stress symptoms, pain catastrophizing and self-efficacy upon commencement and completion of the rehabilitation program. Analyses examined whether pre-treatment variables predicted change in depressive symptoms over treatment and the maintenance of clinically meaningful levels of depressive symptoms at post-treatment.
RESULTS: Duration of work absence and perceived injustice were significant unique predictors of percent change in depressive symptoms in a linear regression analysis. Perceived injustice was the only significant unique predictor of the presence of clinically meaningful levels of depressive symptoms at post-treatment in a logistic regression analysis.
CONCLUSIONS: The results suggest that the identification of patients with high levels of perceived injustice and implementation of targeted interventions for these patients might contribute to greater improvements in their depressive symptomatology.
Source: Scott W, Trost Z, Milioto M, Sullivan MJ. Clin. J. Pain. 2014.
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