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Jackson JA, Sund M, Barlari Lobos G, Melin L, Mathiassen SE. Assessing the efficacy of a job rotation for improving occupational physical and psychosocial work environment, musculoskeletal health, social equality, production quality and resilience at a commercial laundromat: protocol for a longitudinal case study. BMJ Open 2023; 13:e067633. [PMID: 37173106 DOI: 10.1136/bmjopen-2022-067633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/15/2023] Open
Abstract
INTRODUCTION Job rotation is a work organisation strategy used to reduce work-related exposures and musculoskeletal complaints, yet evidence for the efficacy of the approach is weak. Mismatch between job rotation and company needs, lack of full implementation, lack of exposure variation in included tasks and failure to assess variation may underlie inconclusive research findings to date. The study aims to develop a job rotation with company stakeholders, perform a process evaluation of the implementation, and determine the extent to which the intervention improves the physical and psychosocial work environment, indicators of health, gender and social equality among workers and production quality and resilience. METHODS AND ANALYSIS Approximately 60 production workers at a Swedish commercial laundromat will be recruited. Physical and psychosocial work environment conditions, health, productivity and gender and social equality will be assessed pre and post intervention, using surveys, accelerometers, heart rate, electromyography and focus groups. A task-based exposure matrix will be constructed, and exposure variation estimated at the level of the individual worker pre and post intervention. An implementation process evaluation will be conducted. Job rotation efficacy will be assessed in terms of improvement in work environment conditions, health, gender and social inequality, and production quality and resilience. This study will provide novel information on the effects of the job rotation on physical and psychosocial work environment conditions, production quality and rate, health and gender and social inequality among blue-collar workers in a highly multicultural workplace. ETHICS AND DISSEMINATION The study received approval from the Swedish Ethical Review Authority (reference number 2019-00228). The results of the project will be shared directly with the employees, managers and union representatives from the participating company, other relevant labour market stakeholders and with researchers at national and international conferences and via scientific publication. TRIAL REGISTRATION NUMBER The study is preregistered with the Open Science Framework (https://osf.io/zmdc8/).
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Affiliation(s)
- Jennie A Jackson
- Department of Occupational Health Sciences and Psychology, University of Gävle, Gavle, Sweden
| | | | | | | | - Svend Erik Mathiassen
- Department of Occupational Health Sciences and Psychology, University of Gävle, Gavle, Sweden
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Mlekus L, Lehmann J, Maier GW. New work situations call for familiar work design methods: Effects of task rotation and how they are mediated in a technology-supported workplace. Front Psychol 2022; 13:935952. [PMID: 36312181 PMCID: PMC9597497 DOI: 10.3389/fpsyg.2022.935952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 08/29/2022] [Indexed: 11/19/2022] Open
Abstract
New digital assistive technologies strive to alleviate the completion of work tasks but thereby often threaten to make jobs increasingly monotonous. To counteract jobs becoming more and more monotonous, task rotation might be an appropriate technology feature. However, it is uncertain whether task rotation has unique positive effects, why it works, and whether there are any boundary conditions. To investigate this, we conducted two experimental vignette studies. In Study 1 (N1 = 135), we drew on the job characteristics model and self-determination theory to examine perceived task variety, skill variety, and task identity, and expected satisfaction of the need for competence as mediators of the effect of task rotation on anticipated employee attitudes (job satisfaction, intrinsic work motivation), behavior (subjective performance), and well-being (positive and negative affect). The investigated vignette described a job where a digital assistance system either indicated the task rotation or only supported work steps. Regression analyses showed direct effects of task rotation on expected job satisfaction, intrinsic motivation, and positive affect. There were indirect effects of task rotation on all outcomes except expected negative affect. We used Study 2 (N2 = 159) as an exact replication of Study 1. Additionally, to investigate the boundary conditions of task rotation effects, we drew on person-job fit theory and investigated openness to experience as a moderator of the effects of task and skill variety on the outcomes. Regression analyses showed direct effects of task rotation on expected job satisfaction, subjective performance, and positive affect. There were indirect effects of task rotation on all outcomes except expected negative affect and intrinsic motivation. Thus, the results of Study 1 could only be partly replicated. Openness to experience did not moderate the effects of task and skill variety on the outcomes. The results support the relevance of task rotation as a technology feature and indicate that rotations should offer especially skill variety and task identity, as these were the strongest mediators in our studies.
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Affiliation(s)
- Lisa Mlekus
- Department of Psychology, Bielefeld University, Bielefeld, Germany
- Research Institute for Cognition and Robotics – CoR-Lab, Bielefeld University, Bielefeld, Germany
- *Correspondence: Lisa Mlekus,
| | - Janine Lehmann
- Department of Psychology, Bielefeld University, Bielefeld, Germany
| | - Günter W. Maier
- Department of Psychology, Bielefeld University, Bielefeld, Germany
- Research Institute for Cognition and Robotics – CoR-Lab, Bielefeld University, Bielefeld, Germany
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Heijkants CH, van Hooff MLM, Geurts SAE, Boot CRL. A team level participatory approach aimed at improving sustainable employability of long-term care workers: a study protocol of a randomised controlled trial. BMC Public Health 2022; 22:984. [PMID: 35578213 PMCID: PMC9109341 DOI: 10.1186/s12889-022-13312-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 04/27/2022] [Indexed: 11/25/2022] Open
Abstract
Background Staff currently working in long-term care experience several difficulties. Shortage of staff and poor working conditions are amongst the most prominent, which pose a threat to staff’s sustainable employability. To improve their sustainable employability it is important to create working conditions that fulfil workers’ basic psychological need for autonomy, relatedness and competence in line with Self-Determination Theory. Since many long-term care organisations work with self-managing teams, challenges exist at team level. Therefore, there is a need to implement an intervention aimed at maintaining and improving the sustainable employability of staff on team level. Methods We developed a participatory workplace intervention, the Healthy Working Approach. In this intervention teams will uncover what problems they face related to autonomy, relatedness and competence in their team, come up with solutions for those problems and evaluate the effects of these solutions. We will evaluate this intervention by means of a two-arm randomized controlled trial with a follow-up of one year. One arm includes the intervention group and one includes the waitlist control group, each consisting of about 100 participants. The primary outcome is need for recovery as proxy for sustainable employability. Intervention effects will be analysed by linear mixed model analyses. A process evaluation with key figures will provide insight into barriers and facilitators of the intervention implementation. The Ethical Committee Social Sciences of the Radboud University approved the study. Discussion This study will provide insight in both the effectiveness, and the barriers/facilitators of the implementation process of the Healthy Working Approach. The approach is co-created with long-term care workers, focuses on team-specific challenges, and is rooted in the evidence-based participatory workplace approach and Self-Determination Theory. First results are expected in 2022. Trial registration Netherlands Trial Register, NL9627. Registered 29 July 2021 - Retrospectively registered.
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Affiliation(s)
- Ceciel H Heijkants
- Radboud University, Behavioural Science Institute, Thomas van Aquinostraat 4, Nijmegen, 6525GD, The Netherlands.
