Effectiveness of workplace interventions in the prevention of upper extremity musculoskeletal disorders and symptoms

An update of the evidence
The burden of disabling musculoskeletal pain and injuries (musculoskeletal disorders, MSDs) arising from work-related causes in many workplaces remains substantial. There is little consensus on the most appropriate interventions for MSDs. Our objective was to update a systematic review of workplace-based interventions for preventing and managing upper extremity MSD (UEMSD). We followed a systematic review process developed by the Institute for Work & Health and an adapted best evidence synthesis. 6 electronic databases were searched (January 2008 until April 2013 inclusive) yielding 9909 non-duplicate references. 26 high-quality and medium-quality studies relevant to our research question were combined with 35 from the original review to synthesise the evidence on 30 different intervention categories. There was strong evidence for one intervention category, resistance training, leading to the recommendation: Implementing a workplace-based resistance training exercise programme can help prevent and manage UEMSD and symptoms. The synthesis also revealed moderate evidence for stretching programmes, mouse use feedback and forearm supports in preventing UEMSD or symptoms. There was also moderate evidence for no benefit for EMG biofeedback, job stress management training, and office workstation adjustment for UEMSD and symptoms. Messages are proposed for both these and other intervention categories.

Source: D Van Eerd, C Munhall, E Irvin, D Rempel, S Brewer, A J van der Beek, J T Dennerlein, J Tullar, K Skivington, C Pinion, B Amick. Occup Environ Med, 2015.   http://dx.doi.org/10.1136/oemed-2015-102992

Systematic review of biochemical biomarkers for neck and upper-extremity musculoskeletal disorders

Objective: This study systematically summarizes biochemical biomarker research in non-traumatic musculoskeletal disorders (MSD). Two research questions guided the review: (i) Are there biochemical markers associated with neck and upper-extremity MSD? and (ii) Are there biochemical markers associated with the severity of neck and upper-extremity MSD?
Methods: A literature search was conducted in PubMed and SCOPUS, and 87 studies met primary inclusion criteria. Following a quality screen, data were extracted from 44 articles of sufficient quality.
Results: Most of the 87 studies were cross-sectional and utilized convenience samples of patients as both cases and controls. A response rate was explicitly stated in only 11 (13%) studies. Less than half of the studies controlled for potential confounding through restriction or in the analysis. Most sufficient-quality studies were conducted in older populations (mean age in one or more analysis group >50 years). In sufficient-quality articles, 82% demonstrated at least one statistically significant association between the MSD and biomarker(s) studied. Evidence suggested that: (i) the collagen-repair marker TIMP-1 is decreased in fibro proliferative disorders, (ii) 5-HT (serotonin) is increased in trapezius myalgia, and (iii) triglycerides are increased in a variety of MSD. Only 5 studies showed an association between a biochemical marker and MSD severity.
Conclusion: While some MSD biomarkers were identified, limitations in the articles examined included possible selection bias, confounding, spectrum effect (potentially heterogeneous biomarker associations in populations according to symptom severity or duration), and insufficient attention to comorbid conditions. A list of recommendations for future studies is provided.

Source: Gold JE, Hallman DM, Hellström F, Björklund M, Crenshaw AG, Djupsjobacka M, Heiden M, Mathiassen SE, Piligian G, Barbe MF. Scand J Work Environ Health, 2015.  

Tarification à l’expérience, incidence des troubles musculo-squelettiques et arrêts de travail

Dans un grand nombre de pays, l'assurance des risques professionnels est financée par les entreprises qui versent des contributions modulées selon leur sinistralité
passée. En France, pour une entreprise de plus de 10 salariés, plus le nombre et la gravité des accidents et maladies professionnels sont importants, plus le montant de sa contribution sera élevée. Ce mode de tarification devrait contribuer à sensibiliser les employeurs à l'intérêt de développer des démarches préventives (primaires ou secondaires), afin de réduire leur coût d'assurance, et ainsi contribuer à minimiser le coût social des accidents du travail et maladies professionnels. À partir d'une expérience naturelle observée en 2007 dans le contexte français, nous étudions l'influence d'une augmentation exogène de la contribution des entreprises au coût des troubles musculo - squelettiques (TMS) sur l'incidence de ces maladies et les arrêts de travail associés. Nous estimons un modèle de différence-de-différences, à partir des données administratives de tarification des risques professionnels pour la période 2004-2010. Selon nos résultats, cette augmentation a entraîné une diminution substantielle de l'incidence des TMS, du nombre de jours d'arrêt de travail et du montant des indemnités journalières associés.

