Cumulative occupational mechanical exposures during working life and risk of sickness absence and disability pension

Prospective cohort study
Using a biomechanical job exposure matrix combined with Danish registers, cumulative occupational mechanical exposures throughout life (ie, more years with heavy and frequent lifting, and kneeling work) predicted risk of long-term sickness absence among older workers. Importantly, heavy lifting throughout working life was associated with disability pension.

Source: Sundstrup E, Hansen ÅM, Mortensen EL, Poulsen OM, Clausen T, Rugulies R, Møller A, Andersen LL. (2017). Scand J Work Environ Health.

Decrease in musculoskeletal pain after 4 and 12 months of an aerobic exercise intervention

A worksite RCT among cleaners
Background: Prevalence of musculoskeletal pain is high in jobs with high physical work demands. An aerobic exercise intervention targeting cardiovascular health was evaluated for its long term side effects on musculoskeletal pain. Objective: The objective was to investigate if aerobic exercise affects level of musculoskeletal pain from baseline to 4- and 12-months follow-up. Methods: One-hundred-and-sixteen cleaners aged 18–65 years were cluster-randomized. The aerobic exercise group (n = 57) received worksite aerobic exercise (30 min twice a week) and the reference group (n = 59) lectures in health promotion. Strata were formed according to closest manager (total 11 strata); clusters were set within strata (total 40 clusters, 20 in each group). Musculoskeletal pain data from eight body regions was collected at baseline and after 4- and 12-months follow-up. The participants stated highest pain in the last month on a scale from 0, stating no pain, up to 10, stating worst possible pain. A repeated-measure 2 × 2 multi-adjusted mixed-models design was applied to compare the between-groups differences in an intention to treat analysis. Participants were entered as a random effect nested in clusters to account for the cluster-based randomization. Results: Clinically significant reductions (>30%, f 2 > 0.25) in the aerobic exercise group, compared to the reference group, in pain intensity in neck, shoulders, arms/wrists were found at 12-months follow-up, and a tendency (p = 0.07, f 2 = 0.18) to an increase for the knees. At 4-months follow-up the only significant between-group change was an increase in hip pain. Conclusions: This study indicates that aerobic exercise reduces musculoskeletal pain in the upper extremities, but as an unintended side effect may increase pain in the lower extremities. Aerobic exercise interventions among workers standing or walking in the majority of the working hours should tailor exercise to only maintain the positive effect on musculoskeletal pain.

Source: Korshøj, M., Birk Jørgensen, M., Lidegaard, M., Mortensen, O. S., Krustrup, P., Holtermann, A., & Søgaard, K. (2017). Scandinavian Journal of Public Health.

Work-related biomechanical exposure and job strain in midlife separately and jointly predict disability after 28 years

A Finnish longitudinal study
Higher level of work-related biomechanical exposure and job strain in midlife separately and jointly carried a higher risk for increase in disability after 28 years. Mitigation of both of these co-occurring exposures at work in midlife could reduce the risk of disability in later life. Thus the workplace should be promoted as an arena for preventive interventions regarding disability in old age.

Source: Prakash KC, Neupane S, Leino-Arjas P, von Bonsdorff MB, Rantanen T, von Bonsdorff ME, Seitsamo J, Ilmarinen J, Nygård C-H. (2017). Scand J Work Environ Health.

Relations between work and upper extremity musculoskeletal problems (UEMSP) and the moderating role of psychosocial work factors on the relation between computer work and UEMSP

Purpose: Computer work has been identified as a risk factor for upper extremity musculoskeletal problems (UEMSP). But few studies have investigated how psychosocial and organizational work factors affect this relation. Nor have gender differences in the relation between UEMSP and these work factors  been studied. We sought to estimate: (1) the association between UEMSP and a range of physical, psychosocial and organizational work exposures, including the duration of computer work, and (2) the moderating effect of psychosocial work exposures on the relation between computer work and UEMSP.
Methods: Using 2007–2008 Québec survey data on 2478 workers, we carried out gender-stratified multivariable logistic regression modeling and two-way interaction analyses.
Results: In both genders, odds of UEMSP were higher with exposure to high physical work demands and emotionally demanding work. Additionally among women, UEMSP were associated with duration of occupational computer exposure, sexual harassment, tense situations when dealing with clients, high quantitative demands and lack of prospects for promotion, and among men, with low coworker support, episodes of unemployment, low job security and contradictory work demands. Among women, the effect of computer work on UEMSP was considerably increased in the presence of emotionally demanding work, and may also be moderated by low recognition at work, contradictory work demands, and low supervisor support.
Conclusions: These results suggest that the relations between UEMSP and computer work are moderated by psychosocial work exposures and that the relations between working conditions and UEMSP are somewhat different for each gender, highlighting the complexity of these relations and the importance of considering gender.

