2014-01-01 12:00 - Messages

Cost-efficient assessment of biomechanical exposure in occupational groups, exemplified by posture observation and inclinometry

Objectives : This study compared the cost efficiency of observation and inclinometer assessment of trunk and upper-arm inclination in a population of flight baggage handlers, as an illustration of a general procedure for addressing the trade-off between resource consumption and statistical performance in occupational epidemiology.
Methods : Trunk and upper-arm inclination with respect to the line of gravity were assessed for three days on each of 27 airport baggage handlers using simultaneous inclinometer and video recordings. Labor and equipment costs associated with data collection and processing were tracked throughout. Statistical performance was computed from the variance components within and between workers and bias (with inclinometer assumed to produce “correct” inclination angles). The behavior of the trade-off between cost and efficiency with changed sample size, as well as with changed logistics for data collection and processing, was investigated using simulations.
Results : At similar total costs, time spent at trunk and arm inclination angles >60 ° as well as 90th percentile arm inclination were estimated at higher precision using inclinometers, while median inclination and 90th percentile trunk inclination was determined more precisely using observation. This hierarchy remained when the study was reproduced in another population, while inclinometry was more cost-efficient than observation for all three posture variables in a scenario where data were already collected and only needed to be processed.
Conclusions : When statistical performance was measured only in terms of precision, inclinometers were more cost-efficient than observation for two out of three posture metrics investigated. Since observations were biased, inclinometers consistently outperformed observation when both bias and precision were included in statistical performance. This general model for assessing cost efficiency may be used for designing exposure assessment strategies with considerations not only of statistical but also cost criteria. The empirical data provide a specific basis for planning assessments of working postures in occupational groups.

Source : Trask C, Mathiassen SE, Wahlström J, Forsman M. Scand J Work Environ Health. 2014.

Predictors of sickness absence related to musculoskeletal pain

A two-year follow-up study of workers in municipal kitchens
Objective : We studied predictors of sickness absences (SA) due to musculoskeletal pain over two years among 386 municipal female kitchen workers.
Methods : Pain and SA periods (no/yes) due to pain in seven sites during the past three months were assessed at 3-month intervals over two years by questionnaire. Age, musculoskeletal pain, multisite pain (pain in ≥3 sites), musculoskeletal and other somatic diseases, depressive symptoms, physical and psychosocial workload, body mass index, smoking, and leisure-time physical activity (LTPA) at baseline were considered as predictors. Trajectory analysis and multinomial logistic regression were used.
Results : Three trajectories of SA emerged, labelled as “none” (41% of the subjects), “intermediate” (48%), and “high” (11%). With the “none” trajectory (no SA) as reference, pain in all musculoskeletal sites excepting the low back predicted belonging to the “intermediate” [odds ratio (OR) 1.82–2.48] or “high” (OR 2.56–3.74) trajectory adjusted for age; multisite pain predicted membership of the “intermediate” [OR 2.15, 95% confidence interval (95% CI) 1.38–3.34] or “high” (OR 4.66, 95% CI 2.10–10.3) trajectories. In a mutually adjusted final model, smoking (OR 2.12, 95% CI 1.22–3.69), multisite pain (OR 1.87, 95% CI 1.15–3.02), and overweight/obesity (OR 1.71, 95% CI 1.08–2.72) predicted belonging to the “intermediate” trajectory, while depressive symptoms (OR 3.57, 95% CI 1.57–8.10), musculoskeletal diseases (OR 3.18, 95% CI 1.37–7.37), and multisite pain (OR 2.72, 95% CI 1.15–6.40) were associated with the “high” trajectory.
Conclusion : Along with the number of pain sites and musculoskeletal diseases, attention to depressive symptoms, smoking, and overweight/obesity is needed to tackle SA related to musculoskeletal pain.

Source : Haukka E, Kaila-Kangas L, Luukkonen R, Takala E-P, Viikari-Juntura E, Leino-Arjas P. Scand J Work Environ Health. 2014.

Patient transfers and assistive devices

Prospective cohort study on the risk for occupational back injury among healthcare workers
Objectives : This prospective cohort study investigates work-related risk factors for occupational back injury among healthcare workers.
Methods : The study comprised 5017 female healthcare workers in eldercare from 36 municipalities in Denmark who responded to a baseline and follow-up questionnaire in 2005 and 2006, respectively. Using logistic regression, the odds for occupational back injury (ie, sudden onset episodes) in 2006 from patient transfers in 2005 was modeled.
Results : In the total study population, 3.9% experienced back injury during follow-up, of which 0.5% were recurrent events. When adjusting for lifestyle (body mass index, leisure-time physical activity, smoking), work-related characteristics (seniority and perceived influence at work), and history of back pain and injury, daily patient transfers increased the risk for back injury (trend, P=0.03): odds ratio (OR) 1.75 [95% confidence interval (95% CI) 1.05–2.93] for 1–2 transfers per day, OR 1.81 (95% CI 1.14–2.85) for 3–10 transfers per day, and OR 1.56 (95% CI 0.96–2.54) for >10 transfers per day, referencing those with <1 patient transfer on average per day. The population attributable fraction of daily patient transfer for back injury was estimated to be 36%. Among those with daily patient transfer (N=3820), using an assistive device decreased the risk for back injury for “often” and “very often” use [OR 0.59 (95% CI 0.36–0.98) and OR 0.62 (95% CI 0.38–1.00), respectively] referencing those who “seldom” use assistive devices.
Conclusion : Daily patient transfer was associated with increased risk for back injury among healthcare workers. Persistent use of an assistive device was associated with reduced risk for back injury among healthcare workers with daily patient transfers.

