Protocol for a Mixed-Methods Process Evaluation
Background: Previous research has shown that reducing physical workload among workers in the construction industry is complicated. In order to address this issue, we developed a process evaluation in a formative mixed-methods design, drawing on existing knowledge of the potential barriers for implementation.
Objective: We present the design of a mixed-methods process evaluation of the organizational, social, and subjective practices that play roles in the intervention study, integrating technical measurements to detect excessive physical exertion measured with electromyography and accelerometers, video documentation of working tasks, and a 3-phased workshop program.
Methods: The evaluation is designed in an adapted process evaluation framework, addressing recruitment, reach, fidelity, satisfaction, intervention delivery, intervention received, and context of the intervention companies. Observational studies, interviews, and questionnaires among 80 construction workers organized in 20 work gangs, as well as health and safety staff, contribute to the creation of knowledge about these phenomena.
Results: At the time of publication, the process of participant recruitment is underway.
Conclusions: Intervention studies are challenging to conduct and evaluate in the construction industry, often because of narrow time frames and ever-changing contexts. The mixed-methods design presents opportunities for obtaining detailed knowledge of the practices intra-acting with the intervention, while offering the opportunity to customize parts of the intervention.
Source: Ajslev J, Brandt M, Møller JL, et al. JMIR Research Protocols, Vol 5, No 2 (2016): Apr-Jun.
Stepped wedge cluster randomised trial
Aims: The aims of this study were to test whether a multi-faceted intervention effective for low back pain was effective for physical capacity, work demands, maladaptive pain behaviours, work ability and sickness absence due to low back pain. Methods: A stepped wedge cluster randomised, controlled trial with 594 nurses' aides was conducted. The intervention lasted 12 weeks and consisted of physical training (12 sessions), cognitive behavioural training (two sessions) and participatory ergonomics (five sessions). Occupational lifting, fear avoidance, physical exertion, muscle strength, support from management, work ability and sickness absence due to low back pain were measured every 3 months. Before and after the intervention we measured physical capacity, kinesiophobia and need for recovery. Linear mixed models adjusted for baseline values of the outcome were used to estimate the effect. Results: Significant reduction in occupational lifting (–0.35 (95% confidence interval −0.61 to −0.08)), and improvement in two measures of fear avoidance ((–0.75 (95% confidence interval −1.05 to −0.45) and −0.45 (95% confidence interval −0.80 to −0.11)) were found for the intervention group compared to the control. There were no significant effects on physical exertion, muscle strength, support from management, work ability or sickness absence due to low back pain. After the intervention, significant increased physical capacity and improvements in kinesiophobia were found, but no change in need for recovery. Conclusions: The intervention was significantly effective for physical work demands and maladaptive pain behaviours, but not for work ability and sickness absence due to low back pain. To improve work ability or reduce sickness absence due to low back pain more specific interventions should probably be developed.
Source: Rasmussen CD, Holtermann A, Jørgensen MB, et al. Journal of Public Health, 2016.
A new mobile app for ergonomic audits in the mining industry is now available from the National Institute for Occupational Safety and Health (NIOSH). The app, ErgoMine, is available for Android devices and provides an ergonomic assessment for three types of operations in the mining industry: bagging, maintenance and repair, and haul truck operations. By asking users a series of questions about work tasks and worksite conditions, ErgoMine produces recommendations for ergonomic improvements in a final summary which details the results of the audit. The app also provides the option for users to email the recommendations to themselves or others for further review.
Background: Many office employees are spending up to 90% of their workday seated, and employers are considering stand-capable desks as a way to increase physical activity throughout the day. When deciding on adoption of stand-capable workstations, a major concern for employers is that the benefits, over time, may not offset the initial cost of implementation.
Methods: This study compared objective measures of productivity over time between a group of stand-capable desk users and a seated control group in a call center. Comparison analysis was completed for continuous six-month secondary data for 167 employees, across two job categories.
