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Brandt M, Bláfoss R, Jakobsen MD, Samani A, Ajslev JZN, Madeleine P, Andersen LL. Influence of brick laying height on biomechanical load in masons: Cross-sectional field study with technical measurements. Work 2024:WOR230325. [PMID: 38517831 DOI: 10.3233/wor-230325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2024] Open
Abstract
BACKGROUND Work-related musculoskeletal disorders (WMSDs) located in the low back and neck/shoulder regions are major concerns for both workers, workplaces, and society. Masons are prone to WMSD, because their work is characterized by repetitive work and high physical workload. However, the knowledge on the physical workload during bricklaying is primarily based on subjective measurements. OBJECTIVE This cross-sectional field study with technical measurements aimed to quantify physical workload in terms of muscular activity and degree of forward bending during bricklaying at different working heights among masons, i.e., knee, hip, shoulder, and above shoulder height. METHODS Twelve male (36.1±16.1 years) experienced masons participated in a cross-sectional field study with technical measurements. Surface electromyography from erector spinae longissimus and upper trapezius muscles and an inertial measurement unit-sensor placed on the upper back were used to assess the physical workload (level of muscle activation and degree of forward bending) different bricklaying heights. Manual video analysis was used to determine duration of work tasks, frequency, type, and working height. The working heights were categorized as 'knee', 'hip', 'shoulder', and 'above shoulder'. The 95 percentiles of the normalized Root Mean Square (RMSn) values were extracted assess from erector spinae and trapezius recordings to assess strenuous level muscle of muscle activation. RESULTS The RMSn of dominant erector spinae muscle increased from hip- to shoulder height (from 26.6 to 29.6, P < 0.0001), but not from hip to above shoulder height and decreased from hip to knee height (from 26.6 to 18.9, P < 0.0001). For the dominant trapezius muscle, the RMSn increased from hip- to shoulder- and above shoulder height (from 13.9 to 19.7 and 24.0, respectively, P < 0.0001) but decreased from hip- to knee height (from 13.9 to 11.5, P < 0.0001). Compared to hip height (27.9°), an increased forward bending was detected during bricklaying at knee height (34.5°, P < 0.0001) and a decreased degree of forward bending at shoulder- and above shoulder height (17.6° and 12.5°, P < 0.0001, respectively). CONCLUSION Based on technical measurements, bricklaying at hip height showed the best compromise between muscular load and degree of forward bending. This study contributes to the development of the work environment for masons and can help guide preventive initiatives to reduce physical workload.
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Affiliation(s)
- Mikkel Brandt
- National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Rúni Bláfoss
- National Research Centre for the Working Environment, Copenhagen, Denmark
- Research Unit for Muscle Physiology and Biomechanics, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | | | - Afshin Samani
- ExerciseTech, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Denmark
| | - Jeppe Z N Ajslev
- National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Pascal Madeleine
- ExerciseTech, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Denmark
| | - Lars L Andersen
- National Research Centre for the Working Environment, Copenhagen, Denmark
- ExerciseTech, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Denmark
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Jorgensen MJ, Hafez K, Hakansson NA. The ACGIH TLV for lifting: Estimated TLVs for torso asymmetry beyond 30 degrees. Work 2024:WOR230405. [PMID: 38306083 DOI: 10.3233/wor-230405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND The American Conference of Governmental Industrial Hygienists (ACGIH) Threshold Limit Values (TLVs) for Lifting is a manual material handling (MMH) assessment method to identify weight limits that nearly all workers may be exposed to without developing work-related low back disorders (LBD). However, this assessment method only applies to lifting with the torso within 30° asymmetry of the sagittal plane. OBJECTIVE Estimate TLV weight limits while lifting with torso asymmetry greater than 30° beyond the sagittal plane. METHODS Lifting tasks were performed from various horizontal and vertical locations, at torso asymmetry angles of 0°, 15°, 30°, 45°, 60°, 75° and 90°, using ACGIH identified TLVs. Validated MMH assessment methods (NIOSH Lifting Equation, Ohio State University LBD Risk Model) were utilized to estimate TLVs at torso asymmetries greater than 30°. RESULTS The current ACGIH TLVs resulted in low- to moderate-risk risk levels for torso asymmetries from 0° to 30°, and the risk incrementally increased as torso asymmetry increased to 90°. With the intention to keep the risk levels to that found at 30° torso asymmetry, lower TLV weight limits in the vertical and horizontal zones investigated were estimated for torso asymmetries from 45° to 90°. The resulting adjusted TLVs were consistent with weight limits identified for similar lifting conditions from other assessment methods that account for torso asymmetry. CONCLUSIONS This research found current ACGIH-defined TLVs possess less than high-risk for LBD, and provided guidance to practitioners for reduced TLVs when torso asymmetry is greater than 30° from the sagittal plane.