Source: Nicolakakis, Nektaria, Stock, Susan R., Abrahamowicz, Michal, Kline, Rex, & Messing, Karen. (2017). International Archives of Occupational and Environmental Health.

Paramedics' working strategies while loading a stretcher into an ambulance

For paramedics, loading a stretcher into an ambulance is an activity with a high risk of back injury and accidents. The objective of this study was to document strategies paramedics use at work while loading a powered stretcher into an ambulance. A total of 249 stretcher loading operations performed by 58 paramedics, and 51 semistructured post-intervention interviews were analyzed. Almost three quarters of loading operations required additional actions (e.g., raising the shoulders and additional lifting) to insert the stretcher into the cot fastener system in the ambulance. Some strategies that were necessary to complete the stretcher loading operation seemed to have negative impacts on the workers' health, such as repositioning the stretcher. This action wastes time and requires significant physical efforts, as it is usually done alone. This study suggests some potential solutions, related to equipment, training, workers and work organization, to reduce the risk of injury while loading stretchers.

Source: Prairie, J., Plamondon, A., Larouche, D., Hegg-Deloye, S., & Corbeil, P. (2017). Applied Ergonomics, 65, 112-122.

Older females in the workforce

The effects of age on psychophysical estimates of maximum acceptable lifting loads
This psychophysical study demonstrated that older female workers (aged 50–63 years) selected maximum acceptable lift masses that were (on average) 24% lower than younger workers (aged 20–32 years), which corresponded with lower grip strength and heart rate reserve. Current maximum acceptable lifting weights based on psychophysical information may not protect female workers greater than 50 years of age.

Source: Chen, J. A., Dickerson, C. R., Wells, R. P., & Laing, A. C. (2017). Ergonomics, 1-34.

Méthode d'analyse de la charge physique de travail - Secteur sanitaire et social

La méthode d'analyse de la charge physique de travail dans le secteur sanitaire et social a été conçue pour être utilisée dans les établissements spécialisés (hôpitaux, cliniques, hébergements pour personnes âgées, handicapés, enfants) et les services d'aide et de soins à domicile. Elle permet de repérer et d'analyser les facteurs de risques pour l'appareil locomoteur en tenant compte de la globalité des composantes de l'activité.
Elle propose une conduite d'action de prévention qui permet d'établir des priorités, d'orienter vers des pistes de prévention pertinentes et d'en évaluer l'efficacité. Elle est applicable dans les structures de toutes tailles. Sa mise en oeuvre peut être initiée par tous les acteurs de la structure, mais son efficacité repose sur une démarche collective.


Perceived affordances and postures for lifting in child care

Childcare work appears to be full of the physical and mental risk factors frequently associated with chronic exertion leading to injury of the musculoskeletal system. The purpose of this study was to examine the affordances and mechanics for lifting a child, and to associate those mechanics with physical demands reports provided by experienced childcare workers. Participants perceived a smaller safe reaching distance to a child compared to a conventional handling target, despite the identical load and similar load distribution. This difference may reflect the influence of coupling (suitcase had ‘good' coupling, child manikin had ‘poor' coupling), or an increased concern for the safety of the child over the suitcase. While lifting at a smaller affordant distance could contribute to decreasing spinal loading from reactive moments, the greater trunk and knee flexions observed in child lifting may be contributing to childcare workers' musculoskeletal discomfort and injury in those regions.

Source: Doan, Jon, Awosoga, Olu, Provost, Trishell, Blinch, Jarrod, & Hudson, Jessica. (2017). Theoretical Issues in Ergonomics Science.

