Ergonomic design and training for preventing work-related musculoskeletal disorders of the upper limb and neck in adults

Effects of computer use on upper limb musculoskeletal disorders and function in academicians

Objectives. This study aimed to investigate the effects of academician's demographic characteristics and computer usage habits on upper limb musculoskeletal disorders (MSDs) and function. Methods. A cross-sectional observational study was conducted with 100 academicians. Data were collected using questionnaires, which included the patient-rated wrist evaluation questionnaire - Turkish version (PRWE-T), the Cornell musculoskeletal discomfort questionnaire - Turkish version (CMDQ-T), the upper extremity functional index - Turkish version (UEFI-T), demographic characteristics and average daily computer usage time. Results. A low-level significant correlation was found between the age of the individuals and the CMDQ-T forearm (p = 0.044; r = 0.202) and CMDQ-T wrist (p = 0.001; r = 0.337) scores. Women had higher CMDQ-T neck scores and lower UEFI-T scores than men (p < 0.05). Academicians who used computers for 6 h a day or more had higher PRWE-T and CMDQ-T neck, shoulder, upper arm and forearm scores, and had a lower UEFI-T score (p < 0.05). Conclusion. Neck, shoulder, upper arm and forearm symptoms were higher and upper extremity function was impaired in academicians who used computers for 6 h a day or more. Besides, gender and age were associated with upper limb MSDs and function, but occupation duration did not affect those outcomes in academicians.

Physical symptoms among professional gamers within eSports, a survey study

BACKGROUND

There is a need to establish the prevalence of self-reported physical symptoms such as pain in professional gamers (PGs) and to analyse whether there are correlations between lifestyle factors and self-reported physical symptoms. The purpose of this study was to analyse the prevalence of self-reported physical symptoms including eye-related problems in PGs. A further aim was to analyse the association between physical symptoms and lifestyle factors such as sleep time, play time and physical activity.

METHODS

This study was designed as a cross-sectional study with data based on an electronic survey, created specifically for this study, through discussion and screening of established validated questionnaires for physical symptoms in musculoskeletal conditions: the Karolinska Sleep Questionnaire and the Nordic Musculoskeletal Questionnaire. The survey comprised age and years of experience as a PG as descriptive variables, as well as questions on sleep, play time, physical activity and physical symptoms for the purpose of analysis. The directors of 10 professional gaming corporations were contacted by email with a link to the study-specific survey to distribute to all employees.

RESULTS

A total of 40 answers to the electronic survey were retrieved from 40 PGs, of which 62.5% (n = 25) had experienced at least one physical symptom in the three months prior to answering the survey. There was a significant association between playing time and physical symptoms (OR = 8.0; 95% CI 1.4-44.6, p = 0.018), where playing for more than 35 h a week was positively associated with eight times higher odds of experiencing physical symptoms.

CONCLUSION

There is a high prevalence of physical symptoms, such as headache and eye symptoms, in professional eSports gamers. There was an association between playing more than 35 h per week with the prevalence of physical symptoms.

Prevalence and risk factors of work-related musculoskeletal disorders among cashiers in small-scale businesses: a cross-sectional study in Ethiopia

OBJECTIVE

This study aimed to investigate the prevalence and factors associated with work-related musculoskeletal disorders among cashiers in small-scale businesses in Northwestern Ethiopia.

DESIGN

A multicentre cross-sectional study was conducted from July to September 2022. The data were collected using a validated and standardised Nordic Musculoskeletal Questionnaire. The collected data were entered into EpiData V.4.6 and analysed using Stata V.14. A multivariable logistic regression analysis was used to ascertain the significance of associations at p<0.05 and the adjusted OR (AOR) with a 95% CI.

SETTING

The study was conducted in small-scale businesses in the North Gondar Zone.

PARTICIPANTS

A total of 618 cashiers participated in this study.

OUTCOME MEASURES

The primary outcome of the study is the prevalence of work-related musculoskeletal disorders, which was measured using the Nordic Musculoskeletal Questionnaire.

RESULTS

The response rate was 97.5% (N=618). The majority (373; 60.4%) of the study participants were female. The mean (±SD) age of the participants was 30 (±8.3) years. The prevalence of work-related musculoskeletal disorders during the last 12 months was found to be 75.4% (n=466) (95% CI 71.8%, 78.8%). Marital status (married) (AOR=2.12; 95% CI 1.26, 3.56), lack of physical exercise (AOR=2.07; 95% CI 1.32, 3.23), alcohol consumption (AOR=3.55; 95% CI 2.18, 5.78) and awkward work posture (AOR=2.40; 95% CI 1.43, 4.0) were significant factors associated with work-related musculoskeletal disorders among sampled cashiers.

CONCLUSION

This study concluded that the overall prevalence of work-related musculoskeletal disorders was high among cashiers in small-scale businesses. Being married, a lack of physical exercise, alcohol consumption and awkward work posture were significant factors of work-related musculoskeletal disorders. To reduce work-related musculoskeletal disorders, it is recommended taking part in physical activity, avoiding alcohol consumption and avoiding awkward work posture.

Pinch Grip per SE Is Not an Occupational Risk Factor for the Musculoskeletal System: An Experimental Study on Field

Introduction: Some ergonomic evaluation methods define pinch grip as a risk factor independent of the exerted force. The present experimental study was performed with the main aim of objectively measuring the muscle engagement during the execution of pinch grip. Methods: the participants of the study were healthy workers occupationally involved in a high-intensity repetitive job related to the sorting of letters and small packages. Surface electromyography (sEMG) was used to study the activity of the abductor pollicis brevis and first dorsal interosseous fibers related to the execution of the required working tasks, while the force exerted during voluntary muscle contraction for pinch grip was measured by a portable acquisition system. The subjects were specifically asked to exert the maximum voluntary isometric contraction (MVIC) and further voluntary isometric contractions with a spontaneous force (SF) equal to 10%,20% and 50% of the MVIC; finally, the workers were asked to hold in pinch grip two types of envelopes, weighing 100 g and 500 g, respectively. Results: The force required to pinch 100 and 500 g envelopes by the fifteen subjects of the study corresponded to 4 and 5% MVIC, respectively. The corresponding sEMG average rectified values (ARV) were approximately 6% of that at MVIC for first dorsal interosseus (FDI) fibers and approximately 20–25% of MVIC for abductor pollicis brevis (ABP) fibers. Bivariate correlation analysis showed significant relationships between force at MVIC and FDI ARV at MCV. Conclusions: The obtained results demonstrate that muscle recruitment during pinch grip varies as a function of the SF: not only the position but also the exerted force should be considered when assessing the pinch grip as risk factor for biomechanical overload of the upper limb.

Effectiveness of training program in manual material handling: A health promotion approach

BACKGROUND

Even in an era of automation and digitalization, Manual Material Handling (MMH) can be called the most common industrial task. The aim of this study was to evaluate the prevalence of musculoskeletal disorders (MSDs) induced by manual handling tasks on the workers of a printing factory in Tehran in 2017 and then to evaluate the effectiveness of a training intervention based on health promotion.

MATERIALS AND METHODS

This study had quasi experimental design and was conducted on 40 men. First, demographic data were collected and the Nordic questionnaire was used to determine the prevalence of MSDs in workers. Then, MMH tasks were assessed using Manual Handling Assessment Chart (MAC). A short training course was designed to promote health. Finally, the same MMH tasks were re-evaluated 3 months after the training intervention.

RESULTS

Among the various tasks, the highest prevalence of work-related MSDs (WMSDs) was observed in the lower back (77.5%) and shoulder (62.5%). Based on the final scores of the MAC method, the jobs that received the highest scores were cutting (individual lifting), with 22 scores and action level "immediately necessary," cutting (individual load carrying), with 15 scores with action level "urgently needed." Arranging the forms (individual lifting) received a similar score. After the training intervention, the estimated risk level reduced by 12, 9, and 6 points, respectively, reaching a safe action level, i.e., "necessary in the future."

CONCLUSION

The results demonstrated that educational interventions might be equally effective in low-technology work environments. More in general, the MAC method can be used to make informed planning of educational interventions against WMSDs risk in MSDs. This health promotion approach is critical for care of human recourse.

Telework benefits and associated health problems during the long COVID-19 era

BACKGROUND

Teleworking became a necessary practice as an alternative to office work during the long COVID-19 era.

