Frequent Exertion and Frequent Standing at Work, by Industry and Occupation Group - United States, 2015

Repeated exposure to occupational ergonomic hazards, such as frequent exertion (repetitive bending or twisting) and frequent standing, can lead to injuries, most commonly musculoskeletal disorders. Work-related musculoskeletal disorders have been estimated to cost the United States approximately $2.6 billion in annual direct and indirect costs. A recent literature review provided evidence that prolonged standing at work also leads to adverse health outcomes, such as back pain, physical fatigue, and muscle pain. To determine which industry and occupation groups currently have the highest prevalence rates of frequent exertion at work and frequent standing at work, CDC analyzed data from the 2015 National Health Interview Survey (NHIS) Occupational Health Supplement (OHS) regarding currently employed adults in the United States. By industry, the highest prevalence of both frequent exertion and frequent standing at work was among those in the agriculture, forestry, fishing, and hunting industry group (70.9%); by occupation, the highest prevalence was among those in the construction and extraction occupation group (76.9%). Large differences among industry and occupation groups were found with regard to these ergonomic hazards, suggesting a need for targeted interventions designed to reduce workplace exposure.


The efficacy of interventions for low back pain in nurses

A systematic review
OBJECTIVES: To investigate the efficacy of interventions for the prevention and treatment of low back pain in nurses.
DESIGN: Systematic review.
DATA SOURCES: The review was registered on the PROSPERO database (CRD42015026941) and followed the PRISMA statement guidelines. A two phase approach was used. In phase one, all randomised controlled trials included in the systematic review of Dawson et al. (2007) which reviewed interventions for low back pain in nurses until 2004 were selected. In phase two, relevant randomised controlled trials and cluster randomised controlled trials published from 2004 until December 2015 were identified by an electronic search of nine databases (Embase, CINAHL, SPORTDiscus, PsycARTICLES, Cochrane Library, Web of Science, PEDro, Scopus and MEDLINE). To be eligible, trials had to examine the efficacy of interventions either for the prevention or treatment of low back pain in nurses. Primary outcomes of interest were any measure of pain and/or disability.
REVIEW METHODS: Three reviewers independently assessed eligibility and two reviewers independently conducted a risk of bias assessment (Cochrane Back and Neck Group).
RESULTS: Four studies were retrieved from phase one. In phase two, 15,628 titles and abstracts were scanned. From these, 150 full-text studies were retrieved and ten were eligible. Fourteen studies (four from phase one, ten from phase two) were eligible for risk of bias assessment. The included trials were highly heterogeneous, differing in pain and disability outcome measures, types of intervention, types of control group and follow-up durations. Only four of the included studies (n=644 subjects) had a low risk of bias (≥6/12). Manual handling training and stress management in isolation were not effective in nurses with and without low back pain (risk of bias, 7/12, n=210); the addition of a stretching exercise intervention was better than only performing usual activities (risk of bias, 6/12, n=127); combining manual handling training and back school was better than passive physiotherapy (risk of bias, 7/12, n=124); and a multidimensional intervention (risk of bias, 7/12, n=183) was not superior to a general exercise program in reducing low back pain in nurses.
CONCLUSIONS: Only four relevant low risk of bias randomised controlled trials were found. At present there is no strong evidence of efficacy for any intervention in preventing or treating low back pain in nurses. Additional high quality randomised controlled trials are required. It may be worth exploring the efficacy of more individualised multidimensional interventions for low back pain in the nursing population.

Source: Van Hoof, W., O'Sullivan, K., O'Keeffe, M., Verschueren, S., O'Sullivan, P., & Dankaerts, W. (2018). International journal of nursing studies, 77, 222-231.

