Biobehavioral Mechanisms of Work-Related Upper Extremity Disorders. Proceedings of a symposium. 6-7 November 2000, Washington, DC, USA

Identifying Barriers to Recovery from Work Related Upper Extremity Disorders: Use of a Collaborative Problem Solving Technique

Improving health and work outcomes for individuals with work related upper extremity disorders (WRUEDs) may require a broad assessment of potential return to work barriers by engaging workers in collaborative problem solving. In this study, half of all nurse case managers from a large workers’ compensation system were randomly selected and invited to participate in a randomized, controlled trial of an integrated case management (ICM) approach for WRUEDs. The focus of ICM was problem solving skills training and workplace accommodation. Volunteer nurses attended a 2 day ICM training workshop including instruction in a 6 step process to engage clients in problem solving to overcome barriers to recovery. A chart review of WRUED case management reports (n = 70) during the following 2 years was conducted to extract case managers’ reports of barriers to recovery and return to work. Case managers documented from 0 to 21 barriers per case (M = 6.24, SD = 4.02) within 5 domains: signs and symptoms (36%), work environment (27%), medical care (13%), functional limitations (12%), and coping (12%). Compared with case managers who did not receive the training (n = 67), workshop participants identified more barriers related to signs and symptoms, work environment, functional limitations, and coping (p < .05), but not to medical care. Problem solving skills training may help focus case management services on the most salient recovery factors affecting return to work.

Requirements for more effective prevention of work-related musculoskeletal disorders

BACKGROUND

Exposures to occupational hazards substantially increase workers' risk of developing musculoskeletal disorders (MSDs) and can exacerbate pre-existing disorders. The effects on MSD risk of the physical requirements of work performance are well recognised, but there is now ample evidence that work-related psychosocial hazards can also have substantial effects; further, some hazards may be additive or interactive. This evidence is not reflected in current workplace risk management practices.

DISCUSSION

Barriers to more effective workplace management of MSD risk include: the widespread belief that risk arises largely or entirely from physical hazard exposures; regulatory and guidance documents targeting MSDs, most of which reflect this belief; risk assessment tools that focus narrowly on subsets of mainly physical hazards and yet generate outputs in the form of MSD risk indicators; and the conventional occupational health and safety (OHS) risk management paradigm, which is ill-suited to manage MSD risk. It is argued that improved workplace management of MSD risk requires a systems-based management framework and more holistic risk assessment and control procedures that address risk from all types of hazard together rather than in isolation from each other, and that support participation by workers themselves. New MSD risk management tools are needed to meet these requirements. Further, successful implementation of such changes is likely to require some restructuring of workplace responsibilities for MSD risk management. Line managers and supervisors often play key roles in generating hazards, both physical and psychosocial, so there is a need for their more active participation, along with OHS personnel and workers themselves, in routine risk assessment and control procedures. MSDs are one of our largest OHS problems, but workplace risk management procedures do not reflect current evidence concerning their work-related causes. Inadequate attention is given to assessing and controlling risk from psychosocial hazards, and the conventional risk management paradigm focuses too narrowly on risk from individual hazards rather than promoting the more holistic approach needed to manage the combined effects of all relevant hazards. Achievement of such changes requires new MSD risk management tools and better integration of the roles of OHS personnel with those of line managers.

A study on the relationship between stress and fatigue and the musculoskeletal symptoms experienced by Korean radiation workers