| | - Madelon L M van Hooff
- Radboud University, Behavioural Science Institute, Thomas van Aquinostraat 4, Nijmegen, 6525GD, The Netherlands
| | - Sabine A E Geurts
- Radboud University, Behavioural Science Institute, Thomas van Aquinostraat 4, Nijmegen, 6525GD, The Netherlands
| | - Cécile R L Boot
- Radboud University, Behavioural Science Institute, Thomas van Aquinostraat 4, Nijmegen, 6525GD, The Netherlands
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Bagherifard F, Daneshmandi H, Ziaei M, Ghaem H, Khoshbakht R, Jaberi O, Choobineh A. Comparison of physical workload and physical work capacity among municipality cleaners in Shiraz to determine number of workers needed to counterbalance physical workload. BMC Sports Sci Med Rehabil 2022; 14:85. [PMID: 35526069 PMCID: PMC9080208 DOI: 10.1186/s13102-022-00476-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 05/03/2022] [Indexed: 11/10/2022]
Abstract
Background Assessing physical workload is the most important step in deciding whether a workload is high and adopting appropriate control strategies to reduce physical workload. This study aimed to compare physical workload and Physical Work Capacity (PWC) among municipality cleaners in Shiraz to determine the number of workers needed to counterbalance physical workload. Methods The present cross-sectional study was performed on 97 municipality cleaners in Shiraz. In the first step, the participants' maximum aerobic capacity (VO2-max) was estimated in the laboratory using an ergometer bicycle and the Young Men’s Christian Association (YMCA) protocol, based on which the PWC was estimated. Secondly, energy expenditure and heart rate during work were measured using a POLAR400 device in an eight-hour shift. At the end of the work shift, the workers’ perceived physical exertion was assessed using a Rating of Perceived Exertion 6–20 (RPE 6–20) Borg scale. In the final stage, the physical workload was assessed based on the results of the two steps. Results The mean VO2-max of the cleaners and PWC were estimated to be 2.6 ± 0.66 l min−1 and 4.3 ± 1.088 kcal min−1, respectively. The average energy consumed during work was 4.122 ± 1.016 kcal min−1. The overall results of this study showed that physical workload was greater than PWC in 46% of the municipality cleaners. In addition, it was found that 12.45% workforce was required to be added to the street cleaners of Shiraz municipality to reduce the physiological workload on the employed workforce. Conclusions With respect to the high level of physical activity in a significant proportion of the cleaners, measures such as increasing the workforce are suggested.
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Affiliation(s)
- Farnaz Bagherifard
- Department of Occupational Health Engineering, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hadi Daneshmandi
- Research Center for Health Sciences, Institute of Health, Shiraz University of Medical Sciences, PO Box: 71645-111, Shiraz, Iran
| | - Mansour Ziaei
- School of Health and Nutrition, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Haleh Ghaem
- Department of Epidemiology, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ruhollah Khoshbakht
- Health and Safety Executive Unit, Shiraz Waste Management Organization, Shiraz, Iran
| | - Omid Jaberi
- Health and Safety Executive Unit, Shiraz Waste Management Organization, Shiraz, Iran
| | - Alireza Choobineh
- Research Center for Health Sciences, Institute of Health, Shiraz University of Medical Sciences, PO Box: 71645-111, Shiraz, Iran.
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Relationship between job rotation and work-related low back pain: a cross-sectional study using data from the fifth Korean working conditions survey. Ann Occup Environ Med 2021; 33:e3. [PMID: 34754464 PMCID: PMC7952754 DOI: 10.35371/aoem.2021.33.e3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 01/05/2021] [Indexed: 11/25/2022] Open
Abstract
Background Job rotation was introduced in various industries as a strategic form of work for improving workers' job skills and health management. This study aims to examine the relationship between job rotation and work-related low back pain (LBP), one of the typical work-related musculoskeletal symptoms of Korean workers. Methods We conducted this study using the data of the 5th Korean Working Conditions Survey (KWCS). As the subject of this study, 27,163 wage workers were selected, and classified into three groups according to occupational type (white-collar, service and sales, and blue-collar). In this study, job rotation means to change the work-related activities with other colleagues periodically and work-related LBP was defined as whether there was work-related LBP in the last 12 months. Chi-square test and logistic regression were used to analyze the relationship between job rotation and work-related LBP. Results Out of 27,163 workers, 2,421 (8.9%) answered that they had job rotation and 2,281 (8.4%) answered that they experienced work-related LBP. According to the results from logistic regression, job rotation was significantly associated with low prevalence of work-related LBP among blue-collar workers (odds ratio [OR]: 0.71, 95% confidence interval [CI]: 0.58–0.88), whereas no significant relationship was observed among white-collar, service and sales groups. In addition, the negative association between job rotation and work-related LBP among blue-collar workers was more pronounced when exposed to ergonomic risk factors (uncomfortable posture OR: 0.79, 95% CI: 0.64–0.98; heavy work OR: 0.74, 95% CI: 0.57–0.96; repetitive work OR: 0.74, 95% CI: 0.60–0.92). Conclusions Job rotation was associated with low prevalence of work-related LBP among workers in the blue-collar occupational group in Korea. It is necessary to evaluate the effect of job rotation by occupational type and introduce an appropriate method of job rotation to reduce workers' work-related musculoskeletal symptoms.
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Motabar H, Nimbarte AD. The effect of task rotation on activation and fatigue response of rotator cuff muscles during overhead work. APPLIED ERGONOMICS 2021; 97:103461. [PMID: 34174574 DOI: 10.1016/j.apergo.2021.103461] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 05/04/2021] [Accepted: 05/05/2021] [Indexed: 06/13/2023]
Abstract
Overhead work is known as one of the ergonomic risk factors that can lead to shoulder overload and injury. Anatomical alignment of rotator cuff muscles makes them the most vulnerable to injuries during overhead work. In this study, the effect of task rotation, as one of the administrative controls to reduce the risk of injury during overhead work, on the fatigue response of rotator cuff muscles was investigated. Twelve participants performed three submaximal exertions (5, 20, and 35% of maximum voluntary contraction (MVC)) using four task rotation sequences (increasing, decreasing, upward parabolic, and downward parabolic). Median frequency of surface electromyography (EMG), shoulder strength, and ratings of perceived exertion (RPE) were used to study the fatigue response of rotator cuff muscles. Although the average normalized muscle activity was similar in all sequences, the task rotation sequence had a significant effect on the median frequency. The effect of task rotation sequence on the strength and RPE was similar to that of the median frequency but was statistically not significant. The upward parabolic task rotation sequence resulted in the lowest fatigue among all the task sequences. Performing intense exertions apart from each other, warm-up exertions, and the presence of active recovery after the intense exertions could be the factors that produced the lowest fatigue during this sequence.
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Affiliation(s)
- Hossein Motabar
- Industrial and Management Systems Engineering, West Virginia University, PO Box 6070, Morgantown, WV, 26506-6107, USA
| | - Ashish D Nimbarte
- Industrial and Management Systems Engineering, West Virginia University, PO Box 6070, Morgantown, WV, 26506-6107, USA.
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James C, Bezzina A, Rahman MM. Task rotation in an underground coal mine: Implications on injury and musculoskeletal discomfort. APPLIED ERGONOMICS 2021; 93:103388. [PMID: 33618315 DOI: 10.1016/j.apergo.2021.103388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 02/10/2021] [Accepted: 02/11/2021] [Indexed: 06/12/2023]
Abstract
PURPOSE To investigate the effect of a task rotation schedule on musculoskeletal injury and the challenges of implementing a task rotation schedule within an underground coal mine. METHODS This was a pre-post cross-sectional intervention study with two underground coal mines. Participant-surveys were collected at baseline and 12-months. RESULTS There were no significant differences in musculoskeletal discomfort between the two sites in any body region. Tasks were rotated two to three times a shift on average. CONCLUSIONS The task rotation schedule did not have a significant impact upon musculoskeletal discomfort although this does not necessarily reflect that the rotation schedule was in-effective in curbing injury, rather highlights the complexity of developing a successful task rotation schedule within an underground coal mine. The task rotation schedule, its implementation and execution need consideration and further investigation to assist in effectively controlling injury and fatigue risk.
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Affiliation(s)
- Carole James
- Centre for Resources Health and Safety, College of Health, Medicine and Wellbeing, University of Newcastle, Australia; School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Australia.
| | - Aaron Bezzina
- Centre for Resources Health and Safety, College of Health, Medicine and Wellbeing, University of Newcastle, Australia; School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Australia
| | - Md Mijanur Rahman
- Centre for Health Service Development, University of Wollongong, Australia; Department of Statistics, Comilla University, Bangladesh
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Mlekus L, Maier GW. More Hype Than Substance? A Meta-Analysis on Job and Task Rotation. Front Psychol 2021; 12:633530. [PMID: 33868097 PMCID: PMC8044787 DOI: 10.3389/fpsyg.2021.633530] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 03/04/2021] [Indexed: 11/24/2022] Open
Abstract
Although there exist numerous publications on job and task rotation from various disciplines, there is no consistent evidence of their effectiveness. Drawing on theories from industrial and organizational psychology, knowledge management, ergonomics, and management science, we meta-analytically investigated relationships between job/task rotation and employee attitudes, learning and development, psychological and physical health, and organizational performance. Due to a conceptual overlap and frequent confusion of terminology, we analyzed the design of the rotation (job rotation vs. task rotation) as a possible moderator. The three-level meta-analysis on 56 studies (N = 284,086) showed that rotation was significantly associated with job satisfaction (r = 0.27), organizational commitment (r = 0.16), career success (r = 0.31), labor flexibility (r = 0.32), general psychological health (r = 0.20), stress/burnout (r = -0.13), individual performance (r = 0.13), and productivity (r = 0.13). Positive relationships between rotation and physical health could only be found when rotation was compared to high-intensity work. Task rotation yielded stronger relationships with attitudinal outcomes, job rotation with learning and development, psychological health, and organizational performance outcomes. Further moderator analyses showed that individualism decreased relationships between task rotation and attitudes, and correlations with organizational performance and physical health were stronger for subjective measures. The findings indicate that many expectations toward job and task rotation are not fully supported.