Prediction models to identify workers at risk of sick leave due to low-back pain in the Dutch construction industry

Objective: The aim of this study was to develop a prediction model based on variables measured in occupational health checks to identify non-sick listed workers at risk of sick leave due to non-specific low-back pain (LBP).
Methods: This cohort study comprised manual (N=22 648) and non-manual (N=9735) construction workers who participated in occupational health checks between 2010 and 2013. Occupational health check variables were used as potential predictors and LBP sick leave was recorded during 1-year follow-up. The prediction model was developed with logistic regression analysis among the manual construction workers and validated in non-manual construction workers. The performance of the prediction model was evaluated with explained variances (Nagelkerke's R-square), calibration (Hosmer-Lemeshow test), and discrimination (area under the receiver operating curve, AUC) measures.
Results: During follow-up, 178 (0.79%) manual and 17 (0.17%) non-manual construction workers reported LBP sick leave. Backward selection resulted in a model with pain/stiffness in the back, physician-diagnosed
musculoskeletal disorders/injuries, postural physical demands, feeling healthy, vitality, and organization of work as predictor variables. The Nagelkerke's R-square was 3.6%; calibration was adequate, but discrimination was poor (AUC=0.692; 95% CI 0.568–0.815).
Conclusions: A prediction model based on occupational health check variables does not identify non-sick listed workers at increased risk of LBP sick leave correctly. The model could be used to exclude the workers at the lowest risk on LBP sick leave from costly preventive interventions.

Source: Bosman LC, Dijkstra L, Joling CI, Heymans MW, Twisk JWR, Roelen CAM. (2018). Scand J Work Environ Health.

Développement du monoripage et conditions de travail

Depuis quelques années se développe la pratique du monoripage, c'est-à-dire la collecte des déchets par un équipage constitué d'un opérateur de collecte et d'un chauffeur. Une étude menée par l'INRS révèle que dans les conditions observées une telle collecte est physiquement plus intense que celle réalisée en biripage.
Elle présente alors un risque plus élevé de troubles musculosquelettiques et une astreinte cardiaque excessive. L'étude montre qu'il est possible, pour une collectivité territoriale, d'imposer dans le cahier des charges d'un marché de collecte, les conditions sous lesquelles les entreprises sont autorisées à proposer des collectes en monoripage, de façon à préserver la santé et la sécurité des opérateurs.

Source: Delecroix, B., Salmon, I., Desbrosses, K., Vieira, M., Adam, B. (2017). Références en santé au travail (152), 53-63.

Economic evaluations of ergonomic interventions preventing work-related musculoskeletal disorders

A systematic review of organizational-level interventions
Background: Work-related musculoskeletal disorders (WMSD) represent a major public health problem and economic burden to employers, workers and health insurance systems. This systematic review had two objectives: (1) to analyze the cost-benefit results of organizational-level ergonomic workplace-based interventions aimed at preventing WMSD, (2) to explore factors related to the implementation process of these interventions (obstacles and facilitating factors) in order to identify whether economic results may be due to a successful or unsuccessful implementation.
Methods: Systematic review. Studies were searched in eight electronic databases and in reference lists of included studies. Companion papers were identified through backward and forward citation tracking. A quality assessment tool was developed following guidelines available in the literature. An integration of quantitative economic results and qualitative implementation data was conducted following an explanatory sequential design.
Results: Out of 189 records, nine studies met selection criteria and were included in our review. Out of nine included studies, grouped into four types of interventions, seven yielded positive economic results, one produced a negative result and one mixed results (negative cost-effectiveness and positive net benefit). However, the level of evidence was limited for the four types of interventions given the quality and the limited number of studies identified. Our review shows that among the nine included studies, negative and mixed economic results were observed when the dose delivered and received by participants was low, when the support from top and/or middle management was limited either due to limited participation of supervisors in training sessions or a lack of financial resources and when adequacy of intervention to workers' needs was low. In studies where economic results were positive, implementation data showed strong support from supervisors and a high rate of employee participation.
Conclusion: Studies investigating the determinants of financial outcomes of prevention related to implementation process are very seldom. We recommend that in future research economic evaluation should include information on the implementation process in order to permit the interpretation of economic results and enhance the generalizability of results. This is also necessary for knowledge transfer and utilization of research results for prevention-oriented decision-making in occupational health and safety.