OBJECTIVES

To recognize the telework associated benefits and health problems and to assess the relationship between some teleworkers' characteristics, their health problems with job satisfaction and recuperation for promoting telework practices.

METHODS

A cross-sectional online survey was conducted among employees working remotely in different work sectors using a questionnaire assessing job satisfaction and recuperation.

RESULTS

Telework benefits included saving time and money (89.3%), minimizing the COVID-19 spread (86.9%), and balancing of work and life (63.4%). Telework associated health problems included musculoskeletal (78.2%), work-related stress (65.9%), and visual problems (47%). Telework job satisfaction was significantly higher among married male workers, working less than 40hs/week, and with previous remote working experience before COVID-19. On the other hand, married female teleworkers working more than 40hs/week and without previous remote working experience before COVID-19 had significantly more perceived fatigue and less recuperation. All teleworkers with reported health problems showed significantly more perceived fatigue and less recuperation.

CONCLUSIONS

More than half of the participants recommended continuing teleworking post-COVID-19 due to its benefits on their working and social life. Telework would enables the employers to adapt and satisfy the teleworkers' expectations to maintain their work and productivity.

COVİD-19 PANDEMİSİ SÜRESİNCE UZAKTAN EĞİTİM GÖREN ÜNİVERSİTE ÖĞRENCİLERİNİN YAŞADIĞI BOYUN VE ÜST EKSTREMİTE AĞRILARI VE DİZABİLİTE

Objective: Musculoskeletal system problems emerged in students who had to attend classes with a computer or smartphone during the weekly course hours, due to the fact that the universities providing face-to-face education switched to the online method of distance education due to the Covid-19 pandemic. Purpose of the study; To determine the severity of the pain experienced by the students, to reveal its relationship with disability, and to find the factors that induce pain and disability in daily life. Method: 100 students between the ages of 18-25, who attended distance education for at least 2 academic semesters and met the study criteria were included in the study. After the Sociodemographic Data Questionnaire was applied to the students included in the study, the Arm, Shoulder and Hand Problems Quick Questionnaire (Q-DASH), Neck Disability Index and NRS tests were applied. Results: As a result of the Quick Questionnaire for Arm, Shoulder and Hand Problems (Q-DASH), 43% of the students included in the study had moderate disability, and according to the Neck Disability Index, 37% of the study group had complete disability. According to multivariate regression analysis, gender (p

[The influence of occupational activity on diseases of the musculoskeletal system of the upper extremity]

Einleitung

Erkrankungen des Bewegungsapparates der oberen Extremität sind Grund für zunehmende krankheitsbedingte Fehlzeiten bei Erwerbspersonen.

Zielsetzung

Ziel dieser Studie ist es, den Einfluss der Berufsabhängigkeit auf die Entstehung von Erkrankungen des Bewegungsapparates der oberen Extremität zu untersuchen und neben berufsspezifischen Faktoren, gesundheitsbezogene Risiken darzustellen.

Material und Methoden

Es wurden 1070 Patienten eingeschlossen, bei denen zwischen 2016 und 2019 bei einer Läsion der Rotatorenmanschette (RM) eine operative RM-Rekonstruktion durchgeführt wurde. Die relevanten Daten wurden retrospektiv aus dem Krankenhausinformationssystem dokumentiert. Die Berufszweige der Patienten wurden nach der Klassifikation der Berufe 2010 (KldB 2010) eingeteilt und mit routinemäßig erfassten und anonymisierten, frei verfügbaren Daten (Statistisches Bundesamt, Bundesagentur für Arbeit) verglichen.

Ergebnisse

Von den 1070 Patienten waren 844 Patienten im arbeitsfähigen Alter. Die Altersstruktur der einzelnen Bereiche zeigten keine signifikanten Unterschiede. Anhand der Vergleiche der Patientendaten mit der Bevölkerung ergaben sich signifikant höhere RM-Erkrankungsraten in den Bereichen Land‑, Forst- und Tierwirtschaft sowie Gartenbau (p = 0,003); Bau, Architektur, Vermessung und Gebäudetechnik (p < 0,001); Verkehr, Logistik, Schutz und Sicherheit (p < 0,001) und Unternehmensorganisation, Buchhaltung, Recht und Verwaltung (p < 0,001). Ein signifikant reduziertes Risiko bestand in Naturwissenshaft, Geografie und Informatik (p = 0,015); kaufmännische Dienstleistungen, Warenhandel, Vertrieb, Hotel und Tourismus (p < 0,001); Gesundheit, Soziales, Lehre und Erziehung (p < 0,001).

Schlussfolgerung

Die Prävalenz von RM-Läsionen zeigt einen statistischen Zusammenhang zur ausgeführten Berufstätigkeit in Abhängigkeit von den Berufszweigen. Neben der Berufsabhängigkeit spielen geschlechtsspezifische Arbeitsfaktoren eine Rolle. Schulterschmerzen bei Erwerbstätigkeiten sollten differenzierter betrachtet werden. Dadurch sollen gezielt Präventivmaßnahmen eingeleitet werden können, um vorzubeugen.

Self-Reported Work-Related Musculoskeletal Disorders and Associated Factors among Restaurant Workers in Gondar City, Northwest Ethiopia, 2020

Introduction

Globally, work-related musculoskeletal disorders (WMSDs) have resulted in occupational disability and injury. Of these, restaurant workers are among the high-risk professionals usually affected by WMSDs. In Ethiopia, evidence on the burden of musculoskeletal disorder and contributing factors among restaurant workers were very limited. Therefore, this study was aimed at assessing the prevalence of self-reported WMSDs and contributing factors among restaurant workers in Gondar city, northwest Ethiopia, 2020.

Methods

An institutional-based cross-sectional study was conducted from February 2020 to March 2020 among restaurant workers in Gondar city. A two-stage sampling technique was used to choose 633 study subjects. A structured Nordic questioner was used to collect the data. Data was entered into EpiData version 3.1 and exported to Stata version 14.0 for analysis. Both bivariable and multivariable logistic regression analyses were computed. An adjusted odds ratio with a 95% confidence interval was used to measure the association between WMSDs and independent variables. In the multivariable analysis, a P value of <0.05 was used to declare a statistically significant association. To check the goodness of fit, the Hosmer and Lemeshow test was used.

Results

The prevalence of WMSDs among restaurant workers in the past 12 months was 81.5% [95% CI (78.18-84.44)]. Attending primary education [AOR: 2.14, 95% CI (1.17-3.90)], attending secondary education [AOR: 1.71 (1.02-2.86)], and job satisfaction [AOR: 1.90, 95%CI (1.13-3.19)] were significantly associated with WMSDs.

Conclusion

In this study, the prevalence of WMSDs among restaurant workers was high. The upper back, lower back, elbow, and wrist were the most affected body parts. Age above 30 years, educational status being primary and secondary, and being dissatisfied by their job were positively associated with a high prevalence of WMSDs.

Insufficient Rest Breaks at Workplace and Musculoskeletal Disorders Among Korean Kitchen Workers

Background

The socioeconomic burden of musculoskeletal disorders (MSDs) is significant, and kitchen work is a high-risk occupation for MSDs due to the intensive manual workload and repetitive movements that are involved. However, there are very few studies on MSDs and rest breaks as a workplace intervention among kitchen workers. This study examined the relationship between insufficient rest breaks and increased MSD risk among Korean kitchen workers.

Methods

Sociodemographic and occupational factors of 1,909 kitchen workers were collected from the 3rd–4th Korean Working Conditions Survey data. Five items on rest breaks at work were categorized into two groups, “sufficient” and “insufficient.” The number of MSDs and work-related MSDs (WMSDs), an outcome variable, was obtained from the sum of MSDs/WMSDs in three anatomical sites (back, neck, and upper limb, lower limb). The association between rest breaks and MSDs was estimated using zero-inflated negative binomial analyses, with adjustments for age, education level, and weekly working hours, and the analyses were stratified by sex.

Results

After adjustment, significant associations were found between insufficient rest breaks and an increased risk of MSDs (odds ratio [OR] 1.68 95% confidence interval [CI] 1.11–2.54) and WMSDs (OR 1.40 95% CI 1.01–1.96) among female kitchen workers. Insufficient rest breaks were significantly associated with MSDs in female kitchen workers in all three anatomical sites.

Conclusion

This study emphasizes the need for rest breaks as a workplace intervention for preventing MSDs in kitchen workers. Further studies to reveal the causality of this relationship are required.