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Affiliation(s)
- Lisa Mlekus
- Department of Psychology, Bielefeld University, Bielefeld, Germany
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Moore CAB, Armstrong DP, Fischer SL. Exploring the prospective efficacy of waste bag-body contact allowance to reduce biomechanical exposure in municipal waste collection. APPLIED ERGONOMICS 2021; 90:103182. [PMID: 32920222 DOI: 10.1016/j.apergo.2020.103182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 05/30/2020] [Accepted: 06/01/2020] [Indexed: 06/11/2023]
Abstract
Municipal waste collectors must avoid bag-body contact, requiring waste bags to be held further from the body. Donning sharps-proof clothing would permit bag-body contact, allowing the bag to be closer to the body, reducing biomechanical exposures. To test this hypothesis, 25 participants loaded waste bags into a simulated garbage truck hopper under two lifting (contact allowed, no contact) and bag mass (7 kg and 20 kg) conditions. Bottom-up rigid-link biomechanical modelling results including peak low back compression force, antero-posterior shear force and peak low back flexion angle were not different between the lifting conditions, but cumulative compression was decreased with bag-body contact, although only at the 20 kg mass. Bag mass had significant effects on outcome measures, causing compression to increase to 4663 (±697) N, exceeding recommended thresholds. Sharps-proof clothing and municipally mandated 23 kg maximum allowable bag mass restrictions may not sufficiently reduce biomechanical exposures to prevent MSD.
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Affiliation(s)
| | | | - Steven L Fischer
- Department of Kinesiology, University of Waterloo, Waterloo, ON, Canada.
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Verbeek J, Ruotsalainen J, Laitinen J, Korkiakangas E, Lusa S, Mänttäri S, Oksanen T. Interventions to enhance recovery in healthy workers; a scoping review. Occup Med (Lond) 2020; 69:54-63. [PMID: 30380126 DOI: 10.1093/occmed/kqy141] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background Faster recovery from work may help to prevent work-related ill health. Aims To provide a preliminary assessment of the range and nature of interventions that aim to improve recovery from cognitive and physical work. Methods A scoping review to examine the range and nature of the evidence, to identify gaps in the evidence base and to provide input for systematic reviews. We searched for workplace intervention studies that aimed at enhancing recovery. We used an iterative method common in qualitative research to obtain an overview of study elements, including intervention content, design, theory, measurements, effects and cost-effectiveness. Results We found 28 studies evaluating seven types of interventions mostly using a randomized controlled study design. For person-directed interventions, we found relaxation techniques, training of recovery experiences, promotion of physical activity and stress management. For work-directed interventions, there were participatory changes, work-break schedules and task variation. Most interventions were based on the conservation of resources and affect-regulation theories, none were based on the effort-recovery theory. The need for recovery (NfR) and the recovery experiences questionnaires (REQ) were used most often. Study authors reported a beneficial effect of the intervention in 14 of 26 published studies. None of the studies that used the NfR scale found a beneficial effect, whereas studies that used the REQ showed beneficial effects. Three studies indicated that interventions were not cost-effective. Conclusions Feasible and possibly effective interventions are available for improving recovery from cognitive and physical workload. Systematic reviews are needed to determine their effectiveness.
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Affiliation(s)
- J Verbeek
- Finnish Institute of Occupational Health, Kuopio, Työterveyslaitos, Finland
| | - J Ruotsalainen
- Finnish Institute of Occupational Health, Kuopio, Työterveyslaitos, Finland
| | - J Laitinen
- Finnish Institute of Occupational Health, Oulu, Finland
| | | | - S Lusa
- Finnish Institute of Occupational Health, Tampere, Finland
| | - S Mänttäri
- Finnish Institute of Occupational Health, Oulu, Finland
| | - T Oksanen
- Finnish Institute of Occupational Health, Turku, Finland
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Designing Cyclic Job Rotations to Reduce the Exposure to Ergonomics Risk Factors. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17031073. [PMID: 32046262 PMCID: PMC7038130 DOI: 10.3390/ijerph17031073] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 02/04/2020] [Accepted: 02/06/2020] [Indexed: 11/16/2022]
Abstract
Job rotation is an administrative solution to prevent work-related musculoskeletal disorders that has become widespread. However, job rotation schedules development is a complex problem. This is due to the multi-factorial character of the disorders and to the productive and organizational constraints of the real working environments. To avoid these problems, this work presents an evolutionary algorithm to generate rotation schedules in which a set of workers rotate cyclically over a small number of jobs while reducing the potential for injury. The algorithm is able to generate rotation schedules that optimize multiple ergonomics criteria by clustering the tasks into rotation groups, selecting the workers for each group, and determining the sequence of rotation of the workers to minimize the effects of fatigue. The algorithm reduces prolonged exposure to risks related to musculoskeletal injuries and simplifies the assignment of workers to different tasks in each rotation. The presented procedure can be an effective tool for the design of job-rotation schedules that prevent work-related musculoskeletal disorders while simplifying scheduled changeovers at each rotation and facilitating job monitoring.
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Asante BO, Trask C, Adebayo O, Bath B. Prevalence and risk factors of low back disorders among waste collection workers: A systematic review. Work 2019; 64:33-42. [PMID: 31450537 DOI: 10.3233/wor-192977] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Waste management is a growing industry worldwide. Working conditions may entail risk factors for musculoskeletal disorders, and especially low back disorders (LBD). OBJECTIVE The purpose of this study was to perform a systematic review on: (i) the prevalence of LBD; and (ii) risk factors for LBD among waste collection workers. METHOD A search was conducted in three electronic databases: Ovid Medline, EMBASE, and Global Health ePublications. Data were extracted on study design, sampling strategy, geographical region, LBD prevalence, and risk factors. Data were reported narratively. RESULTS Thirteen full-text articles met the study criteria. Using a range of definitions for LBD, the included articles reported a 12-month prevalence of 'LBD' between 16 to 74%, although none of the included studies quantified relationships between risk factors and LBD. None of the studies met all 9 risk of bias criteria. No articles investigated the association of risk factors and LBD, but even in absence this evidence authors of included studies suggested physical risk factors for LBD among waste workers: awkward posture, repetitive motion, and work duration. CONCLUSION In light of these risks and future growth in this industry, the lack of high quality studies and investigation of risk factors highlight the need for more research in this sector which will support future LBD prevention efforts.
