Comparison of concepts in easy-to-use methods for MSD risk assessment

Impact of Fatigue on Ergonomic Risk Scores and Foot Kinetics: A Field Study Employing Inertial and In-Shoe Plantar Pressure Measurement Devices

(1) Background: Occupational fatigue is a primary factor leading to work-related musculoskeletal disorders (WRMSDs). Kinematic and kinetic experimental studies have been able to identify indicators of WRMSD, but research addressing real-world workplace scenarios is lacking. Hence, the authors of this study aimed to assess the influence of physical strain on the Borg CR-10 body map, ergonomic risk scores, and foot pressure in a real-world setting. (2) Methods: Twenty-four participants (seventeen men and seven women) were included in this field study. Inertial measurement units (IMUs) (n = 24) and in-shoe plantar pressure measurements (n = 18) captured the workload of production and office workers at the beginning of their work shift and three hours later, working without any break. In addition to the two 12 min motion capture processes, a Borg CR-10 body map and fatigue visual analog scale (VAS) were applied twice. Kinematic and kinetic data were processed using MATLAB and SPSS software, resulting in scores representing the relative distribution of the Rapid Upper Limb Assessment (RULA) and Computer-Assisted Recording and Long-Term Analysis of Musculoskeletal Load (CUELA), and in-shoe plantar pressure. (3) Results: Significant differences were observed between the two measurement times of physical exertion and fatigue, but not for ergonomic risk scores. Contrary to the hypothesis of the authors, there were no significant differences between the in-shoe plantar pressures. Significant differences were observed between the dominant and non-dominant sides for all kinetic variables. (4) Conclusions: The posture scores of RULA and CUELA and in-shoe plantar pressure side differences were a valuable basis for adapting one-sided requirements in the work process of the workers. Traditional observational methods must be adapted more sensitively to detect kinematic deviations at work. The results of this field study enhance our knowledge about the use and benefits of sensors for ergonomic risk assessments and interventions.

Ergonomic investigations on novel dynamic postural estimator using blaze pose and transfer learning

The aim is to develop a computer-based assessment model for novel dynamic postural evaluation using RULA. The present study proposed a camera-based, three-dimensional (3D) dynamic human pose estimation model using 'BlazePose' with a data set of 50,000 action-level-based images. The model was investigated using the Deep Neural Network (DNN) and Transfer Learning (TL) approach. The model has been trained to evaluate the posture with high accuracy, precision, and recall for each output prediction class. The model can quickly analyse the ergonomics of dynamic posture online and offline with a promising accuracy of 94.12%. A novel dynamic postural estimator using blaze pose and transfer learning is proposed and assessed for accuracy. The model is subjected to a constant muscle loading factor and foot support score that could evaluate one person with good image clarity at a time.Practitioner summary: A detailed investigation of dynamic work postures is largely missing in the literature. Experimental analysis has been performed using transfer learning, BlazePose, and RULA action levels. An overall accuracy of 94.12% is achieved for dynamic postural assessment.

Structured Multidisciplinary work Evaluation Tool (SMET) questionnaire: Translation, cultural adaptation and psychometric evaluation of the Persian version

BACKGROUND

To assess relevant environmental conditions in any work-setting requires a multidisciplinary perspective that is practical, valid, and reliable. This includes the physical, environmental, and psychosocial risk-factors. The Structured Multidisciplinary work Evaluation Tool (SMET) questionnaire simultaneously considers multiple work-related demands.

OBJECTIVE

This study translated and culturally adapted the SMET into Persian and evaluated its psychometric properties in Persian industrial workers.

METHODS

Cross-sectional translation and cross-cultural adaptation in five standardized phases. A convenience sample (n = 211) recruited from an industrial-occupation setting completed: the SMET; and the Rapid Upper Limb Assessment (RULA), and National Aeronautics and Space Administration Task Load Index (NASA-TLX) criteria; plus light and noise levels were concurrently assessed. Psychometric properties included: validity, with face (from confirmed language clarity, simplicity, and readability), content (via the content validity index, CVI, for equivalency and relevancy), criterion (through Pearson's r correlation with relevant criteria), and construct (through known group validity between participants with/without work-related musculoskeletal disorders, WMSDs); internal consistency (Cronbach's α); and test-retest reliability (intraclass correlation coefficient, ICC2.1).

