Do workplace interventions prevent low-back disorders? If so, why?: a methodologic commentary

Rehabilitation engineers, technologists, and technicians: Vital members of the assistive technology team

The rehabilitation engineering professions include rehabilitation engineers, rehabilitation technologists / assistive technologists and rehabilitation technicians. The purpose of this white paper is to define the rehabilitation engineering professions, describe educational pathways for the field of rehabilitation engineering, and describe the role of the rehabilitation engineering professions in a multitude of professional settings. An ad-hoc committee was convened by the Rehabilitation Engineering and Technologists (RE&T) Professional Standards Group (PSG) at the 2013 annual meeting, RESNA Conference in Seattle, Washington. The ad-hoc committee reviewed over 80 different sources in preparing the white paper, which included peer reviewed journal articles, conference proceedings, professional organization websites. Based on this review, in addition to expert opinion and stakeholder feedback, the committee developed the following definitions.Rehabilitation Engineer (RE) uses the innovative and methodical application of scientific knowledge and technology to design and develop a device, system or process, which is intended to satisfy the human needs of an individual with a disability.Rehabilitation Technologist / Assistive Technologist (RT/AT) combines scientific and engineering knowledge and methods with technical skills to complement engineering activities for an individual with a disability.Rehabilitation Technician (RTn) works with equipment, primarily assembling and testing component parts of devices or systems that have been designed by others for individuals with disabilities; usually under direct supervision of a rehabilitation engineer or rehabilitation technologist / assistive technologist. Their preferences are given to assembly, repair, or evolutionary improvements to technical equipment by learning its characteristics, rather than by studying the scientific or engineering basis for its original design.This whitepaper provides a framework for future discussions on the advancement of the rehabilitation engineering professions with the goal of improving the quality of life of individuals with disabilities through the application of science and technology.

Collecting evidence from distributed sources to evaluate railway suicide and trespass prevention measures

It can be difficult to select from available safety preventative measures, especially where there is limited evidence of effectiveness in different contexts. This paper describes application of a method to identify and evaluate wide-ranging preventative measures for rail suicide and trespass fatalities. Evidence from literature and industry sources was collated and reviewed in a two stage process to achieve consensus among experts on the likely effects of the measures and factors influencing their implementation. Multiple evaluation criteria were used to examine the measures from different perspectives. Fencing, awareness campaigns and different types of organisational initiatives were recommended for further testing. This is the first time evidence has been collected internationally across such a range of preventative measures. Commentary is provided on using this type of approach to select safety measures from a pool of prevention options, including how re-framing the scope of the exercise could identify alternative options for prevention. Practitioner summary: The findings give insight to how different measures work in different ways and how industry can consider this in strategic initiatives. The method could be used in future studies with different frames of reference (e.g. different timescales, level of ambition and safety context e.g. railway crossings or highway fatalities). Abbreviation: RESTRAIL: REduction of Suicides and Trespasses on RAILway property.

Circadian rhythms as a basis for work organization: a study with live line electricians

OBJECTIVE

With the assumption that circadian rhythms influence human performance, the work of live line electricians was reorganized and evaluated. The hypothesis was that in highly physical and attention-demanding work, the organization of tasks, according to the ideal period of day and day of week, should diminish stress and consequent work risks.

BACKGROUND

There are only a few studies reporting the work of electricians and even fewer approaching work organization. Moreover, these investigations often do not consider human physiological limitations and capabilities as well as task demands.

METHOD

A new work system was proposed with consideration of (a) the circadian cycles and homeostatic processes; (b) the effect of heat, which is a zeitgeber (synchronizer) for the biological clocks; and (c) the degree of physical and mental demands of the different performed tasks, which was assessed on the basis of opinions of the electricians and physiological markers of stress that are controlled by circadian rhythms. The traditional and new systems were compared on the basis of two cognitive indices (the arrangement of matchsticks and the perception of a minute) and three physiological markers of mental-to-physical loads (heart frequency and the level of adrenaline and noradrenaline).