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Affiliation(s)
- Benedicta O Asante
- Canadian Centre for Health and Safety in Agriculture, College of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Catherine Trask
- Canadian Centre for Health and Safety in Agriculture, College of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Olugbenga Adebayo
- Canadian Centre for Health and Safety in Agriculture, College of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Brenna Bath
- Canadian Centre for Health and Safety in Agriculture, College of Medicine, University of Saskatchewan, Saskatoon, Canada
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Moretto AF, Chesani FH, Grillo LP. Sintomas osteomusculares e qualidade de vida em costureiras do município de Indaial, Santa Catarina. FISIOTERAPIA E PESQUISA 2017. [DOI: 10.1590/1809-2950/16833624022017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO Os problemas de saúde decorrentes da relação de trabalho têm se tornado um fenômeno mundial. O objetivo deste estudo foi avaliar os sintomas osteomusculares e a qualidade de vida em profissionais do ramo da costura no município de Indaial (SC). Trata-se de um estudo de natureza transversal com abordagem quantitativa. A amostra foi constituída por 118 costureiras de 48 empresas que responderam a três questionários: um sociodemográfico, outro de sintomas osteomusculares e um de qualidade de vida. Das costureiras avaliadas, 71,1% apresentaram sintomas osteomusculares nos últimos sete dias e 88,1% nos últimos doze meses. A região corporal mais afetada de acordo com a maioria dos relatos foi a dos ombros (18,6%) e as causas de afastamento foram as dores dorsais e lombares (cada uma correspondendo a 19,1% dos casos). O domínio de qualidade de vida mais comprometido foi o estado geral de saúde (57,03±16,08), seguido pelos de vitalidade (58,89±17,65), dor (60,53±22,28), saúde mental (66,81±19,19), aspectos emocionais (67,72±38,29), aspectos físicos (73,94±32,91), aspectos sociais (75,63±23,10) e capacidade funcional (77,16±19,19). Percebe-se que quanto maior o escore de qualidade de vida, menor o número de regiões anatômicas com dor. A associação de medidas preventivas ao trabalhar, como períodos de micropausas, atenção para posturas corretas e ginástica laboral, podem influenciar a redução de dor e prevenção de doenças, como também aprimorar a qualidade de vida.
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Zhang H, Liu H, Lin Q, Zhang G, Mason DC. Effects of intermittent pressure imitating rolling manipulation on calcium ion homeostasis in human skeletal muscle cells. Altern Ther Health Med 2016; 16:314. [PMID: 27561948 PMCID: PMC5000503 DOI: 10.1186/s12906-016-1314-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2016] [Accepted: 08/23/2016] [Indexed: 11/25/2022]
Abstract
Background Homeostasis imbalance of intracellular Ca2+ is one of the key pathophysiological factors in skeletal muscle injuries. Such imbalance can cause significant change in the metabolism of Ca2+-related biomarkers in skeletal muscle, such as superoxide dismutase (SOD), malondialdehyde (MDA) and creatine kinase (CK). Measurements of these biomarkers can be used to evaluate the degree of damage to human skeletal muscle cells (HSKMCs) injury. Rolling manipulation is the most popular myofascial release technique in Traditional Chinese Medicine. The mechanism of how this technique works in ameliorating muscle injury is unknown. This study aimed to investigate the possible Ca2+ mediated effects of intermittent pressure imitating rolling manipulation (IPIRM) of Traditional Chinese Medicine in the injured HSKMCs. Methods The normal HSKMCs was used as control normal group (CNG), while the injured HSKMCs were further divided into five different groups: control injured group (CIG), Rolling manipulation group (RMG), Rolling manipulation-Verapamil group (RMVG), static pressure group (SPG) and static pressure-Verapamil group (SPVG). RMG and RMVG cells were cyclically exposed to 9.5-12.5 N/cm2 of IPIRM at a frequency of 1.0 Hz for 10 min. SPG and SPVG were loaded to a continuous pressure of 12.5 N/cm2 for 10 min. Verapamil, a calcium antagonist, was added into the culture mediums of both RMVG and SPVG groups to block the influx of calcium ion. Result Compared with the CNG (normal cells), SOD activity was remarkably decreased while both MDA content and CK activity were significantly increased in the CIG (injured cells). When the injured cells were treated with the intermittent rolling manipulation pressure (RMG), the SOD activity was significantly increased and MDA content and CK activity were remarkably decreased. These effects were suppressed by adding the calcium antagonist Verapamil into the culture medium in RMVG. On the other hand, exposure to static pressure in SPG and SPVG affected neither the SOD activity nor the MDA content and CK activity in the injured muscle cells regardless of the presence of verapamil or not in the culture medium. Conclusion These data suggest that the intermittent rolling pressure with the manipulation could ameliorate HSKMCs injury through a Ca2+ dependent pathway. Static pressure did not lead to the same results.
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Yoon SY, Ko J, Jung MC. A model for developing job rotation schedules that eliminate sequential high workloads and minimize between-worker variability in cumulative daily workloads: Application to automotive assembly lines. APPLIED ERGONOMICS 2016; 55:8-15. [PMID: 26995031 DOI: 10.1016/j.apergo.2016.01.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Revised: 11/26/2015] [Accepted: 01/11/2016] [Indexed: 06/05/2023]
Abstract
The aim of study is to suggest a job rotation schedule by developing a mathematical model in order to reduce cumulative workload from the successive use of the same body region. Workload assessment using rapid entire body assessment (REBA) was performed for the model in three automotive assembly lines of chassis, trim, and finishing to identify which body part exposed to relatively high workloads at workstations. The workloads were incorporated to the model to develop a job rotation schedule. The proposed schedules prevent the exposure to high workloads successively on the same body region and minimized between-worker variance in cumulative daily workload. Whereas some of workers were successively assigned to high workload workstation under no job rotation and serial job rotation. This model would help to reduce the potential for work-related musculoskeletal disorders (WMSDs) without additional cost for engineering work, although it may need more computational time and relative complex job rotation sequences.
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Affiliation(s)
- Sang-Young Yoon
- Department of Industrial Engineering, Ajou University, Suwon, 16499, Republic of Korea.
| | - Jeonghan Ko
- Department of Industrial Engineering, Ajou University, Suwon, 16499, Republic of Korea.
| | - Myung-Chul Jung
- Department of Industrial Engineering, Ajou University, Suwon, 16499, Republic of Korea.
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16
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Is rotating between static and dynamic work beneficial for our fatigue state? J Electromyogr Kinesiol 2016; 28:104-13. [DOI: 10.1016/j.jelekin.2016.04.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Revised: 03/29/2016] [Accepted: 04/05/2016] [Indexed: 11/17/2022] Open
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17
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Leider PC, Boschman JS, Frings-Dresen MHW, van der Molen HF. When is job rotation perceived useful and easy to use to prevent work-related musculoskeletal complaints? APPLIED ERGONOMICS 2015; 51:205-210. [PMID: 26154219 DOI: 10.1016/j.apergo.2015.05.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Revised: 05/08/2015] [Accepted: 05/12/2015] [Indexed: 06/04/2023]
Abstract
Job rotation is often recommended to optimize physical work demands and prevent work-related musculoskeletal complaints, but little is known about possible facilitators and barriers to its usefulness and ease of use. Following a qualitative research design, semi-structured interviews with employers (n = 12) and workers (n = 11) from the construction industry were conducted. Organizational climate, job autonomy, job characteristics and work processes were mentioned as either facilitators or barriers on an organizational level. Worker characteristics, work behavior and attitude were mentioned as either facilitators or barriers on an individual level. Following a structured approach to assess usefulness of job rotation to optimize physical work exposures and identifying barriers to usefulness and ease of use in relevant stakeholder groups is necessary in order to select or develop strategies to overcome these barriers, or to reject job rotation as a useful or easy to use intervention in the given context.
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Affiliation(s)
- Priscilla C Leider
- Coronel Institute of Occupational Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Julitta S Boschman
- Coronel Institute of Occupational Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Monique H W Frings-Dresen
- Coronel Institute of Occupational Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Henk F van der Molen
- Coronel Institute of Occupational Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Arbouw, Dutch Health & Safety Institute Construction Industry, Harderwijk, The Netherlands.
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18
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Horton LM, Nussbaum MA, Agnew MJ. Rotation during lifting tasks: effects of rotation frequency and task order on localized muscle fatigue and performance. JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HYGIENE 2015; 12:95-106. [PMID: 25551257 DOI: 10.1080/15459624.2014.957829] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Though widely considered to reduce the risk of work-related musculoskeletal disorders, there is limited evidence suggesting that rotating between tasks is effective in doing so. The purpose of the current study was to quantify the effects of rotation and parameters of rotation (frequency and task order) on muscle fatigue and performance. This was done using a simulated lifting task, with rotation between two levels of loading of the same muscle groups. Twelve participants completed six experimental sessions during which repetitive box lifting was performed for one hour either with or without rotation. When rotation was present, it occurred every 15 minutes or every 30 minutes and was between two load levels (box weights). Rotation reduced fatigue and cardiovascular demand compared to the heavier load without rotation, with a mean reduction of ∼33% in perceived discomfort and a ∼17% reduction in percentage of heart rate reserve. Further, rotation increased fatigue and cardiovascular demand compared to the lighter load without rotation, with a mean increase of ∼34% perceived discomfort and a ∼19% increase in percentage of heart rate reserve. Neither rotation frequency nor task order had definitive effects, though maximum discomfort ratings were nearly 20% higher when starting with the lighter load task. These parameters of rotation should be further evaluated under more realistic task conditions.