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Affiliation(s)
- Michael J Jorgensen
- Industrial, Systems and Manufacturing Engineering Department, Wichita State University, Wichita, KS, USA
| | - Khaled Hafez
- Industrial and Systems Engineering Department, University of Jeddah, Jeddah, Saudi Arabia
| | - Nils A Hakansson
- Biomedical Engineering Department, Wichita State University, Wichita, KS, USA
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Chen N, Li G, Sun X, Zhang M, Zhang H, Ling R, Liu Y, Li G, Ren Z, Yin Y, Shao H, Zhang H, Li J, Qiu B, Wang D, Zeng Q, Liang Z, Wang R, Chen J, Zhang D, Mei L, Liu Y, Liu J, Zhang C, Li T, Wang Z, Chen Q, Jia N. Prevalence status and associated factors of wrist postural injury in the Chinese occupational population. Front Public Health 2022; 10:1047814. [PMID: 36504943 PMCID: PMC9727286 DOI: 10.3389/fpubh.2022.1047814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 11/07/2022] [Indexed: 11/24/2022] Open
Abstract
Objective This study investigated the prevalence of wrist injuries in 15 industries and different types of work in China. Study on the associated factors of wrist injuries provides a scientific basis for prevention and treatment of wrist diseases in occupational workers. Methods A cross-sectional study of musculoskeletal symptoms of related practitioners in 15 industries, including automobile manufacturing, was conducted to retrieve worker demographic information, working wrist posture, and pain conditions. Multivariable binary logistic regression analyses were performed to identify factors associated with work-related musculoskeletal disorders (WMSDs). Results The prevalence of wrist injuries among the study population was 13.2%. Toy manufacturing, animal husbandry, automobile manufacturing, shoe manufacturing, and biopharmaceutical manufacturing had the highest wrist injury rates at 29.1, 19.1, 14.9, 14.9, and 14.0%, respectively. Among the types of jobs, enamel workers (63.0%), butchers (43.6%), combers (32.5%), welders (31.3%), and scaffolders (26.5%) had the highest prevalence rates. Based on the final multivariate logistic regression analysis: female [odds ratios (OR) = 1.24; 95% confidence interval (CI), 1.15-1.35], 6-10 years of service (OR = 1.11; 95% CI, 1.03-1.18), >10 years of service (OR = 1.15; 95% CI, 1.06-1.25), frequent upward and downward flexion in wrist posture at work (OR = 1.81; 95% CI, 1.84-2.11), and frequent wrist placement on the edge of angular objects increased the OR of injury (OR = 1.52; 95% CI, 1.44-1.61). Need to squeeze objects tightly while working (OR = 1.72; 95% CI, 1.57-1.89), prolonged wrist flexion (OR = 1.86; 95% CI, 1.75-1.97), and work hand position above the shoulder for prolonged periods (OR = 1.11; 95% CI, 1.04-1.19) also suggested the relationship between these factors and the higher prevalence of wrist injury in the workers. The associated factor was physical activity (OR = 0.86; 95% CI, 0.80-0.94). Conclusion This study suggested the relationship between these factors and the higher prevalence of wrist injury in the toy manufacturing, animal husbandry, automobile manufacturing, and shoe-making industries, enamel workers, butchers, and combers. And are work types that require special attention. Females, working age, physical activity, and abnormal posture of the wrist were factors significantly associated with WMSDs.
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Affiliation(s)
- Nengzhou Chen
- Guangdong Public Health Testing and Evaluation Engineering Technology Center, Guangdong Pharmaceutical University, Guangzhou, China
| | - Guanlin Li
- Guangdong Public Health Testing and Evaluation Engineering Technology Center, Guangdong Pharmaceutical University, Guangzhou, China
| | - Xin Sun
- National Institute of Occupational Health and Poisoning Control, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Meibian Zhang
- National Institute of Occupational Health and Poisoning Control, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Huadong Zhang
- Chongqing Center for Disease Control and Prevention, Chongqing, China
| | | | - Yiming Liu
- Guangzhou Occupational Disease Prevention and Treatment Hospital, Guangzhou, China
| | - Gang Li
- Liaoning Provincial Health Service Center, Shenyang, China
| | - Zaoliang Ren
- Guizhou Province Hospital for Occupational Disease Prevention and Treatment, Guiyang, China
| | - Yan Yin
- Shanghai Center for Disease Control and Prevention, Shanghai, China
| | - Hua Shao
- Shandong Academy of Occupational Health and Occupational Disease Control, Jinan, China
| | - Hengdong Zhang
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Jiajie Li
- Guangdong Public Health Testing and Evaluation Engineering Technology Center, Guangdong Pharmaceutical University, Guangzhou, China
| | - Bing Qiu
- Civil Aviation Medical Center, Civil Aviation Administration of China, Beijing, China
| | - Dayu Wang
- Tianjin Occupational Disease Prevention and Treatment Hospital, Tianjin, China
| | - Qiang Zeng
- Tianjin Center for Disease Control and Prevention, Tianjin, China
| | - Zhanhui Liang
- Guangdong Public Health Testing and Evaluation Engineering Technology Center, Guangdong Pharmaceutical University, Guangzhou, China
| | - Rugang Wang
- Beijing Center for Disease Control and Prevention, Beijing, China
| | - Jianchao Chen
- Fujian Provincial Center for Occupational Disease and Chemical Poisoning Prevention and Control, Fuzhou, China
| | - Danying Zhang
- Guangdong Provincial Occupational Disease Prevention and Control Institute, Guangzhou, China
| | - Liangying Mei
- Hubei Provincial Center for Disease Control and Prevention, Wuhan, China
| | - Yongquan Liu
- Institute of Occupational Medicine of Jiangxi, Nanchang, China
| | - Jixiang Liu
- Ningxia Center for Disease Control and Prevention, Yinchuan, China
| | - Chengyun Zhang
- Sichuan Provincial Center for Disease Control and Prevention, Chengdu, China
