Musculoskeletal injury as "part of the job"

Health and safety in hand-intensive healthcare occupations Preventing work-related upper limb disorders
The main focus of previous research on musculoskeletal injuries in healthcare workers has been on back injuries, in particular to nurses. Less attention has been given to work-related upper limb disorders (WRULDs) specifically for those who are performing hand-intensive tasks as part of their work; that include precision hand and wrist movements, repetitive hand motions and sustained awkward postures. Professional healthcare workers such as physiotherapists, physical therapists, sports therapists and manual/manipulative therapists are exposed to risk factors for upper limb disorders on a daily basis, despite the irony that they treat patients and clients with musculoskeletal disorders, and also have specialist knowledge of body mechanics and injury prevention strategies. However physiotherapists and physical therapists are just typical occupations from a range of other health care occupations with hand-intensive work characteristics such as podiatrists, sonographers, dentists and many more.


Feasibility and acceptability of reducing workplace sitting time

A qualitative study with Australian office workers
Office workers spend a large proportion of their working hours sitting. This may contribute to an increased risk of chronic disease and premature mortality. While there is growing interest in workplace interventions targeting prolonged sitting, few qualitative studies have explored workers' perceptions of reducing occupational sitting outside of an intervention context. This study explored barriers to reducing office workplace sitting, and the feasibility and acceptability of strategies targeting prolonged sitting in this context.

Source: Hadgraft, N. T., Brakenridge, C. L., LaMontagne, A. D., Fjeldsoe, B. S., Lynch, B. M., Dunstan, D. W., ... & Lawler, S. P. (2016). BMC Public Health, 16(1), 933.

How Does Definition of Minimum Break Length Affect Objective Measures of Sitting Outcomes Among Office Workers?

BACKGROUND: Harmful health effects associated with sedentary behaviour may be attenuated by breaking up long periods of sitting by standing or walking. However, studies assess interruptions in sitting time differently, making comparisons between studies difficult. It has not previously been described how the definition of minimum break duration affects sitting outcomes. Therefore, the aim was to address how definitions of break length affect total sitting time, number of sit-to-stand transitions, prolonged sitting periods and time accumulated in prolonged sitting periods among office workers. METHODS: Data were collected from 317 office workers. Thigh position was assessed with an ActiGraph GT3x+ fixed on the right thigh. Data were exported with varying bout length of breaks. Afterwards, sitting outcomes were calculated for the respective break lengths. RESULTS: Absolute numbers of sit-to-stand transitions decreased, and number of prolonged sitting periods and total time accumulated in prolonged sitting periods increased, with increasing minimum break length. Total sitting time was not influenced by varying break length. CONCLUSIONS: The definition of minimum break length influenced the sitting outcomes with the exception of total sitting time. A standard definition of break length is needed for comparison and interpretation of studies in the evolving research field of sedentary behaviour.

Source: Kloster S, Danquah IH, Holtermann A, et al. (2016). Journal of Physical Activity & Health.

Les départs précoces des pâtissiers salariés de l'artisanat

Comprendre pour agir en prévention
Le départ précoce de la plupart des pâtissiers salariés de l'artisanat, survenant bien avant l'âge légal de la retraite, constitue à la fois un paradoxe et un défi de prévention en santé au travail. Le présent article fondé sur une analyse pluridisciplinaire décrit l'activité et les altérations de santé caractéristiques de ce métier, ses contraintes et la tension entre deux configurations différentes d'exercice. Des marges de progrès et des actions possibles de prévention à adapter aux particularités de l'entreprise sont décrites.

Source: PICHENE-HOUARD A., LAPOIRE-CHASSET M., MARTEL L., GAUDART C., VOLKOFF S., CLAUDON L. Références en santé au travail, septembre 2016, no 147, p. 51-68. 240

Long-term effectiveness of an educational and physical intervention for preventing low-back pain recurrence

A randomized controlled trial
This paper notes that a careful case definition of workers with previous history of low-back pain (LBP) is needed to better characterize sub-groups based on their  recurrences profile. Workers with highly recurrent LBP may require a stepped secondary prevention in order to prevent recurrences and sick leave. The value of a workplace component reducing physical and psychosocial risks in secondary prevention of LBP must be explored.