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Affiliation(s)
- Leanna M Horton
- a Department of Industrial and Systems Engineering , Virginia Tech , Blacksburg , Virginia
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19
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Coffeng JK, Boot CRL, Duijts SFA, Twisk JWR, van Mechelen W, Hendriksen IJM. Effectiveness of a worksite social & physical environment intervention on need for recovery, physical activity and relaxation; results of a randomized controlled trial. PLoS One 2014; 9:e114860. [PMID: 25542039 PMCID: PMC4277283 DOI: 10.1371/journal.pone.0114860] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Accepted: 10/22/2014] [Indexed: 11/29/2022] Open
Abstract
Objective To investigate the effectiveness of a worksite social and physical environment intervention on need for recovery (i.e., early symptoms of work-related mental and physical fatigue), physical activity and relaxation. Also, the effectiveness of the separate interventions was investigated. Methods In this 2×2 factorial design study, 412 office employees from a financial service provider participated. Participants were allocated to the combined social and physical intervention, to the social intervention only, to the physical intervention only or to the control group. The primary outcome measure was need for recovery. Secondary outcomes were work-related stress (i.e., exhaustion, detachment and relaxation), small breaks, physical activity (i.e., stair climbing, active commuting, sport activities, light/moderate/vigorous physical activity) and sedentary behavior. Outcomes were measured by questionnaires at baseline, 6 and 12 months follow-up. Multilevel analyses were performed to investigate the effects of the three interventions. Results In all intervention groups, a non-significant reduction was found in need for recovery. In the combined intervention (n = 92), exhaustion and vigorous physical activities decreased significantly, and small breaks at work and active commuting increased significantly compared to the control group. The social intervention (n = 118) showed a significant reduction in exhaustion, sedentary behavior at work and a significant increase in small breaks at work and leisure activities. In the physical intervention (n = 96), stair climbing at work and active commuting significantly increased, and sedentary behavior at work decreased significantly compared to the control group. Conclusion None of the interventions was effective in improving the need for recovery. It is recommended to implement the social and physical intervention among a population with higher baseline values of need for recovery. Furthermore, the intervention itself could be improved by increasing the intensity of the intervention (for example weekly GMI-sessions), providing physical activity opportunities and exercise schemes, and by more drastic environment interventions (restructuring entire department floor). Trial Registration Nederlands Trial Register NTR2553
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Affiliation(s)
- Jennifer K. Coffeng
- Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
- Body@Work TNO- VU University Medical Center, Research Center Physical Activity, Work and Health, Amsterdam, The Netherlands
- * E-mail:
| | - Cécile R. L. Boot
- Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
- Body@Work TNO- VU University Medical Center, Research Center Physical Activity, Work and Health, Amsterdam, The Netherlands
| | - Saskia F. A. Duijts
- Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Jos W. R. Twisk
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
- Department of Health Sciences, VU University, Amsterdam, The Netherlands
| | - Willem van Mechelen
- Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
- Body@Work TNO- VU University Medical Center, Research Center Physical Activity, Work and Health, Amsterdam, The Netherlands
| | - Ingrid J. M. Hendriksen
- Body@Work TNO- VU University Medical Center, Research Center Physical Activity, Work and Health, Amsterdam, The Netherlands
- TNO (Expert Center Life Style), Leiden, The Netherlands
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20
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Mathiassen SE, Hallman DM, Lyskov E, Hygge S. Can cognitive activities during breaks in repetitive manual work accelerate recovery from fatigue? A controlled experiment. PLoS One 2014; 9:e112090. [PMID: 25375644 PMCID: PMC4222971 DOI: 10.1371/journal.pone.0112090] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Accepted: 10/13/2014] [Indexed: 11/18/2022] Open
Abstract
Neurophysiologic theory and some empirical evidence suggest that fatigue caused by physical work may be more effectively recovered during “diverting” periods of cognitive activity than during passive rest; a phenomenon of great interest in working life. We investigated the extent to which development and recovery of fatigue during repeated bouts of an occupationally relevant reaching task was influenced by the difficulty of a cognitive activity between these bouts. Eighteen male volunteers performed three experimental sessions, consisting of six 7-min bouts of reaching alternating with 3 minutes of a memory test differing in difficulty between sessions. Throughout each session, recordings were made of upper trapezius muscle activity using electromyography (EMG), heart rate and heart rate variability (HRV) using electrocardiography, arterial blood pressure, and perceived fatigue (Borg CR10 scale and SOFI). A test battery before, immediately after and 1 hour after the work period included measurements of maximal shoulder elevation strength (MVC), pressure pain threshold (PPT) over the trapezius muscles, and a submaximal isometric contraction. As expected, perceived fatigue and EMG amplitude increased during the physical work bouts. Recovery did occur between the bouts, but fatigue accumulated throughout the work period. Neither EMG changes nor recovery of perceived fatigue during breaks were influenced by cognitive task difficulty, while heart rate and HRV recovered the most during breaks with the most difficult task. Recovery of perceived fatigue after the 1 hour work period was also most pronounced for the most difficult cognitive condition, while MVC and PPT showed ambiguous patterns, and EMG recovered similarly after all three cognitive protocols. Thus, we could confirm that cognitive tasks between bouts of fatiguing physical work can, indeed, accelerate recovery of some factors associated with fatigue, even if benefits may be moderate and some responses may be equivocal. Our results encourage further research into combinations of physical and mental tasks in an occupational context.
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Affiliation(s)
- Svend Erik Mathiassen
- Centre for Musculoskeletal Research, Department of Occupational and Public Health Sciences, University of Gävle, Gävle, Sweden
- * E-mail:
| | - David M. Hallman
- Centre for Musculoskeletal Research, Department of Occupational and Public Health Sciences, University of Gävle, Gävle, Sweden
| | - Eugene Lyskov
- Centre for Musculoskeletal Research, Department of Occupational and Public Health Sciences, University of Gävle, Gävle, Sweden
| | - Staffan Hygge
- Department of Building, Energy and Environmental Engineering, University of Gävle, Gävle, Sweden
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21
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Leider PC, Boschman JS, Frings-Dresen MHW, van der Molen HF. Effects of job rotation on musculoskeletal complaints and related work exposures: a systematic literature review. ERGONOMICS 2014; 58:18-32. [PMID: 25267494 DOI: 10.1080/00140139.2014.961566] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The aim of this systematic review was to summarise evidence on the effects of job rotation on musculoskeletal complaints, exposures related to musculoskeletal complaints and sustainable working life parameters. A total of 16 studies were included. No studies on sustainable working life parameters were found. The quality of the studies was assessed using a checklist; eight field studies and three laboratory studies of sufficient quality were used to summarise the following evidence: one field study showed positive results and one field study showed negative results for musculoskeletal complaints, two field studies showed positive results and two field studies showed inconsistent results for exposures, and two field studies showed inconsistent results for musculoskeletal complaints and exposures. Two laboratory studies showed inconsistent results and one laboratory study showed no changes for exposures. In conclusion, there is currently inconsistent evidence for positive or negative effects of job rotation on musculoskeletal complaints and exposures related to musculoskeletal complaints. Practitioner's Summary: Currently, there is inconsistent evidence for recommending job rotation as a strategy for preventing musculoskeletal complaints. Exposures from all involved work activities and body regions should be identified and assessed first, to determine if job rotation provides increased exposure variation and/or beneficial changes in mean exposures related to musculoskeletal complaints.