Results: Users of stand-capable desks were ∼45% more productive on a daily basis compared to their seated counterparts. Further, productivity of the stand-capable desk users significantly increased over time, from ∼23% in the first month to ∼53% over the next six months. Finally, this productivity increase was similar for employees across both job categories.
Conclusions: These findings suggest important benefits of employing stand-capable desks in the work force to increase productivity. Prospective studies that include employee health status, perceptions of (dis)comfort and preference over time, along with productivity metrics, are needed to test the effectiveness of stand-capable desks on employee health and performance.
Source: Garrett, Gregory, Benden, Mark, Mehta, Ranjana, Pickens, Adam, Peres, Camille, & Zhao, Hongwei. (2016). IIE Transactions on Occupational Ergonomics and Human Factors.
A Systematic Review and Meta-Analysis
This article reviews the effectiveness of physical activity (PA) interventions at the workplace to reduce musculoskeletal pain among employees and assesses the effect size of these programs using meta-analysis. Four databases (i.e., PubMed, EBSCO, Web of Science, and Cochrane) were searched for research trials, which included comparison groups of employees that assessed PA programs, musculoskeletal pain, and health-related behaviors, published between January 1990 and March 2013. The meta-analysis estimates of standardized mean differences (Hedges' g) present significant evidence of less general pain (g = −.40 with a 95% confidence interval [CI] = [−0.78, −0.02]) and neck and shoulder pain (g = −.37 with a 95% CI = [−0.63, −0.12]) in intervention groups. The few studies of low back pain and arm, elbow, wrist, hand, or finger pain did not present sufficient statistically significant evidence. Consistent evidence demonstrates that workplace PA interventions significantly reduce general musculoskeletal pain and neck and shoulder pain. More studies are needed to determine the effectiveness of work-related PA interventions for arm, elbow, wrist, hand or finger, and low back pain.
Source: Moreira-Silva, Isabel, Teixeira, Pedro M., Santos, Rute, Abreu, Sandra, Moreira, Carlos, & Mota, Jorge. (2016). Workplace Health & Safety, 64 (5), p. 210-222. http://dx.doi.org/10.1177/2165079916629688
Daycare employees, specifically caregivers, are a distinct population that may experience increased risk of injury due to the high exposure to bent postures, lifting conditions and high stress associated with their work. The objectives of the study were to collect up to date data on daycare workers and to compare the data between groups working with children of different ages (Infant, Toddler and Preschool).
The study consisted of two distinct phases: Phase 1 – Questionnaire distribution, Phase 2 – Observation and analysis involving three dimensional postural monitoring and video recording as well as an analysis of the low back forces and moments in lifting.
Results suggested that these employees experience an elevated risk of low back injury caused by their occupational tasks and thus, further research is required to determine appropriate worker accommodations and safe work practices to help mediate these risks for all daycare caregivers.
Source: Labaj, Adam, Diesbourg, Tara, Dumas, Geneviève, Plamondon, André, Mercheri, Hakim, & Larue, Christian. (2016). International Journal of Industrial Ergonomics, 54 (7), p. 83-92.
Amulti-component intervention aimed at reducing sitting time among office workers - A cluster randomized trial
BACKGROUND: Prolonged sitting time has been associated with adverse health outcomes. Interventions at work may contribute to reduced sitting. The objective was to test if a multicomponent work-based intervention can reduce sitting time and the number of prolonged sitting periods (> 30 min), increase the number of sit-to-stand transitions and decrease waist circumference and body fat percentage among office workers. Primary outcomes were: change in sitting time, prolonged sitting periods and sit-to-stand transitions at follow-up 1 month later. METHODS: At four workplaces, 19 offices (317 workers in total) were cluster randomized for intervention or control. The intervention included the appointment of local ambassadors, management support, environmental changes, a lecture and a workshop. Sitting time was measured using an ActiGraph GT3X+ fixed on the thigh. Data were processed using Acti4 software providing data on time spent sitting, standing and doing other activities. Control participants were instructed to behave as usual. Follow-up measurements were obtained after 1 and 3 months. RESULTS: At 1 and 3 months, total sitting time was 71 (P< 0.001) and 48 min (P< 0.001) lower per 8-h workday in the intervention group compared with the control group. At 1 month, the number of prolonged sitting periods was lower (-0.79/8-h workday,P< 0.001) and sit-to-stand transitions were higher (+14%/sitting hour,P= 0.001) in the intervention compared with the control group. After 3 months, trends persisted. The body fat percentage was lower by 0.61 percentage points (P= 0.011) in the intervention group compared with the control group after 3 months. CONCLUSIONS: The multicomponent workplace-based intervention was effective in reducing sitting time, prolonged sitting periods and body fat percentage, and in increasing the number of sit-to-stand transitions.