[Purpose] The purpose of this study was to examine the relationship between factors such as stress and fatigue on musculoskeletal symptoms experienced by radiologists who were working in clinics and hospitals. [Subjects and Methods] A survey was conducted for radiologists in clinics, general hospitals, and university hospitals across the nation in a 20-day period from July 10-31, 2011. [Results] According to the comprehensive results of this study, job stress, psychosocial stress, and fatigue felt by radiologists had impacts on musculoskeletal disease in multiple body regions. First, according to the analysis results, job stress was scored at 2.48 on average on a 4-point Likert scale, while psychosocial stress was scored at 2.27 on average on the same scale, which demonstrated that job stress had a slightly higher score than psychosocial stress. Second, job stress, psychosocial stress, and fatigue had impacts on musculoskeletal symptoms experienced by radiologists; the possibility of musculoskeletal symptoms on the neck area increased as the physical environment got worse, interpersonal conflicts got serious, stress from organizational system increased, and psychosocial stress went up. [Conclusion] We expect that the results of this study would be useful as basic data for systematic and efficient management of resources when taking preventative measures against musculoskeletal disease experienced by radiologists in the future.

Psychosocial Risk Factors and Musculoskeletal Symptoms among White and Blue-collar Workers at Private and Public Sectors

OBJECTIVES

The aim of this study was to evaluate musculoskeletal and psychosocial perception and compare these conditions regarding the type of job (white or blue-collar) and the type of management model (private or public).

METHODS

Forty-seven public white-collar (PuWC), 84 private white-collar (PrWC) and 83 blue-collar workers (PrBC) were evaluated. Job Content Questionnaire (JCQ) and Utrecht Work Engagement Scale (UWES) were applied to evaluate psychosocial factors. Nordic Musculoskeletal Questionnaire (NMQ) was used to assess musculoskeletal symptoms. Pressure Pain Threshold (PPT) was measured to evaluate sensory responses.

RESULTS

According to JCQ, all groups were classified as active profile. There was a significant association between work engagement and workers' categories (p < 0.05). PrWC workers had the highest scores for all the UWES domains, while PrBC had the lowest ones. PPT showed that PrBC workers had an increased sensitivity for left deltoid (p < 0.01), and for both epicondyles (p < 0.01), when compared to the other groups. PrWC workers had an increased sensitivity for both epicondyles than PuWC (right p < 0.01; left, p = 0.05). There was no significant association in the report of symptoms across the groups (p > 0.05).

CONCLUSION

This study showed differences in psychosocial risk factors and musculoskeletal symptoms in workers engaged in different types of jobs and work organization. Personal and work-related characteristics, psychosocial factors and PPT responses were different across workers' group. Despite all, there was no significant difference in reported symptoms across the groups, possibly indicating that the physical load is similar among the sectors.

Psychosocial stress and multi-site musculoskeletal pain: a cross-sectional survey of patient care workers

The aim of this study was to assess the relationship between psychosocial factors at work and multi-site musculoskeletal pain among patient care workers. In a survey of 1,572 workers from two hospitals, occupational psychosocial factors and health outcomes of workers with single and multi-site pain were evaluated using items from the Job Content Questionnaire that was designed to measure psychological demands, decision latitude, and social support. An adapted Nordic Questionnaire provided data on the musculoskeletal pain outcome. Covariates included body mass index, age, gender, and occupation. The analyses revealed statistically significant associations between psychosocial demands and multi-site musculoskeletal pain among patient care associates, nurses, and administrative personnel, both men and women. Supervisor support played a significant role for nurses and women. These results remained statistically significant after adjusting for covariates. These results highlight the associations between workplace psychosocial strain and multi-site musculoskeletal pain, setting the stage for future longitudinal explorations.

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.

Workstyle: development of a measure of response to work in those with upper extremity pain