A Study of the Prevalence of Musculoskeletal Disorders in Surgeons Performing Minimally Invasive Surgery

Introduction: Minimally invasive surgery (MIS) has shown significant benefits for patients and healthcare systems. However, due to the poor ergonomic adaptation of operating rooms and surgical instruments, most surgeons suffer from pain caused by musculoskeletal disorders (MSDs).
Methods: A descriptive survey on MIS surgeons working on different surgical specialties has been carried out in Hospital Valdecilla (Spain). The aim is to determine the prevalence of MSDs by using a personal interview and the standardized Nordic questionnaire (SNQ). The study determines the prevalence of MSDs in different parts of the body and their relationship with epidemiological and labor variables. A questionnaire was filled out by 129 surgeons.
Results: 90% of surgeons reported MSDs. The higher prevalence appears in the most experienced surgeons. The most affected zones are the lower back (54%), neck (51%), upper back (44%), lower extremities (42%), right shoulder (29%) and right hand (28%).
Conclusions: The prevalence of MSDs is higher in MIS surgeons than in any other occupational group. The most vulnerable group is experienced surgeons and there is a potential risk that symptoms will be increased in the future. Muscle strength is revealed as a protective factor against MSDs.

Source: Gutierrez-Diez, M. C., Benito-Gonzalez, M. A., Sancibrian, R., Gandarillas-Gonzalez, M. A., Redondo-Figuero, C., & Manuel-Palazuelos, J. C. (2017). International Journal of Occupational Safety and Ergonomics, 1-19.

Temporal relationships between job strain and low-back pain

To our knowledge this is one of the first studies to examine reciprocal relationships between job strain and back pain and which accounts for time-invariant characteristics. The study highlights a need for more
work to establish if there are bidirectional relationships, with more frequent repeat measurements and which account for time-stable individual factors.

Source: Hanson, L. L. M., Madsen, I. E., Rugulies, R., Peristera, P., Westerlund, H., & Descatha, A. Scandinavian Journal of Work.

Evaluating biomechanics of user-selected sitting and standing computer workstation

A standing computer workstation has now become a popular modern work place intervention to reduce sedentary behavior at work. However, user's interaction related to a standing computer workstation and its differences with a sitting workstation need to be understood to assist in developing recommendations for use and set up. The study compared the differences in upper extremity posture and muscle activity between user-selected sitting and standing workstation setups. Twenty participants (10 females, 10 males) volunteered for the study. 3-D posture, surface electromyography, and user-reported discomfort were measured while completing simulated tasks with each participant's self-selected workstation setups. Sitting computer workstation associated with more non-neutral shoulder postures and greater shoulder muscle activity, while standing computer workstation induced greater wrist adduction angle and greater extensor carpi radialis muscle activity. Sitting computer workstation also associated with greater shoulder abduction postural variation (90th–10th percentile) while standing computer workstation associated with greater variation for should rotation and wrist extension. Users reported similar overall discomfort levels within the first 10 min of work but had more than twice as much discomfort while standing than sitting after 45 min; with most discomfort reported in the low back for standing and shoulder for sitting. These different measures provide understanding in users' different interactions with sitting and standing and by alternating between the two configurations in short bouts may be a way of changing the loading pattern on the upper extremity.

Source: Lin, M. Y., Barbir, A., & Dennerlein, J. T. (2017). Applied Ergonomics.

Pre-existing low-back symptoms impact adversely on sitting time reduction in office workers