RESULTS

Validity was confirmed with: face through the adaptation; content from suitable CVI values for items (CVI range = 0.78-1.0) and scale-total (CVI = 0.86); criterion from SMET associations with levels for light (r = - 0.42) and noise (r = 0.21), plus RULA (r = 0.42) and NASA-TLX (r = 0.39); and construct through participants with WMSD having significantly higher SMET total-scores (p = 0.01). Internal consistency (α= 0.89) and reliability (ICC2.1 = 0.87) were acceptable and strong.

CONCLUSION

This study indicated that the SMET Persian version had acceptable psychometric properties in an industrial occupational setting. Further investigation in longitudinal populations is recommended.

Psychosocial hazards play a key role in differentiating MSD risk levels of workers in high-risk occupations

OBJECTIVES

Workplace management practices targeting risk of musculoskeletal disorders (MSDs) fail to reflect evidence that risk is affected by psychosocial as well as physical hazards. To promote improved practices in occupations where MSD risk is highest, better information is needed on how psychosocial hazards, combined with physical hazards, affect risk of workers in these occupations.

METHODS

Survey ratings of physical and psychosocial hazards by 2329 Australian workers in occupations with high MSD risk were subjected to Principal Components Analysis. Latent Profile Analysis of hazard factor scores identified different combinations of hazards to which latent subgroups of workers were typically exposed. Survey ratings of frequency and severity of musculoskeletal discomfort or pain (MSP) generated a pre-validated MSP score and its relationship with subgroup membership was analysed. Demographic variables associated with group membership were investigated using regression modelling and descriptive statistics.

RESULTS

Analyses identified three physical and seven psychosocial hazard factors and three participant subgroups with differing hazard profiles. Profile group differences were greater for psychosocial than physical hazards, and MSP scores out of 60 ranged from 6.7 for the low hazard profile (29% of participants) to 17.5 for the high hazard profile (21%). Differences between occupations in hazard profiles were not large.

CONCLUSIONS

Both physical and psychosocial hazards affect MSD risk of workers in high-risk occupations. In workplaces such as this large Australian sample where risk management has focused on physical hazards, actions targeting psychosocial hazards may now be the most effective way to reduce risk further.

Selection of ergonomic risk assessment method with pythagorean fuzzy sets: practice in emergency medical services

It is difficult to evaluate ergonomic risk factors in occupations with unpredictable tasks, random demands, and variable settings such as emergency medical services (EMS). This study deals with the problem of selecting an ergonomic risk-evaluation method with Pythagorean Fuzzy Sets (PFSs) based Pythagorean Fuzzy AHP (PF-AHP) and Pythagorean Fuzzy WASPAS (PF-WASPAS) methodology. The method selection criteria were obtained by consulting five different anonymous experts on the candidate criteria obtained from the literature review. The final four main criteria and ten sub-criteria were then decided. After the determination of the decision criteria, five experts were asked to evaluate the criteria and to express their opinions on criteria-alternative scoring by means of a questionnaire for method selection. A two-step method is suggested for the selection of the ergonomic risk-evaluation method. In the first step, PF-AHP is utilized in order to identify the weight of criteria used in the method selection. In the second step, the PF-WASPAS method is proposed in order to OWAS, RULA, and REBA methods. The accuracy and validity of the suggested hybrid model is tested with real data in İstanbul Ambulance Service stations. A sensitivity analysis is carried out to test the reliability of the model. Moreover a comparative analysis is carried out with AHP and Fuzzy AHP methods to identify criteria weights. Study results show that REBA is the most appropriate ergonomic risk-evaluation method in EMS.