Workstyle or the behavioral, cognitive, and physiological response that can occur in some individuals to increases in work demands has been proposed to help explain the link between ergonomic and psychosocial factors in the exacerbation of work-related upper extremity symptoms. Currently, there is no measure of this construct, hindering research on its potential link to work related upper extremity problems in the workplace. The present study describes the development and psychometric properties of a measure of workstyle. Questionnaire items reflecting dimensions of workstyle as per the original conceptualization were generated primarily through focus groups with office workers and separate groups held with occupational physicians, physical therapists, occupational health psychologists, and experts in ergonomics, behavioral science, and human factors. Items created through this process were then administered to 282 symptomatic and asymptomatic office workers. Measures of job stress, ergonomic risk, upper extremity symptoms, and functional limitations were also obtained. The workstyle questionnaire was divided into two broad dimensions: Characteristic responses to work and Response to increased work demands. The scale development process as indicated by factor analysis yielded subscales that are theoretically consistent with the workstyle construct. These subscales include: working through pain, social reactivity at work, limited workplace support, deadlines/pressure, self imposed work pace/workload, breaks, mood, pain/tension, autonomic response, and numbness tingling. The internal consistency of these subscales varied from 0.61 to 0.91, n = 282 while the test-retest (3 weeks) reliability for the various subscales ranged from r = 0.68 to 0.89, n = 143. A total workstyle score was computed that excluded the pain/tension and numbness/tingling subscales to avoid circular reasoning in terms of the measure's relationship to outcomes of pain and functional limitations. The total score was stable over time and provided unique variance in relation to traditional measures of job stress. Total workstyle score was significantly associated with higher levels of pain, and greater functional limitations. Dimensions of the workstyle construct were identified. The workstyle measure possesses acceptable psychometric properties in office workers who work with computers. This measure can be used in future studies on the interaction of psychosocial and ergonomic factors in the exacerbation of upper extremity pain and functional limitation.

Workstyle and Upper-Extremity Symptoms: A Biobehavioral Perspective

OBJECTIVES

Workstyle has been proposed to help explain the link between ergonomic and psychosocial factors in work-related upper-extremity symptoms/disorders. This study investigated ergonomic factors, work demands, job stress, and workstyle on pain and functional limitations in computer users.

METHODS

One hundred sixty-nine participants completed self-report ratings of job stress, ergonomic exposures, and workstyle at baseline. Three months, later ratings of pain and functional limitations were obtained.

RESULTS

Multivariable logistic regression indicated that ergonomic exposure (odds ratio [OR] = 2.7, 95% confidence interval [CI] = 1.3-5.5), time spent at a computer (OR = 1.9, 95% CI = 0.95-3.6), and higher scores on a workstyle measure (2.4, 95% CI = 1.1-5.3) were independently associated with case status. Path analyses revealed that a model that included ergonomic exposure, work demands, and workstyle predicted pain and functional limitations at 3 months.

CONCLUSIONS

Workstyle contributes to case definition and is predictive of future pain and functional limitations in office workers with upper extremity symptoms.

Preliminary evaluation of the generalized work distress scale in patients with work-related upper extremity disorders

This study evaluated the reliability and construct validity of the Generalized Work Distress Scale in 207 patients attending a specialty clinic with work-related upper extremity disorders. Factor analyses were conducted and compared to the original developmental study confirming a two-factor solution: an internal factor related to Work-Related Dysphoria and an external factor related to Work-Related Support. Reliability (internal consistency) of factors was high (Cronbach's alpha = 0.87 and 0.89). The Work-Related Dysphoria factor was more related to self-reported global depressed mood and self-reported upper extremity functional disability, than was Work-Related Support. This study provided preliminary support for the use of this scale in patients with work-related upper extremity disorders and consideration to depressive symptoms in these patients. Further investigation of the psychometric properties of this scale and its predictive validity are required.

Study of the effectiveness of a participatory ergonomics intervention in reducing worker pain severity through physical exposure pathways

A participatory ergonomics programme was implemented in an automotive parts manufacturing factory. An ergonomics change team was formed composed of members from management and the organized labour union. It was hypothesized that the physical change projects implemented as part of this process would result in decreased worker exposures to peak and cumulative physical demands and reduced worker perceptions of physical effort and pain severity. A quasi-experimental design was employed, utilizing a sister plant in the corporation as a referent group. A longitudinal questionnaire approach was used to document pre-post changes in worker perceptions. In general, the physical change projects were rated as improvements by workers and were successful at reducing peak and/or cumulative mechanical exposures. However, there were few systematic changes in perceived effort or pain severity levels. Explanations include the confounding effects of differential production rate and staffing changes at the intervention and referent plants and/or insufficient overall intervention intensity due to a relatively short intervention period, plant and team ambivalence towards the process and the low overall impact on exposure of the particular changes implemented.