Objectives: Initiatives to reduce office-workplace sitting are proliferating, but the impact of pre-existing musculoskeletal symptoms on their effectiveness has not been determined. We assessed the influence of musculoskeletal symptoms on the outcomes of a workplace sitting intervention.
Methods: Baseline and 3-month data from a cluster-randomized controlled trial of a workplace sitting intervention (Stand Up Victoria; trial registration number ACTRN12611000742976) were used. Office workers (n = 231) from 14 work teams within one organisation were randomised (by worksite) to a multicomponent program with individual-, organisational-, and environmental-level (sit-stand workstations) change strategies; or, to a control condition (no intervention). Musculoskeletal symptoms in the low-back, upper and lower extremities (present/absent) were assessed through self-report. Linear regression models tested the moderation by baseline musculoskeletal symptoms of intervention effects on workplace sitting and standing time and on sitting and standing bout durations, assessed by the activPAL3™ activity monitor.
Results: There were significant reductions in sitting and increased standing at work (p < 0.05). However, effects varied significantly by the presence of pre-existing low-back (but not other) symptoms, with greater benefit being seen in those without symptoms. Effects on sitting time and sitting bout duration were weaker in those with low-back symptoms compared to those without by 34.6 [95% CI (0.9; 68.3)] min/8-h workday and 5.1 [95% CI (0.2; 9.9)] min, respectively. Comparable effects were seen for standing.
Conclusion: Low-back symptoms may impact on the extent to which office workers change their workplace sitting and standing time. A prudent next step to improve the effectiveness of workplace sitting-reduction initiatives such as Stand Up Victoria may be to assess and address the needs of those who displayed comparatively limited behaviour change, namely those with pre-existing low-back discomfort.

Source: Coenen, P., Healy, G. N., Winkler, E. A., Dunstan, D. W., Owen, N., Moodie, M., ... & Straker, L. M. (2017). International Archives of Occupational and Environmental Health, 1-10.

Reducing Office Workers' Sitting Time at Work Using Sit-Stand Protocols

Results From a Pilot Randomized Controlled Trial
Objective: To examine the effects of different sit-stand protocols on work-time sitting and physical activity (PA) of office workers.
Methods: Participants (n = 26, 77% women, mean age 42) were randomly allocated to usual sitting (control) or one of three sit-stand protocols (intervention) facilitated by height-adjustable workstations for a 4-week period between June and August 2015. Sitting, standing, and stepping time were assessed by inclinometry (activPAL); leisure-time physical activity (LTPA) by self-report. One-way analysis of covariance (ANCOVA) and post-hoc (Bonferroni) tests explored between-group differences.
Results: Compared with baseline, intervention groups reduced work sitting time by 113 minutes/8-hour workday (95% confidence interval [CI] [-147,-79]) and increased work standing time by 96 minutes/8-hour workday (95% CI [67,125]) without significantly impacting LTPA/sleep time.
Conclusions: Sit-stand protocols facilitated by height-adjustable workstations appear to reduce office workers' sitting time without significant adverse effects on LTPA.

Source: Li, I., Mackey, M. G., Foley, B., Pappas, E., Edwards, K., Chau, J. Y., ... & Winkler, E. (2017). Journal of Occupational and Environmental Medicine.

Development and validation of an easy-to-use risk assessment tool for cumulative low back loading

The Lifting Fatigue Failure Tool (LiFFT)
Recent evidence suggests that musculoskeletal disorders (MSDs) may be the result of a fatigue failure process in affected tissues. This paper describes a new low back exposure assessment tool (the Lifting Fatigue Failure Tool [LiFFT]), which estimates a “daily dose” of cumulative loading on the low back using fatigue failure principles. Only three variables are necessary to derive the cumulative load associated with a lifting task: the weight of the load, the maximum horizontal distance from the spine to the load, and the number of repetitions for tasks performed during the workday. The new tool was validated using two existing epidemiological databases: the Lumbar Motion Monitor (LMM) database, and a database from a U.S. automotive manufacturer. The LiFFT cumulative damage metric explained 92% of the deviance in low back disorders (LBDs) in the LMM database and 72–95% of the deviance in low back outcomes in the automotive database (depending on the outcome measure). Thus, LiFFT is practitioner friendly and its cumulative damage metric highly related to low back outcomes.

Source: Gallagher, S., Sesek, R. F., Schall, M. C., & Huangfu, R. (2017). Applied Ergonomics.

Les lombalgies liées au travail

Les lombalgies représentent aujourd'hui 20 % des accidents du travail : c'est le chiffre révélé par une étude inédite de l'Assurance Maladie - Risques professionnels. Le nombre des lombalgies d'origine professionnelle ne diminue pas depuis dix ans en dépit de la baisse de la sinistralité. Elles coûtent près d'un milliard d'euros par an, soit l'équivalent du coût des autres troubles musculo-squelettiques (TMS). Certains secteurs d'activité présentent un sur-risque en matière de lombalgie, comme les métiers d'aide et de soins à la personne et les activités logistiques.


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