Source: Chaléat-Valayer E, Denis A, Abelin-Genevois K, Zelmar A, Siani-Trebern F, Touzet S, Bergeret A, Colin C, Fassier J-B. Scand J Work Environ Health, 2016.

Processes, barriers and facilitators to implementation of a participatory ergonomics program among eldercare workers

This study aimed to investigate the processes of a participatory ergonomics program among 594 eldercare workers with emphasis on identified risk factors for low back pain and solutions, and reveal barriers and facilitators for implementation.
Sixty-nine per cent of the identified risk factors were physical ergonomic, 24% were organisational and 7% were psychosocial risk factors. Most solutions were organisational (55%), followed by physical (43%) and psychosocial solutions (2%). Internal factors (e.g. team or management) constituted 47% of the barriers and 75% of the facilitators. External factors (e.g. time, financial resources, collaboration with resident or relatives) constituted 53% of the barriers and 25% of the facilitators.
This study revealed the processes and implementation of a participatory ergonomics program among eldercare workers. The findings can be transferred to workers, workplaces, health and safety professionals, and researchers to improve future participatory ergonomics programs.

Source: Charlotte Diana Nørregaard Rasmussena, Naja Klærke Lindbergb, Marie Højbjerg Ravna, Marie Birk Jørgensena, Karen Søgaardb, Andreas Holtermanna. Applied Ergonomics, Volume 58, January 2017, p. 491-499.

Does objectively measured daily duration of forward bending predict development and aggravation of low-back pain

A prospective study
OBJECTIVES: The aim of this paper was to investigate if objectively measured daily duration of forward bending of the trunk increases the risk of the development or aggravation of low-back pain (LBP) over one year in a working blue-collar population by examining (i) the incidence rate of LBP among workers reporting no LBP at baseline, and (ii) the aggravation of LBP among workers reporting LBP at baseline. METHODS: Using data from the Danish Physical Activity Cohort with Objective Measurements (DPhacto), the study measured forward bending of the trunk (>60 ) at work (FBW) and during leisure time (FBL), diurnally with accelerometers, and LBP with one-year monthly self-reports among 682 blue-collar workers from 15 workplaces. The development of LBP was investigated with Cox's proportional hazards model (N=200), and the aggravation of LBP was investigated with mixed model for repeated measurements (N=482). RESULTS: Workers with no LBP at baseline had a FBW median of 7.9 minutes/day. Workers with LBP at baseline had a FBW median of 7.3 minutes/day. No significant associations were found between daily duration of forward bending of the trunk and development or aggravation of LBP. Similar results were found in the secondary analyses, in which FBL, different degrees of forward bending (>30 and >90 ), and varying follow-up time since measurement were considered. CONCLUSION: Using objective measurements of forward bending and monthly follow-up of LBP over one year, this study did not confirm the hypothesis of a positive association between daily duration of forward bending and LBP.

Source: Lagersted-Olsen J, Thomsen BL, Holtermann A, et al. Scandinavian Journal of Work Environment & Health, 2016.

Regular use of medication for musculoskeletal pain and risk of long-term sickness absence