Headache and musculoskeletal pain in school children are associated with uncorrected vision problems and need for glasses: a case-control study

Musculoskeletal pain and headache are leading causes of years lived with disability, and an escalating problem in school children. Children spend increasingly more time reading and using digital screens, and increased near tasks intensify the workload on the precise coordination of the visual and head-stabilizing systems. Even minor vision problems can provoke headache and neck- and shoulder (pericranial) pain. This study investigated the association between headaches, pericranial tenderness, vision problems, and the need for glasses in children. An eye and physical examination was performed in twenty 10–15 year old children presenting to the school health nurse with headache and pericranial pain (pain group), and twenty age-and-gender matched classmates (control group). The results showed that twice as many children in the pain group had uncorrected vision and needed glasses. Most children were hyperopic, and glasses were recommended mainly for near work. Headache and pericranial tenderness were significantly correlated to reduced binocular vision, reduced distance vision, and the need for new glasses. That uncorrected vision problems are related to upper body musculoskeletal symptoms and headache, indicate that all children with these symptoms should have a full eye examination to promote health and academic performance.

A cluster-randomized trial of workplace ergonomics and neck-specific exercise versus ergonomics and health promotion for office workers to manage neck pain - a secondary outcome analysis

Background

Neck pain is prevalent among office workers. This study evaluated the impact of an ergonomic and exercise training (EET) intervention and an ergonomic and health promotion (EHP) intervention on neck pain intensity among the All Workers and a subgroup of Neck Pain cases at baseline.

Methods

A 12-month cluster-randomized trial was conducted in 14 public and private organisations. Office workers aged ≥18 years working ≥30 h per week (n = 740) received an individualised workstation ergonomic intervention, followed by 1:1 allocation to the EET group (neck-specific exercise training), or the EHP group (health promotion) for 12 weeks. Neck pain intensity (scale: 0–9) was recorded at baseline, 12 weeks, and 12 months. Participants with data at these three time points were included for analysis (n = 367). Intervention group differences were analysed using generalized estimating equation models on an intention-to-treat basis and adjusted for potential confounders. Subgroup analysis was performed on neck cases reporting pain ≥3 at baseline (n = 96).

Results

The EET group demonstrated significantly greater reductions in neck pain intensity at 12 weeks compared to the EHP group for All Workers (EET: β = − 0.53 points 95% CI: − 0.84– − 0.22 [36%] and EHP: β = − 0.17 points 95% CI: − 0.47–0.13 [10.5%], p-value = 0.02) and the Neck Cases (EET: β = − 2.32 points 95% CI: − 3.09– − 1.56 [53%] and EHP: β = − 1.75 points 95% CI: − 2.35– − 1.16 [36%], p = 0.04). Reductions in pain intensity were not maintained at 12 months with no between-group differences observed in All Workers (EET: β = − 0.18, 95% CI: − 0.53–0.16 and EHP: β = − 0.14 points 95% CI: − 0.49–0.21, p = 0.53) or Neck Cases, although in both groups an overall reduction was found (EET: β = − 1.61 points 95% CI: − 2.36– − 0.89 and EHP: β = − 1.9 points 95% CI: − 2.59– − 1.20, p = 0.26).

Conclusion

EET was more effective than EHP in reducing neck pain intensity in All Workers and Neck Cases immediately following the intervention period (12 weeks) but not at 12 months, with changes at 12 weeks reaching clinically meaningful thresholds for the Neck Cases. Findings suggest the need for continuation of exercise to maintain benefits in the longer term.

Clinical trial registration

hACTRN12612001154897 Date of Registration: 31/10/2012.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12891-021-03945-y.

Work-Related Musculoskeletal Disorders and Associated Factors Among Bankers in Ethiopia, 2018

Background

Work-related musculoskeletal disorders (WMSDs) are an important public health problem in working environments. WMSDs are the major causes of disability and cause individual suffering and financial burdens to the individual, families, industry or employer, healthcare system, and society at large. This study aims to assess the prevalence and associated factors of work-related musculoskeletal disorders among bankers working in Mekelle city, Tigray, Ethiopia, 2018. This study is based on an institutional-based cross-sectional study design, where 328 bankers are selected randomly from bankers working in Mekelle city from February to June 2018. Data were entered, organized, and analyzed by SPSS version 23. A final logistic model was run to identify factors associated with WMSDs, and the magnitude and direction of association were decided based on the adjusted odds ratio (AOR) and its corresponding 95% confidence interval (95% CI).

Result

Out of 307 bankers, the annual prevalence rate of WMSDs was 65.5% (201). Significant predictors were being 30–39 years old [AOR = 5.552; 95% CI = 1.465–21.039] and above 40 years old [AOR = 5.719; 95% CI = 1.422–22.994], low educational level [AOR = 4.256; 95% CI = 1.139–15.895], working > 5 years [AOR = 3.892; 95% CI = 1.841–8.231], not doing physical exercises [AOR = 2.866; 95% CI = 1.303–6.304], stress [AOR = 4.723; 95% CI = 2.421–9.213], poor posture [AOR = 2.692; 95% CI = 1.339–5.411], breaks [AOR = 5.170; 95% CI = 2.070–12.912], and ergonomics [AOR = 3.801; 95% CI = 1.260–11.472].

Conclusion

The prevalence of WMSDs among bankers was high. The significant associated factors responsible for the occurrence of work-related musculoskeletal disorders include longer working experience, being above 30 years old, low educational status, physical exercise, job stress, poor posture, absence of breaks during working hours, and absence of ergonomic training.

On-site multi-component intervention to improve productivity and reduce the economic and personal burden of neck pain in Swiss office-workers (NEXpro): protocol for a cluster-randomized controlled trial

Background

Non-specific neck pain and headache are major economic and individual burden in office-workers. The aim of this study is to investigate the effect of a multi-component intervention combining workstation ergonomics, health promotion information group workshops, neck exercises, and an app to enhance intervention adherence to assess possible reductions in the economic and individual burden of prevalent and incident neck pain and headache in office workers.

Methods/design

This study is a stepped wedge cluster-randomized controlled trial. Eligible participants will be any office-worker aged 18–65 years from two Swiss organisations in the Cantons of Zurich and Aargau, working more than 25 h a week in predominantly sedentary office work and without serious health conditions of the neck. One hundred twenty voluntary participants will be assigned to 15 clusters which, at randomly selected time steps, switch from the control to the intervention group. The intervention will last 12 weeks and comprises workstation ergonomics, health promotion information group workshops, neck exercises and an adherence app. The primary outcome will be health-related productivity losses (presenteeism, absenteeism) using the Work Productivity and Activity Impairment Questionnaire. Secondary outcomes are neck disability and pain (measured by the Neck Disability Index, and muscle strength and endurance measures), headache (measured by the short-form headache impact test), psychosocial outcomes (e.g. job-stress index, Fear-Avoidance Beliefs Questionnaire), workplace outcomes (e.g. workstation ergonomics), adherence to intervention, and additional measures (e.g. care-seeking). Measurements will take place at baseline, 4 months, 8 months, and 12 months after commencement. Data will be analysed on an intention to treat basis and per protocol. Primary and secondary outcomes will be examined using linear mixed-effects models.

Discussion

To the authors’ knowledge, this study is the first that investigates the impact of a multi-component intervention combining current evidence of effective interventions with an adherence app to assess the potential benefits on productivity, prevalent and incident neck pain, and headache. The outcomes will impact the individual, their workplace, as well as private and public policy by offering evidence for treatment and prevention of neck pain and headache in office-workers.

Trial registration

ClinicalTrials.gov, NCT04169646. Registered 15 November 2019 - Retrospectively registered.

Effects of Using Immersive Media on the Effectiveness of Training to Prevent Ergonomics Risks

In this work, the effects of using immersive media such as virtual reality on the performance of training programs to avoid ergonomics risks are analyzed. The advance of technology has made it possible to use low-cost portable devices able to generate highly immersive experiences in training programs. The effects of using this kind of device in training programs have been studied in several fields such as industrial security, medicine and surgery, rehabilitation, or construction. However, there is very little research on the effects of using immersive media in training workers to avoid ergonomics risk factors. In this study, we compare the effects of using traditional and immersive media in a training program to avoid three common ergonomics risk factors in industrial environments. Our results showed that using immersive media increases the participant’s engagement during the training. In the same way, the learning contents are perceived as more interesting and useful and are better remembered over time, leading to an increased perception of the ergonomics risks among workers. However, we found that little training was finally transferred to the workplace three months after the training session.