Source: http://www.irdes.fr/english/working-papers/069-experience-rating-incidence-of-musculoskeletal-disorders-and-related-absences.pdf

Association between objectively measured sitting time and neck–shoulder pain among blue-collar workers

Objectives: Prolonged sitting has been suggested as a risk factor for neck–shoulder pain (NSP). Using a cross-sectional design, we investigated the extent to which objectively measured time sitting is associated with NSP among blue-collar workers.
Methods: Sitting time was measured during multiple working days on male (n = 118) and female (n = 84) blue-collar workers (n = 202) using triaxial accelerometers (Actigraph) placed on the thigh and trunk. Workers were categorized into having, on average, a low, moderate or high sitting time, with mean values (SD between subjects) of 4.9 (1.0), 7.3 (0.5) and 9.6 (1.1) h in total per day. Workers rated their largest NSP intensity during the previous month on a numerical scale (0–9) and were subsequently dichotomized into a low and high NSP intensity group (ratings 0–4 and >4, respectively). Logistic regression analyses adjusted for several individual, and work-related factors were used to investigate the association between average sitting time per day (work, leisure and total) and NSP intensity.
Results: For total sitting time, workers in the high sitting category were more likely (adjusted OR 2.97, CI 1.25–7.03) to report high NSP intensity than those who sat moderately (reference category). Low sitting during work was associated with a reduced NSP intensity, but only for males (adjusted OR 0.26 CI 0.07–0.96). No significant association was found between sitting during leisure and NSP intensity.
Conclusion: These findings suggest an association between sitting time, in total per day and specifically during work, and NSP intensity among blue-collar workers. We encourage studying the structure and explanation of this association further in prospective studies on larger populations.

Source: Latza U, Rossnagel K, Hannerz H, et al. International Archives of Occupational and Environmental Health 2015;88(8):1087-97.

Ischaemic heart disease among workers in occupations associated with heavy lifting

OBJECTIVES: To investigate a hypothesized positive association between employment in occupations where heavy lifting is likely to occur, and the risk of ischaemic heart disease (IHD). MATERIAL AND METHODS: Male blue-collar workers from Denmark (N = 516 180) were monitored with respect to hospital treatment or death due to IHD, through national registers over the years 2001-2010. Poisson regression was used to estimate relative rates of IHD between "workers in occupations which, according to an expert opinion, are likely to involve heavy lifting" and "other blue-collar workers." Prevalent cases were excluded from the analysis. RESULTS: The rate ratio was estimated at 0.97 (95% confidence interval (CI): 0.94-1.00) for deaths or hospitalizations due to IHD and 1.07 (95% CI: 0.94-1.21) for deaths due to IHD. CONCLUSIONS: The results do not support the hypothesis that occupational heavy lifting is an important risk factor for IHD.

Source: Hannerz H, Holtermann A. International Journal of Occupational Medicine and Environmental Health, 2015.

Observed use of voluntary controls to reduce physical exposures among sheet metal workers of the mechanical trade

INTRODUCTION: Little is known about the transfer into the workplace of interventions designed to reduce the physical demands of sheet metal workers.
METHODS: We reviewed videos from a case series of 15 sheet metal worksite assessments performed in 2007-2009 to score postures and physical loads, and to observe the use of recommended interventions to reduce physical exposures in sheet metal activities made by a NIOSH stakeholder meeting in 2002.
RESULTS: Workers showed consistent use of material handling devices, but we observed few uses of recommended interventions to reduce exposures during overhead work. Workers spent large proportions of time in awkward shoulder elevation and low back rotation postures.
CONCLUSIONS: In addition to the development of new technologies and system designs, increased adoption of existing tools and practices could reduce time spent in awkward postures and other risks for musculoskeletal disorders in sheet metal work.

Source: Dale AM, Miller K, Gardner BT, Hwang CT, Evanoff B, Welch L. Appl. Ergon. 2016; 52: 69-76.

Les pratiques de prévention des TMS dans l’économie sociale et solidaire

Les structures de l'économie sociale sont caractérisées par des métiers en contact avec un public en situation de difficultés sociales, de santé, d'autonomie, et par des financements très contraints liés aux politiques publiques. Ces spécificités ont un effet sur l'exposition des salariés au risque TMS.
Le projet « Prévenir les TMS dans les métiers de l'économie sociale » a été initié par CIDES, Chorum Initiatives pour le Développement de l'Economie Sociale, le centre de ressources et d'action de Chorum, afin de contribuer à l'accompagnement des branches professionnelles de l'économie sociale en matière de prévention des TMS.
L'enquête « Les pratiques de prévention des TMS dans l'ESS » a été lancée dans le cadre de ce projet. Son but était d'obtenir une vision qualitative des marges de manoeuvre et modalités d'action efficaces que les structures de l'ESS mettent en place. L'objectif est de bien identifier les capacités réelles des structures à s'engager dans des actions de prévention, et de ne pas construire des outils ou des démarches qu'elles ne pourraient pas mettre en oeuvre.
Sur cette base, nous avons pu identifier une diversité de pratiques, qui nous le souhaitons, représenteront un point d'appui pour les établissements qui souhaitent développer des démarches de prévention des risques professionnels incluant le risque TMS.