Source: Danquah IH, Kloster S, Holtermann A, et al. Int J Epidemiol, 2016.
The OCTOPUS cohort, results of a ten-year longitudinal study
This large longitudinal cohort study provides a prospective validation of the ACGIH TLV® method for the assessment of biomechanical exposures at work. It confirmed that “forceful hand exertions” more than “any exertion” significantly increase the risk of CTS. This study suggests that the current limits (AL and TLV) might not be sufficiently protective for some workers.
Source: Violante FS, Farioli A, Graziosi F, Marinelli F, Curti S, Armstrong TJ, Mattioli S, Bonfiglioli R. Scand J Work Environ Health, 2016.
L'assurance des risques professionnels des travailleurs salariés du Régime général est financée par les entreprises sur la base de cotisations modulées selon leur sinistralité passée. En théorie, ce mode de tarification devrait contribuer à inciter les employeurs à développer des démarches de prévention des risques professionnels et à minimiser ainsi le coût des mauvaises conditions de travail. À partir d'une expérience naturelle observée en région Nord – Pas-de-Calais – Picardie en 2007, cette étude mesure l'influence d'une augmentation de la contribution des entreprises au coût des troubles musculo-squelettiques (TMS) sur l'incidence de ces maladies et les arrêts de travail associés. Cette étude s'appuie sur les données administratives de tarification des risques professionnels. La méthode repose sur une estimation en différence de différences. Les résultats indiquent que l'augmentation de la contribution des entreprises au coût des TMS a eu pour effet de limiter l'incidence de ces maladies. Cela s'est traduit par une baisse significative du nombre de jours d'arrêts de travail liés à ces pathologies.
Objective: To evaluate the participatory ergonomic method on the development of upper extremity musculoskeletal disorders and disability in office employees. Methods: This study is a randomized controlled intervention study. It comprised 116 office workers using computers. Those in the intervention group were taught office ergonomics and the risk assessment method. Cox proportional hazards model and generalized estimating equations (GEEs) were used. Results: In the 10-month postintervention follow-up, the possibility of developing symptoms was 50.9%. According to multivariate analysis results, the possibility of developing symptoms on the right side of the neck and in the right wrist and hand was significantly less in the intervention group than in the control group (p < 0.05). Neck disability/symptom scores over time were significantly lower in the intervention group compared with the control group (p < 0.05). Conclusion: The participatory ergonomic intervention decreases the possibility of musculoskeletal complaints and disability/symptom level in office workers.
Source: Baydur, Hakan, Ergör, Alp, Demiral, Yücef, & Akalin, Elif. (2016). Journal of Occupational Health.
Mammographers are an understudied group of health care workers, yet the prevalence of musculoskeletal (MSK) symptoms in mammographers appears to be elevated, similar to many occupations in health care. In this study, we used a participatory approach to identify needs and opportunities for developing interventions to reduce mammographers' exposures to risk factors that lead to the development of MSK symptoms. In this paper, we present a number of those needs and several intervention concepts along with evaluations of those concepts from experienced mammographers. We include findings from a preliminary field test of a novel intervention concept to reduce the need to adopt awkward postures while positioning patients for a screening or diagnostic mammogram.