Source: Sultan-Taïeb, H., Parent-Lamarche, A., Gaillard, A., Stock, S., Nicolakakis, N., Hong, Q. N., ... et Berthelette, D. (2017). BMC public health, 17(1), 935.

Musculoskeletal Symptoms Among Finnish Professional Orchestra Musicians

BACKGROUND: The prevalence of musculoskeletal symptoms is high among professional musicians (73-88%). AIMS: We investigated the prevalence of musculoskeletal symptoms in Finnish symphony orchestra musicians. We compared individual instruments as well as the perceived demands of orchestral programs and difficulties in recovering after performances. METHODS: In this cross-sectional questionnaire 920 of 2,785 members of the Finnish Musicians Union (33%) completed the questionnaire, including 361 full-time members of symphony orchestras. Questions about pain symptoms and frequency were based on the national survey done in 2011. RESULTS: Among the 361 full-time orchestra musicians, those playing all instruments experienced frequent pain, both in the last 30 days and exceeding 30 days in the last 12 months, in their neck or upper extremities. Female musicians experienced significantly more neck (69%), elbow (31%), and wrist (30%) pain than males (neck 52%, elbow 23%, wrist 19%). The profiles varied according to the different instruments and their playing positions. Musculoskeletal symptoms correlated with perceived demand of the orchestral program and difficulties in recovering after performances. Professional musicians experienced nearly twice as often neck pain in the last 30 days (female musicians 69%, male musicians 52%) than persons of the same age in the Finnish working population (female 41%, male 27%). CONCLUSION: Symphony orchestra musicians experience nearly twice as much musculoskeletal symptoms of the neck and upper extremities as others their age. To prevent musicians¿ playing-related problems, special emphasis should be focused on recovery after concerts, including the special demands of different composers and the frequency of rehearsals and performances.

Source: Viljamaa, K., Liira, J., Kaakkola, S. et Savolainen, A. (2017). Medical Problems of Performing Artists, 32(4), 195.

Conception des équipements de travail et prévention des TMS Complémentarités et points d’ancrage des démarches

Après un bref rappel sur les démarches de prévention des TMS et de conception des équipements de travail, cet article présente dans un premier temps les difficultés constatées vis-à-vis de leur articulation. Il propose ensuite des « points d’ancrage » pour accompagner, dans un cadre participatif et multidisciplinaire, les temps de recherche de solutions et de décisions. Les interactions ainsi obtenues favorisent le partage des référentiels et explicitent les processus de décision. Elles fonctionnent à l’identique d’un « moteur méthodologique » qui implante la problématique des TMS à chaque séquence de la conception.
Cette approche doit permettre aux petites et moyennes entreprises (PME) de trouver des réponses à leurs besoins en matière de prévention des TMS très en amont dans le processus de conception d’un équipement de travail. Elle contribue en effet à une meilleure compréhension des leviers favorisant la prise en compte des TMS et à l’élaboration de nouvelles références d’actions vis-à-vis du processus de conception.

Source: Marsot, J. et Atain-Kouadio, J. J. (2017). Perspectives interdisciplinaires sur le travail et la santé, (19-2).

Are work organization interventions effective in preventing or reducing work-related musculoskeletal disorders?

