Current techniques for assessing physical exposure to work-related musculoskeletal risks, with emphasis on posture-based methods

Working conditions of Iranian hand-sewn shoe workers and associations with musculoskeletal symptoms

The working conditions and the prevalence of self-reported musculoskeletal symptoms among 180 Iranian hand-sewn shoe workers were evaluated in this cross-sectional study. Data were collected using both questionnaire (for assessing musculoskeletal symptoms and associated risk factors) and direct observations of posture (by the Rapid Upper Limb Assessment [RULA] method). The prevalence and severity of symptoms was very high among the study population. The mean RULA grand score of 6.2 indicates that in most cases the workers' postures at their workstations need to be investigated and some changes are required immediately. Multiple logistic regression models indicated that the job experience, daily working hours, duration of continuous work without breaks, feeling pressure due to work and working postures were significantly associated with musculoskeletal symptoms of different body regions. The results are discussed in terms of their implications for hand-sewing tasks. These findings can help to better understand the working conditions of those jobs involving hand-sewing operation and highlight the potential for ergonomic interventions to reduce musculoskeletal symptoms among these working groups.

Inter-rater reliability of cyclic and non-cyclic task assessment using the hand activity level in appliance manufacturing

This study evaluated the inter-rater reliability of the American Conference of Governmental Industrial Hygienists (ACGIH®) hand activity level (HAL), an observational ergonomic assessment method used to estimate physical exposure to repetitive exertions during task performance. Video recordings of 858 cyclic and non-cyclic appliance manufacturing tasks were assessed by sixteen pairs of raters using the HAL visual-analog scale. A weighted Pearson Product Moment-Correlation Coefficient was used to evaluate the agreement between the HAL scores recorded by each rater pair, and the mean weighted correlation coefficients for cyclic and non-cyclic tasks were calculated. Results indicated that the HAL is a reliable exposure assessment method for cyclic (r̄-bar w = 0.69) and non-cyclic work tasks (r̄-bar w = 0.68). When the two reliability scores were compared using a two-sample Student's t-test, no significant difference in reliability (p = 0.63) between these work task categories was found. This study demonstrated that the HAL may be a useful measure of exposure to repetitive exertions during cyclic and non-cyclic tasks.

RELEVANCE TO INDUSTRY

Exposure to hazardous levels of repetitive action during non-cyclic task completion has traditionally been difficult to assess using simple observational techniques. The present study suggests that ergonomists could use the HAL to reliably and easily evaluate exposures associated with some non-cyclic work tasks.

Statistical performance of observational work sampling for assessment of categorical exposure variables: a simulation approach illustrated using PATH data

Objectives:

Observational work sampling is often used in occupational studies to assess categorical biomechanical exposures and occurrence of specific work tasks. The statistical performance of data obtained by work sampling is, however, not well understood, impeding informed measurement strategy design. The purpose of this study was to develop a procedure for assessing the statistical properties of work sampling strategies evaluating categorical exposure variables and to illustrate the usefulness of this procedure to examine bias and precision of exposure estimates from samples of different sizes.

Methods:

From a parent data set of observations on 10 construction workers performing a single operation, the probabilities were determined for each worker of performing four component tasks and working in four mutually exclusive trunk posture categories (neutral, mild flexion, severe flexion, twisted). Using these probabilities, 5000 simulated data sets were created via probability-based resampling for each of six sampling strategies, ranging from 300 to 4500 observations. For each strategy, mean exposure and exposure variability metrics were calculated at both the operation level and task level and for each metric, bias and precision were assessed across the 5000 simulations.

Results:

Estimates of exposure variability were substantially more uncertain at all sample sizes than estimates of mean exposures and task proportions. Estimates at small sample sizes were also biased. With only 600 samples, proportions of the different tasks and of working with a neutral trunk posture (the most common) were within 10% of the true target value in at least 80% of all the simulated data sets; rarer exposures required at least 1500 samples. For most task-level mean exposure variables and for all operation-level and task-level estimates of exposure variability, performance was low, even with 4500 samples. In general, the precision of mean exposure estimates did not depend on the exposure variability between workers.

Conclusions:

The suggested probability-based simulation approach proved to be versatile and generally suitable for assessing bias and precision of data collection strategies using work sampling to estimate categorical data. The approach can be used in both real and hypothetical scenarios, in ergonomics, as well as in other areas of occupational epidemiology and intervention research. The reported statistical properties associated with sample size are likely widely relevant to studies using work sampling to assess categorical variables.

Investigation of Ergonomics Risk Factors for Musculoskeletal Disorders among Oil Palm Workers Using Quick Exposure Check (QEC)

Oil palm workers perform daily activities that exposed themselves to various ergonomics risk factors. To harvest oil palm fruits from tall trees, specific technique is required. To quantify the ergonomics risks factors, postural analysis was conducted using Quick Exposure Check (QEC) system. It was found oil palm workers were exposed to many postural problems while performing harvesting and collecting fresh fruit bunch (FFB) activities. However, to quantify the actual load, many limitations of the QEC have been revealed such the missing of legs assessment, the crude analysis for arm and shoulder, no pushing and pulling assessment and the biased may be existed due to the workers perception on the ergonomics factors. Thus, it can be concluded that QEC system was not suitable for conducting postural analysis during harvesting in oil palm plantation especially in tall trees due to the above limitations.

A method for non-experts in assessing exposure to risk factors for work-related musculoskeletal disorders--ERIN

A practical method for non-experts in assessing exposure to risk factors for work-related musculoskeletal disorders (WMSDs) is presented. Evaluación del Riesgo Individual (Individual Risk Assessment) (ERIN) is based on available ergonomic tools, epidemiological evidence and the joint IEA-WHO project for developing WMSDs risk management in developing countries. ERIN focuses primarily on the interaction of some physical workplace factors but also includes the workers' assessment. A scoring system has been proposed to indicate the level of intervention required to reduce the risk of injury. A worksheet has also been designed for increasing the usability of the method. Preliminary tests show that it is easy and quick to use, but further work is needed to establish its reliability and validity. The use of ERIN can contribute to the prevention of WMSDs in Cuba and other developing countries.

