Misclassification of physical work exposures as a design issue for musculoskeletal intervention studies

An expert-based job exposure matrix for large scale epidemiologic studies of primary hip and knee osteoarthritis: the Lower Body JEM

BACKGROUND

When conducting large scale epidemiologic studies, it is a challenge to obtain quantitative exposure estimates, which do not rely on self-report where estimates may be influenced by symptoms and knowledge of disease status. In this study we developed a job exposure matrix (JEM) for use in population studies of the work-relatedness of hip and knee osteoarthritis.

METHODS

Based on all 2227 occupational titles in the Danish version of the International Standard Classification of Occupations (D-ISCO 88), we constructed 121 job groups comprising occupational titles with expected homogeneous exposure patterns in addition to a minimally exposed job group, which was not included in the JEM. The job groups were allocated the mean value of five experts' ratings of daily duration (hours/day) of standing/walking, kneeling/squatting, and whole-body vibration as well as total load lifted (kg/day), and frequency of lifting loads weighing ≥20 kg (times/day). Weighted kappa statistics were used to evaluate inter-rater agreement on rankings of the job groups for four of these exposures (whole-body vibration could not be evaluated due to few exposed job groups). Two external experts checked the face validity of the rankings of the mean values.

RESULTS

A JEM was constructed and English ISCO codes were provided where possible. The experts' ratings showed fair to moderate agreement with respect to rankings of the job groups (mean weighted kappa values between 0.36 and 0.49). The external experts agreed on 586 of the 605 rankings.

CONCLUSION

The Lower Body JEM based on experts' ratings was established. Experts agreed on rankings of the job groups, and rankings based on mean values were in accordance with the opinion of external experts.

Using job-title-based physical exposures from O*NET in an epidemiological study of carpal tunnel syndrome

OBJECTIVE

We studied associations between job-title-based measures of force and repetition and incident carpal tunnel syndrome (CTS).

BACKGROUND

Job exposure matrices (JEMs) are not commonly used in studies of work-related upper-extremity disorders.

METHOD

We enrolled newly hired workers in a prospective cohort study. We assigned a Standard Occupational Classification (SOC) code to each job held and extracted physical work exposure variables from the Occupational Information Network (O*NET). CTS case definition required both characteristic symptoms and abnormal median nerve conduction.

RESULTS

Of 1,107 workers, 751 (67.8%) completed follow-up evaluations. A total of 31 respondents (4.4%) developed CTS during an average of 3.3 years of follow-up. Repetitive motion, static strength, and dynamic strength from the most recent job held were all significant predictors of CTS when included individually as physical exposures in models adjusting for age, gender, and BMI. Similar results were found using time-weighted exposure across all jobs held during the study. Repetitive motion, static strength, and dynamic strength were correlated, precluding meaningful analysis of their independent effects.

CONCLUSION

This study found strong relationships between workplace physical exposures assessed via a JEM and CTS, after adjusting for age, gender, and BMI. Though job-title-based exposures are likely to result in significant exposure misclassification, they can be useful for large population studies where more precise exposure data are not available.

APPLICATION

JEMs can be used as a measure of workplace physical exposures for some studies of musculoskeletal disorders.

A survey of laboratory and statistical issues related to farmworker exposure studies

Developing internally valid, and perhaps generalizable, farmworker exposure studies is a complex process that involves many statistical and laboratory considerations. Statistics are an integral component of each study beginning with the design stage and continuing to the final data analysis and interpretation. Similarly, data quality plays a significant role in the overall value of the study. Data quality can be derived from several experimental parameters including statistical design of the study and quality of environmental and biological analytical measurements. We discuss statistical and analytic issues that should be addressed in every farmworker study. These issues include study design and sample size determination, analytical methods and quality control and assurance, treatment of missing data or data below the method's limits of detection, and post-hoc analyses of data from multiple studies. Key words: analytical methodology, biomarkers, laboratory, limit of detection, omics, quality control, sample size, statistics.

Anticipatory control of vertical lifting force and momentum during the squat lift with expected and unexpected loads

STUDY DESIGN

Mixed, repeated measures design.

OBJECTIVES

To determine if previous experience with loads of similar weight influences the anticipatory lifting force and postural adjustments during the squat lift. To examine a multijoint, functional task for coordination between stability and movement. To determine if lifting unexpected loads results in trunk loading patterns associated with greater injury risk.

BACKGROUND

Workers are increasingly exposed to variability in materials handling thereby increasing the risk of injury. Understanding the control processes underlying lifting will support clinical decision making for preparing injured workers to return to realistic working conditions.

METHODS AND MEASURES

Subjects (19 men, 4 women; mean age, 25.4 +/- 3.5 y) lifted a series of boxes weighing 5%, 20%, and 35% of their maximal lifting capacity. The loads were delivered via a gravity conveyor. The identical-appearing loads were ordered so that the subjects lifted several loads of similar weight, immediately followed by a lighter or heavier than expected load based on the previous lift.

RESULTS

Generally, the vertical lifting force, force rate, horizontal momentum, and angular momentum increased with an increase in expected load. Higher peak lumbar extensor moments occurred with lighter than expected loads (expected 20% and lifted 5% load = 238.2 +/- 91.2 N-m; expected 35% and lifted 5% load = 278.2 +/- 101.8 N-m) compared to expected loads of similar weight (expected and lifted 5% load = 205.0 +/- 73.2 N-m). Heavier than expected loads led to eccentric trunk movements when there were large mismatches between the expected and actual loads.

CONCLUSIONS

The vertical lifting forces and whole body momentum were predictively scaled according to the expected load. The loading phase relationships indicated coordination between the lifting force, force rate, horizontal momentum, and angular momentum. Trunk loading during the lifts with unexpected loads showed patterns associated with increased injury risk.