| | - Tianlai Li
- Shanxi Provincial Center for Disease Control and Prevention, Xian, China
| | - Zhongxu Wang
- National Institute of Occupational Health and Poisoning Control, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Qingsong Chen
- Guangdong Public Health Testing and Evaluation Engineering Technology Center, Guangdong Pharmaceutical University, Guangzhou, China,Qingsong Chen
| | - Ning Jia
- National Institute of Occupational Health and Poisoning Control, Chinese Center for Disease Control and Prevention, Beijing, China,*Correspondence: Ning Jia
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Mirzaian M, Sanderson W, Browning S, Bunn T. Workers' compensation reported injuries among distillery industry workers, 2010-2019. Am J Ind Med 2022; 65:483-491. [PMID: 35338513 DOI: 10.1002/ajim.23350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 02/09/2022] [Accepted: 03/02/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND The objective of this study was to identify the most frequent type, nature, and cause of work-related injuries among distillery workers and the contributing factors for these events to target interventions to reduce injuries. METHODS Workers' compensation first reports of injury (FROI) from the years 2010 through 2019 were obtained. Variables were created for "occupational category" and "cause of injury" for evaluation of the injurious events. The ratchet circular scan test was used to assess seasonal variation in injury, and kernel density estimation to assess rates of injury by calendar year. RESULTS A total of 974 FROIs were recorded over these 10 years; 908 of the injuries resulted in lost time, 65 resulted in no lost time, and 1 resulted in a fatality. The most common injuries reported were strains or tears, lacerations, and contusions (33.4%, 14.7%, and 13.5%, respectively). The most frequent anatomical sites of injury were the shoulders, fingers, and low back area (11.8%, 11.4%, and 8.9%, respectively). Barreling operation activities experienced the greatest frequency of work-related injury at 28.5% of all FROIs. A seasonal peak of injuries was observed during May and June. CONCLUSIONS Implementing ergonomic and safety solutions for transportation and work tasks associated with barreling operations may significantly reduce the rate of work-related injuries in distillery workers. Injury prevention interventions should particularly target strain or tear injuries caused by repetitive motion or bodily reaction and overexertion. Contact with objects or machinery accounted for one-third of distillery industry FROIs.
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Affiliation(s)
- Mira Mirzaian
- Kentucky Injury Prevention and Research Center, University of Kentucky, Lexington, Kentucky, USA
| | - Wayne Sanderson
- Department of Biosystems and Agricultural Engineering, College of Agriculture, Food, and the Environment, University of Kentucky, Lexington, Kentucky, USA
| | - Steven Browning
- College of Public Health, University of Kentucky, Lexington, Kentucky, USA
| | - Terry Bunn
- Kentucky Injury Prevention and Research Center, University of Kentucky, Lexington, Kentucky, USA
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Rubery PT, Ramirez G, D'Agostino CR, Vasalos K, Thirukumaran C. A workplace wellness program at an academic health center influences employee health, satisfaction, productivity and the rate of workplace injury. Int Arch Occup Environ Health 2022; 95:1603-1632. [PMID: 35501508 DOI: 10.1007/s00420-022-01865-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 04/07/2022] [Indexed: 11/05/2022]
Abstract
PURPOSE Workplace wellness (WP) programs are an employer strategy to improve employee health and satisfaction. Their impact on productivity and benefit expense remains unclear. This study examines the association of a voluntary WP at an academic health center with both employee metrics and employer costs. METHODS We retrospectively reviewed prospectively collected data from January 2016 to April 2018 for employees who voluntarily underwent screening for a WP at an academic medical center. We used their demographic, social, work, and clinical data to address the central research question. The primary outcomes included wellness measures from the Patient-Reported Outcomes Measurement Information System (PROMIS), secondary wellness outcomes such as body mass index, job-related outcomes such as job satisfaction, and workers' compensation metrics such as the claim amount. The key independent variables were whether an observation was from before or after the WP. For workers' compensation metrics, additional key independent variables were intervention/control group, and an interaction between the before/after and intervention/control variables. We conducted univariate and bivariate/unadjusted analyses, and estimated multivariable linear, logistic, and gamma regression models that also controlled for confounders. RESULTS The study included 370 employees. Participation in the program was associated with significant improvements in the PROMIS pain interference, fatigue and sleep quality domains. Hip circumference diminished, and functional movement outcomes were improved. Job satisfaction improved by 4.4 percentage points (95% Confidence Interval [CI]: 0.3-8.5, p = 0.04) and self-reported productivity by 14.5 percentage points (95% Confidence Interval [CI]: 9.5-19.5, p < 0.001). The likelihood of a new compensation claim during the 12-month follow-up period fell by 10.1% (95% Confidence Interval [CI]: - 15.5 to - 4.7, p < 0.001). However, the value of a new claim was unchanged. CONCLUSION Employees who completed a WP at an academic medical center demonstrated improvements in several recognized patient-reported outcome measures, in job satisfaction and self-reported productivity, a decrease in hip circumference, an improvement in functional motion and a decreased rate of compensable injury.