Avaliação do risco ergonômico em trabalhadores da indústria têxtil por dois instrumentos: quick exposure check e job factors questionnaire

A análise dos fatores de risco ergonômicos presentes em indústrias têxteis auxilia no planejamento de estratégias que contribuem para a melhora das condições de trabalho e redução dos distúrbios osteomusculares. Este estudo se propôs a mensurar os níveis de exposição aos fatores de risco ergonômicos em trabalhadores de dois setores de produção de uma indústria têxtil. Para tanto, os instrumentos Job Factors Questionnaire (JFQ) e o Quick Exposure Check (QEC) foram aplicados em 107 trabalhadores. Os resultados foram analisados por estatística descritiva. O teste de Mann-Whitney foi utilizado para comparação dos resultados obtidos entre os setores de produção. O diagnóstico do nível de exposição ao risco ergonômico, obtido por ambos os instrumentos, foi moderado. Os fatores de risco considerados pelo JFQ como mais criticos estão relacionados à temperatura ambiental; postura mantida em longos períodos de tempo; posturas inadequadas para coluna e continuar trabalhando quando está com alguma dor ou com alguma lesão. O QEC identificou as regiões de coluna lombar e punhos/mãos como expostas ao alto risco. Não houveram diferenças estatisticamente significante entre os setores.

Workload as a Determinant of Staff Injury in Intermediate Care

Care aides (CAs) and licensed practical nurses (LPNs) in intermediate care (IC) facilities experience high risks of injury. Workload measures were examined in eight IC facilities to ascertain their relationships with musculoskeletal injury rates, pain, burnout, and self-reported health. Workload was measured using (1) focus groups and telephone interviews to obtain CA/LPN perceptions; (2) systematic observation (numbers of tasks performed in shift); and (3) CA-to-resident staffing ratios. Controlling for resident dependency and facility funding, all workload measures were correlated with staff injury rates and burnout. Facilities with low injury rates had better CA/LPN-to-resident staffing ratios and fewer tasks. The differences in staffing reflected differences in how organizations prioritized and allocated resources. Thus, workload is an important determinant of injuries and increased staffing levels correlate with decreased injuries.

Joint motion pattern classification by cluster analysis of kinematic, demographic, and subjective variables

The purpose of this study is to identify joint motion patterns by classifying the full range of motion (ROM) into several sections. Forty participants were stratified by age and gender and they performed 18 full-swing motions at a self-selected speed. Joint angle, angular velocity, angular acceleration, and subjective discomfort rating were collected for each motion. K-means cluster analyses were used to classify joint motion patterns and ROM sections. The results showed that two or three clusters were mainly determined by the kinematic variables of angular velocity and acceleration. The motions of three clusters showed that the ROM sections of low and moderate velocity with moderate and high accelerations occurred in the initial (negative) and terminal (positive) phases, respectively, whereas those of high velocity with low acceleration were shown in the mid (neutral) phase. The motions of two clusters revealed that while the patterns of high velocity and high acceleration were found on the positive side of the ROM, those of low velocity and low acceleration were on the negative and neutral sides. The ROM sections close to both ends of the ROM may have a larger physical load than the others. This study provides information that could be useful for developing postural analysis tools for dynamic work.

Innovative system for real-time ergonomic feedback in industrial manufacturing

This work presents a system that permits a real-time ergonomic assessment of manual tasks in an industrial environment. First, a biomechanical model of the upper body has been developed by using inertial sensors placed at different locations on the upper body. Based on this model, a computerized RULA ergonomic assessment was implemented to permit a global risk assessment of musculoskeletal disorders in real-time. Furthermore, local scores were calculated per segment, e.g. the neck region, and gave information on the local risks for musculoskeletal disorders. Visual information was fed back to the user by using a see-through head mounted display. Additional visual highlighting and auditory warnings were provided when some predefined thresholds were exceeded. In a user study (N = 12 participants) a group with the RULA feedback was compared to a control group. Results demonstrate that the real-time ergonomic feedback significantly decreased the outcome of both globally as well as locally hazardous RULA values that are associated with increased risk for musculoskeletal disorders. Task execution time did not differ between groups. The real-time ergonomic tool introduced in this study has the potential to considerably reduce the risk of musculoskeletal disorders in industrial settings. Implications for ergonomics in manufacturing and user feedback modalities are further discussed.

Cost-efficient measurement strategies for posture observations based on video recordings

Assessment of working postures by observation is a common practice in ergonomics. The present study investigated whether monetary resources invested in a video-based posture observation study should preferably be spent in collecting many video recordings of the work and have them observed once by one observer, or in having multiple observers rate postures repeatedly from fewer videos. The study addressed this question from a practitioner's perspective by focusing two plausible scenarios: documenting the mean exposure of one individual, and of a specific occupational group. Using a data set of observed working postures among hairdressers, empirical values of posture variability, observer variability, and costs for recording and observing one video were entered into equations expressing the total cost of data collection and the information (defined as 1/SD) provided by the resulting estimates of two variables: percentage time with the arm elevated <15° and >90°. Sixteen measurement strategies involving 1-4 observers repeating their posture ratings 1-4 times were examined for budgets up to €2000. For both posture variables and in both the individual and group scenario, the most cost-efficient strategy at any specific budget was to engage 3-4 observers and/or having observer(s) rate postures multiple times each. Between 17% and 34% less information was produced when using the commonly practiced approach of having one observer rate a number of video recordings one time each. We therefore recommend observational posture assessment to be based on video recordings of work, since this allows for multiple observations; and to allocate monetary resources to repeated observations rather than many video recordings.