The Ipswich Microbreak Technique to alleviate neck and shoulder discomfort during microscopic procedures

Neck and shoulder disorders are a considerable health problem amongst frequent microscope users. We aimed to investigate the neck and shoulder discomfort experienced during prolonged microscopic activity and to assess the benefits of minibreaks. A prospective crossover study was performed on 17 healthy volunteers sitting still while looking down a bench with and without the Ipswich Microbreak Technique (IMT). We used a subjective measure of time to fatigue and pain in the neck and shoulder regions as well as objective readings from a surface electromyogram (sEMG). The IMT delayed the sensation of pain in the neck and shoulder region while reducing the overall sEMG muscle activation. In conclusion, IMT is a useful strategy in reducing and delaying the pain in neck and shoulder from prolonged working under the microscope. This technique can be incorporated in other activities that involve a sustained stationary position.

Estimation of absolute states of human skeletal muscle via standard B-mode ultrasound imaging and deep convolutional neural networks

The objective is to test automated in vivo estimation of active and passive skeletal muscle states using ultrasonic imaging. Current technology (electromyography, dynamometry, shear wave imaging) provides no general, non-invasive method for online estimation of skeletal muscle states. Ultrasound (US) allows non-invasive imaging of muscle, yet current computational approaches have never achieved simultaneous extraction or generalization of independently varying active and passive states. We use deep learning to investigate the generalizable content of two-dimensional (2D) US muscle images. US data synchronized with electromyography of the calf muscles, with measures of joint moment/angle, were recorded from 32 healthy participants (seven female; ages: 27.5, 19–65). We extracted a region of interest of medial gastrocnemius and soleus using our prior developed accurate segmentation algorithm. From the segmented images, a deep convolutional neural network was trained to predict three absolute, drift-free components of the neurobiomechanical state (activity, joint angle, joint moment) during experimentally designed, simultaneous independent variation of passive (joint angle) and active (electromyography) inputs. For all 32 held-out participants (16-fold cross-validation) the ankle joint angle, electromyography and joint moment were estimated to accuracy 55 ± 8%, 57 ± 11% and 46 ± 9%, respectively. With 2D US imaging, deep neural networks can encode, in generalizable form, the activity–length–tension state relationship of these muscles. Observation-only, low-power 2D US imaging can provide a new category of technology for non-invasive estimation of neural output, length and tension in skeletal muscle. This proof of principle has value for personalized muscle assessment in pain, injury, neurological conditions, neuropathies, myopathies and ageing.

Evidence-based occupational health and safety interventions: a comprehensive overview of reviews

OBJECTIVES

Occupational injuries and diseases are a huge public health problem and cause extensive suffering and loss of productivity. Nevertheless, many occupational health and safety (OHS) guidelines are still not based on the best available evidence. In the last decade, numerous systematic reviews on behavioural, relational and mixed interventions to reduce occupational injuries and diseases have been carried out, but a comprehensive synopsis is yet missing. The aim of this overview of reviews is to provide a comprehensive basis to inform evidence-based decision-making about interventions in the field of OHS.

METHODS

We conducted an overview of reviews. We searched MEDLINE (Ovid), the Cochrane Library (Wiley), epistemonikos.org and Scopus (Elsevier) for relevant systematic reviews published between January 2008 and June 2018. Two authors independently screened abstracts and full-text publications and determined the risk of bias of the included systematic reviews with the ROBIS (Risk of Bias in Systematic Reviews) tool.

RESULTS

We screened 2287 abstracts and 200 full-texts for eligibility. Finally, we included 25 systematic reviews with a low risk of bias for data synthesis and analysis. We identified systematic reviews on the prevention of occupational injuries, musculoskeletal, skin and lung diseases, occupational hearing impairment and interventions without specific target diseases. Several interventions led to consistently positive results on individual diseases; other interventions did not show any effects, or the studies are contradictory. We provide detailed results on all included interventions.

DISCUSSION

To our knowledge, this is the first comprehensive overview of behavioural, relational and mixed interventions and their effectiveness in preventing occupational injuries and diseases. It provides policymakers with an important basis for making evidence-based decisions on interventions in this field.

PROSPERO REGISTRATION NUMBER

CRD42018100341.

Reducing shoulder complaints in employees with high occupational shoulder exposures: study protocol for a cluster-randomised controlled study (The Shoulder-Café Study)

Background

In Denmark, exercise therapy in combination with work modification is the first-choice treatment for persons with shoulder complaints and high occupational shoulder exposures. To obtain this treatment they must visit several healthcare providers, which makes usual care fragmented and uncoordinated. Therefore, we developed a new intervention which unifies the expertise that is needed. The main hypotheses are that a group-based Shoulder-Café intervention will more effectively reduce (1) shoulder complaints and (2) occupational shoulder exposures than an individual-based Shoulder-Guidance intervention (active control – enhanced usual care).

Methods

A cluster-randomised trial is conducted including 120 employees with high occupational shoulder exposures. Companies (clusters) are randomised to either Shoulder-Café or Shoulder-Guidance with a 1:1 allocation ratio. Participants are 18–65 years old and have an Oxford Shoulder Score (OSS) ≤ 40. Both interventions include a home-based shoulder-exercise programme, assessment of shoulder exposures by technical measurements and self-report, and general information on how to reduce shoulder exposures. The Shoulder-Café course also includes three café meetings with physiotherapist-supervised exercises, clinical shoulder evaluation, education on shoulder anatomy, workplace-orientated counselling, and an opportunity for a workplace visit by a health and safety consultant. The primary outcomes are the OSS at 6-month follow-up (hypothesis I), and the mean number of min/day with the arm elevated > 60° shortly after the end of the intervention (hypothesis II). We will use a mixed-model analysis that allows for company clustering, and data will be analysed according to the intention-to-treat principle.

Discussion

Persons with shoulder complaints and high occupational shoulder exposures are an obvious target group for secondary prevention efforts. We developed the Shoulder-Café to reduce shoulder complaints and shoulder exposures while unifying the expertise that is needed to evaluate and treat shoulder complaints. If the intervention is effective, it would warrant widespread implementation.

Trial registration

Clinicaltrials.gov, ID: NCT03159910. Registered on 18 May 2017

WHO/ILO work-related burden of disease and injury: Protocol for systematic reviews of exposure to occupational ergonomic risk factors and of the effect of exposure to occupational ergonomic risk factors on osteoarthritis of hip or knee and selected other musculoskeletal diseases

BACKGROUND

The World Health Organization (WHO) and the International Labour Organization (ILO) are developing a joint methodology for estimating the national and global work-related burden of disease and injury (WHO/ILO joint methodology), with contributions from a large network of experts. In this paper, we present the protocol for two systematic reviews of parameters for estimating the number of disability-adjusted life years from osteoarthritis of hip or knee, and selected other musculoskeletal diseases respectively, attributable to exposure to occupational ergonomic risk factors to inform the development of the WHO/ILO joint methodology.

OBJECTIVES

We aim to systematically review studies on exposure to occupational ergonomic risk factors (Systematic Review 1) and systematically review and meta-analyze estimates of the effect of exposure to occupational ergonomic risk factors on osteoarthritis of the hip or knee, and selected other musculoskeletal diseases respectively (Systematic Review 2), applying the Navigation Guide systematic review methodology as an organizing framework, conducting both systematic reviews in tandem and in a harmonized way.

DATA SOURCES

Separately for Systematic Reviews 1 and 2, we will search electronic academic databases for potentially relevant records from published and unpublished studies, including Medline, EMBASE, Web of Science and CISDOC. We will also search electronic grey literature databases, Internet search engines and organizational websites; hand-search reference lists of previous systematic reviews and included study records; and consult additional experts.

