2014-08-01 12:00 - Messages

Association Between Lifting and Use of Medication for Low Back Pain

Results From the Backworks Prospective Cohort Study
Objective: To evaluate relationships between lifting and lowering of loads and risk of low back pain resulting in medication use (M-LBP).
Methods: At baseline, worker demographics, psychosocial factors, hobbies, LBP history, and lifting and lowering (quantified using the Revised NIOSH Lifting Equation) were assessed. A cohort of 258 incident-eligible workers was followed up for 4.5 years to determine new M-LBP cases and changes in lifting/lowering requirements. Proportional hazards regression with time-varying covariates was used to model associations.
Results: Factors predicting M-LBP included peak lifting index (PLI) and composite lifting index (PCLI), LBP history, anxiety, and housework. In adjusted models, PLI and PCLI showed exposure–response relationships with peak hazard ratios of 3.8 and 4.3, respectively (P ≤ 0.02).
Conclusions: Lifting of loads is associated with increased risk of M-LBP. The PLI and PCLI are useful metrics for estimating the risk of M-LBP from lifting.

Source: Kapellusch, Jay M.; Garg, Arun; Boda, Sruthi; Hegmann, Kurt T.; Moore, J. Steven; Thiese, Matthew S.; Merryweather, Andrew; Tomich, Suzanna; Foster, James C.; Bloswick, Donald; Malloy, Elizabeth J. Journal of Occupational & Environmental Medicine: August 2014, Volume 56, Issue 8, p. 867–877.

The Effectiveness of Post-Offer Pre-Placement Nerve Conduction Screening for Carpal Tunnel Syndrome

Objective: We evaluated post-offer pre-placement (POPP) nerve conduction studies (NCS) for carpal tunnel syndrome (CTS), testing diagnostic yield and cost-effectiveness.
Methods: A total of 1027 newly hired workers underwent baseline NCS and were followed for an average of 3.7 years for diagnosed CTS. Measures of diagnostic yield included sensitivity, specificity, and positive predictive value (PPV). Cost-effectiveness of POPP screening was evaluated using a range of inputs.
Results: Abnormal NCS was strongly associated with future CTS with univariate hazard ratios ranging from 2.95 to 11.25, depending on test parameters used. Nevertheless, PPV was poor, 6.4% to 18.5%. Cost-effectiveness of POPP varied with CTS case costs, screening costs, and NCS thresholds.
Conclusions: Although abnormal NCS at hire increases risk of future CTS, the PPV is low, and POPP screening is not cost-effective to employers in most scenarios tested.

Source: Dale, Ann Marie; Gardner, Bethany T.; Zeringue, Angelique; Werner, Robert; Franzblau, Alfred; Evanoff, Bradley. Journal of Occupational & Environmental Medicine:
August 2014, Volume 56, Issue 8, p. 840–847.

Developing a comprehensive approach to risk management of musculoskeletal disorders in non-nursing health care sector employees

This study of selected jobs in the health care sector explored a range of physical and psychosocial factors to identify those that most strongly predicted work-related musculoskeletal disorders (WMSD) risk. A self-report survey was used to collect data on physical and psychosocial risk factors from employees in three health care organisations in Victoria, Australia. Multivariate analyses demonstrated the importance of both psychosocial and physical hazards in predicting WMSD risk and provides evidence for risk management of WMSDs to incorporate a more comprehensive and integrated approach. Use of a risk management toolkit is recommended to address WMSD risk in the workplace.

Source: Oakman, Jodi, Macdonald, Wendy, Wells, Yvonne. (2014). Applied Ergonomics

Observation-Based Posture Assessment

Review of Current Practice and Recommendations for Improvement
This document is a joint effort between NIOSH and the Canadian Centre of Research Expertise for the Prevention of Musculoskeletal Disorders (CRE-MSD).
The purpose of this document is to help practitioners assess working posture for the prevention and control of occupational musculoskeletal disorders (MSDs). Quantitative or semiquantitative descriptions of posture are inputs to many job analysis tools applied in MSD prevention and control. Studies of the relationship between risk factors (such as posture, repetition, and force) and resulting MSD prevalence have used various approaches to characterizing working posture, including observation-based methods. Posture classification by systematic observation of a worker is commonly used in research and by practitioners, such as ergonomists, industrial hygienists, and safety professionals, to help inform job design decisions and establish safe work limits to reduce MSD injury risk in the workplace.

Source: http://www.cdc.gov/niosh/docs/2014-131/default.html

Are pushing and pulling work-related risk factors for upper extremity symptoms?

A systematic review of observational studies
Systematically review observational studies concerning the question whether workers that perform pushing/pulling activities have an increased risk for upper extremity symptoms as compared to workers that perform no pushing/pulling activities. A search in MEDLINE via PubMed and EMBASE was performed with work-related search terms combined with push/pushing/pull/pulling. Studies had to examine exposure to pushing/pulling in relation to upper extremity symptoms. Two authors performed the literature selection and assessment of the risk of bias in the studies independently. A best evidence synthesis was used to draw conclusions in terms of strong, moderate or conflicting/insufficient evidence. The search resulted in 4764 studies. Seven studies were included, with three of them of low risk of bias, in total including 8279 participants. A positive significant relationship with upper extremity symptoms was observed in all four prospective cohort studies with effect sizes varying between 1.5 and 4.9. Two out of the three remaining studies also reported a positive association with upper extremity symptoms. In addition, significant positive associations with neck/shoulder symptoms were found in two prospective cohort studies with effect sizes of 1.5 and 1.6, and with shoulder symptoms in one of two cross-sectional studies with an effect size of 2.1. There is strong evidence that pushing/pulling is related to upper extremity symptoms, specifically for shoulder symptoms. There is insufficient or conflicting evidence that pushing/pulling is related to (combinations of) upper arm, elbow, forearm, wrist or hand symptoms.

Source: Hoozemans, Marco J.M., Knelange, E.B., Frings-Dresen, M.H.W., Veeger, H.E.J., et Kuijer, P.P.F.M. (2014). Occupational & Environmental Medicine.

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