Source: Sommerich, Carolyn M., Lavender, Steven A., Evans, kevin D., Sanders, Elizabeth, Joines, Sharon, Lamar, Sabrina,... Park, SangHyun. (2016). Ergonomics. http://dx.doi.org/10.1080/00140139.2016.1140815
Objective: The aim of this study was to determine user self-selected setup for both sitting and standing computer workstations and identify major differences.
Background: No current ergonomic setup guideline for standing computer workstations is available.
Methods: Twenty adult participants completed four 45-min sessions of simulated office computer work with an adjustable sit-stand computer workstation. Placement and relative position of all workstation components, including a cordless mouse, a cordless keyboard, a height-adjustable desk, and a 22-inch monitor mounted on a mechanical-assisted arm were recorded during the four sessions, which alternated between sitting and standing for each session. Participants were interrupted four times within each session, and the workstation was “reset” to extreme locations. Participants were instructed to adjust the location to achieve the most comfortable arrangement and to make as many adjustments during the session to achieve this goal.
Results: Overall, users placed the keyboard closer to their body (sternum), set desk height lower than their elbow, and set the monitor lower relative to their eyes with a greater upward tilt while standing compared to sitting. During the 45-min sessions, the number of adjustments participants made became smaller and over the four sessions was consistent, suggesting the psychophysical protocol was effective and consistent.
Conclusion: Users preferred different workstation setups for sitting and standing computer workstations. Therefore, future setup guidelines and principles for standing computer workstations may not be simply translated from those for sitting.
Application: These results can serve as the first step toward making recommendations to establish ergonomic guidelines for standing computer workstation arrangement.
Source: Lin, Michael Y., Catalano, Paul, & Dennerlein, Jack T. (2016). Human Factors.
A systematic review
Objectives: To explore the safety risks associated with physical interactions between patients and caregivers during treatment and care delivery in Home Care settings.
Design: Seven-stage framework from the PRISMA statement for research question, eligibility (definition), search, identification of relevant papers from title and abstract, selection and retrieval of papers, appraisal and synthesis.
Review methods: The included references (n = 42) were critically appraised using a modified version of Downs and Black checklist and the Mixed Methods Appraisal Tool.
Results: The risk factors are reported using the modified model of human factors of health care in the home to represent the roles of both patients and caregivers in the system. The results are grouped as environment (health policy, physical and social), artefacts (equipment and technology), tasks (procedures and work schedules) and care recipient/provider. These include permanent and temporary building design and access, communication and lone working, provision of equipment and consumables, and clinical tasks. The topics with strong evidence from at least 2 papers relate to risks associated with awkward working positions, social environment issues (additional tasks and distractions), abuse and violence, inadequate team (peer) support, problems with workload planning, needle stick injuries and physical workload (moving and handling patients).
Conclusions: As home care increases, there is a need to ensure the safety of both patients and caregivers with an understanding of the physical interactions and tasks to manage safety risks and plan safer care delivery systems.
Source: Hignett, Sue, Otter, Mary Edmunds, Keen, Christine. (2016). International Journal of Nursing Studies, 59, 1-14.
The purpose of this study was to evaluate the postural and muscular demands placed on the shoulders and neck of dental hygienists when performing a simulated manual scaling task. Nineteen healthy female dental hygienists performed 30-min of simulated manual scaling on a manikin head in a laboratory setting. Surface electromyography was used to monitor muscle activity from several neck and shoulder muscles, and neck and arm elevation kinematics were evaluated using motion capture. The simulated scaling task resulted in a large range of neck and arm elevation angles and excessive low-level muscular demands in the neck extensor and scapular stabilising muscles. The physical demands varied depending on the working position of the hygienists relative to the manikin head. These findings are valuable in guiding future ergonomics interventions aimed at reducing the physical exposures of dental hygiene work.
Source: La Delfa, Nicholas J., Grondin, Diane E., Cox, Jocelyn, Potvin, Jim R., & Howarth, Samuel J. (2016). Ergonomics.
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.
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