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Affiliation(s)
- Priscilla C Leider
- a Coronel Institute of Occupational Health, Academic Medical Center, University of Amsterdam , Amsterdam , The Netherlands
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22
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Comper MLC, Padula RS. The effectiveness of job rotation to prevent work-related musculoskeletal disorders: protocol of a cluster randomized clinical trial. BMC Musculoskelet Disord 2014; 15:170. [PMID: 24885958 PMCID: PMC4040481 DOI: 10.1186/1471-2474-15-170] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Accepted: 05/16/2014] [Indexed: 11/11/2022] Open
Abstract
Background Job rotation has often been used in situations where the level of exposure cannot be reduced due to the characteristics of the job or through physical measures. However, the effectiveness of the job rotation strategy at preventing musculoskeletal complaints lacks adequate scientific data. Methods/Design A cluster randomized controlled trial will be used to investigate the effectiveness of job rotation to prevent musculoskeletal disorders in industrial workers. The randomized cluster was based in characteristics of production sectors. A total cluster will be 4 sectors, and 957 workers will be recruited from a textile industry and randomly allocated into intervention or control groups. Both groups will receive training on ergonomics guidelines. In addition, the intervention group will perform job rotation, switching between tasks with low, moderate, and high risk for musculoskeletal complaints. The primary outcome will be the number of working hours lost due to sick leave by musculoskeletal injuries recorded in employee administrative data bases. Secondary outcomes measured via survey include: body parts with musculoskeletal pain, the intensity of this pain, physical workload, fatigue, general health status, physical activity level, and work productivity. Secondary outcome measures will be assessed at baseline and after 3, 6, 9, and 12 months. The cost-effectiveness analysis will be performed from the societal and company perspective. Discussion Prevention of work-related musculoskeletal disorders is beneficial for workers, employers, and society. The results of this study will provide new information about the effectiveness of job rotation as a strategy to reduce work-related musculoskeletal disorders. Trial registration NCT01979731, November 3, 2013
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Affiliation(s)
- Maria Luiza Caires Comper
- Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, Rua Cesário Galeno 475, 03071-000 São Paulo, Brazil.
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23
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Kuijer PPFM, van der Molen HF, Schop A, Moeijes F, Frings-Dresen MHW, Hulshof CTJ. Annual incidence of non-specific low back pain as an occupational disease attributed to whole-body vibration according to the National Dutch Register 2005-2012. ERGONOMICS 2014; 58:1232-1238. [PMID: 24823257 DOI: 10.1080/00140139.2014.915991] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
UNLABELLED Non-specific low back pain (nLBP) is the second most important reason for sick leave in the Netherlands, and more than 50% of the workers on sick leave attribute these complaints to their work. To stimulate recognition and prevention, an occupational disease (OD) registration-guideline was implemented for the assessment of the work-relatedness of nLBP in the Netherlands in 2005. The aim of this study is to present the annual incidence of nLBP as an OD and specifically for whole-body vibration (WBV) including patient characteristics such as age, sick leave and actions initiated by the occupational physician (OP). The data were retrieved from the National Dutch Register for 2005-2012. Each year about 118 OPs reported 509 cases (SD 139) of nLBP as an OD in a Dutch working population of 7.5 million workers (8% of all annual reported ODs). Less than 1% of these cases were attributed to WBV: 94% were men, 45% were between 51 and 60 years and 35% were on sick leave for more than 2 weeks. Most initiated actions were ergonomic interventions (35%). PRACTITIONER SUMMARY The number of notified cases of nLPB as an occupational disease attributed to whole-body vibration is low with less than 1% of all cases in the Netherlands. An explanation is that other work-related risk factors for nLBP such as lifting are more frequently occurring, more visible and have a higher attributable risk than WBV. However, continuing attention for WBV remains warranted given a higher percentage of cases with sick leave of more than 2 weeks.
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Affiliation(s)
- P Paul F M Kuijer
- a Netherlands Center for Occupational Diseases, Coronel Institute of Occupational Health, Academic Medical Center , PO Box 22660, 1100 DD Amsterdam , The Netherlands
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24
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Organizational and psychosocial risk factors for carpal tunnel syndrome: a cross-sectional study of French workers. Int Arch Occup Environ Health 2013; 87:147-54. [DOI: 10.1007/s00420-013-0846-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2012] [Accepted: 01/11/2013] [Indexed: 10/27/2022]
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25
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Coffeng JK, Hendriksen IJM, Duijts SF, Proper KI, van Mechelen W, Boot CRL. The development of the Be Active & Relax "Vitality in Practice" (VIP) project and design of an RCT to reduce the need for recovery in office employees. BMC Public Health 2012; 12:592. [PMID: 22852835 PMCID: PMC3487972 DOI: 10.1186/1471-2458-12-592] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Accepted: 07/11/2012] [Indexed: 11/24/2022] Open
Abstract
Background There is strong evidence to suggest that multiple work-related health problems are preceded by a higher need for recovery. Physical activity and relaxation are helpful in decreasing the need for recovery. This article aims to describe (1) the development and (2) the design of the evaluation of a daily physical activity and relaxation intervention to reduce the need for recovery in office employees. Methods/Design The study population will consist of employees of a Dutch financial service provider. The intervention was systematically developed, based on parts of the Intervention Mapping (IM) protocol. Assessment of employees needs was done by combining results of face-to-face interviews, a questionnaire and focus group interviews. A set of theoretical methods and practical strategies were selected which resulted in an intervention program consisting of Group Motivational Interviewing (GMI) supported by a social media platform, and environmental modifications. The Be Active & Relax program will be evaluated in a modified 2 X 2 factorial design. The environmental modifications will be pre-stratified and GMI will be randomised on department level. The program will be evaluated, using 4 arms: (1) GMI and environmental modifications; (2) environmental modifications; (3) GMI; (4) no intervention (control group). Questionnaire data on the primary outcome (need for recovery) and secondary outcomes (daily physical activity, sedentary behaviour, relaxation/detachment, work- and health-related factors) will be gathered at baseline (T0), at 6 months (T1), and at 12 months (T2) follow-up. In addition, an economic and a process evaluation will be performed. Discussion Reducing the need for recovery is hypothesized to be beneficial for employees, employers and society. It is assumed that there will be a reduction in need for recovery after 6 months and 12 months in the intervention group, compared to the control group. Results are expected in 2013. Trial registration Netherlands Trial Register (NTR): NTR2553
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Affiliation(s)
- Jennifer K Coffeng
- Department of Public and Occupational Health, EMGO+ Institute for Health and Care Research, VU University Medical Center (VUmc), Amsterdam, the Netherlands
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26
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Horton LM, Nussbaum MA, Agnew MJ. Effects of rotation frequency and task order on localised muscle fatigue and performance during repetitive static shoulder exertions. ERGONOMICS 2012; 55:1205-1217. [PMID: 22849348 DOI: 10.1080/00140139.2012.704406] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
UNLABELLED Though widely considered to reduce physical exposures and increase exposure variation, there is limited evidence that rotating between tasks is effective in reducing the risk of work-related musculoskeletal disorders (WMSDs). The purpose of this study was to assess the effects of rotation, specifically focusing on rotation frequency and task order, on muscle fatigue and performance when rotating between tasks that load the same muscle group. Twelve participants completed six experimental sessions during which repetitive static shoulder abduction tasks were performed at two exertion levels for one hour either with or without rotation. Compared to only performing a higher or lower exertion task, rotating between the two tasks decreased and increased fatigue, respectively. Increasing rotation frequency adversely affected task performance, and task order had a minor effect on muscle fatigue. These rotation parameters may be important considerations when implementing rotation in the workplace. PRACTITIONER SUMMARY Rotation is widely used and assumed to reduce the risk of WMSDs, yet little research supports that it is effective in doing so. Results here show that specific aspects of a rotation scheme may influence muscle fatigue and task performance, though further research is needed under more realistic task conditions.