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Affiliation(s)
- Paul T Rubery
- Department of Orthopaedics, University of Rochester, 601 Elmwood Ave. Box 665, Rochester, NY, 14642, USA.
| | - Gabriel Ramirez
- Department of Orthopaedics, University of Rochester, 601 Elmwood Ave. Box 665, Rochester, NY, 14642, USA
| | - Charles R D'Agostino
- Department of Orthopaedics, University of Rochester, 601 Elmwood Ave. Box 665, Rochester, NY, 14642, USA
| | - Kostantinos Vasalos
- Department of Orthopaedics, University of Rochester, 601 Elmwood Ave. Box 665, Rochester, NY, 14642, USA
| | - Caroline Thirukumaran
- Department of Orthopaedics, University of Rochester, 601 Elmwood Ave. Box 665, Rochester, NY, 14642, USA
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Davis KG, Freeman AM, Ying J, Huth JR. Workers' compensation costs for healthcare caregivers: Home healthcare, long-term care, and hospital nurses and nursing aides. Am J Ind Med 2021; 64:369-380. [PMID: 33616226 DOI: 10.1002/ajim.23237] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 01/28/2021] [Accepted: 01/29/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND Healthcare workers (nurses and nursing aides) often have different exposures and injury risk factors depending on their occupational subsector and location (hospital, long-term care, or home health care). METHODS A total of 5234 compensation claims for nurses and nursing aides who suffered injuries to their lower back, knee, and/or shoulder over a 5-year period were obtained from the Ohio Bureau of Workers' Compensation and analyzed. Injury causation data was also collected for each claim. The outcome variables included indemnity costs, medical costs, total costs, and the number of lost work days. The highest prescribed morphine equivalent dose for opioid medications was also calculated for each claim. RESULTS Home healthcare nurses and nursing aides had the highest average total costs per claim. Hospital nurses and nursing aides had the highest total claim costs, of $5 million/year. Shoulder injuries for home healthcare nursing aides (HHNAs) had the highest average total claim costs ($20,600/injury) for all occupation, setting, and body area combinations. Opioids were most frequently prescribed for home healthcare nurses (HHNs) and nursing aides (18.9% and 17.7% having been prescribed opioids, respectively). Overexertion was the most common cause for HHN and nursing aide claims. CONCLUSIONS With the rapidly expanding workforce in the home healthcare sector, there is a potential health crisis from the continued expansion of home healthcare worker injuries and their associated costs. In addition, the potential for opioid drug usage places these workers at risk for future dependence, overdose, and prolonged disability. Future research is needed to investigate the specific and ideally reversible causes of injury in claims categorized as caused by overexertion.
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Affiliation(s)
- Kermit G. Davis
- Department of Environmental and Public Health Sciences, College of Medicine University of Cincinnati Cincinnati Ohio USA
| | - Andrew M. Freeman
- Department of Environmental and Public Health Sciences, College of Medicine University of Cincinnati Cincinnati Ohio USA
| | - Jun Ying
- Department of Environmental and Public Health Sciences, College of Medicine University of Cincinnati Cincinnati Ohio USA
| | - Jeffrey R. Huth
- Department of Environmental and Public Health Sciences, College of Medicine University of Cincinnati Cincinnati Ohio USA
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Liu J, Farr J, Ramos O, Voigt J, Amin N. Workers' Societal Costs After Knee and Shoulder Injuries and Diagnosis with In-Office Arthroscopy or Delayed MRI: A Cost-Minimization Analysis. JB JS Open Access 2021; 6:e20.00151. [PMID: 34136739 PMCID: PMC8202550 DOI: 10.2106/jbjs.oa.20.00151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The goal of this study was to evaluate the societal costs of using in-office diagnostic arthroscopy (IDA) compared with magnetic resonance imaging (MRI) for the diagnosis of intra-articular knee and shoulder pathology in employed patients receiving Workers' Compensation or disability coverage. The prevalence is estimated at 260,000 total cases per year. METHODS A cost-minimization analysis of IDA compared with MRI was conducted. Direct costs (in 2018 U.S. dollars) were calculated from private reimbursement amounts and Medicare. Indirect costs were estimated from a societal perspective including effects of delayed surgical procedures on the ability to work, lost income, Workers' Compensation or disability coverage, and absenteeism. Four regions were selected: Boston, Massachusetts; Detroit, Michigan; Denver, Colorado; and San Bernadino, California. Sensitivity analyses were performed using TreeAge Pro 2019 software. The base assumption was that it would take approximately 4 weeks for a diagnosis with MRI and 0 weeks for a diagnosis with IDA. RESULTS Direct costs to determine a knee diagnosis with IDA were $556 less expensive (California) to $470 more expensive (Massachusetts) than MRI. Assuming a 4-week wait, societal costs (indirect and direct) for knee diagnosis were anywhere from $7,852 (Denver) to $11,227 (Boston) less using IDA. Direct costs were similar for shoulder pathology. In order for MRI to be the less costly option, the MRI and the follow-up visit to the physician would need to occur directly after consultation. Under Medicare, direct costs were similar for both the knee and shoulder when comparing IDA and MRI. Including indirect costs resulted in IDA being the less costly option. CONCLUSIONS The use of IDA instead of MRI for the diagnosis of knee and shoulder pathology reduced costs. The potential savings to society were approximately $7,852 to $11,227 per operative patient and were dependent on scheduling and follow-up using MRI and on Workers' Compensation. LEVEL OF EVIDENCE Economic and Decision Analysis Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Joseph Liu
- Department of Orthopedic Surgery, Loma Linda Medical Center, Loma Linda, California
| | - Jack Farr
- Indiana University School of Medicine, OrthoIndy and OrthoIndy Hospital, Indianapolis, Indiana
| | - Omar Ramos
- Department of Orthopedic Surgery, Loma Linda Medical Center, Loma Linda, California
| | - Jeff Voigt
- Medical Device Consultants of Ridgewood, LLC, Ridgewood, New Jersey
| | - Nirav Amin
- Department of Orthopedic Surgery, Loma Linda Medical Center, Loma Linda, California
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Trunk Flexion Monitoring among Warehouse Workers Using a Single Inertial Sensor and the Influence of Different Sampling Durations. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17197117. [PMID: 32998476 PMCID: PMC7594050 DOI: 10.3390/ijerph17197117] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 09/23/2020] [Accepted: 09/25/2020] [Indexed: 01/05/2023]
Abstract
Trunk flexion represents a risk factor for the onset of low-back disorders, yet limited quantitative data exist regarding flexion exposures in actual working conditions. In this study, we evaluated the potential of using a single inertial measurement unit (IMU) to classify trunk flexion, in terms of amplitude, frequency, and duration, and assessed the influence of alternative time durations on exposure results. Twelve warehouse workers were monitored during two hours of an actual shift while wearing a single IMU on their low back. Trunk flexion data were reduced using exposure variation analysis integrated with recommended exposure thresholds. Workers spent 5.1% of their working time with trunk flexion of 30-60° and 2.3% with flexion of 60-90°. Depending on the level of acceptable error, relatively shorter monitoring periods (up to 50 min) might be sufficient to characterize trunk flexion exposures. Future work is needed, however, to determine if these results generalize to other postural exposures and tasks.