RESULTS

Both physical and mental loads were reduced in the new system.

CONCLUSION

Work organization should include consideration of human circadian rhythms, mainly when stressful and high-risk tasks are involved.

APPLICATION

The findings can be applied in any work design, but they are especially suited for highly demanding work carried out outdoors.

Cost-benefit analysis of a socio-technical intervention in a Brazilian footwear company

This article presents a costs-benefits analysis of a macroergonomic intervention in a Brazilian footwear company. Comparing results of a pilot line (composed by 100 multiskilled workers organized in teams) with eight traditional lines (still working in a one human being/one task model) the intervention showed to be worth pursuing since achieved gains were higher than intervention costs: there was a reduction in human resource costs (80% reduction in industrial accidents, 100% reduction in work-related musculoskeletal disorders or WMSD, medical consultations and turnover, and a 45.65% reduction in absenteeism) and production improvement (productivity increased in 3% and production waste decrease to less than 1%). The net intervention value of the intervention was around U$ 430,000 with a benefit-to-cost ratio of 7.2. Moreover, employees who worked in the pilot line understood that their quality of work life improved, compensating the anxiety brought up by the radical changes implemented.

Ergonomics action research II: a framework for integrating HF into work system design

This paper presents a conceptual framework that can support efforts to integrate human factors (HF) into the work system design process, where improved and cost-effective application of HF is possible. The framework advocates strategies of broad stakeholder participation, linking of performance and health goals, and process focussed change tools that can help practitioners engage in improvements to embed HF into a firm's work system design process. Recommended tools include business process mapping of the design process, implementing design criteria, using cognitive mapping to connect to managers' strategic goals, tactical use of training and adopting virtual HF (VHF) tools to support the integration effort. Consistent with organisational change research, the framework provides guidance but does not suggest a strict set of steps. This allows more adaptability for the practitioner who must navigate within a particular organisational context to secure support for embedding HF into the design process for improved operator wellbeing and system performance.

PRACTITIONER SUMMARY

There has been little scientific literature about how a practitioner might integrate HF into a company's work system design process. This paper proposes a framework for this effort by presenting a coherent conceptual framework, process tools, design tools and procedural advice that can be adapted for a target organisation.

Ergonomics action research I: shifting from hypothesis testing to experiential learning

This paper presents the case for the need for 'Action Research' (AR) approaches to gain understanding of how ergonomics considerations can best be integrated into the design of new work systems. The AR researchers work collaboratively with other stakeholders to solve a real-world problem: gaining insight into the problem and factors influencing solution building from an embedded position in the development process. This experience is interpreted in terms of available theory and can support further theory development. This non-experimental approach can help provide practical new approaches for integrating ergonomics considerations into real work system design processes. The AR approach suffers from a lack of acceptance by conventionally trained scientists. This paper aims to help overcome this weakness by developing the underlying theory and rationale for using AR approaches in ergonomics research. We propose further development of hybrid approaches which incorporate other evaluation techniques to extend the knowledge gains from AR projects.

PRACTITIONER SUMMARY

Researchers should engage directly with organisations in ergonomics projects so that they can better understand the challenges and needs of practitioners who are trying to apply available scientific knowledge in their own unique context. Such 'Action Research' could help develop theory and approaches useful to improve mobilisation and application of ergonomics knowledge in organisations.

Effect assessment in work environment interventions: a methodological reflection

This paper addresses a number of issues for work environment intervention (WEI) researchers in light of the mixed results reported in the literature. If researchers emphasise study quality over intervention quality, reviews that exclude case studies with high quality and multifactorial interventions may be vulnerable to 'quality criteria selection bias'. Learning from 'failed' interventions is inhibited by both publication bias and reporting lengths that limit information on relevant contextual and implementation factors. The authors argue for the need to develop evaluation approaches consistent with the complexity of multifactorial WEIs that: a) are owned by and aimed at the whole organisation; and b) include intervention in early design stages where potential impact is highest. Context variety, complexity and instability in and around organisations suggest that attention might usefully shift from generalisable 'proof of effectiveness' to a more nuanced identification of intervention elements and the situations in which they are more likely to work as intended. STATEMENT OF RELEVANCE: This paper considers ergonomics interventions from perspectives of what constitutes quality and 'proof". It points to limitations of traditional experimental intervention designs and argues that the complexity of organisational change, and the need for multifactorial interventions that reach deep into work processes for greater impact, should be recognised.