STUDY ELIGIBILITY AND CRITERIA

We will include working-age (≥15 years) workers in the formal and informal economy in any WHO and/or ILO Member State, but exclude children (<15 years) and unpaid domestic workers. The included occupational ergonomic risk factors will be any exposure to one or more of: force exertion; demanding posture; repetitiveness; hand-arm vibration; lifting; kneeling and/or squatting; and climbing. Included outcomes will be (i) osteoarthritis and (ii) other musculoskeletal diseases (i.e., one or more of: rotator cuff syndrome; bicipital tendinitis; calcific tendinitis; shoulder impingement; bursitis shoulder; epicondylitis medialis; epicondylitis lateralis; bursitis elbow; bursitis hip; chondromalacia patellae; meniscus disorders; and/or bursitis knee). For Systematic Review 1, we will include quantitative prevalence studies of any exposure to occupational ergonomic risk factors stratified by country, gender, age and industrial sector or occupation. For Systematic Review 2, we will include randomized controlled trials, cohort studies, case-control-studies and other non-randomized intervention studies with an estimate of the relative effect of any exposure with occupational ergonomic risk factors on the prevalence or incidence of osteoarthritis and/or selected musculoskeletal diseases, compared with the theoretical minimum risk exposure level (i.e., no exposure).

STUDY APPRAISAL AND SYNTHESIS METHODS

At least two review authors will independently screen titles and abstracts against the eligibility criteria at a first stage and full texts of potentially eligible records at a second stage, followed by extraction of data from qualifying studies. At least two review authors will assess risk of bias and the quality of evidence, using the most suited tools currently available. For Systematic Review 2, if feasible, we will combine relative risks using meta-analysis. We will report results using the guidelines for accurate and transparent health estimates reporting (GATHER) for Systematic Review 1 and the preferred reporting items for systematic reviews and meta-analyses guidelines (PRISMA) for Systematic Review 2. PROSPERO registration number: CRD42018102631.

Ergonomic interventions for preventing work-related musculoskeletal disorders of the upper limb and neck among office workers

BACKGROUND

Work-related upper limb and neck musculoskeletal disorders (MSDs) are one of the most common occupational disorders worldwide. Studies have shown that the percentage of office workers that suffer from MSDs ranges from 20 to 60 per cent. The direct and indirect costs of work-related upper limb MSDs have been reported to be high in Europe, Australia, and the United States. Although ergonomic interventions are likely to reduce the risk of office workers developing work-related upper limb and neck MSDs, the evidence is unclear. This is an update of a Cochrane Review which was last published in 2012.

OBJECTIVES

To assess the effects of physical, cognitive and organisational ergonomic interventions, or combinations of those interventions for the prevention of work-related upper limb and neck MSDs among office workers.

SEARCH METHODS

We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, CINAHL, Web of Science (Science Citation Index), SPORTDiscus, Embase, the US Centers for Disease Control and Prevention, the National Institute for Occupational Safety and Health database, and the World Health Organization's International Clinical Trials Registry Platform, to 10 October 2018.

SELECTION CRITERIA

We included randomised controlled trials (RCTs) of ergonomic interventions for preventing work-related upper limb or neck MSDs (or both) among office workers. We only included studies where the baseline prevalence of MSDs of the upper limb or neck, or both, was less than 25%.

DATA COLLECTION AND ANALYSIS

Two review authors independently extracted data and assessed risk of bias. We included studies with relevant data that we judged to be sufficiently homogeneous regarding the interventions and outcomes in the meta-analysis. We assessed the overall quality of the evidence for each comparison using the GRADE approach.

MAIN RESULTS

We included 15 RCTs (2165 workers). We judged one study to have a low risk of bias and the remaining 14 studies to have a high risk of bias due to small numbers of participants and the potential for selection bias.Physical ergonomic interventionsThere is inconsistent evidence for arm supports and alternative computer mouse designs. There is moderate-quality evidence that an arm support with an alternative computer mouse (two studies) reduced the incidence of neck or shoulder MSDs (risk ratio (RR) 0.52; 95% confidence interval (CI) 0.27 to 0.99), but not the incidence of right upper limb MSDs (RR 0.73; 95% CI 0.32 to 1.66); and low-quality evidence that this intervention reduced neck or shoulder discomfort (standardised mean difference (SMD) -0.41; 95% CI -0.69 to -0.12) and right upper limb discomfort (SMD -0.34; 95% CI -0.63 to -0.06).There is moderate-quality evidence that the incidence of neck or shoulder and right upper limb disorders were not considerably reduced when comparing an alternative computer mouse and a conventional mouse (two studies; neck or shoulder: RR 0.62; 95% CI 0.19 to 2.00; right upper limb: RR 0.91; 95% CI 0.48 to 1.72), and also when comparing an arm support with a conventional mouse and a conventional mouse alone (two studies) (neck or shoulder: RR 0.91; 95% CI 0.12 to 6.98; right upper limb: RR 1.07; 95% CI 0.58 to 1.96).Workstation adjustment (one study) and sit-stand desks (one study) did not have an effect on upper limb pain or discomfort, compared to no intervention.Organisational ergonomic interventionsThere is very low-quality evidence that supplementary breaks (two studies) reduce discomfort of the neck (MD -0.25; 95% CI -0.40 to -0.11), right shoulder or upper arm (MD -0.33; 95% CI -0.46 to -0.19), and right forearm or wrist or hand (MD -0.18; 95% CI -0.29 to -0.08) among data entry workers.Training in ergonomic interventionsThere is low to very low-quality evidence in five studies that participatory and active training interventions may or may not prevent work-related MSDs of the upper limb or neck or both.Multifaceted ergonomic interventionsFor multifaceted interventions there is one study (very low-quality evidence) that showed no effect on any of the six upper limb pain outcomes measured in that study.

AUTHORS' CONCLUSIONS

We found inconsistent evidence that the use of an arm support or an alternative mouse may or may not reduce the incidence of neck or shoulder MSDs. For other physical ergonomic interventions there is no evidence of an effect. For organisational interventions, in the form of supplementary breaks, there is very low-quality evidence of an effect on upper limb discomfort. For training and multifaceted interventions there is no evidence of an effect on upper limb pain or discomfort. Further high-quality studies are needed to determine the effectiveness of these interventions among office workers.

Physical and Mental Impact of Laparoscopic Sleeve Gastrectomy on the Surgeon: French vs. American Positions. A Randomized and Controlled Study

PURPOSE

To determine the physical and mental impact on the primary surgeon, by the patient's and surgical staff's dispositions at the operating table, during laparoscopic vertical sleeve gastrectomy.

MATERIALS AND METHODS

This is a randomized and controlled study that included 18 laparoscopic sleeve gastrectomy procedures performed by two surgeons in a private and academic hospital. The cases were randomized for the American or French position. After surgery, the National Aeronautics and Space Administration - Task Load Index (NASA-TLX) and the Body Part Discomfort (BPD) scales were applied to the primary surgeon.

RESULTS

An increased workload and more discomfort were reported when using the French position. The NASA-TLX was 28 ± 8 vs. 57 ± 18 (p = 0.001), and the BPD was 2 vs. 8 (p = 0.001).

CONCLUSIONS

The American position resulted in a lower physical and mental impact on the surgeon when performing a laparoscopic sleeve gastrectomy.

What is the effect of prolonged sitting and physical activity on thoracic spine mobility? An observational study of young adults in a UK university setting

OBJECTIVE

Sedentary behaviour has long been associated with neck and low back pain, although relatively little is known about the thoracic spine. Contributing around 33% of functional neck movement, understanding the effect of sedentary behaviour and physical activity on thoracic spinal mobility may guide clinical practice and inform research of novel interventions.

DESIGN

An assessor-blinded prospective observational study designed and reported in accordance with Strengthening the Reporting of Observational Studies in Epidemiology.

SETTING

UK university (June-September 2016).

PARTICIPANTS

A convenience sample (18-30 years) was recruited and based on self-report behaviours, the participants were assigned to one of three groups: group 1, sitters-sitting >7 hours/day+physical activity<150 min/week; group 2, physically active-moderate exercise >150 min/week+sitting <4 hours/day and group 3, low activity-sitting 2-7 hours/day+physical activity <150 min/week.

OUTCOME MEASURES

Thoracic spine mobility was assessed in the heel-sit position using Acumar digital goniometer; a validated measure. Descriptive and inferential analyses included analysis of variance and analysis of covariance for between group differences and Spearman's rank correlation for post hoc analysis of associations.

RESULTS

The sample (n=92) comprised: sitters n=30, physically active n=32 and low activity n=30. Groups were comparable with respect to age and body mass index.Thoracic spine mobility (mean (SD)) was: group 1 sitters 64.75 (1.20), group 2 physically active 74.96 (1.18) and group 3 low activity 68.44 (1.22). Significant differences were detected between (1) sitters and low activity, (2) sitters and physically active (p<0.001). There was an overall effect size of 0.31. Correlations between thoracic rotation and exercise duration (r=0.67, p<0.001), sitting duration (r=-0.29, p<0.001) and days exercised (r=0.45, p<0.001) were observed.