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9
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Brandt M, Madeleine P, Samani A, Ajslev JZ, Jakobsen MD, Sundstrup E, Andersen LL. Effects of a Participatory Ergonomics Intervention With Wearable Technical Measurements of Physical Workload in the Construction Industry: Cluster Randomized Controlled Trial. J Med Internet Res 2018; 20:e10272. [PMID: 30567694 PMCID: PMC6315250 DOI: 10.2196/10272] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 09/04/2018] [Accepted: 09/10/2018] [Indexed: 12/22/2022] Open
Abstract
Background Construction work frequently involves heavy physical work, and a reduction of the physical workload should have high priority. Technological development has made it possible to obtain field measurements with surface electromyography (sEMG), kinematics measured with inertial measurement units (IMUs), and video recordings. However, no studies have used these methods simultaneously to detect situations with excessive physical workload (events) during a working day. Thus, knowledge about these specific events may combat work-related risk factors. Participatory ergonomics (PE) has shown promising results, but whether it can be used as a tool to reduce the physical workload during construction work remains unknown. Objective This cluster randomized controlled trial investigated whether a PE intervention with technical measurements consisting of IMUs, sEMG, heart rate monitoring, and video recordings of physical workload could reduce the number of events with excessive physical workload during a working day. Furthermore, other outcomes were obtained from questionnaires. Methods A total of 80 male full-time construction workers (aged 19 to 67 years) were randomized at the cluster level (gang) to a PE intervention consisting of 3 workshops (7 gangs and 32 workers) or to a control group (8 gangs and 48 workers). The physical workload was recorded by technical measurements, that is, IMUs, sEMG, heart rate monitoring, and video recordings during a full working day at baseline and 3 and 6 months’ follow-up. On the basis of the technical measurements, a custom-made computer program detected the situations (events) where the construction workers were exposed to excessive physical workload and used in the intervention. Differences in the number of events from baseline to follow-up between intervention and control were evaluated using linear mixed models (intention-to-treat), with individual nested in cluster as a random factor. Furthermore, questionnaires were filled out on test days. Results The results of the primary outcome showed no change in the number of events with excessive physical workload. However, compared with the control group, the other outcomes showed decreased general fatigue after a typical working day (P=.001) and increased influence on own work (P=.04). Conclusions This PE intervention with technical measurements did not reduce the number of events with excessive physical workload during construction work. However, the intervention led to decreased general fatigue and increased influence on own work. Trial Registration ClinicalTrials.gov NCT02498197; https://clinicaltrials.gov/ct2/show/NCT02498197 (Archived by WebCite at http://www.webcitation.org/74SZ3DIWS)
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Affiliation(s)
- Mikkel Brandt
- National Research Centre for the Working Environment, Copenhagen, Denmark.,Sport Sciences, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Pascal Madeleine
- Sport Sciences, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Afshin Samani
- Sport Sciences, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Jeppe Zn Ajslev
- National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Markus D Jakobsen
- National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Emil Sundstrup
- National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Lars L Andersen
- National Research Centre for the Working Environment, Copenhagen, Denmark.,Sport Sciences, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
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Goes SM, Trask CM, Boden C, Bath B, Ribeiro DC, Hendrick P, Clay L, Zeng X, Milosavljevic S. Measurement properties of instruments assessing permanent functional impairment of the spine: a systematic review protocol. BMJ Open 2018; 8:e019276. [PMID: 29374671 PMCID: PMC5829857 DOI: 10.1136/bmjopen-2017-019276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Permanent functional impairment (PFI) of the spine is a rating system used by compensation authorities, such as workers compensation boards, to establish an appropriate level of financial compensation for persistent loss of function. Determination of PFI of the spine is commonly based on the assessment of spinal movement combined with other measures of physical and functional impairments; however, the reliability and validity of the measurement instruments used for these evaluations have yet to be established. The aim of this study is to systematically review and synthesise the literature concerning measurement properties of the various and different instruments used for assessing PFI of the spine. METHODS Three conceptual groups of terms (1) PFI, (2) spinal disorder and (3) measurement properties will be combined to search Medline, EMBASE, CINAHL, Web of Science, Scopus, PEDro, OTSeeker and Health and Safety Science Abstracts. We will examine peer-reviewed, full-text articles over the full available date range. Two reviewers will independently screen citations (title, abstract and full text) and perform data extraction. Included studies will be appraised as to their methodological quality using the COnsensus-based Standards for the selection of health Measurement INstruments criteria. Findings will be summarised and presented descriptively, with meta-analysis pursued as appropriate. ETHICS AND DISSEMINATION This review will summarise the current level of evidence of measurement properties of instruments used for assessing PFI of the spine. Findings of this review may be applicable to clinicians, policy-makers, workers' compensation boards, other insurers and health and safety organisations. The findings will likely provide a foundation and direction for future research priorities for assessing spinal PFI. PROSPERO REGISTRATION NUMBER CRD42017060390.