Source : Andersen LL, Burdorf A, Fallentin N, Persson R, Jakobsen MD, Mortensen OS, Clausen T, Holtermann A. Scand J Work Environ Health. 2014; 40 (1): 74-81.

Conservative interventions for treating work-related complaints of the arm, neck or shoulder in adults

Work-related upper limb disorder (WRULD), repetitive strain injury (RSI), occupational overuse syndrome (OOS) and work-related complaints of the arm, neck or shoulder (CANS) are the most frequently used umbrella terms for disorders that develop as a result of repetitive movements, awkward postures and impact of external forces such as those associated with operating vibrating tools. Work-related CANS, which is the term we use in this review, severely hampers the working population.

Source : http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD008742.pub2/abstract

Results of a Pilot Intervention to Improve Health and Safety for Health Care Workers

Objective: To test the feasibility of a multicomponent pilot intervention to improve worker safety and wellness in two Boston hospitals.
Methods: A 3-month intervention was conducted on seven hospital units. Pre- (374 workers) and postsurveys (303 workers) assessed changes in safety/ergonomic behaviors and practices, and social support. Wellness outcomes included self-reported pain/aching in specific body areas (musculoskeletal disorders or MSDs) and physical activity (PA).
Results: Pain was reported frequently (81%), and PA averaged 4 hours per week. There was a postintervention increase in safe patient handling (P < 0.0001), safety practices (P = 0.0004), ergonomics (P = 0.009), and supervisor support (P = 0.01), but no changes in MSDs or PA.
Conclusions: Safe patient handling, ergonomics, and safety practices are good targets for worker safety and wellness interventions; longer intervention periods may reduce the risk of MSDs.

Source : Caspi, Caitlin Eicher, Dennerlein, Jack T., Kenwwod, Christopher, Stoddard, Anne, Hopcia, Karen, Hashimoto, Dean, et Sorensen, Glorian. (2013). Journal of Occupational & Environmental Medicine, 55(12), 1449-1455.

Paramedics on the job

Dynamic trunk motion assessment at the workplace
Many paramedics' work accidents are related to physical aspects of the job, and the most affected body part is the low back. This study documents the trunk motion exposure of paramedics on the job. Nine paramedics were observed over 12 shifts (120 h). Trunk postures were recorded with the computer-assisted CUELA measurement system worn on the back like a knapsack. Average duration of an emergency call was 23.5 min. Sagittal trunk flexion of >40° and twisting rotation of >24° were observed in 21% and 17% of time-sampled postures. Medical care on the scene (44% of total time) involved prolonged flexed and twisted postures (∼10 s). The highest extreme sagittal trunk flexion (63°) and twisting rotation (40°) were observed during lifting activities, which lasted 2% of the total time. Paramedics adopted trunk motions that may significantly increase the risk of low back disorders during medical care and patient-handling activities.

Source : Prairie, Jérôme, et Corbeil, Philippe (2013). Applied Ergonomics.

Une approche diachronique des TMS

Usage de données quantitatives dans une grande entreprise
Cet article se base sur la partie quantitative d'une recherche en ergonomie dont le but est de comprendre comment des évolutions du travail ont favorisé ou limité la survenue et la persistance de troubles musculo-squelettiques (TMS) chez des opérateurs d'un groupe industriel aéronautique, avec une approche diachronique des faits étudiés. Un observatoire, fondé sur le recueil systématique de données quantitatives auprès des opérateurs (dispositif Evrest), permet de mettre en relation les facteurs de risque TMS passés et présents de ces opérateurs avec leur santé ostéo-articulaire. Sur cette base, sont explorés les mécanismes de régulation, d'usure et de sélection éventuellement à l'œuvre. Pour ces deux derniers mécanismes, l'analyse repose sur l'étude de « séquences d'astreinte » et de « cumuls d'astreinte », l'astreinte étant définie à partir d'une combinaison de questions sur les contraintes physiques, la pression temporelle et les possibilités de choisir la façon de procéder dans son travail.

Source : Céline Mardon, Willy Buchmann et Serge Volkoff. Pistes, vol. 15, no. 3. 2013.

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