Soft-tissue rheumatic disorders of the neck and upper limb: prevalence and risk factors

OBJECTIVES

To review the epidemiologic literature concerning the occurrence of and the risk factors for pain and specific soft-tissue rheumatic conditions that affect the neck and upper limbs.

METHODS

An extensive search of the literature, including a search of Medline and EMBASE, authoritative recent reviews, and relevant textbooks, was performed. Studies that furnished data about the occurrence of or risk factors for regional pain or specific soft-tissue entities were extracted.

RESULTS

Numerous epidemiologic studies among different populations suggest a high prevalence of pain in the neck (10% to 19%), shoulder (18% to 26%), elbow (8% to 12%), and wrist/hand (9% to 17%) at any point in time. Less clear is the proportion of pain caused by specific upper-limb disorders as compared with nonspecific pain; however, as many as 6% of adults may have carpal tunnel syndrome. Significant risk factors for these disorders include age, female gender, obesity, and association with mechanical exposures (eg, posture, force, repetition, vibration) in the workplace. Also implicated are psychologic well-being and psychosocial workplace factors such as high levels of demand, poor control, and poor support.

CONCLUSION

Pain and soft-tissue rheumatic disorders of the neck and upper limb are common. It appears that individual, mechanical, and psychosocial factors all contribute to upper-limb disorders, suggesting that future strategies for prevention will need to address each of these factors if they are to be successful.

Stress and work-related upper extremity disorders: implications for prevention and management

BACKGROUND

A causal link between stress and work-related musculoskeletal disorders of the upper extremities (WRUEDs) has been established, but there is less evidence for a beneficial effect of stress reduction interventions on WRUED symptoms and incidence.

METHODS

Searches of Medline, Ergonomics Abstracts, and Psychlit from 1990 to 2001 identified studies that either targeted stress and measured WRUED outcomes, or described other interventions with both stress and WRUED outcomes.

RESULTS

Workplace interventions, including discrete improvements in technology, work organization and ergonomics, and more comprehensive approaches can reduce levels of stress. In a few studies, these interventions have been associated with decreases in WRUED symptoms. Similar effects are noted in stress-related interventions targeting individuals before WRUEDs have appeared, and at several stages of these conditions.

CONCLUSIONS

Health care providers can recognize stress-WRUED interactions through careful, directed inquiry. Both individual as well as workplace-targeted interventions, delivered in the primary care setting or workplace, may be helpful. Future research priorities include prospective studies of well-defined interventions, with ample measures of subject, intervention and workplace characteristics that can impact outcomes, and adequate follow-up to determine sustained effects.

Are psychosocial factors, risk factors for symptoms and signs of the shoulder, elbow, or hand/wrist?: A review of the epidemiological literature

BACKGROUND

In 1993, an extensive review on the role of psychosocial factors in the development of musculoskeletal problems was published by Bongers et al (1993). Since then, additional reviews on this topic have been published; however, none of these focussed on upper limb problems.

METHODS

In this systematic review, the methodological quality of all studies was assessed and levels of evidence were apriori defined.

RESULTS

The large majority of the studies reported an association between at least one work-related psychosocial factor and adverse upper extremity symptoms or signs. High-perceived job stress was consistently associated with all upper extremity problems (UEP) in high and lower quality studies. Although not often studied, non-work-related stress was also consistently associated with UEP. In addition, there was some evidence for a relationship between high job demands and UEP, although the results did not meet the pre-set criterion for consistency.

CONCLUSIONS

High job stress and non-work-related stress reactions are consistently associated with UEP. In addition, high job demands is also in most studies associated with these disorders. Firm conclusions on the role of these factors in the etiology of UEP are not possible due to the cross-sectional nature of most studies.