Can a single-item measure assess physical load at work? An analysis from the GAZEL cohort

OBJECTIVE

The assessment of workplace physical load is highly resource intensive. This study tested whether a single-item measure asking individuals about perceived physical strain (PPS) at work was an acceptable proxy for physical load.

METHODS

The study was conducted in a subset of the GAZEL cohort (n = 2612) undergoing assessment of exposure to 38 occupational biomechanical constraints (representing eight domains) in 1994. Test-retest reliability analyses compared PPS in 1994 and 1995. Validity analyses compared PPS in 1994 to concurrent strains assessed in the more extensive measure.

RESULTS

The measure showed adequate test-retest reliability. Within and across domains of physical load, linear relationships (P < 0.0001) existed between n exposures and PPS. Domains considered more strenuous (carrying loads, pulling objects) showed the highest PPS.

CONCLUSIONS

Perceived physical strain approximates physical load in the absence of detailed measures. Perceived physical strain could be used in nonoccupational epidemiologic studies.

The effect of camera location on observation-based posture estimation

This study used the observation-based method showing images on computer to evaluate angle estimation errors of 8 body segments in 3 motion planes at up to 28 segment angles and 5 camera locations with respect to goniometric measurements. Thirty observers participated in evaluating segment angles. Forearm (9.9°) and thigh (9.5°) had smaller errors than hand (14.0°) and foot had the smallest error (8.7°) due to its narrow range of motion (ROM). Errors were small with camera locations perpendicular to motions in the planes, such as 90° camera location for the flexion and extension of arm (6.3°), forearm (7.9°), thigh (6.5°), and leg (8.1°) in the sagittal plane. Segments had small errors of 3.1°, 4.6°, and 3.8° at segment angles of -90°, 0° and 90°, respectively. Care should be taken when estimating angles by the observation-based method for a specific segment motion and viewing direction is suggested to be perpendicular to the motion plane.

PRACTITIONER SUMMARY

Some companies may not allow many cameras or have obstacles for working posture evaluation in the workplace. These study results can be a guideline on proper selection of the number of cameras and their locations for a specific segment and its motion of interest to reduce visual segment angle estimation errors.

Bias and imprecision in posture percentile variables estimated from short exposure samples

Background

Upper arm postures are believed to be an important risk determinant for musculoskeletal disorder development in the neck and shoulders. The 10^th and 90^th percentiles of the angular elevation distribution have been reported in many studies as measures of neutral and extreme postural exposures, and variation has been quantified by the 10^th-90^th percentile range. Further, the 50^th percentile is commonly reported as a measure of "average" exposure. These four variables have been estimated using samples of observed or directly measured postures, typically using sampling durations between 5 and 120 min.

Methods

The present study examined the statistical properties of estimated full-shift values of the 10^th, 50^th and 90^th percentile and the 10^th-90^th percentile range of right upper arm elevation obtained from samples of seven different durations, ranging from 5 to 240 min. The sampling strategies were realized by simulation, using a parent data set of 73 full-shift, continuous inclinometer recordings among hairdressers. For each shift, sampling duration and exposure variable, the mean, standard deviation and sample dispersion limits (2.5% and 97.5%) of all possible sample estimates obtained at one minute intervals were calculated and compared to the true full-shift exposure value.

Results

Estimates of the 10^th percentile proved to be upward biased with limited sampling, and those of the 90^th percentile and the percentile range, downward biased. The 50^th percentile was also slightly upwards biased. For all variables, bias was more severe with shorter sampling durations, and it correlated significantly with the true full-shift value for the 10^th and 90^th percentiles and the percentile range. As expected, shorter samples led to decreased precision of the estimate; sample standard deviations correlated strongly with true full-shift exposure values.

Conclusions

The documented risk of pronounced bias and low precision of percentile estimates obtained from short posture samples presents a concern in ergonomics research and practice, and suggests that alternative, unbiased exposure variables should be considered if data collection resources are restricted.

Relationships between subjective and objective measures in assessing postural stresses

The purpose of this study is to investigate the relationships between subjective measures of discomfort and objective measures related to the assessment of postural stresses based on literature survey. Objective measures included posture holding time, maximum holding time (MHT), torque at joints, lifting index (LI) and compressive force (CF) at L5/S1. The major relationships identified in this literature survey were the following: 1) postural discomfort linearly increased with increasing holding time, and holding force, 2) whole body discomfort was inversely linearly proportional to the MHT, 3) body-part discomfort was related to objective measures such as torque at the relevant joint, 4) discomfort was strongly linearly related to LIs and CFs, and 5) the discomfort measured with the magnitude estimation was linearly related to that measured with Borg CR10. Thus, it is thought that discomfort might be used as a measure for quantifying postural stresses.

Tetherless ergonomics workstation to assess nurses' physical workload in a clinical setting

Nurses are at risk of physical injury when moving immobile patients. This paper describes the development and testing of a tetherless ergonomics workstation that is suitable for studying nurses' physical workload in a clinical setting. The workstation uses wearable sensors to record multiple channels of body orientation and muscle activity and wirelessly transmits them to a base station laptop computer for display, storage, and analysis. In preparation for use in a clinical setting, the workstation was tested in a laboratory equipped for multi-camera video motion analysis. The testing included a pilot study of the effect of bed height on student nurses' physical workload while they repositioned a volunteer posing as a bedridden patient toward the head of the bed. Each nurse subject chose a preferred bed height, and data were recorded, in randomized order, with the bed at this height, at 0.1 m below this height, and at 0.1 m above this height. The testing showed that the body orientation recordings made by the wearable sensors agreed closely with those obtained from the video motion analysis system. The pilot study showed the following trends: As the bed height was raised, the nurses' trunk flexion at both thoracic and lumbar sites and lumbar muscle effort decreased, whereas trapezius and deltoid muscle effort increased. These trends will be evaluated by further studies of practicing nurses in the clinical setting.