CONCLUSIONS

Findings evidence reduced thoracic mobility in individuals who spend >7 hours/day sitting and <150 min/week of physical activity. Further research is required to explore possible causal relationships between activity behaviours and spinal musculoskeletal health.

Theoretical impact of simulated workplace-based primary prevention of carpal tunnel syndrome in a French region

BACKGROUND

Carpal tunnel syndrome (CTS) is the most common nerve entrapment neuropathy in the working-age population. The reduction of CTS incidence in the workforce is a priority for policy makers due to the human, social and economic costs. To assess the theoretical impact of workplace-based primary interventions designed to reduce exposure to personal and/or work-related risk factors for CTS.

METHODS

Surgical CTS were assessed using regional hospital discharge records for persons aged 20-59 in 2009. Using work-related attributable fractions (AFEs), we estimated the number of work-related CTS (WR-CTS) in high-risk jobs. We simulated three theoretical scenarios of workplace-based primary prevention for jobs at risk: a mono-component work-centered intervention reducing the incidence of WR-CTS arbitrarily by 10% (10%-WI), and multicomponent global interventions reducing the incidence of all surgical CTS by 5% and 10% by targeting personal and work risk factors.

RESULTS

A limited proportion of CTS were work-related in the region's population. WR-CTS were concentrated in nine jobs at high risk of CTS, amounting to 1603 [1137-2212] CTS, of which 906 [450-1522] were WR-CTS. The 10%-WI, 5%-GI and 10%-GI hypothetically prevented 90 [46-153], 81 [58-111] and 159 [114-223] CTS, respectively. The 10%-GI had the greatest impact regardless of the job. The impact of the 10%-WI interventions was high only in jobs at highest risk and AFEs (e.g. food industry jobs). The 10%-WI and 5%-GI had a similar impact for moderate-risk jobs (e.g. healthcare jobs).

CONCLUSION

The impact of simulated workplace-based interventions suggests that prevention efforts to reduce exposure to work-related risk factors should focus on high-risk jobs. Reducing CTS rates will also require integrated strategies to reduce personal risk factors, particularly in jobs with low levels of work-related risk of CTS.

Prominent exostosis projecting from the occipital squama more substantial and prevalent in young adult than older age groups

Recently we reported the development of prominent exostosis young adults' skulls (41%; 10-31 mm) emanating from the external occipital protuberance (EOP). These findings contrast existing reports that large enthesophytes are not seen in young adults. Here we show that a combination sex, the degree of forward head protraction (FHP) and age predicted the presence of enlarged EOP (EEOP) (n = 1200, age 18-86). While being a male and increased FHP had a positive effect on prominent exostosis, paradoxically, increase in age was linked to a decrease in enthesophyte size. Our latter findings provide a conundrum, as the frequency and severity of degenerative skeletal features in humans are associated typically with aging. Our findings and the literature provide evidence that mechanical load plays a vital role in the development and maintenance of the enthesis (insertion) and draws a direct link between aberrant loading of the enthesis and related pathologies. We hypothesize EEOP may be linked to sustained aberrant postures associated with the emergence and extensive use of hand-held contemporary technologies, such as smartphones and tablets. Our findings raise a concern about the future musculoskeletal health of the young adult population and reinforce the need for prevention intervention through posture improvement education.

Effectiveness of exercise in office workers with neck pain: A systematic review and meta-analysis

BACKGROUND

Non-specific neck pain is a common health problem of global concern for office workers. This systematic review ascertained the latest evidence for the effectiveness of therapeutic exercise versus no therapeutic exercise on reducing neck pain and improving quality of life (QoL) in office workers with non-specific neck pain.

METHOD

Seven electronic databases using keywords, that is, 'office workers', 'non-specific neck pain', 'exercise' and/or 'exercise therapy', 'QoL', 'strengthening', 'stretching', 'endurance', 'physiotherapy' and/or 'physical therapy', were searched from inception until March 2017. Heterogeneous data were reported in narrative format and comparable homogenous data were pooled using Revman.

RESULTS

Eight randomised control trials were reviewed and scored on average 6.63/10 on the Physiotherapy Evidence Database (PEDro) scale. Five studies performed strengthening exercise, one study had a strengthening and an endurance exercise group, one study performed stretching exercise and one study had an endurance intervention group and a stretching intervention group. Five and four studies reported significant improvement in neck pain and QoL, respectively, when conducting strengthening exercise. When performing endurance exercises, one and two studies reported significant changes in neck pain and QoL, respectively. The one study incorporating stretching exercise reported significant improvement in neck pain. The meta-analysis revealed that there is a clinically significant difference favouring strengthening exercise over no exercise in pain reduction but not for QoL.

CONCLUSION

There is level II evidence recommending that clinicians include strengthening exercise to improve neck pain and QoL. However, the effect of endurance and stretching exercise needs to be explored further.

Chiropractic curriculum mapping and congruence of the evidence for workplace interventions in work-related neck pain

OBJECTIVE

The purpose of this study was to provide a best-synthesis summary of the literature for effective workplace health promotion interventions (WHPI) for work-related mechanical neck pain (MNP) and to determine the congruence between knowledge of WHPI for work-related MNP and coverage of MNP in the chiropractic postgraduate program at Macquarie University.

METHODS

A literature review was undertaken to determine effective WHPI for work-related MNP. We searched Cochrane Library, PubMed, EMBASE, CINAHL, and PEDro (from 1991 to 2016) for systematic reviews and meta-analyses. The PRISMA (2009) 27-item checklist was used to critically appraise included articles. Lectures, tutorials, and assessment tasks within the chiropractic postgraduate program were mapped to the literature review findings and analyzed.

RESULTS

There was moderate-quality evidence for multidimensional WHPI, including aspects of mental and physical functioning, activity performance and modifications, and environmental modifications, to reduce MNP and disability in workers, particularly in the long term. Education on coverage of MNP and effective WHPI for MNP was inadequately covered although congruent with synthesis of current literature. Education on body functions and structures and personal factors were the most commonly covered components.

CONCLUSION

Multidimensional WHPI, focusing on physical, mental, and environmental modifications, appear to reduce self-reported MNP primarily in office workers. There is adequate congruence between the chiropractic postgraduate program at Macquarie University and the published literature on some WHPI. However, there is inadequate coverage on aspects of MNP and effective WHPI for MNP, particularly those focusing on activity and participation and environmental factors.

A long-term evaluation of the stage of change approach and compensable injury outcomes - a cluster-randomised trial

This study investigated the long-term injury outcomes for workers in companies from a range of industries which had been randomly allocated to receive ergonomics interventions tailored according to the stage of change (SOC) approach or standard ergonomics advice. Differences in compensable injury outcomes between the groups were analysed using logistic regression models. Questionnaire results from face-to-face interviews to assess musculoskeletal pain and discomfort (MSPD), job satisfaction and other factors were also analysed. Although not significant at the 0.05 level, after adjusting for workgroup clustering, workers in receipt of tailored advice were 55% (OR = 0.45, 95% CI = 0.19-1.08) less likely to report a compensable injury than those in receipt of standard ergonomics advice. Workload, job satisfaction and MSPD were significantly correlated with injury outcomes. The observed outcomes support the potential value of the SOC approach, as well as highlighting the need to consider workload, job satisfaction and MSPD when planning injury prevention programmes. Practitioner Summary: This study investigated compensable injury outcomes for workers who had received ergonomics advice tailored according to the stage of change (SOC) approach compared with standard ergonomics advice. The results support the potential value of the SOC approach and highlight the need to consider workload, job satisfaction and musculoskeletal pain and discomfort when planning injury prevention interventions.