Effectiveness of workplace rehabilitation interventions in the treatment of work-related low back pain: A systematic review

PURPOSE

A systematic review was conducted to evaluate the effectiveness of workplace rehabilitation interventions for injured workers with low back pain (LBP).

METHOD

MEDLINE, CINAHL (Cumulative Index to Nursing and Allied Health Literature), EMBASE, and AMED (Allied and Complementary Medicine) were searched from 1982 to 2005 for peer-reviewed studies of rehabilitation interventions that were provided at the workplace to workers with musculoskeletal work-related LBP. Methodological quality appraisal and data extraction were conducted by five reviewers.

RESULTS

Of a total of 1,224 articles that were identified by the search, 15 articles, consisting of 10 studies, were of sufficient quality to be included in the review. The best evidence was that clinical interventions with occupational interventions as well as early return to work/modified work interventions were effective in returning workers to work faster, reducing pain and disability, and decreasing the rate of back injuries. Ergonomic interventions also were found to be effective workplace interventions.

CONCLUSION

The need for further research in this area is necessary to reduce the burden of back pain on employees and their families, employers, and the health care system.

Estimating the effectiveness of ergonomics interventions through case studies: implications for predictive cost-benefit analysis

PROBLEM

Cost-benefit analysis (CBA) can help to justify an investment in ergonomics interventions. A predictive CBA model would allow practitioners to present a cost justification to management during the planning stages, but such a model requires reliable estimates of the benefits of ergonomics interventions.

METHOD

Through literature reviews and Internet searches, 250 case studies that reported the benefits of ergonomics programs and control measures were collected and summarized.

RESULTS

Commonly reported benefits included reductions in the number of work-related musculoskeletal disorders (WMSDs) or their incidence rate, as well as related lost workdays, restricted workdays, and workers' compensation costs. Additional benefits reported were related to productivity, quality, turnover and absenteeism.

DISCUSSION

Benefits reported were largely positive, and payback periods for ergonomics interventions were typically less than one year.

SUMMARY

The results of this review could be used to develop predictive CBA models for ergonomics programs and individual control measures.

IMPACT ON INDUSTRY

Cost-justifying ergonomics interventions prior to implementation may help to secure management support for proposed changes. Numbers used for the benefits side of a cost-benefit analysis (CBA) need to be based on "real world" data in order to be credible. The data presented in this paper may help in the development of simple cost-benefit models for ergonomics programs and control measures.

The relation between OSH and ergonomics: a 'mother-daughter' or 'sister-sister' relation?

Despite the growing importance of ergonomics and ergonomists worldwide, the position of ergonomics in companies is often not clear. Today, in many countries ergonomics is mainly (or even only) associated with the reduction of risks of work-related musculoskeletal disorders (WMSDs). Therefore, many companies consider ergonomics a part of occupational safety and health (OSH) that focuses mainly on the reduction of risks. This paper aims to analyse the links between occupational ergonomics and OSH. The position of occupational ergonomics in legislation, the presence of ergonomics in OSH networks, and the position of ergonomics in OSH company services are discussed. In addition, the added value of ergonomics to companies is examined. From these discussions, it becomes clear that ergonomics should be part of the OSH policy of companies, and should be integrated into today's company strategies to improve labour conditions. If ergonomics is considered as a discipline in its own right, a clear legislative context should be developed that goes beyond voluntary guidelines and the goodwill of employers, and necessitates the presence of ergonomics professionals in companies.