Effects of prismatic glasses including optometric correction on head and neck kinematics, perceived exertion and comfort during dental work in the oral cavity--a randomised controlled intervention

AIM

To quantify the effects of using prismatic glasses including optometric correction, on head and neck kinematics, perceived exertion and comfort, during work in the oral cavity.

METHODS

The study population consisted of forty-five participants. After a basic ergonomic education, baseline measurements of head and neck kinematics were made using inclinometers. Perceived exertion and comfort were rated by the participants. An intervention group (n = 25), selected at random from the participants, received prismatic glasses and optometric correction when needed and were compared with a control group (n = 20). Follow up assessments were made after the intervention.

RESULTS

At follow up there was a reduction in both the intervention group (8.7°) and in the control group (3.6°) regarding head flexion. Neck flexion was reduced by 8.2° in the intervention group and 3.3° in the control group. The difference between the intervention and the control groups, i.e. the effect of the intervention, was statistically significant for both head (5.1°; p = 0.009) and neck (4.9°; p = 0.045) flexion. No effect of the intervention was seen regarding perceived exertion and comfort.

CONCLUSION

The reduction in head and neck flexion achieved by the prismatic glasses is likely to reduce the risk of neck pain during dental work. The effect of the prismatic lenses could not be separated from the effect of the optometric correction. The possible effect of the ergonomic education was not evaluated.

Novel method for quantitative assessment of physical workload of healthcare workers by a tetherless ergonomics workstation

Healthcare workers are at risk of physical injury. Our laboratory has developed a tetherless ergonomics workstation that is suitable for studying physicians' and nurses' physical workloads in clinical settings. The workstation uses wearable sensors to record multiple channels of body orientation and muscle activity and wirelessly transmits them to a base station laptop computer for display, storage, and analysis. The ergonomics workstation generates long records of multi-channel data, so it is desired that the workstation automatically process these records and provide graphical and quantitative summaries of the physical workloads experienced by the healthcare workers. This paper describes a novel method of automated quantitative assessment of physical workload, termed joint cumulative amplitude-duration (JCAD) analysis, that has advantages over previous methods and illustrates its use in a comparison of the physical workloads of robotically-assisted surgery versus manual video-endoscopic surgery.

The effect of viewing angle on wrist posture estimation from photographic images using novice raters

Observational assessment of wrist posture using photographic methods is theoretically affected by camera view angle. A study was conducted to investigate whether wrist flexion/extension and radial/ulnar deviation postures were estimated differently by raters depending on the viewing angle and compared to predictions using a quantitative 2D model of parallax. Novice raters (n=26) estimated joint angles from images of wrist postures photographed from ten different viewing angles. Results indicated that ideal views, orthogonal to the plane of motion, produced more accurate estimates of posture compared to non-ideal views. The neutral (0°) posture was estimated the most accurately even at different viewing angles. Raters were more accurate than model predictions. Findings demonstrate a need for more systematic methods for collecting and analyzing photographic data for observational studies of posture. Renewed caution in interpreting existing studies of wrist posture where viewing angle was not controlled is advised.

The quality of evidence of psychometric properties of three-dimensional spinal posture-measuring instruments

BACKGROUND

Psychometric properties include validity, reliability and sensitivity to change. Establishing the psychometric properties of an instrument which measures three-dimensional human posture are essential prior to applying it in clinical practice or research.

METHODS

This paper reports the findings of a systematic literature review which aimed to 1) identify non-invasive three-dimensional (3D) human posture-measuring instruments; and 2) assess the quality of reporting of the methodological procedures undertaken to establish their psychometric properties, using a purpose-build critical appraisal tool.

RESULTS

Seventeen instruments were identified, of which nine were supported by research into psychometric properties. Eleven and six papers respectively, reported on validity and reliability testing. Rater qualification and reference standards were generally poorly addressed, and there was variable quality reporting of rater blinding and statistical analysis.

CONCLUSIONS

There is a lack of current research to establish the psychometric properties of non-invasive 3D human posture-measuring instruments.

Ergonomic task analysis of ultrasound-guided femoral nerve block: a pilot study

STUDY OBJECTIVE

To apply ergonomic task analysis to the performance of ultrasound-guided (US-guided) femoral nerve block (FNB) in an acute hospital setting.

DESIGN

Pilot prospective observational study.

SETTING

Orthopedic operating room of a regional trauma hospital.

SUBJECTS

15 anesthesiologists of various levels of experience in US-guided FNB (estimated minimum experience < 10 procedures; maximum about 50 procedures, and from basic trainees to consultants); and 15 patients (5 men and 10 women), aged 77 ± 15 (mean ± SD yrs) years. MEASUREMENTS/OBSERVATIONS: A data capture "tool", which was modified from one previously developed for ergonomic study of spinal anesthesia, was studied. Patient, operator, and heterogeneous environmental factors related to ergonomic performance of US-guided FNB were identified. The observation period started immediately before commencement of positioning the patient and ended on completion of perineural injection. Data were acquired using direct observations, photography, and application of a questionnaire.

MAIN RESULTS

The quality of ergonomic performance was generally suboptimal and varied greatly among operators. Eight (experience < 10 procedures) of 15 operators excessively rotated their head, neck, and/or back to visualize the image on the ultrasound machine. Eight operators (experience < 10 procedures) performed the procedure with excessive thoracolumbar flexion.

CONCLUSION

Performance of US-guided FNB presents ergonomic challenges and was suboptimal during most of the procedures observed. Formal training in US-guided peripheral nerve blockade should include reference to ergonomic factors.

In vivo measurement of humeral elevation angles and exposure using a triaxial accelerometer

OBJECTIVE

The aim of this study was to measure the capability of a triaxial accelerometer (Virtual Corset) to collect humeral elevation angles and exposure parameters in a simulated occupational environment.

BACKGROUND

There is a need for an economical ambulatory device to estimate elevation angles and exposure parameters in occupational groups.