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Affiliation(s)
- Suelen Meira Goes
- School of Physical Therapy, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Catherine M Trask
- Canadian Centre for Health and Safety in Agriculture (CCHSA), University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Catherine Boden
- Leslie and Irene Dubé Health Sciences Library, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Brenna Bath
- School of Physical Therapy, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | | | - Paul Hendrick
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Lynne Clay
- School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Xiaoke Zeng
- Canadian Centre for Health and Safety in Agriculture (CCHSA), University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Stephan Milosavljevic
- School of Physical Therapy, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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11
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Charles LE, Ma CC, Burchfiel CM, Dong RG. Vibration and Ergonomic Exposures Associated With Musculoskeletal Disorders of the Shoulder and Neck. Saf Health Work 2017; 9:125-132. [PMID: 29928524 PMCID: PMC6005913 DOI: 10.1016/j.shaw.2017.10.003] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 09/18/2017] [Accepted: 10/23/2017] [Indexed: 01/07/2023] Open
Abstract
Background According to the US Bureau of Labor Statistics, musculoskeletal disorders (MSDs) accounted for 32% of all nonfatal injury and illness cases in 2014 among full-time workers. Our objective was to review and summarize the evidence linking occupational exposures to vibration and awkward posture with MSDs of the shoulder and neck. Methods A literature search was conducted using the terms musculoskeletal disorders, vibration, and awkward posture. All types of observational epidemiologic studies, with the exception of case reports, published during 1998–2015 were included. Databases searched were MEDLINE (Ovid), Embase (Ovid), Scopus, Ergonomic Abstracts, NIOSHTIC-2, and Health and Safety Science Abstracts. Results Occupational exposures to whole-body or hand–arm vibration were significantly associated with or resulted in MSDs of the shoulder and neck. Awkward postures while working were also associated with MSDs in these locations. These findings were consistent across study designs, populations, and countries. Conclusion Occupational exposure to vibration and awkward posture are associated with shoulder and neck MSDs. Longitudinal studies are required to elucidate the mechanisms responsible for these associations, and intervention studies are warranted.
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Affiliation(s)
- Luenda E Charles
- Biostatistics and Epidemiology Branch, Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV, USA
| | - Claudia C Ma
- Biostatistics and Epidemiology Branch, Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV, USA
| | - Cecil M Burchfiel
- Biostatistics and Epidemiology Branch, Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV, USA
| | - Renguang G Dong
- Engineering and Control Technology Branch, Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV, USA
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12
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Postoffer Pre-Placement Screening for Carpal Tunnel Syndrome in Newly Hired Manufacturing Workers. J Occup Environ Med 2016; 58:1212-1216. [PMID: 27930481 DOI: 10.1097/jom.0000000000000891] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE We determined the predictive validity of a postoffer pre-placement (POPP) screen using nerve conduction velocity studies (NCV) to identify future cases of carpal tunnel syndrome (CTS). METHODS A cohort of 1648 newly hired manufacturing production workers underwent baseline NCS, and were followed for 5 years. RESULTS There was no association between abnormal POPP NCV results and incident CTS. Varying NCV diagnostic cut-offs did not improve predictive validity. Workers in jobs with high hand/wrist exposure showed greater risk of CTS than those in low exposed jobs (relative risk 2.82; 95% confidence interval 1.52 to 5.22). CONCLUSIONS POPP screening seems ineffective as a preventive strategy for CTS.
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13
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Jia N, Li T, Hu S, Zhu X, Sun K, Yi L, Zhang Q, Luo G, Li Y, Zhang X, Gu Y, Wang Z. Prevalence and its risk factors for low back pain among operation and maintenance personnel in wind farms. BMC Musculoskelet Disord 2016; 17:314. [PMID: 27461535 PMCID: PMC4962352 DOI: 10.1186/s12891-016-1180-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 07/21/2016] [Indexed: 01/07/2023] Open
Abstract
Background With the increasingly severe energy shortage and climate change problems, developing wind power has become a key energy development strategy and an inevitable choice to protect the ecological environment worldwide. The purpose of this study was to investigate the prevalence of low back pain (LBP) and analyze its risk factors among operation and maintenance personnel in wind farms (OMPWF). Methods A cross-sectional survey of 151 OMPWF was performed, and a comprehensive questionnaire, which was modified and combined from Nordic Musculoskeletal Questionnaires (NMQ), Washington State Ergonomics Tool (WSET) and Syndrome Checklist-90(SCL-90) was used to assess the prevalence and risk factors of LBP among OMPWF. Results The prevalence of LBP was 88.74 % (134/151) among OMPWF. The multivariable model highlighted four related factors: backrest, somatization, squatting and lifting objects weighing more than 10 lb more than twice per minute. Conclusions The prevalence of LBP among OMPWF appears to be high and highlights a major occupational health concern.