Source: http://www.anact.fr/portal/pls/portal/docs/1/17588385.PDF

Organizing workplace health literacy to reduce musculoskeletal pain and consequences

BACKGROUND: Despite numerous initiatives to improve the working environment for nursing aides, musculoskeletal disorders (pain) is still a considerable problem because of the prevalence, and pervasive consequences on the individual, the workplace and the society. Discrepancies between effort and effect of workplace health initiatives might be due to the fact that pain and the consequences of pain are affected by various individual, interpersonal and organizational factors in a complex interaction. Recent health literacy models pursue an integrated approach to understanding health behavior and have been suggested as a suitable framework for addressing individual, organizational and interpersonal factors concomitantly. Therefore, the aim of the trial is to examine the effectiveness of an intervention to improve health literacy (building knowledge, competences and structures for communication and action) at both the organizational and individual level and reduce pain among nursing aides. METHODS/DESIGN: The intervention consists of 2 steps: 1) Courses at the workplace for employees and management in order to organize a joint fundament of knowledge and understanding, and a platform for communication and action about pain prevention in the organization. 2) Organizing a fixed 3-weekly structured dialogue between each employee and her/his supervisor, with particular focus on developing specific plans to prevent and reduce pain and its consequences. This enables the workplace to generate knowledge about employee resources and health challenges and to act and convey this knowledge into initiatives at the workplace. DISCUSSION: Previous studies to improve health literacy have primarily targeted patients or specific deprived groups in health care or community settings. Recently the idea of the workplace as an arena for improving health literacy has developed emphasizing the organizational responsibility in facilitating and supporting that employees obtain basic knowledge and information needed to understand and take action on individual and occupational health concerns. The literature about workplace health literacy is very limited but points at the importance of educating employees to be able to access, appraise and apply health information and of organizing the infrastructure and communication in the organization. This study suggests a concrete operationalization of health literacy in a workplace setting. Results are expected published in 2016.

Source: Larsen AK, Holtermann A, Mortensen OS, et al. BMC Nursing, 2015, vol.14, No 46.

Effect of individually tailored biopsychosocial workplace interventions on chronic musculoskeletal pain and stress among laboratory technicians

Randomized controlled trial
BACKGROUND: Chronic musculoskeletal pain is prevalent among laboratory technicians and work-related stress may aggravate the problem. OBJECTIVES: This study investigated the effect of a multifaceted worksite intervention on pain and stress among laboratory technicians with chronic musculoskeletal pain using individually tailored physical and cognitive elements.
STUDY DESIGN: This trial uses a single-blind randomized controlled design with allocation concealment in a 2-armed parallel group format among laboratory technicians. The trial "Implementation of physical exercise at the Workplace (IRMA09) - Laboratory technicians" was registered at ClinicalTrials.gov prior to participant enrolment.
SETTING: The study was conducted at the head division of a large private pharmaceutical company's research and development department in Denmark. The study duration was March 2014 (baseline) to July 2014 (follow-up).
METHODS: Participants (n = 112) were allocated to receive either physical, cognitive, and mindfulness group-based training (PCMT group) or a reference group (REF) for 10 weeks at the worksite. PCMT consisted of 4 major elements: 1) resistance training individually tailored to the pain affected area, 2) motor control training, 3) mindfulness, and 4) cognitive and behavioral therapy/education. Participants of the REF group were encouraged to follow ongoing company health initiatives. The predefined primary outcome measure was pain intensity (VAS scale 0 - 10) in average of the regions: neck, shoulder, lower and upper back, elbow, and hand at 10 week follow-up. The secondary outcome measure was stress assessed by Cohen s perceived stress questionnaire. In addition, an explorative dose-response analysis was performed on the adherence to PCMT with pain and stress, respectively, as outcome measures.
RESULTS: A significant (P < 0.0001) treatment by time interaction in pain intensity was observed with a between-group difference at follow-up of -1.0 (95%CI: -1.4 to -0.6). No significant effect on stress was observed (treatment by time P = 0.16). Exploratory analyses for each body region separately showed significant pain reductions of the neck, shoulders, upper back and lower back, as well as a tendency for hand pain.
Within the PCMT group, general linear models adjusted for age, baseline pain, and stress levels showed significant associations for the change in pain with the number of physical-cognitive training sessions per week (-0.60 [95%CI -0.95 to -0.25]) and the number of mindfulness sessions (0.15 [95%CI 0.02 to 0.18]). No such associations were found with the change in stress as outcome.
LIMITATIONS: Limitations of behavioral interventions include the inability to blind participants to which intervention they receive. Self-reported outcomes are a limitation as they may be influenced by placebo effects and outcome expectations.
CONCLUSIONS: We observed significant reductions in chronic musculoskeletal pain following a 10-week individually adjusted multifaceted intervention with physical training emphasizing dynamic joint mobility and mindfulness coupled with fear-avoidance and de-catastrophizing behavioral therapy compared to a reference group encouraged to follow on-going company health initiatives. A higher dose of physical-cognitive training appears to facilitate pain reduction, whereas a higher dose of mindfulness appears to increase pain. Hence, combining physical training with mindfulness may not be an optimal strategy for pain reduction.