METHOD

A magnetic tracking device was used to assess the ability of the Virtual Corset to evaluate humeral elevation angles and identify exposure parameters with in vivo dynamic conditions for 16 female dental hygienists.

RESULTS

Significant differences were found for the reaching task with the Virtual Corset, underestimating the means of the average humeral elevation angle by 10 degrees and the means for the range of the humeral elevation by 4 degrees. Furthermore, significant differences were found for the exposure parameters with the Virtual Corset, overestimating the jerk by 4% and underestimating the percentage time above 40 degrees and 60 degrees by 9% and 4%, respectively. However, the Virtual Corset was able to identify similar kinematics patterns and exposure data when compared with a magnetic tracking device.

CONCLUSION

The outcomes of the study suggest that the Virtual Corset may be useful for data collection during a dental hygienist workday. Professions that have similar patterns of angular velocity and acceleration and humeral range of elevation as the dental hygienist flossing technique may benefit from the use of the Virtual Corset.

APPLICATION

This study provides evidence that the Virtual Corset can be used to reconstruct humeral elevation angles and identify exposure parameters in some tasks of dental hygienists.

In vivo laboratory validation of the physiometer: a measurement system for long-term recording of posture and movements in the workplace

Posture and movement are thought to be important risk factors for the development of work-related musculoskeletal disorders. Whole day occupational exposure assessment has typically used self-report or observation techniques, but the need for more accurate measurement is now recognised. The aim of this study was to compare the kinematic recordings of a frequently used field system (physiometer) with two laboratory-based systems (Fastrak and Peak) in vivo. Head, thorax and right arm kinematics were recorded simultaneously by the three systems whilst a subject performed 27 single and multiple plane physiological and simulated daily living task movement trials. Errors observed in the Fastrak and Peak data included gimbal lock and quadrant errors. Physiometer data errors included undervalues, overvalues and temporal errors of slow response and resonance. All three systems showed some cross-talk. Agreement between the physiometer and the other systems was generally high for physiological movements (R(2) > 0.8) and less for functional movements (R(2) > 0.5). STATEMENT OF RELEVANCE: The physiometer recording device can provide an indication of posture across time in the workplace; however, its accuracy is limited, particularly during functional movements. Further technology should be developed to unobtrusively capture accurate all day 3-D kinematics.

The ability of limited exposure sampling to detect effects of interventions that reduce the occurrence of pronounced trunk inclination

Ergonomics interventions often focus on reducing exposure in those parts of the job having the highest exposure levels, while leaving other parts unattended. A successful intervention will thus change the form of the job exposure distribution. This disqualifies standard methods for assessing the ability of various exposure measurement strategies to correctly detect an intervention's effect on the overall job exposure of an individual worker, in particular for the safety or ergonomics practitioner who with limited resources can only collect a few measurements. This study used a non-parametric simulation procedure to evaluate the relationship between the number of measurements collected during a self-paced manufacturing job undergoing ergonomics interventions of varying effectiveness, and the probability of correctly determining whether and to which extent the interventions reduced the overall occurrence of pronounced trunk inclination, defined as an inclination of at least 20 degrees . Sixteen video-recordings taken at random times on multiple days for each of three workers were used to estimate the time distribution of each worker's exposure to pronounced trunk inclination. Nine hypothetical ergonomics intervention scenarios were simulated, in which the occurrence of pronounced trunk inclination in the upper 1/8, 1/4, and 1/2 of the job exposure distribution was reduced by 10%, 30% and 50%. Ten exposure measurement strategies were explored, collecting from one to ten pre- and post-intervention exposure samples from an individual worker. For each worker, intervention scenario and sampling strategy, data were bootstrapped from the measured (pre-intervention) and simulated (post-intervention) exposure distributions to generate empirical distributions of the estimated intervention effect. Results showed that for the one to three intervention scenarios that had the greatest effect on the overall occurrence of trunk inclination in the job, one to four pre- and post-intervention measurements, depending on worker, were sufficient to reach an 80% probability of detecting that the intervention did, indeed, have an effect. However, even for the intervention scenario that had the greatest effect on job exposure, seven or more samples were needed for two of the three workers to obtain a probability larger than 50% of estimating the magnitude of the intervention effect to within +/-50% of its true size. For almost all interventions affecting 1/8 or 1/4 of the job, limited exposure sampling led to low probabilities of detecting any intervention effect, let alone its correct size.

Obesity effect on perceived postural stress during static posture maintenance tasks

Postural stresses related to manual work tasks may be significantly affected by the bodily condition of workers. One such condition is obesity, which is characterised by excess fat mass in the body. This study empirically examined the obesity effect on postural stress during static posture maintenance tasks. In total, 20 obese and 20 non-obese participants performed static box-holding for a set of 84 working postures defined based on the Ovako Working Posture Analysing System. The participants reported postural stresses using the rated perceived exertion scale. Obesity was found to significantly increase postural stress across the 84 working postures and, also, amplify the effects of postural changes on postural stress. The study findings suggest that ergonomic workplace/job design for obese workers would be a challenge requiring a proactive approach and creativity in problem solving. In addition, the use of ergonomic knowledge in design would be more critical when targeting obese than non-obese workers. The study findings are relevant to ergonomic workplace/job design for obese workers.