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Affiliation(s)
- Ning Jia
- Department of Occupational Protection and Ergonomics, National Institute of Occupational Health and Poison Control, Chinese Center for Disease Control and Prevention, NO.29, Nanwei Road, Xicheng District, Beijing, 100050, People's Republic of China
| | - Tao Li
- Department of Occupational Protection and Ergonomics, National Institute of Occupational Health and Poison Control, Chinese Center for Disease Control and Prevention, NO.29, Nanwei Road, Xicheng District, Beijing, 100050, People's Republic of China
| | - Shuangqiu Hu
- Labor Health Occupational Disease Prevention and Control Center in Zhuzhou, Zhuzhou, 412011, Hunan, People's Republic of China
| | - Xinhe Zhu
- Labor Health Occupational Disease Prevention and Control Center in Zhuzhou, Zhuzhou, 412011, Hunan, People's Republic of China
| | - Kang Sun
- Labor Health Occupational Disease Prevention and Control Center in Zhuzhou, Zhuzhou, 412011, Hunan, People's Republic of China
| | - Long Yi
- Wind power Division of Zhuzhou Electric Locomotive Institute Corporation, China South Locomotive and Rolling Stock (CSR), Zhuzhou, 412007, Hunan, People's Republic of China
| | - Qiong Zhang
- Wind power Division of Zhuzhou Electric Locomotive Institute Corporation, China South Locomotive and Rolling Stock (CSR), Zhuzhou, 412007, Hunan, People's Republic of China
| | - Guilian Luo
- Hunan University of Technology, Zhuzhou, 412007, Hunan, People's Republic of China
| | - Yuzhen Li
- Department of Occupational Protection and Ergonomics, National Institute of Occupational Health and Poison Control, Chinese Center for Disease Control and Prevention, NO.29, Nanwei Road, Xicheng District, Beijing, 100050, People's Republic of China
| | - Xueyan Zhang
- Department of Occupational Protection and Ergonomics, National Institute of Occupational Health and Poison Control, Chinese Center for Disease Control and Prevention, NO.29, Nanwei Road, Xicheng District, Beijing, 100050, People's Republic of China
| | - Yongen Gu
- Department of Occupational Protection and Ergonomics, National Institute of Occupational Health and Poison Control, Chinese Center for Disease Control and Prevention, NO.29, Nanwei Road, Xicheng District, Beijing, 100050, People's Republic of China
| | - Zhongxu Wang
- Department of Occupational Protection and Ergonomics, National Institute of Occupational Health and Poison Control, Chinese Center for Disease Control and Prevention, NO.29, Nanwei Road, Xicheng District, Beijing, 100050, People's Republic of China.
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14
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Prevalence of Metabolic Syndrome and Its Components among Japanese Workers by Clustered Business Category. PLoS One 2016; 11:e0153368. [PMID: 27082961 PMCID: PMC4833411 DOI: 10.1371/journal.pone.0153368] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 03/29/2016] [Indexed: 02/06/2023] Open
Abstract
The present study was a cross-sectional study conducted to reveal the prevalence of metabolic syndrome and its components and describe the features of such prevalence among Japanese workers by clustered business category using big data. The data of approximately 120,000 workers were obtained from a national representative insurance organization, and the study analyzed the health checkup and questionnaire results according to the field of business of each subject. Abnormalities found during the checkups such as excessive waist circumference, hypertension or glucose intolerance, and metabolic syndrome, were recorded. All subjects were classified by business field into 18 categories based on The North American Industry Classification System. Based on the criteria of the Japanese Committee for the Diagnostic Criteria of Metabolic Syndrome, the standardized prevalence ratio (SPR) of metabolic syndrome and its components by business category was calculated, and the 95% confidence interval of the SPR was computed. Hierarchical cluster analysis was then performed based on the SPR of metabolic syndrome components, and the 18 business categories were classified into three clusters for both males and females. The following business categories were at significantly high risk of metabolic syndrome: among males, Construction, Transportation, Professional Services, and Cooperative Association; and among females, Health Care and Cooperative Association. The results of the cluster analysis indicated one cluster for each gender with a higher prevalence of metabolic syndrome components; among males, a cluster consisting of Manufacturing, Transportation, Finance, and Cooperative Association, and among females, a cluster consisting of Mining, Transportation, Finance, Accommodation, and Cooperative Association. These findings reveal that, when providing health guidance and support regarding metabolic syndrome, consideration must be given to its components and the variety of its prevalence rates by business category and gender.
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15
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The effectiveness of post-offer pre-placement nerve conduction screening for carpal tunnel syndrome. J Occup Environ Med 2015; 56:840-7. [PMID: 25099410 DOI: 10.1097/jom.0000000000000185] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
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.