A systematic review of the literature
Objectives: We sought to determine whether interventions that target work organization or the psychosocial work environment are effective in preventing or reducing work-related musculoskeletal disorders (WMSD) compared to usual work.
Methods: We systematically reviewed the 2000–2015 English and French language scientific literature, including studies evaluating the effectiveness of an organizational or psychosocial work intervention on incidence, prevalence or intensity of work-related musculoskeletal pain or disorders in the neck, shoulders, upper limbs and/or back or of work absence due to such problems, among non-sick-listed workers. We excluded rehabilitation and individual-level behavioral interventions and studies with >50% attrition. We analyzed medium- and high-quality studies and synthesized the evidence using the Grading of Recommendations Assessment, Development & Evaluation (GRADE) approach. An analysis of key workplace intervention elements supplemented interpretation of results.
Results: We identified 884 articles; 28 met selection criteria, yielding 2 high-quality, 10 medium-quality and 16 low-quality studies. There was moderate evidence that supplementary breaks, compared to conventional break schedules, are effective in reducing symptom intensity in various body regions. Evidence was low- to very low-quality for other interventions, primarily due to risk of bias related to study design, high attrition rates, co-interventions, and insensitive indicators. Most interventions lacked key intervention elements, such as work activity analysis and ergonomist guidance during implementation, but the relation of these elements to intervention effectiveness or ineffectiveness remains to be demonstrated.
Conclusions: Targeting work–rest cycles may reduce WMSD. Better quality studies are needed to allow definitive conclusions to be drawn on the effectiveness of other work organizational or psychosocial interventions to prevent or reduce WMSD.

Source: Stock, S. R., Nicolakakis, N., Vézina, N., Vézina, M., Gilbert, L., Turcot, A., ... et Beaucage, C. (2017). Scandinavian Journal of Work, Environment & Health.

Can beliefs about musculoskeletal pain and work be changed at the national level?

Prospective evaluation of the Danish national Job & Body campaign
Using a mixture of networking activities, workplace visits and a mass media campaign, the Danish national Job & Body health campaign improved beliefs about musculoskeletal pain and work among public-sector employees in Denmark. Intensive and long-term national campaigns may be a strategically important tool against musculoskeletal disorders and their consequences in the population.

Source: Andersen, L. L., Geisle, N., & Knudsen, B. (2017). Scand J Work Environ Health.

Time course of neck-shoulder pain among workers

A longitudinal latent class growth analysis
Objectives: The aims of this study were to (i) identify trajectories of neck-shoulder pain (NSP) over one year in an occupational population and (ii) determine whether these trajectories are predicted by NSP characteristics as well as personal and occupational factors at baseline.
Methods: This longitudinal study was conducted among Danish workers (N=748) from 2012–2014. Text messages were used to collect frequent data on NSP over one year (14 waves in total). Peak NSP intensity in the past month was rated on a 0–10 numeric scale. A baseline questionnaire covered NSP characteristics (pain intensity, duration, comorbidity, pain medication, and pain interference) as well as personal (age, gender, body mass index) and occupational (seniority, work type, physical strain at work) factors. Latent class growth analysis was used to distinguish trajectories of NSP. Multivariate regression models with odds ratios (OR) were constructed to predict trajectories of NSP.
Results: Six distinct trajectories of NSP were identified (asymptomatic 11%, very low NSP 10%, low recovering NSP 18%, moderate recovering NSP 28%, strong fluctuating NSP 24% and severe persistent NSP 9% of the workers). Female gender, age, physical strain at work, NSP intensity and duration, pain medication, and pain interference in daily work at baseline were positively associated with severe persistent NSP and strong fluctuating NSP (all P<0.05). Altogether, personal and occupational factors accounted for 14% of the variance, while NSP characteristics accounted for 54%.
Conclusions: In an occupational sample, six distinct trajectories of NSP were identified. Physical strain at work appears to be a pertinent occupational factor predicting strong fluctuating and severe persistent NSP.

Source: Hallman DM, Rasmussen CDN, Jørgensen MB, Holtermann A. (2017). Scand J Work Environ Health.

Les dispositifs d'assistance physique

Exosquelette, cobot, robot collaboratif… Sous ces dénominatifs parfois un peu barbares, se cache une technologie de plus en plus présente dans le monde du travail : les dispositifs d'assistance physique. Qu'ils soient à contention ou sans, ces systèmes sont destinés à aider physiquement des opérateurs dans l'accomplissement de tâches parfois simples en apparence, mais éprouvantes. Objectif : prévenir l'apparition des troubles musculosquelettiques (TMS) et la pénibilité en limitant la charge physique ou la répétitivité, ou encore prendre en compte le vieillissement au travail ou un handicap et favoriser le maintien dans l'emploi…

Source: (2017). Travail & sécurité.