A prospective cohort study among the general working population
BACKGROUND: The aim was to determine the prospective association between use of pain medication - due to musculoskeletal pain in the low back, neck/shoulder and hand/wrist - and long-term sickness absence. METHODS: Cox-regression analysis was performed to estimate the prospective association between regular use of pain medication and long-term sickness absence (LTSA; at least 6 consecutive weeks) among 9,544 employees from the general working population (Danish Work Environment Cohort Study 2010) and free from LTSA during 2009-2010. The fully adjusted model was controlled for age, gender, body mass index, smoking, leisure physical activity, job group, physical activity at work, psychosocial work environment, pain intensity, mental health and chronic disease. RESULTS: In 2010, the proportion of regular pain medication users due to musculoskeletal disorders was 20.8%: 13.4% as over-the-counter (i.e. non-prescription) and 7.4% as doctor prescribed. In the fully adjusted model, regular use of over-the-counter [HR 1.44 (95% CI 1.13-1.83)] and doctor prescribed (HR 2.18 (95% CI 1.67-2.86)) pain medication were prospectively associated with LTSA. CONCLUSIONS: Regular use of pain medication due to musculoskeletal pain is prospectively associated with LTSA even when adjusted for pain intensity. This study suggests that use of pain medication can be an important factor to be aware of in the prevention of sickness absence. Thus, regular use of pain medication - and not solely the intensity of pain - can be an early indicator that musculoskeletal pain can lead to serious consequences such as long-term sickness absence. SIGNIFICANCE: Use of medication due to musculoskeletal pain is prospectively associated with long-term sickness absence even when adjusted for pain intensity. Use of pain medication can be a red flag to be aware of in the prevention of sickness absence.

Source: Sundstrup E, Jakobsen MD, Thorsen SV, et al. European Journal of Pain, 2016.

Association between occupational lifting and day-to-day change in low-back pain intensity based on company records and text messages

Most previous studies assessing the association between physical workload and development of low-back pain have used self-reports for exposure. Using company records for quantifying exposure, this study shows that consecutive working days and higher workload are associated with acutely increased low-back pain.

Source: Andersen LL, Fallentin N, Ajslev JZN, Jakobsen MD, Sundstrup E. Scand J Work Environ Health, 2016.

Risk assessment of pushing and pulling (RAPP) tool

This tool is designed to help assess the key risks in manual pushing and pulling operations involving whole-body effort, eg moving loaded trolleys or roll cages, or dragging, hauling, sliding or rolling loads.
It is intended to be used alongside the Manual handling assessment charts (the MAC tool)1 which helps assess lifting and carrying operations, and follows a similar
approach to that tool. It is aimed at those responsible for health and safety in workplaces and will help you to identify high-risk pushing and pulling activities and check the effectiveness of any risk-reduction measures.


Longitudinal Relationship Between Sitting Time on a Working Day and Vitality, Work Performance, Presenteeism, and Sickness Absence

Objective: The aim of this study was to explore the longitudinal relationship between sitting time on a working day and vitality, work performance, presenteeism, and sickness absence.
Methods: At the start and end of a five-month intervention program at the workplace, as well as 10 months after the intervention, sitting time and work-related outcomes were measured using a standardized self-administered questionnaire and company records. Generalized linear mixed models were used to estimate the longitudinal relationship between sitting time and work-related outcomes, and possible interaction effects over time.
Results: A significant and sustainable decrease in sitting time on a working day was observed. Sitting less was significantly related to higher vitality scores, but this effect was marginal (b?=?−0.0006, P?=?0.000).
Conclusions: Our finding of significant though marginal associations between sitting time and important work-related outcomes justifies further research.

Source: Hendriksen, Ingrid J.M.; Bernaards, Claire M.; Steijn, Wouter M.P.; Hildebrandt, Vincent H. Journal of Occupational & Environmental Medicine: August 2016, Volume 58, Issue 8, p. 784-789.

Predicting chronic low-back pain based on pain trajectories in patients in an occupational setting

An exploratory analysis
We applied latent class growth analysis was applied in low-back pain patients in an occupational setting to determine different pain trajectories, something that has never been done before. The pain trajectories were used as outcome to evaluate a previously developed prognostic model for the development of chronic low back pain. The prediction model shows (after internal validation) a good predictive performance (AUC: 0.75).

Source: Panken G, Hoekstra T, Verhagen A, van Tulder M, Twisk J, Heymans MW. Scand J Work Environ Health, 2016.