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Affiliation(s)
- Leanna M Horton
- Industrial and Systems Engineering, Virginia Tech, 250 Durham Hall (0118), Blacksburg , VA, USA
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27
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Keir PJ, Sanei K, Holmes MWR. Task rotation effects on upper extremity and back muscle activity. APPLIED ERGONOMICS 2011; 42:814-819. [PMID: 21334596 DOI: 10.1016/j.apergo.2011.01.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2010] [Revised: 09/23/2010] [Accepted: 01/25/2011] [Indexed: 05/30/2023]
Abstract
Job rotation is an intuitive approach to distributing work to minimize muscular fatigue. The purpose of the current study was to evaluate rotation between lifting and gripping on muscle activity and effort. Ten male participants performed all 4 combinations of two 15 min tasks in 30 min trials split between separate days to prevent fatigue. The tasks of lifting a 12 kg box and gripping at 20% of maximum were performed 6 times per minute (5 s work: 5 s rest). Muscle activity (percentiles, gaps) and perceived effort were significantly affected by the task combinations. The forearm and upper erector spinae muscles did not benefit as greatly from rotating between lifting and gripping tasks as the lower erector spinae, deltoid or trapezius. In addition to gross task differences, overlaps in muscle activity between "low back" and "upper extremity" tasks must be considered when creating effective job rotation schemes.
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Affiliation(s)
- Peter J Keir
- Occupational Biomechanics Laboratory, Department of Kinesiology, McMaster University, Hamilton, ON L8S4K1, Canada.
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28
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Engkvist IL, Svensson R, Eklund J. Reported occupational injuries at Swedish recycling centres - based on official statistics. ERGONOMICS 2011; 54:357-366. [PMID: 21491278 DOI: 10.1080/00140139.2011.556261] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Swedish recycling centres are manned facilities for waste collection. There is no special category in the official injury statistics for employees at recycling centres, which precludes a straightforward analysis of reported occupational injuries. This study aimed at identifying the frequency of reported accidents and diseases and the type of events that contribute to such injuries at recycling centres, based on official injury statistics. The employees were identified as being affected by more than three to five times as many accidents compared with the total workforce in Sweden. The reported accidents had occurred during a wide range of situations, but most frequently during manual handling of waste. Reported work-related diseases were mostly associated with musculoskeletal disorders, mainly due to heavy lifting. A more detailed classification of sanitation professions and workplaces in the official injury statistics would facilitate future studies of injuries in a specific professional category, e.g. employees at recycling centres. Suggestions for prevention are given. STATEMENT OF RELEVANCE: The present article describes all reported work accidents and diseases among employees at recycling centres from 1992 to February 2005. It also highlights the problem of identifying new working groups in the official statistics and gives advice for a detailed classification to facilitate such future studies of injuries.
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Affiliation(s)
- I-L Engkvist
- Division of Physiotherapy, Linkoping University, Linkoping, Sweden.
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Kuijer PPFM, Sluiter JK, Frings-Dresen MHW. Health and safety in waste collection: Towards evidence-based worker health surveillance. Am J Ind Med 2010; 53:1040-64. [PMID: 20568268 DOI: 10.1002/ajim.20870] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Waste collectors around the world are at risk for work-related disorders and injuries. The aim of this study was to assess work demands, acute physiologic responses, illnesses, and injuries as a starting point for worker health surveillance (WHS). METHODS A systematic search was performed in PubMed and Embase on work demands, acute bodily responses, health, and injuries. A quality assessment and evidence synthesis was performed. RESULTS From a total of 379 retrieved studies, 50 studies fulfilled the inclusion criteria. Waste collecting varied from informal manual gathering to semi-automated systems. Most studies ("number of studies") on work demands and/or acute bodily responses addressed bioaerosols (14). Studies of health effects addressed respiratory complaints (8), and those on injuries addressed acute musculoskeletal disorders (3). Strong evidence is available that exposure to bioaerosols exceeds recommendations. Moderate evidence is available for an increased risk of respiratory complaints and musculoskeletal injuries, with significant odds ratios reported varying between 1.9-4.1 and 1.5-3.3, respectively. Limited evidence exists for gastrointestinal disorders and hearing loss. CONCLUSIONS WHS in waste collection is warranted for early detection of respiratory, gastrointestinal, and musculoskeletal disorders, and hearing loss.
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Affiliation(s)
- P Paul F M Kuijer
- Coronel Institute of Occupational Health, Academic Medical Center, University of Amsterdam, The Netherlands.
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Abstract
Trunk kinematics variables have been shown to be related to low back injury risk during lifting tasks and it was hypothesised that changes in hand-hold positions could influence trunk kinematics and thereby risk. Fourteen subjects lifted a 5 or 10 kg box using four different hand placement locations (two symmetric and two asymmetric) while their trunk kinematics (position, velocity and acceleration in the sagittal, coronal and transverse planes) were captured using the lumbar motion monitor (LMM). These kinematics data were then used to calculate the probability of high risk group membership (PHRGM) as defined in the LMM risk assessment model. The results showed significant effects of hand placement on trunk kinematics, resulting in significant changes in the PHRGM variable ranging from a low of 20% in a the symmetric low load condition to a high of 38% under the asymmetric, 10 kg condition. STATEMENT OF RELEVANCE: Manual materials handlers use a variety of hand-hold positions on boxes during lifting. Where a lifter grabs the box can influence the trunk kinematics during the lifting task and these kinematics have been shown to provide some insight into risk of low back injury. This study documents the trunk postures and kinematics as a function of hand-hold position.
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Affiliation(s)
- Omid Haddad
- The Ergonomics Laboratory, Department of Industrial and Manufacturing Systems Engineering, Iowa State University, Ames, IA 50011-2164, USA
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Scuffham AM, Firth EC, Stevenson MA, Legg SJ. Tasks considered by veterinarians to cause them musculoskeletal discomfort, and suggested solutions. N Z Vet J 2010; 58:37-44. [DOI: 10.1080/00480169.2010.64872] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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What characterizes cleaners sustaining good musculoskeletal health after years with physically heavy work? Int Arch Occup Environ Health 2009; 82:1015-22. [PMID: 19199102 DOI: 10.1007/s00420-009-0401-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2008] [Accepted: 01/18/2009] [Indexed: 10/21/2022]
Abstract
OBJECTIVES The aim of this case-control study was to investigate characteristics of cleaners with good musculoskeletal health after years with physically heavy work. METHODS One hundred and 41 female seniority cleaners participated. Twenty-five reported no musculoskeletal symptoms, whereas 83 reported severe symptoms in the low back, neck shoulders or upper limbs. The groups were of matching age, height, body weight and seniority (19 years). Muscular strength was recorded by isometric maximal voluntary contractions on a day without pain. Exposure to physical risk factors at work, psychosocial work factors, and leisure time physical activity were assessed by a postal questionnaire. RESULTS Cleaners with good musculoskeletal health were not reporting different exposure to physical risk factors at work or leisure time physical activity, but had higher muscular strength and reported higher influence at work than cleaners with severe symptoms. CONCLUSIONS These findings suggest that muscular strength and influence at work are of relevance for sustaining good musculoskeletal health in workers with physically heavy work.
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Garg A, Kapellusch JM. Applications of biomechanics for prevention of work-related musculoskeletal disorders. ERGONOMICS 2009; 52:36-59. [PMID: 19308818 DOI: 10.1080/00140130802480794] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
This paper summarises applications of biomechanical principles and models in industry to control musculoskeletal disorders of the low back and upper extremity. Applications of 2-D and 3-D biomechanical models to estimate compressive force on the low back, the strength requirements of jobs, application of guidelines for overhead work and application of strain index and threshold limit value to address distal upper extremity musculoskeletal disorders are presented. Several case studies applied in the railroad industry, manufacturing, healthcare and warehousing are presented. Finally, future developments needed for improved biomechanical applications in industry are discussed. The information presented will be of value to practising ergonomists to recognise how biomechanics has played a significant role in identifying causes of musculoskeletal disorders and controlling them in the workplace. In particular, the information presented will help practising ergonomists with how physical stresses can be objectively quantified.
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Affiliation(s)
- Arun Garg
- Industrial Engineering, University of Wisconsin-Milwaukee, Milwaukee, WI, USA.