Work-related physical, psychosocial and individual factors associated with musculoskeletal symptoms among surgeons

Implications for ergonomic interventions
This study evaluated the effect of physical, psychosocial and individual factors on the presence of musculoskeletal symptoms (MSS) among surgeons (n = 312) in Iran. Data were collected using questionnaires and analysed by multivariate logistic regression. The prevalence of MSS, particularly in the knees (48.7%), neck (45.8%), low back (42.3%) and shoulders (40.1%) was relatively high. Work-related factors including time spent on surgeries each week (>25 h/week), number of hours working in standing position per day (>4 h/day), moderate to high levels of work–family conflict, duration of each surgery (>3 h), number of years worked as a surgeon (>10 years) and surgical specialty (particularly cardiothoracic and obstetric/gynecologic surgeries) were independently associated with the presence of MSS in different body regions. Individual factors including gender (being female) and little or no involvement in sport and physical activity were also independently associated with the occurrence of complaints. Implications of the findings for further research and development work for improving the working conditions and consequently reducing MSS among this working group are discussed.

Source: Dianat, I., Bazazan, A., Azad, M. A. S., & Salimi, S. S. (2018). Applied Ergonomics, 67, 115-124.

Return on investment of interventions for the prevention and treatment of musculoskeletal

There were two key objectives for the work:
- To conduct a literature review to identify which interventions are cost-effective in reducing the complications associated with osteoarthritis of the hip or knee, neck pain or back pain;
- To develop an ROI tool that allows the resource and financial consequences of implementing these cost-effective interventions nationally and at local levels.


Effectiveness of a participatory physical and psychosocial intervention to balance the demands and resources of industrial workers

A cluster-randomized controlled trial
This study evaluated a participatory intervention aiming to improve the work ability and need for recovery of industrial workers. The intervention was not effective and rather showed tendencies for adverse effects. Companies should consider intervention-related potential adverse effects on workers with already high work demands, and we recommend development of better effect evaluation designs specifically for participatory interventions.

Source: Gupta, N., Wåhlin-Jacobsen, C. D., Abildgaard, J. S., Henriksen, L. N., Nielsen, K., & Holtermann, A. (2017). Scandinavian Journal of Work, Environment & Health.

Saddle Seat Reduces Musculoskeletal Discomfort in Microsurgery Surgeons

Background. Microsurgery is a surgical procedure that requires a high degree of precision and is commonly facilitated through the use of an intraoperative microscope. When operating the microscope system, the long-term posture and stance lead to fatigue and musculoskeletal disorders in surgeons, and seats are commonly employed to diminish these problems. The present study was conducted to evaluate musculoskeletal discomfort during work with a saddle seat especially designed for people using intraoperative microscopes in comparison with conventional seats for microscopic works. Materials and methods. In this study, two types of seats, a saddle and a conventional, were evaluated on 73 microsurgical surgeons in terms of musculoskeletal discomfort. Corlett and Bishop's body part discomfort scale (BPD) was used to assess musculoskeletal discomfort before and after working with the seats. Results. We found that the highest amount of discomfort that microsurgical surgeons acquire in the workplace was focused on their neck, shoulder, arm and back, respectively. During the work with a saddle seat, a significant reduction was found for discomfort values in neck, shoulder, arm, back, elbow and forearm, as well as the whole body (p <0.05). Over 89 percent of the participants said that the use of this seat causes increased comfort during operation. Conclusion. This study showed that the use of saddle seats provides a more appropriate physical posture at work, and can decrease musculoskeletal discomfort in different parts of the body of microsurgical surgeons.

Source: Labbafinejad, Y., Ghasemi, M. S., Bagherzadeh, A., Aazami, H., Eslami-Farsani, M., & Dehghan, N. (2017). International Journal of Occupational Safety and Ergonomics.

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