Real-Time Ultrasound Segmentation, Analysis and Visualisation of Deep Cervical Muscle Structure

Despite widespread availability of ultrasound and a need for personalised muscle diagnosis (neck/back pain-injury, work related disorder, myopathies, neuropathies), robust, online segmentation of muscles within complex groups remains unsolved by existing methods. For example, Cervical Dystonia (CD) is a prevalent neurological condition causing painful spasticity in one or multiple muscles in the cervical muscle system. Clinicians currently have no method for targeting/monitoring treatment of deep muscles. Automated methods of muscle segmentation would enable clinicians to study, target, and monitor the deep cervical muscles via ultrasound. We have developed a method for segmenting five bilateral cervical muscles and the spine via ultrasound alone, in real-time. Magnetic Resonance Imaging (MRI) and ultrasound data were collected from 22 participants (age: 29.0±6.6, male: 12). To acquire ultrasound muscle segment labels, a novel multimodal registration method was developed, involving MRI image annotation, and shape registration to MRI-matched ultrasound images, via approximation of the tissue deformation. We then applied polynomial regression to transform our annotations and textures into a mean space, before using shape statistics to generate a texture-to-shape dictionary. For segmentation, test images were compared to dictionary textures giving an initial segmentation, and then we used a customized Active Shape Model to refine the fit. Using ultrasound alone, on unseen participants, our technique currently segments a single image in [Formula: see text] to over 86% accuracy (Jaccard index). We propose this approach is applicable generally to segment, extrapolate and visualise deep muscle structure, and analyse statistical features online.

A literature review of the effects of computer input device design on biomechanical loading and musculoskeletal outcomes during computer work

BACKGROUND

Extended use of conventional computer input devices is associated with negative musculoskeletal outcomes. While many alternative designs have been proposed, it is unclear whether these devices reduce biomechanical loading and musculoskeletal outcomes.

OBJECTIVE

To review studies describing and evaluating the biomechanical loading and musculoskeletal outcomes associated with conventional and alternative input devices.

METHODS

Included studies evaluated biomechanical loading and/or musculoskeletal outcomes of users' distal or proximal upper extremity regions associated with the operation of alternative input devices (pointing devices, mice, other devices) that could be used in a desktop personal computing environment during typical office work.

RESULTS

Some alternative pointing device designs (e.g. rollerbar) were consistently associated with decreased biomechanical loading while other designs had inconsistent results across studies. Most alternative keyboards evaluated in the literature reduce biomechanical loading and musculoskeletal outcomes. Studies of other input devices (e.g. touchscreen and gestural controls) were rare, however, those reported to date indicate that these devices are currently unsuitable as replacements for traditional devices.

CONCLUSIONS

Alternative input devices that reduce biomechanical loading may make better choices for preventing or alleviating musculoskeletal outcomes during computer use, however, it is unclear whether many existing designs are effective.

Evaluation of the efficacy of a short-course, personalized self-management and intensive spa therapy intervention as active prevention of musculoskeletal disorders of the upper extremities (Muska): a research protocol for a randomized controlled trial

Background

Musculoskeletal disorders (MSDs) constitute a major occupational health problem in the working population, substantially impacting the quality of life of employees. They also cause considerable economic cost to the healthcare system, with, notably, the reimbursement of treatments and compensation for lost income. MSDs manifest as localized pain or functional difficulty in one or more anatomical areas, such as the cervical spine, shoulder, elbow, hand, and wrist. Although prevalence varies depending on the region considered and the method of assessment, a prevalence of 30% is found in different epidemiological studies. The disease needs to be prevented, not only for medical and economic reasons, but also for legal reasons, owing to the requirement of assessing occupational risks. The strategy envisaged may thus revolve around active, multimodal prevention that has employees fully involved at the heart of their care. Although physical exercise is widely recommended, few studies with a good level of evidence have enabled us to base a complete, well-constructed intervention on exercise that can be offered as secondary prevention in these disorders.

Methods

A prospective, multicenter, comparative (intervention arm vs. control arm), randomized (immediate vs. later treatment) study using Zelen’s design. This study falls under active prevention of MSDs of the upper extremities (UE-MSDs). Participants are workers aged between 18 and 65 years with latent or symptomatic MSDS, with any type of job or workstation, with or without an history of sick leave. The primary aim is to show the superiority at 3 months of a combination of spa therapy, exercise, and self-management workshops for 6 days over usual care in the management of MSDs in terms of employee functional capacity in personal and professional daily life. Secondary aims are to assess the benefit of the intervention in terms of pain, quality of life, and accumulated duration of sick leave.

Discussion

This randomized controlled trial is the first that will aim to evaluate multidisciplinary management of UE-MSDs using nonpharmacological treatment combining exercise, self-management, and spa therapy. The originality of this intervention lies, in its short, intensive format, which is compatible with remaining in work; and in its multidisciplinary approach. This trial has the potential to demonstrate, with a good level of evidence, the benefits of a short course of spa therapy combined with a personalized self-management program on the functional capacity, pain, and quality of life of employees in their daily life.

Trial registration

Clinical trial.gov NCT02702466 retrospectively registered.

Protocol: Version 4 of 9/10/2015.

Electronic supplementary material

The online version of this article (doi:10.1186/s12891-016-1353-8) contains supplementary material, which is available to authorized users.

Inter-rater reliability of an observation-based ergonomics assessment checklist for office workers

OBJECTIVES

To establish the inter-rater reliability of an observation-based ergonomics assessment checklist for computer workers.

METHODS

A 37-item (38-item if a laptop was part of the workstation) comprehensive observational ergonomics assessment checklist comparable to government guidelines and up to date with empirical evidence was developed. Two trained practitioners assessed full-time office workers performing their usual computer-based work and evaluated the suitability of workstations used. Practitioners assessed each participant consecutively. The order of assessors was randomised, and the second assessor was blinded to the findings of the first. Unadjusted kappa coefficients between the raters were obtained for the overall checklist and subsections that were formed from question-items relevant to specific workstation equipment.

RESULTS

Twenty-seven office workers were recruited. The inter-rater reliability between two trained practitioners achieved moderate to good reliability for all except one checklist component.

CONCLUSIONS

This checklist has mostly moderate to good reliability between two trained practitioners. Practitioner Summary: This reliable ergonomics assessment checklist for computer workers was designed using accessible government guidelines and supplemented with up-to-date evidence. Employers in Queensland (Australia) can fulfil legislative requirements by using this reliable checklist to identify and subsequently address potential risk factors for work-related injury to provide a safe working environment.

Sex based subgroup differences in randomized controlled trials: empirical evidence from Cochrane meta-analyses

OBJECTIVE

 To evaluate the frequency, validity, and relevance of statistically significant (P<0.05) sex-treatment interactions in randomized controlled trials in Cochrane meta-analyses.

DESIGN

 Meta-epidemiological study.

DATA SOURCES

 Cochrane Database of Systematic Reviews (CDSR) and PubMed.

ELIGIBILITY CRITERIA FOR STUDY SELECTION

 Reviews published in the CDSR with sex-treatment subgroup analyses in the forest plots, using data from randomized controlled trials.

DATA EXTRACTION

 Information on the study design and sex subgroup data were extracted from reviews and forest plots that met inclusion criteria. For each statistically significant sex-treatment interaction, the potential for biological plausibility and clinical significance was considered.

RESULTS

 Among the 41 reviews with relevant data, there were 109 separate treatment-outcome analyses ("topics"). Among the 109 topics, eight (7%) had a statistically significant sex-treatment interaction. The 109 topics included 311 randomized controlled trials (162 with both sexes, 46 with males only, 103 with females only). Of the 162 individual randomized controlled trials that included both sexes, 15 (9%) had a statistically significant sex-treatment interaction. Of four topics where the first published randomized controlled trial had a statistically significant sex-treatment interaction, no meta-analyses that included other randomized controlled trials retained the statistical significance and no meta-analyses showed statistical significance when data from the first published randomized controlled trial were excluded. Of the eight statistically significant sex-treatment interactions from the overall analyses, only three were discussed by the CDSR reviewers for a potential impact on different clinical management for males compared with females. None of these topics had a sex-treatment interaction that influenced treatment recommendations in recent guidelines. UpToDate, an online physician-authored clinical decision support resource, suggested differential management of men and women for one of these sex-treatment interactions.

CONCLUSION

 Statistically significant sex-treatment interactions are only slightly more frequent than what would be expected by chance and there is little evidence of subsequent corroboration or clinical relevance of sex-treatment interactions.

The Prevalence of and Risk Factors Associated with Musculoskeletal Disorders among Sonographers in Central China: A Cross-Sectional Study

Objective

Studies from industrialized countries show that musculoskeletal disorders (MSD) occur commonly in sonographers. However, little is known about sonographers in China, where the awareness of ergonomics and MSD, workload, and available equipment/facilities may differ. We aimed to investigate the prevalence of MSD and associated risk factors in sonographers in central China.

