2015-11-01 12:00 - Messages

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.

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