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16
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Splittstoesser RE, Marras WS, Best TM. Immune responses to low back pain risk factors. ACTA ACUST UNITED AC 2014; 41 Suppl 1:6016-23. [PMID: 22317743 DOI: 10.3233/wor-2012-1053-6016] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
$\underline{Objective}$: Investigate effects of interactions between biomechanical, psychosocial and individual risk factors on the body's immune inflammatory responses. $\underline{Background}$: Current theories for low back pain causation do not fully account for the body's response to tissue loading and tissue trauma. $\underline{Methods}$: Two groups possessing a preference for the sensor or intuitor personality trait performed repetitive lifting combined with high or low mental workload on separate occasions. Spinal loading was assessed using an EMG-assisted subject-specific biomechanical model and immune markers were collected before and after exposure. $\underline{Results}$: Mental workload was associated with a small decrease in AP shear. Both conditions were characterized by a regulated time-dependent immune response making use of markers of inflammation, tissue trauma and muscle damage. Intuitors' creatine kinase levels were increased following low mental workload compared to that observed in Sensors with the opposite trend occurring for high mental workload. $\underline{Conclusions}$: A temporally regulated immune response to lifting combined with mental workload exists. This response is influenced by personality and mental workload.
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Affiliation(s)
- Riley E Splittstoesser
- Department of Integrated Systems Engineering, The Ohio State University, 1971 Neil Avenue, Columbus OH 43210, USA.
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17
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Chen Z, Chakrabarty S, Levine RS, Aliyu MH, Ding T, Jackson LL. Work-related knee injuries treated in US emergency departments. J Occup Environ Med 2013; 55:1091-9. [PMID: 23969507 PMCID: PMC4553424 DOI: 10.1097/jom.0b013e31829b27bf] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To characterize work-related knee injuries treated in US emergency departments (EDs). METHODS We characterized work-related knee injuries treated in EDs in 2007 and examined trends from 1998 to 2007 by using the National Electronic Injury Surveillance System-occupational supplement. RESULTS In 2007, 184,300 (± 54,000; 95% confidence interval) occupational knee injuries were treated in US EDs, accounting for 5% of the 3.4 (± 0.9) million ED-treated occupational injuries. The ED-treated knee injury rate was 13 (± 4) injuries per 10,000 full-time equivalent workers. Younger workers and older female workers had high rates. Strains/sprains and contusions/abrasions were common-frequently resulting from falls and bodily reaction/overexertion events. Knee injury rates declined from 1998 through 2007. CONCLUSIONS Knee injury prevention should emphasize reducing falls and bodily reaction/overexertion events, particularly among all youth and older women.
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Affiliation(s)
- Zhiqiang Chen
- Division of Preventive and Occupational Medicine, Department of Family and Community Medicine, Nashville, Tenn., USA
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18
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Ferguson SA, Allread WG, Burr DL, Heaney C, Marras WS. Biomechanical, psychosocial and individual risk factors predicting low back functional impairment among furniture distribution employees. Clin Biomech (Bristol, Avon) 2012; 27:117-23. [PMID: 21955915 PMCID: PMC3796440 DOI: 10.1016/j.clinbiomech.2011.09.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2011] [Revised: 08/27/2011] [Accepted: 09/06/2011] [Indexed: 02/07/2023]
Abstract
BACKGROUND Biomechanical, psychosocial and individual risk factors for low back disorder have been studied extensively however few researchers have examined all three risk factors. The objective of this was to develop a low back disorder risk model in furniture distribution workers using biomechanical, psychosocial and individual risk factors. METHODS This was a prospective study with a six month follow-up time. There were 454 subjects at 9 furniture distribution facilities enrolled in the study. Biomechanical exposure was evaluated using the American Conference of Governmental Industrial Hygienists (2001) lifting threshold limit values for low back injury risk. Psychosocial and individual risk factors were evaluated via questionnaires. Low back health functional status was measured using the lumbar motion monitor. Low back disorder cases were defined as a loss of low back functional performance of -0.14 or more. FINDINGS There were 92 cases of meaningful loss in low back functional performance and 185 non cases. A multivariate logistic regression model included baseline functional performance probability, facility, perceived workload, intermediated reach distance number of exertions above threshold limit values, job tenure manual material handling, and age combined to provide a model sensitivity of 68.5% and specificity of 71.9%. INTERPRETATION The results of this study indicate which biomechanical, individual and psychosocial risk factors are important as well as how much of each risk factor is too much resulting in increased risk of low back disorder among furniture distribution workers.
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Affiliation(s)
- Sue A. Ferguson
- The Ohio State University, Biodynamics Laboratory, Columbus, OH, USA
,Corresponding author at: 210 Baker Systems, 1971 Neil Avenue, Columbus, OH 43210-1271, USA. (S.A. Ferguson)
| | - W. Gary Allread
- The Ohio State University, Biodynamics Laboratory, Columbus, OH, USA
| | - Deborah L. Burr
- University of Florida, College of Public Health and Health Professions, Gainesville, FL, USA
| | - Catherine Heaney
- Stanford University, Department of Psychology, Stanford, CA, USA
| | - William S. Marras
- The Ohio State University, Biodynamics Laboratory, Columbus, OH, USA
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Abstract
OBJECTIVE To describe the burden of knee work-related musculoskeletal disorders (WMSDs). METHODS Knee WMSDs were identified using Washington State Fund workers' compensation data from 1999 to 2007 and analyzed by cost, industry, occupation, and claims incidence rates. RESULTS Knee WMSDs accounted for 7% of WMSD claims and 10% of WMSD costs. The rate of decline in claims incidence rates for knee WMSDs was similar to the rate of decline for all other WMSDs. Industries at highest risk for knee WMSDs included construction and building contractors. Occupations of concern included carpenters and truck drivers in men and nursing aides and housekeepers in women. CONCLUSIONS Between 1999 and 2007, Washington State Fund knee WMSDs were widespread and associated with a large cost. Identification of specific occupational knee WMSD risk factors in high-risk industries is needed to guide prevention efforts.
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