Methods

A cross-sectional survey was conducted with 381 sonographers from 14 randomly selected tertiary hospitals in Hubei province, central China. Musculoskeletal symptoms (using the Nordic Questionnaire) and risk factors (mostly derived from the Health Benefit Trust survey instrument and the Dutch Musculoskeletal Questionnaire) were recorded. Multivariate logistic regression was used to quantify associations between risk factors and MSD.

Results

The 12-month period prevalence of MSD was 98.3%, being highest in the neck (93.5%) and shoulder (92.2%), followed by the lower back (83.2%), wrist/hand, upper back, and elbow. Factors contributing to neck pain were psychological fatigue, shoulder abduction and trunk bend-and-twist posture. Height-adjustable tables and chairs were protective factors. Shoulder pain was associated with female sex, health status, mental stress, shoulder abduction, and trunk bend-and-twist posture. Height-adjustable chairs and the awareness of adjusting the workstation before scanning were protective factors. Elbow pain was associated with health status and height-adjustable tables. Wrist/hand pain was associated with female sex, bending the wrist, and working with obese patients. Upper back pain was associated with shoulder abduction, height-adjustable chairs, and device location. Lower back pain was associated with the number of scans performed per day, awkward postures, bending the trunk, twisting or bending the neck forward, and using a footrest.

Conclusions

This study suggests a high prevalence of MSD in sonographers in central China. Hence, it is necessary to improve the awareness of MSD by training, and the ergonomics of their current work environment by addressing physical workload, and psychological and equipment/facility-related factors.

Upper trapezius muscle activity in healthy office workers: reliability and sensitivity of occupational exposure measures to differences in sex and hand dominance

Patterns of cervical muscle activity may contribute to overuse injuries in office workers. The purpose of this investigation was to characterise patterns of upper trapezius muscle activity in pain-free office workers using traditional occupational exposure measures and a modified Active Amplitude Probability Distribution Function (APDF), which considers only periods of active muscle contraction. Bilateral trapezius muscle activity was recorded in 77 pain-free office workers for 1-2 full days in their natural work environment. Mean amplitude, gap frequency, muscular rest and Traditional and Active APDF amplitudes were calculated. All measures demonstrated fair to substantial reliability. Dominant muscles demonstrated higher amplitudes of activity and less muscular rest compared to non-dominant, and women demonstrated less muscular rest with no significant difference in amplitude assessed by Active APDF compared to men. These findings provide normative data to identify atypical motor patterns that may contribute to persistence or recurrence of neck pain in office workers. Practitioner Summary: Upper trapezius muscle activity was characterised in a large cohort of pain-free workers using electromyographic recordings from office environments. Dominant muscles demonstrated higher activity and less rest than non-dominant, and women demonstrated less rest than men. Results may be used to identify atypical trapezius muscle activity in office workers.

Promoting a Shared Representation of Workers' Activities to Improve Integrated Prevention of Work-Related Musculoskeletal Disorders

Effective and sustainable prevention of work-related musculoskeletal disorders (WR-MSDs) remains a challenge for preventers and policy makers. Coordination of stakeholders involved in the prevention of WR-MSDs is a key factor that requires greater reflection on common knowledge and shared representation of workers' activities among stakeholders. Information on workers' strategies and operational leeway should be the core of common representations, because it places workers at the center of the "work situation system" considered by the intervention models. Participatory ergonomics permitting debates among stakeholders about workers' activity and strategies to cope with the work constraints in practice could help them to share representations of the "work situation system" and cooperate. Sharing representation therefore represents a useful tool for prevention, and preventers should provide sufficient space and time for dialogue and discussion of workers' activities among stakeholders during the conception, implementation, and management of integrated prevention programs.

The Effects of High-Frequency Transcutaneous Electrical Nerve Stimulation for Dental Professionals with Work-Related Musculoskeletal Disorders: A Single-Blind Randomized Placebo-Controlled Trial

Work-related musculoskeletal symptom disorders (WMSDs) have a significant issue for dental professionals. This study investigated the effects of high-frequency transcutaneous electrical nerve stimulation (TENS) on work-related pain, fatigue, and the active range of motion in dental professionals. Among recruited 47 dental professionals with WMSDs, 24 subjects received high-frequency TENS (the TENS group), while 23 subjects received placebo stimulation (the placebo group). TENS was applied to the muscle trigger points of the levator scapulae and upper trapezius, while placebo-TENS was administered without electrical stimulation during 60 min. Pain and fatigue at rest and during movement were assessed using the visual analog scale (VAS), pain pressure threshold (PPT), and active range of motion (AROM) of horizontal head rotation at six time points: prelabor, postlabor, post-TENS, and at 1 h, 3 h, and 1 day after TENS application. Both groups showed significantly increased pain and fatigue and decreased PPT and AROM after completing a work task. The TENS group showed significantly greater improvements in VAS score, fatigue, PPT, and AROM at post-TENS and at 1 h and 3 h after application (all P < 0.05) as compared to the placebo group. A single session high-frequency TENS may immediately reduce symptoms related to WMSDs in dental professionals.

Effectiveness of workplace interventions in the prevention of upper extremity musculoskeletal disorders and symptoms: an update of the evidence

The burden of disabling musculoskeletal pain and injuries (musculoskeletal disorders, MSDs) arising from work-related causes in many workplaces remains substantial. There is little consensus on the most appropriate interventions for MSDs. Our objective was to update a systematic review of workplace-based interventions for preventing and managing upper extremity MSD (UEMSD). We followed a systematic review process developed by the Institute for Work & Health and an adapted best evidence synthesis. 6 electronic databases were searched (January 2008 until April 2013 inclusive) yielding 9909 non-duplicate references. 26 high-quality and medium-quality studies relevant to our research question were combined with 35 from the original review to synthesise the evidence on 30 different intervention categories. There was strong evidence for one intervention category, resistance training, leading to the recommendation: Implementing a workplace-based resistance training exercise programme can help prevent and manage UEMSD and symptoms. The synthesis also revealed moderate evidence for stretching programmes, mouse use feedback and forearm supports in preventing UEMSD or symptoms. There was also moderate evidence for no benefit for EMG biofeedback, job stress management training, and office workstation adjustment for UEMSD and symptoms. Messages are proposed for both these and other intervention categories.

A review of the current state of digital plate reading of cultures in clinical microbiology

Digital plate reading (DPR) is increasingly being adopted as a means to facilitate the analysis and improve the quality and efficiency within the clinical microbiology laboratory. This review discusses the role of DPR in the context of total laboratory automation and explores some of the platforms currently available or in development for digital image capturing of microbial growth on media. The review focuses on the advantages and challenges of DPR. Peer-reviewed studies describing the utility and quality of these novel DPR systems are largely lacking, and professional guidelines for DPR implementation and quality management are needed. Further development and more widespread adoption of DPR is anticipated.

Assessing the effects of an educational program for the prevention of work-related musculoskeletal disorders among school teachers

BACKGROUND

Musculoskeletal disorders represent one of the most common and most costly occupational health problems in both developed and developing countries. The aim of this study was to assess the effect of occupational health education and ergonomic training on awareness, attitude and behavior of work-related musculoskeletal disorders among teachers.

METHODS

A self-controlled longitudinal study with pre/post design was used to evaluate the effects of intervention among school teachers from the 21st of June, 2010 to the 21st of August, 2011. Choosing a cluster random sampling method, 350 (70.0% response rate (350/500)) teachers from four schools were assigned to receive eight weeks of intervention (participatory ergonomic training and occupational health education). Evaluations focused on teachers who participated in both pre- and post-questionnaires. Two post-tests were then administered to the participants to identify changes at six and 12 months after intervention.

RESULTS

The follow-up rate was 93.7% (328/350) at six months after intervention, and 90.9% (319/350) at 12 months after intervention. After the intervention, the awareness rate, attitude and health behavior improved. The self-reported prevalence of work-related musculoskeletal disorders for neck, shoulder, upper and lower back pain, or discomfort were lower than before intervention (P < 0.05).

CONCLUSION

Interventions based on occupational health education lectures, on-site ergonomics training, publicity brochures and posters showed a positive effect on prevention and control of the occurrence of work-related musculoskeletal disorders in teachers. Improvement in awareness, behavior and attitude changes, and prevalence were found at both six and 12 months post-intervention, confirming that the effectiveness of the program can be sustained.