Source: Jay K, Brandt M, Hansen K, et al. Pain Physician, 2015; 18 (5): 459-71.

Occupational sitting time and risk of all-cause mortality among Japanese workers

Objectives: Prolonged sitting is a health risk for cardiovascular diseases and all-cause mortality, independent of moderate-to-vigorous physical activity. Epidemiological evaluation of occupational sitting has received little attention, even though it may have a potential impact on workers' health. We prospectively examined the association between occupational sitting time and all-cause mortality.
Methods: Community-dwelling, Japanese workers aged 50–74 years who responded to a questionnaire in 2000–2003 were followed for all-cause mortality through 2011. Cox proportional hazard models were employed to calculate hazard ratios (HR) of all-cause mortality among middle (1 to <3 hours/day) or longer (≥≥3 hours/day) occupationally sedentary subjects by gender or types of engaging industry (“primary industry” and “secondary or tertiary industry”).
Results: During 368 120 person-years of follow-up (average follow-up period, 10.1 years) for the 36 516 subjects, 2209 deaths were identified. Among workers in primary industry, longer duration of occupational sitting was significantly or marginally associated with higher mortality [HR 1.23, 95% confidence interval (95% CI) 1.00–1.51 among men; HR 1.34, 95% CI 0.97–1.84 among women]. No associations were found among secondary or tertiary industry workers (men: HR 0.87, 95% CI 0.75–1.01; women: HR 1.03, 95% CI 0.77–1.39).
Conclusions: Occupational sitting time increased all-cause mortality among primary industry workers, however similar relationships were not observed for secondary-tertiary workers. Future studies are needed to confirm detailed dose–response relationships by using objective measures. In addition, studies using cause-specific mortality data would be important to clarify the physiological underlying mechanism.

Source: Kikuchi H, Inoue S, Odagiri Y, Inoue M, Sawada N, Tsugane S. Scand J Work Environ Health, 2015.

L’évaluation clinique, les traitements et le retour en emploi de travailleurs souffrant d’atteintes de la coiffe des rotateurs

Bilan des connaissances
Les atteintes musculosquelettiques de l'épaule constituent une problématique importante au sein de la population générale, et particulièrement chez les travailleurs. Ce type d'atteintes affecte le statut fonctionnel de l'épaule et la qualité de vie des personnes et peut entrainer, chez les travailleurs, des problématiques d'absentéisme ou des pertes de productivité. Les travailleurs effectuant des tâches avec les bras au-dessus des épaules ou des tâches répétitives présentent un risque plus important de développer une lésion à l'épaule, particulièrement une atteinte de la coiffe des rotateurs (CR). Pour la période 2005-2007, les coûts totaux générés annuellement par les lésions aux épaules acceptées par la Commission de la santé et de la sécurité du travail (CSST), incluant les coûts humains et ceux associés aux pertes de productivité, se chiffraient à 393 204 738$.
Devant l'importance de cette problématique, un vaste bilan des connaissances a été effectué sur plusieurs aspects liés aux atteintes de la CR. L'objectif principal de ce bilan des connaissances était de synthétiser les données probantes et de formuler des recommandations concernant les outils diagnostiques et d'évaluation clinique, les interventions thérapeutiques ainsi que les interventions en milieu de travail pour les travailleurs souffrant d'une atteinte de la CR. Des revues systématiques ou des méta-analyses de la littérature pertinente ont été effectuées pour chacun de ces thèmes. Plusieurs acteurs du réseau ont contribué à dresser ce bilan, soit des chercheurs, des collaborateurs et des cliniciens.