How Do Job Stress and Ergonomic Factors Impact Clinic Visits in Acute Low Back Pain? A Prospective Study

OBJECTIVE

We sought to identify whether ergonomic factors, job stress, health behavior, and emotional distress are prospectively related to return visits for acute back pain.

METHODS

A total of 368 U.S. Army soldiers completed a baseline survey of health and work factors at their first visit for back pain. Multivariable regression and structural equation modeling were used to describe the relationships among ergonomic exposure, job stress, smoking, and emotional distress and their ability to predict repeat clinic visits.

RESULTS

The path analysis indicated that higher levels of ergonomic exposures were directly related to increased job stress (beta = 0.29). Higher levels of job stress were directly related to higher levels of general distress (beta = -35). General distress (beta = -0.70) and smoking (beta = 0.67) were directly linked to clinic visits.

CONCLUSIONS

Efforts to directly impact emotional distress or indirectly reduce distress by intervening at the levels of ergonomic risks and psychosocial workplace stress should prove useful in the management of acute low back pain.

The cost effectiveness of occupational health interventions: preventing occupational back pain

BACKGROUND

Occupational back pain exacts a toll on society with concomitant economic losses; it is imperative to evaluate the cost-effectiveness of interventions to reduce the relevant ergonomic stressors at work. This study estimates and evaluates the average and incremental cost-effectiveness ratios (CERs) of specific interventions for the prevention of occupationally induced back pain for the World Health Organization (WHO) defined subregions of the world.

METHODS

Four back-pain interventions were selected from the literature: training (T), engineering controls (EC), engineering controls and training (EC&T), and a comprehensive full ergonomics program (EP) for evaluation. A simulation model for a 100-year time horizon, developed by the WHO CHOICE initiative project was used to estimate the effectiveness of the interventions in healthy year equivalents. The intervention costs were adjusted for all WHO subregions.

RESULTS

In all of the subregions, training was the most cost-effective with CERs varying from 74 dollars per healthy life years gained in the subregion comprising of Egypt, Iraq, Morocco, Yemen (EMROD) to approximately 567 dollars in the subregion covering Canada and the United States (AMROA). Training is considered to be very cost-effective and would be the first choice option where resources are scarce. However, the overall effectiveness of training is low. Although other interventions such as engineering controls and total ergonomic interventions are relatively more expensive, the addition to health outcome through these interventions is much higher. The difference in the CERs for training and other engineering controls and full ergonomic interventions is relatively small for most of the industrialized regions of the world. It is clear from the ranked CERs and incremental CERs over the different subregions that in most of the industrialized regions of the world additional resources, if they become available, should go straight to the full ergonomics program.

CONCLUSIONS

The model results based on CERs show that worker training is a low cost, feasible first step toward reducing back pain/injury incidence. However, all of the average CERs for the different interventions, for each of the regions, fall well within their GDP per capita estimates [World Bank, 2001]. According to the WHO Commission on Macroeconomics and Health any intervention that costs less than three times GDP per capita for saving a healthy year equivalent should be considered worthwhile and good value for money [WHO, 2002]. Given this criterion, the engineering controls interventions as well as the full ergonomics program look very cost effective for all of the WHO subregions.

Intensive education combined with low tech ergonomic intervention does not prevent low back pain in nurses

AIMS

To evaluate the effectiveness of an intensive educational and low-tech ergonomic intervention programme aimed at reducing low back pain (LBP) among home care nurses and nurses' aids.

METHODS

In 1999, 345 home care nurses and nurses' aids in four Danish municipalities were studied. Participants in two municipalities constituted the intervention group and participants in the other two served as the control group. In the intervention group, participants were divided into small groups, each of which was assigned one specially trained instructor. During weekly meetings participants were educated in body mechanics, patient transfer, and lifting techniques, and use of low-tech ergonomic aids. In the control group, participants attended a one time only three hour instructional meeting. Information on LBP was collected using the Standardised Nordic Questionnaire supplemented with information on number of episodes of LBP and care seeking due to LBP during the past year.