Optimal inertial sensor location for ambulatory measurement of trunk inclination

Trunk inclination (TI) is used often to quantify back loading in ergonomic workplace evaluation. The aim of the present study was to determine whether TI can be obtained using a single inertial sensor (IS) on the back, and to determine the optimal IS location on the back for the estimation of TI. Gold standard TI, the angle between the vertical and the line connecting the L5/S1 joint and the trunk centre of mass, was measured using an optoelectronic system. Ten subjects performed experimental trials, each consisting of a symmetric and an asymmetric lifting task, and of a left-right lateral flexion movement. Trials were repeated and, in between trials, the IS was shifted in small steps from a location on the thorax towards a location on the sacrum. Optimal IS location was defined as the IS location with minimum root-mean-square (RMS) error between the gold standard TI and the IS TI. Averaged over subjects, the optimal IS location for symmetric and asymmetric lifting was at about 25% of the distance from the midpoint between the posterior superior iliac spines (MPSIS) to the C7 spinous process. The RMS error at this location, averaged over subjects, was 4.6+/-2.9 degrees. For the left-right lateral flexion task, the optimal IS location was at about 30% of the MPSIS to C7 distance. Because in most activities of daily living, pure lateral flexion does not occur often, it is recommended place the IS at 25% of the distance from the MPSIS to C7.

Validity of self-reported mechanical demands for occupational epidemiologic research of musculoskeletal disorders

OBJECTIVES

To describe the relation of the measured validity of self-reported mechanical demands (self-reports) with the quality of validity assessments and the variability of the assessed exposure in the study population.

METHODS

We searched for original articles, published between 1990 and 2008, reporting the validity of self-reports in three major databases: EBSCOhost, Web of Science and PubMed. Identified assessments were classified by methodological characteristics (eg, type of self-report and reference method) and exposure dimension was measured. We also classified assessments by the degree of comparability between the self-report and the employed reference method, and the variability of the assessed exposure in the study population. Finally, we examined the association of the published validity (r) with this degree of comparability, as well as with the variability of the exposure variable in the study population.

RESULTS

Of the 490 assessments identified, 75% used observation-based reference measures and 55% tested self-reports of posture duration and movement frequency. Frequently, validity studies did not report demographic information (eg, education, age, and gender distribution). Among assessments reporting correlations as measure of validity, studies with a better match between the self-report and the reference method, and studies conducted in more heterogeneous populations tended to report higher correlations [odds ratio (OR) 2.03, 95% confidence interval (95% CI) 0.89-4.65 and OR 1.60, 95% CI 0.96-2.61, respectively].

CONCLUSIONS

The reported data support the hypothesis that validity depends on study-specific factors often not examined. Experimentally manipulating the testing setting could lead to a better understanding of the capabilities and limitations of self-reported information.

Potentially problematic postures during work site keyboard use

OBJECTIVE

We described the frequency and distribution of keyboard users' potentially risky postural behaviors.

METHOD

Forty-three participants' keyboard postural behaviors were rated with the Keyboard-Personal Computer Style instrument (Baker & Redfern, 2005). The frequency and distribution of keyboard postural behaviors and the associations and differences between the right and left sides were assessed.

RESULTS

Generally, each static posture had one criterion that occurred frequently, whereas dynamic postures were distributed throughout the criteria. The right and left sides were significantly associated for shoulder flexion, elbow flexion, hand displacement, wrist extension, forearm rotation, isolated fifth digit, metacarpophalangeal hyperextension, and wrist support use and significantly different for hand displacement, isolated thumb, number of digits, and metacarpophalangeal hyperextension.

CONCLUSION

Potentially problematic postural behaviors are common among keyboard users. Our results suggest that occupational therapists must systematically assess postures on both the right and the left sides to develop the most effective intervention strategies.

Predictors of severe trunk postures among short-haul truck drivers during non-driving tasks: an exploratory investigation involving video-assessment and driver behavioural self-monitoring

Short-haul truck (lorry) drivers are particularly vulnerable to back pain and injury due to exposure to whole body vibration, prolonged sitting and demanding material handling tasks. The current project reports the results of video-based assessments (711 stops) and driver behavioural self-monitoring (BSM) (385 stops) of injury hazards during non-driving work. Participants (n = 3) worked in a trailer fitted with a camera system during baseline and BSM phases. Descriptive analyses showed that challenging customer environments and non-standard ingress/egress were prevalent. Statistical modelling of video-assessment results showed that each instance of manual material handling increased the predicted mean for severe trunk postures by 7%, while customer use of a forklift, moving standard pallets and moving non-standard pallets decreased predicted means by 12%, 20% and 22% respectively. Video and BSM comparisons showed that drivers were accurate at self-monitoring frequent environmental conditions, but less accurate at monitoring trunk postures and rare work events. The current study identified four predictors of severe trunk postures that can be modified to reduce risk of injury among truck drivers and showed that workers can produce reliable self-assessment data with BSM methods for frequent and easily discriminated events environmental.

Reliability of assessing upper limb postures among workers performing manufacturing tasks

The purpose of this study was to determine the inter- and intra-rater reliability of assessing upper limb postures of workers performing manufacturing tasks. Assessment of neck, shoulder, and wrist postures of 20 manufacturing employees was conducted by two raters observing digital video files using Multimedia Video Task Analysis (MVTA). Generalizability theory was used to estimate the inter- and intra-rater reliability. The results demonstrated good to excellent inter-rater reliability for neck and shoulder postures and fair to excellent inter-rater reliability for wrist postures. Intra-rater posture assessment demonstrated good to excellent reliability for both raters in all postures of the neck, shoulder, and wrist. This study demonstrated that posture assessment of manufacturing workers using MVTA is a reliable method.

Self-administered questionnaire and direct observation by checklist: comparing two methods for physical exposure surveillance in a highly repetitive tasks plant

BACKGROUND

We evaluated the agreement between a questionnaire and an observational checklist for exposure assessment in the setting of an upper-limb work-related musculoskeletal disorders (UWMSD) surveillance program in a population with a high level of physical exposures.

METHODS

A surveillance program was implemented in a large shoe factory. Physical exposures were assessed in 1996 by a self-administered questionnaire and by the direct observation of work tasks assessed using a checklist filled out by trained assessors. Items were summed into a "questionnaire" score and an "observational" score. These scores were compared by Pearson's correlation. The association between exposure assessment by each method and UWMSD incidence between 1996 and 1997, defined by a standardized examination, was also studied.