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Barrero LH, Katz JN, Perry MJ, Krishnan R, Ware JH, Dennerlein JT. Work pattern causes bias in self-reported activity duration: a randomised study of mechanisms and implications for exposure assessment and epidemiology. Occup Environ Med 2009; 66:38-44. [PMID: 18805887 PMCID: PMC3257319 DOI: 10.1136/oem.2007.037291] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Self-reported activity duration is used to estimate cumulative exposures in epidemiological research. OBJECTIVE The effects of work pattern, self-reported task dullness (a measure of cognitive task demand), and heart rate ratio and perceived physical exertion (measures of physical task demands) on error in task duration estimation were investigated. METHODS 24 participants (23-54 years old, 12 males) were randomly assigned to execute three tasks in either a continuous (three periods of 40 continuous minutes, one for each task) or a discontinuous work pattern (40 min tasks each divided into four periods of 4, 8, 12 and 16 min). Heart rate was measured during tasks. After completing the 2 h work session, subjects reported the perceived duration, dullness and physical exertion for each of the three tasks. Multivariate models were fitted to analyse errors and their absolute value to assess the accuracy in task duration estimation and the mediating role of task demands on the observed results. RESULTS Participants overestimated the time spent shelving boxes (up to 38%) and filing journals (up to 9%), and underestimated the time typing articles (up to -22%). Over- and underestimates and absolute errors were greater in the discontinuous work pattern group. Only the self-reported task dullness mediated the differences in task duration estimation accuracy between work patterns. CONCLUSIONS Task-related factors can affect self-reported activity duration. Exposure assessment strategies requiring workers to allocate work time to different tasks could result in biased measures of association depending on the demands of the tasks during which the exposure of interest occurs.
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Affiliation(s)
- L H Barrero
- Department of Environmental Health, Harvard School of Public Health, Boston, MA 02215, USA
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Hanse JJ, Winkel J. Work organisation constructs and ergonomic outcomes among European forest machine operators. ERGONOMICS 2008; 51:968-981. [PMID: 18568958 DOI: 10.1080/00140130801961893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
The aims of the study were to: 1) create work organisation constructs for forest machine operators; 2) examine relationships between these work organisation constructs and different ergonomic outcomes. The study was carried out among forest machine operators in six European countries and was based on a questionnaire survey (n = 358). Exploratory factor analysis (EFA) was used in the formation of the construct measures of work organisation. The EFA resulted in a five-factor structure. The factors were named 'job control', 'variation', 'job rotation', 'breaks' and 'rate of work'. Three multiple regression analyses were carried out separately for the dependent variables job satisfaction, musculoskeletal symptoms and headache/sleeping problems. All regression analyses resulted in significant overall models. The highest explained variance among the dependent variables was found for job satisfaction (R = 0.51, i.e. 'large' effect size). The unique contribution of the work organisation constructs varied in the models, but 'job rotation' contributed significantly in all regression models. The results may be used as a source for ergonomic improvements to work organisation. The present study was performed as part of the EU project 'ErgoWood', which resulted in a European handbook for mechanised forest operations (Gellerstedt et al. 2005). The results delivered part of the evidence base for a toolbox in this handbook regarding changes in work organisation to improve health and performance.
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Wells R, Mathiassen SE, Medbo L, Winkel J. Time--a key issue for musculoskeletal health and manufacturing. APPLIED ERGONOMICS 2007; 38:733-44. [PMID: 17379179 DOI: 10.1016/j.apergo.2006.12.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2005] [Revised: 11/13/2006] [Accepted: 12/11/2006] [Indexed: 05/14/2023]
Abstract
Time is a key issue for both ergonomists and engineers when they engage in production system interventions. While not their primary purpose, the actions of engineers have major effects on biomechanical exposure; possibly of much greater magnitude than many ergonomics interventions. This paper summarises the aims, actions and tools of engineers and ergonomists, emphasising time-related outcomes. Activities of the two groups when attempting to manipulate time aspects of work may be contradictory; engineers wishing to improve production and ergonomists aiming at better health as well as contributing to production. Consequently, tools developed by ergonomists for assessing time aspects of work describe rest patterns, movement velocities or daily duration of exposures, while engineering tools emphasise time-efficient production. The paper identifies measures that could be used to communicate time-relevant information between engineers and ergonomists. Further cooperation between these two stakeholders as well as research on the topic are needed to enable ergonomists to have a larger impact on the design of production systems.
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Affiliation(s)
- Richard Wells
- Kinesiology Department, University of Waterloo, Waterloo, Canada.
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Jaturanonda C, Nanthavanij S, Chongphaisal P. A survey study on weights of decision criteria for job rotation in Thailand: comparison between public and private sectors. INTERNATIONAL JOURNAL OF HUMAN RESOURCE MANAGEMENT 2006. [DOI: 10.1080/09585190600965324] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Bongers PM, Ijmker S, van den Heuvel S, Blatter BM. Epidemiology of work related neck and upper limb problems: psychosocial and personal risk factors (part I) and effective interventions from a bio behavioural perspective (part II). JOURNAL OF OCCUPATIONAL REHABILITATION 2006; 16:279-302. [PMID: 16850279 DOI: 10.1007/s10926-006-9044-1] [Citation(s) in RCA: 238] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Work related neck and upper limb symptoms have a multi-factorial origin. Possible risk factors are of a physical, psychosocial or personal origin. These factors can reinforce each other and their influence can also be mediated by cultural or societal factors. Initially, most research on neck and upper limb symptoms focused on work-related physical exposure. Nowadays, psychosocial work characteristics are recognized as important risk factors. Various models have been developed to offer frameworks for possible pathways, but their empirical support is still not conclusive. In part I of this paper an overview is presented of the results of recent epidemiological studies on work related psychosocial and personal risk factors for neck and upper limb symptoms. In addition, the interplay between these factors and the possible intermediate role of an individuals work style in this process is explored. In contrast to previous reviews, it is now possible to base the conclusions on the effect of work related psychosocial factors on neck and upper limb symptoms on quite a few longitudinal studies. These studies show that high work demands or little control at work are often related to these symptoms. However, this relationship is neither very strong nor very specific. Perceived stress is studied in not as many studies but more consistently related to neck and upper limb symptoms. This also applies to general distress or other pain (co-morbidity). Job dissatisfaction does not contribute to neck and upper limb symptoms. Too little research on personal characteristics is available to draw any conclusions. It is plausible that behavioural aspects, such as work style, are of importance in the etiology of work related upper limb symptoms. However, studies concerning these factors are promising but too scarce to draw conclusions. Future studies should address these behavioural aspects. In part II, the recent studies on the effectiveness of preventive measures for work related neck and upper limb problems are discussed. Few randomised or non randomised controlled trials have been carried out to evaluate the effectiveness of individual or organisational interventions to improve work related psychosocial factors. Very few have reported on the preventive effect for work related neck and upper limb symptoms. Therefore, there is a great need for additional high quality trials before any conclusions on effectiveness of bio-behavioural interventions for reduction of neck and upper limb problems and return to work after these symptoms can be made. From the low back pain intervention research can be learned that interventions should best be targeted to both the worker and the organisation and that interventions will only be successful when all stakeholders are involved.
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Affiliation(s)
- P M Bongers
- TNO Quality of Life, Work and Employment, Hoofddorp, The Netherlands.
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Mathiassen SE. Diversity and variation in biomechanical exposure: what is it, and why would we like to know? APPLIED ERGONOMICS 2006; 37:419-27. [PMID: 16764816 DOI: 10.1016/j.apergo.2006.04.006] [Citation(s) in RCA: 104] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Trends in global working life suggest that the occurrence of jobs characterized by long-lasting low-level loads or repetitive operations is increasing. More physical "variation" is commonly believed to be a remedy against musculoskeletal disorders in such jobs. One aim of the present paper was to shortly review the validity of this conviction. An examination of the available epidemiologic literature pointed out that the effectiveness of initiatives like job rotation or more breaks is weakly supported by empirical evidence, and only for short-term psychophysical outcomes. Only a limited number of studies have been devoted to physical variation, and concepts and metrics for variation in biomechanical exposure are not well developed. Thus, as a second objective, the paper proposes a framework for investigating and evaluating aspects of exposure variation, based on explicit definitions of variation as "the change in exposure across time" and diversity as "the extent that exposure entities differ". Operational methods for assessing these concepts are also discussed.
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Affiliation(s)
- Svend Erik Mathiassen
- Centre for Musculoskeletal Research, University of Gävle, P.O. Box 7629, SE 90712 Umeå, Sweden.
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