RESULTS

A total of 309 nurses and nurses' aids returned the questionnaire at baseline and 255 at follow up in August 2001. At follow up, no significant differences were found between the two groups for any of the LBP variables, and both groups thought that education in patient transfer techniques had been helpful. Within group changes in LBP status was not related to the intervention or to satisfaction with participating in the project.

CONCLUSIONS

Intensive weekly education in body mechanics, patient transfer techniques, and use of low-tech ergonomic equipment was not superior to a one time only three hour instructional meeting for home care nurses and nurses' aids.

Processes, barriers, and outcomes described by ergonomics consultants in preventing work-related musculoskeletal disorders

Despite the importance of reducing work-related musculoskeletal disorders, there appears to have been little evaluation of routine ergonomics consultancy interventions aimed at reducing risks leading to these conditions. In many instances, the effectiveness of advice depends on organisations accepting and implementing measures recommended, involving changes of both individual and collective behaviour. Behaviour change theory, developed elsewhere, suggests that if change is to take place, recipients need to hold positive attitudes and beliefs relating to the desirable behaviour. To investigate the extent to which this is accommodated by current ergonomics consultancy practices, 14 ergonomics consultants were interviewed to explore the consultancy process from which recommendations are developed, exploring the factors that are assessed by consultants, perceived barriers to promoting change, and the extent to which evaluation of outcomes takes place. Consultants' recommendations generally focused on physical aspects of the work environment and did not take explicit account of employees' knowledge or attitudes. Little evaluation of outcomes was conducted by the consultants interviewed. Implications of these findings for improving the efficacy of interventions to reduce work-related musculoskeletal disorders within organisations are discussed.

Intervention, intervene, interfere ... what are we doing?

TOPIC

A concept analysis of the meaning and attributes of the term intervention.

PURPOSE

To define the essence of the term intervention and the role of nurses in nurse-facilitated interventions.

SOURCES

Literature review of journals, texts, and popular periodicals from 1983 to the present via CINAHL and Medline.

CONCLUSIONS

A more accurate specification of the meaning and relevant attributes of the term intervention as it relates to nursing may lead to more effective clinical applications, as well as a more realistic definition of the term intervention and how it applies to the role.

The association between physical workload and low back pain clouded by the "healthy worker" effect: population-based cross-sectional and 5-year prospective questionnaire study

STUDY DESIGN

A population-based cross-sectional and 5-year prospective questionnaire study.

OBJECTIVE

To investigate self-reported physical workload as a risk factor for low back pain.

SUMMARY OF BACKGROUND DATA

Both physical and psychosocial workplace factors are considered risk factors for low back pain. However, today no consensus has been reached regarding the exact role of these factors in the genesis of low back pain.

METHODS

Questionnaire data were collected at baseline for 1397 (and after 5 years for 1163) men and women aged 31--50 years at baseline. Low back pain ("any low back pain within the past year," "low back pain < or = 30 days in total during the past year," "low back pain > 30 days in total during the past year") was analyzed in relation to physical workload (sedentary, light physical, and heavy physical work) using logistic regression and controlling for age, gender, and social group. The proportions of workers changing between the workload groups over the 5-year period were analyzed in relation to low back pain status.

RESULTS

At baseline no statistically significant differences in low back pain outcomes were found for workers exposed to sedentary, light physical, or heavy physical work. This was true for all age, gender, and social groups. At follow-up there was a statistically significant dose-response association between any low back pain and longstanding low back pain within the past year and increasing physical workload at baseline also after controlling for age, gender, and social group. Subjects with heavy physical workload at baseline changed statistically significantly more often to sedentary work if they experienced low back pain for more than 30 days out of the past year.

CONCLUSIONS

Having a sedentary job might have a protective or neutral effect in relation to low back pain, whereas having a heavy physical job constitutes a significant risk factor. Because of migration between exposure groups (the "healthy-worker" effect), longitudinal studies are necessary for investigating the associations between physical workload and low back pain.