RESULTS

Correlation between the "questionnaire" score and the "observational" score was low among the 196 workers (77%) who received both evaluations (rho=0.06, p>0.05). Only exposure assessed by the questionnaire method was significantly associated with high incidence of UWMSD between 1996 and 1997, with good sensitivity (97%) and poor specificity (27%).

CONCLUSION

In this surveillance program, self-reported physical exposures assessed by questionnaire and by direct observation did not evaluate same dimensions of high physical exposures. In this sample, exposures assessed by questionnaire identified workers at high risk of incident UWMSD more precisely than exposures identified by direct observation.

Rater reliability and concurrent validity of the Keyboard Personal Computer Style instrument (K-PeCS)

This paper describes the inter-rater and intra-rater reliability, and the concurrent validity of an observational instrument, the Keyboard Personal Computer Style instrument (K-PeCS), which assesses stereotypical postures and movements associated with computer keyboard use. Three trained raters independently rated the video clips of 45 computer keyboard users to ascertain inter-rater reliability, and then re-rated a sub-sample of 15 video clips to ascertain intra-rater reliability. Concurrent validity was assessed by comparing the ratings obtained using the K-PeCS to scores developed from a 3D motion analysis system. The overall K-PeCS had excellent reliability [inter-rater: intra-class correlation coefficients (ICC)=.90; intra-rater: ICC=.92]. Most individual items on the K-PeCS had from good to excellent reliability, although six items fell below ICC=.75. Those K-PeCS items that were assessed for concurrent validity compared favorably to the motion analysis data for all but two items. These results suggest that most items on the K-PeCS can be used to reliably document computer keyboarding style.

Quantifying relationships between selected work-related risk factors and back pain: a systematic review of objective biomechanical measures and cost-related health outcomes

The objective of this investigation was to use published literature to demonstrate that specific changes in workplace biomechanical exposure levels can predict reductions in back injuries. A systematic literature review was conducted to identify epidemiologic studies which could be used to quantify relationships between several well-recognized biomechanical measures of back stress and economically relevant outcome measures. Eighteen publications, describing 15 research studies, which fulfilled search criteria were found. Quantitative associations were observed between back injuries and measures of spinal compression, lifting, lifting ratios, postures, and combinations thereof. Results were intended to provide safety practitioners with information that could be applied to their own work situations to estimate costs and benefits of ergonomic intervention strategies before they are implemented.

Wearable monitoring of seated spinal posture

This work describes the evaluation of a wearable plastic optical fiber (POF) sensor for monitoring seated spinal posture, as compared to a conventional expert visual analysis, and the development of a field-deployable posture monitoring system. A garment-integrated POF sensor was developed and tested on nine healthy subjects. Data from the wearable sensor were compared to data taken simultaneously from a marker-based motion capture system, for accuracy and reliability. Peak analysis of the resulting data showed a mean time error of 0.53 plusmn 0.8 s, and a mean value error of 0.64 plusmn 3.1 deg, which represents 14.5% of the average range of motion. Expert determination of transitional (good to bad) posture showed a variation of 20.9% of range of motion. These results indicate that the wearable sensor approximates the accuracy of expert visual analysis, and provides sufficient accuracy of measurement to reliably monitor seated spinal posture.

Discriminating between individuals with and without musculoskeletal disorders of the upper extremity by means of items related to computer keyboard use

INTRODUCTION

Identifying postures and behaviors during keyboard use that can discriminate between individuals with and without musculoskeletal disorders of the upper extremity (MSD-UE) is important for developing intervention strategies. This study explores the ability of models built from items of the Keyboard-Personal Computer Style instrument (K-PeCS) to discriminate between subjects who have MSD-UE and those who do not.

METHODS

Forty-two subjects, 21 with diagnosed MSD-UE (cases) and 21 without MSD-UE (controls), were videotaped while using their keyboards at their onsite computer workstations. These video clips were rated using the K-PeCS. The K-PeCS items were used to generate models to discriminate between cases and controls using Classification and Regression Tree (CART) methods.

RESULTS

Two CART models were generated; one that could accurately discriminate between cases and controls when the cases had any diagnosis of MSD-UE (69% accuracy) and one that could accurately discriminate between cases and controls when the cases had neck-related MSD-UE (93% accuracy). Both models had the same single item, "neck flexion angle greater than 20 degrees ". In both models, subjects who did not have a neck flexion angle of greater than 20 degrees were accurately identified as controls.

CONCLUSIONS

The K-PeCS item "neck flexion greater than 20 degrees " can discriminate between subjects with and without MSD-UE. Further research with a larger sample is needed to develop models that have greater accuracy.

The development of the Quick Exposure Check (QEC) for assessing exposure to risk factors for work-related musculoskeletal disorders

This paper describes the development and evaluation of the Quick Exposure Check (QEC), which is an observational tool developed for Occupational Safety and Health (OSH) practitioners to assess exposure to risks for work-related musculoskeletal disorders and provide a basis for ergonomic interventions. The tool is based on epidemiological evidence and investigations of OSH practitioners' aptitudes for undertaking assessments. It has been tested, modified and validated using simulated and workplace tasks, in two phases of development, with participation of 206 practitioners. The QEC allows the four main body areas to be assessed and involves practitioners and workers in the assessment. Trials have determined its usability, intra- and inter-observer reliability, and validity which show it is applicable to a wide range of working activities. The tool focuses primarily on physical workplace factors, but also includes the evaluation of psychosocial factors. Tasks can normally be assessed within 10min. It has a scoring system, and exposure levels have been proposed to guide priorities for intervention. Subsequently it should be used to evaluate the effectiveness of any interventions made. The QEC can contribute to a holistic assessment of all the elements of a work system.