The Impact of a Rigorous Multiple Work Shift Schedule and Day Versus Night Shift Work on Reaction Time and Balance Performance in Female Nurses

A Repeated Measures Study
Objective: The aim of this study was to determine the impact of a demanding work schedule involving long, cumulative work shifts on response time and balance-related performance outcomes and to evaluate the prevalence of musculoskeletal disorders between day and night shift working nurses.
Methods: A questionnaire was used to identify the prevalence of past (12-month) and current (7-day) musculoskeletal disorders. Nurses worked three 12-hour work shifts in a 4-day period. Reaction time and balance tests were conducted before and after the work period.
Results: The work period induced impairments for reaction time, errors on reaction time tasks, and balance performance, independent of shift type. Musculoskeletal symptom prevalence was high in workers of both work shifts.
Conclusions: Compressed work shifts caused performance-based fatigue in nurses. Reaction time and balance tests may be sensitive fatigue identification markers in nurses.

Source: Thompson, Brennan J.; Stock, Matt S.; Banuelas, Victoria K.; Akalonu, Chibuzo C. Journal of Occupational & Environmental Medicine: July 2016, Volume 58, Issue 7, p. 737-743.

Psychosocial work stress, leisure time physical exercise and the risk of chronic pain in the neck/shoulders

Longitudinal data from the Norwegian HUNT Study
Objectives: To prospectively investigate if the risk of chronic neck/shoulder pain is associated with work stress and job control, and to assess if physical exercise modifies these associations. Material and Methods: The study population comprised 29 496 vocationally active women and men in the Norwegian Nord-Trøndelag Health Study (HUNT Study) without chronic pain at baseline in 1984–1986. Chronic neck/shoulder pain was assessed during a follow-up in 1995–1997. A generalized linear model (Poisson regression) was used to calculate adjusted relative risks (RRs). Results: Work stress was dosedependently associated with the risk of neck/shoulder pain (ptrend < 0.001 in both sexes). The women and men who perceived their work as stressful “almost all the time” had multi-adjusted RRs = 1.27 (95% confidence interval (CI): 1.1–1.47) and 1.71 (95% CI: 1.46–2), respectively, referencing those with no stressful work. Work stress interacted with sex (p < 0.001). Poor job control was not associated with the risk of neck/shoulder pain among the women (RR = 1.04, 95% CI: 0.92–1.19) nor the men (RR = 1.09, 95% CI: 0.95–1.26). Combined analyses showed an inverse dose-dependent association between hours of physical exercise/week and the risk of neck/shoulder pain in the men with no stressful work (ptrend = 0.05) and among the men who perceived their work as “rarely stressful” (ptrend < 0.02). This effect was not statistically significant among the women or among men with more frequent exposure to work stress. Conclusions: Work stress is an independent predictor of chronic neck/shoulder pain and the effect is stronger in men than in women. Physical exercise does not substantially reduce the risk among the persons with frequent exposure to work stress.

Source: Fanavoll R, Nilsen TI, Holtermann A, et al. International Journal of Occupational Medicine and Environmental Health. 2016; 29 (4): 585-95.

Impact of Work Organizational Factors on Carpal Tunnel Syndrome and Epicondylitis

Objective: The aim of this study was to identify relationships between work organizational variables (job rotation, overtime work, having a second job, and work pacing) (These work organizational variables and their relationships with biomechanical and psychosocial exposures were studied previously and published in a separate paper.) and health outcome measures [carpal tunnel syndrome (CTS), lateral and medial epicondylitis (LEPI/MEPI)].
Methods: Using a pooled baseline cohort of 1834 subjects, the relationships were studied using logistic regression models.
Results: Varied degrees of associations between the work organizational and outcomes variables were found. Job rotation was significantly associated with being a CTS case [odds ratio (OR)=1.23, 95% confidence interval (95% CI): 1.00 to 1.50]. Overtime work was significantly associated with lower LEPI prevalence (OR=0.48, 95% CI: 0.28 to 0.84). No statistically significant associations were found between having a second job and different work pacing and any of the three health outcome measures.
Conclusions: Work organizational variables were only partially associated with the studied health outcomes.

Source: Bao, Stephen S.; Kapellusch, Jay M.; Merryweather, Andrew S.; Thiese, Matthew S.; Garg, Arun; Hegmann, Kurt T. Silverstein, Barbara A.; Marcum, Jennifer L; Tang, Ruoliang. Journal of Occupational & Environmental Medicine: August 2016, Volume 58, Issue 8, p. 760-764.

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