Source: http://www.irsst.qc.ca/publications-et-outils/publication/i/100837/n/traitements-retour-emploi-travailleurs-souffrant-coiffe-rotateurs

One Size Does Not Fit All

When your safety and your life depends on it, you need your equipment to fit properly. This is especially true in the workplace. Improper fit may prevent workers from performing their job duties safely and effectively. If your respirator does not seal properly to your face, if your gloves are too big, if your seatbelt cannot buckle with your safety gear on . . . you get the picture.
Anthropometry is the science of defining human body dimensions and physical characteristics. The National Institute for Occupational Safety and Health (NIOSH) conducts anthropometric research to prevent work-related injuries and deaths by studying how work spaces and equipment fit today's diverse worker population. This includes the fit of machines, vehicles, and personal protective equipment (PPE). Much of the available data were collected in the 1950s and 1970s from military personnel and the general population from that era. These decades-old data do not represent, on average and collectively, the sizes and body types of today's workers, who are much more diverse in age, gender, and ethnicity. NIOSH research has shown workers have unique shapes and sizes for specific occupations.

Source: http://blogs.cdc.gov/niosh-science-blog/2015/09/16/anthropometry/

Work demands and health consequences of organizational and technological measures introduced to enhance the quality of home care services

This study of home care workers in a Norwegian municipality aimed to examine the effect of two measures involving organizational (job checklists) and technological (personal digital assistants) job aids on perceived work demands and musculoskeletal health. Questionnaire data was collected in 2009 (n = 138, response rate 76.2%) and 2011 (n = 80, response rate 54%). Forty-six home care workers responded at both waves. Respondents were assigned into ‘high', ‘moderate' and ‘low' strain groups based on their responses to open and closed survey questions regarding impact of the two measures. One-way ANOVA with post-hoc t-tests and regression analyses investigated group differences and examined development in variables. Perceived work demands and health effects over the two-year study period were unchanged overall, yet significant differences between subgroups were highlighted. Work demands and shoulder-neck pain remained high for high-strain workers, but were reduced for low and moderate strain workers. Management should be aware of diversity in worker responses to rationalizations and give priority to supplementary, targeted measures to counteract adverse effects.

Source: Andersen, Gunn Robstad, Bendal, Synne, & Westgaard, Rolf H. (2015). Applied Ergonomics, 51, 172-179.

Further Trends in Work-Related Musculoskeletal Disorders

A Comparison of Risk Factors for Symptoms Using Quality of Work Life Data From the 2002, 2006, and 2010 General Social Survey
Objective: To report trends for the risk of musculoskeletal disorders.
Methods: Three Quality of Work Life surveys examine the risk factors for musculoskeletal disorders.
Results: Findings similar for several risk factors, but differences across the reporting years may reflect economic conditions. Respondent numbers in 2010 were reduced, some risk factors had pattern changes, and there were sex and age differences. Trend analysis showed most significant changes were for the “work fast” risk factor. New 2010 “physical effort” item showed sex differences, and items reflective of total worker health showed strong associations with “back pain” and “pain in arms.”
Conclusions: Intervention strategies should focus on physical exposures and psychosocial risk factors (work stress, safety climate, job satisfaction, supervisor support, work fast, work freedom, work time) that have been consistently related to reports of musculoskeletal disorders. Economic conditions will influence some psychosocial risk factors.

Source: ***, Robert B.; Lowe, Brian D.; Lu, Ming-Lun; Krieg, Edward F. Journal of Occupational & Environmental Médicine, August 2015, Volume 57, Issue 8, p. 910-928.

Ergonomics Climate Assessment

A measure of operational performance and employee well-being
Ergonomics interventions have the potential to improve operational performance and employee well-being. We introduce a framework for ergonomics climate, the extent to which an organization emphasizes and supports the design and modification of work to maximize both performance and well-being outcomes. We assessed ergonomics climate at a large manufacturing facility twice during a two-year period. When the organization used ergonomics to promote performance and well-being equally, and at a high level, employees reported less work-related pain. A larger discrepancy between measures of operational performance and employee well-being was associated with increased reports of work-related pain. The direction of this discrepancy was not significantly related to work-related pain, such that it didn't matter which facet was valued more. The Ergonomics Climate Assessment can provide companies with a baseline assessment of the overall value placed on ergonomics and help prioritize areas for improving operational performance and employee well-being.

Source: Krista Hoffmeister, Alyssa Gibbons, Natalie Schwatka, John Rosecrance. Applied Ergonomics, Volume 50, September 2015, p. 160-169.

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