Evaluation of a hybrid system for three-dimensional measurement of trunk posture in motion

Ambulatory assessment of trunk posture is important in improving our understanding of the risk of low back injury. Recently, small inertial sensors combining accelerometers, gyroscopes and magnetometers were developed and appear to be promising for measuring human movement. However, the validity of such sensors for assessing three-dimensional (3D) trunk posture in motion has not been documented. The purpose of this study was to evaluate a hybrid system (HS) composed of two inertial sensors for the 3D measurement of trunk posture. A secondary purpose was to explore the utility of adding another source of information, a potentiometer, to measure the relative rotation between both sensors in order to improve the validity of the system. The first sensor was placed over the sacrum and the second on the upper part of the thorax. Both sensors were linked by a flexible rod with a potentiometer. A complementary quaternion filter algorithm was used to estimate trunk orientation by taking advantage of the nine components of each sensor and the potentiometer. The HS's orientations were compared to those obtained from a 3D optoelectronic system. Validation of the HS was performed in three steps in which six subjects had to perform manual handling tasks in: (1) static postures; (2) dynamic motions of short duration (30s); and (3) dynamic motions of long duration (30min). The results showed that the root mean square (RMS) error of the HS was generally below 3 degrees for the flexion and lateral bending axes, and less than 6 degrees for the torsion axis, and that this error was lower for the short-duration tests compared to the long-duration one. The potentiometer proved to be an essential addition, particularly when the magnetometer signals were corrupted and only the gyroscope and accelerometer could be combined. It is concluded that the HS can be a useful tool for quantifying 3D trunk posture in motion.

Measuring low back injury risk factors in challenging work environments: an evaluation of cost and feasibility

BACKGROUND

Measuring low back injury risk factors in field research presents challenges not encountered in laboratory environments.

METHODS

We compared the practical application of five measurement methods (observations, interviews, electromyography (EMG), inclinometry, and vibration monitoring) for 223 worker days in 50 heavy-industry worksites in western Canada. Data collection successes, challenges, costs, and data detail were documented for each method.

RESULTS

Measurement success rates varied from 42.2% (seatpan accelerometer) to 99.6% (post-shift interview) of worker days assessed. Missed days for direct monitoring equipment were primarily due to explosive environments, workplace conditions likely to damage the equipment, and malfunctions. Costs per successful measurement day were lowest for interviews (approximately 23 dollars), about 10-fold higher for observations and inclinometry, and more than 20-fold higher for EMG and vibration monitoring.

CONCLUSIONS

Costs and successful field performance need to be weighed against the added data detail gained from monitoring equipment when making choices about exposure assessment techniques for epidemiological studies.

Measurements of wrist and finger postures: a comparison of goniometric and motion capture techniques

A marker-based kinematic hand model to quantify finger postures was developed and compared to manual goniometric measurements. The model was implemented with data collected from static postures of five subjects. The metacarpal phalangeal (MCP) and proximal interphalangeal (PIP) joints were positioned in flexion of approximately 30, 60, and 90 degrees for 5 subjects. Wrist flexion/extension and ulnar/radial deviations were also examined. The model-based angles for the MCP and PIP joints were not statistically equivalent to the goniometric measurements, with differences of -1.8 degrees and +3.5 degrees, respectively. Differences between the two measurement methods for the MCP and PIP were found to be a function of the posture (i.e., 150, 120, or 90 degree blocks) used. Wrist measurements differed by -4.0 degrees for ulnar/radial deviation and +5.2 degrees for flexion/extension. Much of the difference between the model and goniometric measurements is believed due to inaccuracies in the goniometric measurements. The proposed model is useful for future investigations of finger-intensive activities by supplying accurate and unbiased measures of joint angles.

Work postures and neck-shoulder pain among orchestra musicians

BACKGROUND

The purpose of the present study was to identify associations between a work posture with elevated arm position, duration of active playing time, and neck-shoulder pain among orchestra musicians.

METHODS

In this study, with a cross-sectional study design, a total of 235 subjects from 12 Swedish orchestras were categorized into four exposure groups according to arm position and duration of active playing time. Logistic regression analysis was used to calculate odds ratios (OR) for neck-shoulder pain in the four exposure groups.

RESULTS

A higher prevalence of neck-shoulder pain were found in the groups "elevated arm position, <2 hr per workday" [OR 4.15 (1.30-13.22)], and "elevated arm position, >3 hr per workday" [OR 5.35 (1.96-14.62)] compared to the group "neutral arm position, <2 hr per workday".

CONCLUSIONS

Musicians working in an elevated arm position (e.g., violinists, violists, flutists, and trumpet players) had a higher prevalence of neck-shoulder pain than those working in a more neutral position.

Assessing the physical loading of wearable computers

Wearable computers enable workers to interact with computer equipment in situations where previously they were unable. Attaching a computer to the body though has an unknown physical effect. This paper reports a methodology for addressing this, by assessing postural effects and the effect of added weight. Using the example of arm-mounted computers (AMCs), the paper shows that adopting a posture to interact with an AMC generates fatiguing levels of stress and a load of 0.54 kg results in increased level of stress and increased rate of fatigue. The paper shows that, due to poor postures adopted when wearing and interacting with computers and the weight of the device attached to the body, one possible outcome for prolonged exposure is the development of musculoskeletal disorders.

An evaluation of the predictive power of component vector angles for seated spinal posture monitoring

This work is part of a larger project developing wearable posture monitors for the work environment. We seek to evaluate the predictive power of individual spinal segment vector angles, towards the selection of the optimum angles for posture monitoring. A marker-based optoelectronic motion capture system was used to monitor seated posture for 9 healthy subjects during a range of motion flexion-extension exercise. Machine learning techniques were used to evaluate the prediction accuracy of the component vector angles recorded, and the range of motion for each vector angle was calculated for each subject. The overall flexion vector angle, which encompasses the entire spinal length between the C7 and L4 vertebrae, was determined to be the best predictor angle, due to its predictive accuracy and simplicity, and its relatively larger range of motion in all subjects.