Ergonomics-Related and Work-Related Musculoskeletal Disorders in A High-Hazard Factory in Hatay Region

Objectives: The most common work-related diseases are musculoskeletal system disease. This study aims to determine the prevalence of work-related musculoskeletal disorders (WMSDs) in a high-hazard factory and to determine sociodemographic, occupational, and ergonomic risks. Methods: The research is cross-sectional and was conducted in a high-hazard factory, in Hatay, in 2017. The research population was all factory employees (N=190), and it was aimed to reach the whole population. Of the (97.3%), 185 employees participated in the study. Anthropometric measurements, the Cornell Musculoskeletal Discomfort Scale, the observation-based Rapid Upper Limb Assessment (RULA) Ergonomic Risk Analysis Scale, and a questionnaire developed by the researchers are used for data collection. In the statistical analyses p<0,05was accepted as significant. Results According to the Cornell Scale, the frequency of WMSDs was 58.9%. The most common WMSDs were in the lumbar region (34.1%). According to the RULA Scale, 31.9% of the employees had 3rd and 4th-degree ergonomic risk. There were linear relationships between the Cornell Waist Score and each of the three RULA scores (p<0.001). The risk factors for WMSDs in the lumbar region were the presence of chronic disease (OR=5.35), hand tool use (OR=2.63), not having had a work accident (OR=0.04) and RULA scores (OR=1.61), Conclusion: Approximately one-third of the high-hazard factory employees had a high ergonomic risk. WMSDs existed in more than half of the employees. As the ergonomic risk increases, WMSDs increase.

Development of an ergonomics risk assessment tool for repetitive task assessment (RTRA)

BACKGROUND

Most ergonomics assessment tools for repetitive task have been used in industries which are mainly focused on assessing the biomechanical risk factors that affect musculoskeletal disorders (MSDs)rather than the psychosocial and work environment risk factors.

OBJECTIVE

To develop a tool for Repetitive Task Risk Assessment (RTRA) and Rapid Upper Limb Assessment (RULA) that can identify biomechanical, physical stress and psychosocial risk factors, prioritize risk reduction action and systematic record keeping.

METHODS

The study consisted of 2 phases; tool development and evaluation of the contents of risk factors by 7 ergonomic experts and intra-rater and inter-rater reliability and validity tests of the tool by 1 researcher and 9 Thai practitioners to assess 30 repetitive tasks.

RESULTS

RULA was modified by adding more biomechanical risk, combining psychosocial and work environment risk factors lead to MSD become the first prototype of RTRA. The Item-Objective Congruence Index (IOC) validated 20 items on usability of each step of the RTRA ranged between 0.64 and 0.93. The examination of the overall intra-rater reliability was 0.932 (95% CI: 0.862-0.967) and the overall inter-rater was 0.956 (95% CI: 0.909-0.978).

CONCLUSION

The tool has high test-retest reliability. There is a suggestion for researchers to understand more on the identification of multiple risk factors in one assessment tool and consider a risk-level rating and scoring for prioritizing risk reduction.

Ergonomic risk factors and work-related musculoskeletal disorders in clinical physiotherapy

Objectives

The purpose of this study was to objectively quantify and evaluate the ergonomic risk of clinical physiotherapy practices and evaluate physiotherapists for work-related musculoskeletal disorders and pain.

Methods

Twenty-nine physiotherapists in the rehabilitation department of a large-scale tertiary hospital were recruited in this study. The sampling period lasted for 2 weeks for each physiotherapist and interval sampling was adopted to avoid duplication of cases. Therapist posture during physiotherapy was captured, tracked and analyzed in real time using structured light sensors with an automated assessment program. The quantification of ergonomic risk was based on REBA (Rapid Entire Body Assessment) and the RPE (perceived physical exertion) scores of the therapists were recorded before and after treatment, respectively.

Results

Two hundred and twenty-four clinical physiotherapy cases were recorded, of which 49.6% were high risk and 33% were very high risk, with none of the cases presenting negligible risk. The positioning (p < 0.001) of physiotherapist had a considerable impact on ergonomic risk and pediatric physiotherapy presented a higher risk to physiotherapists than adults (p < 0.001). The RPE score of physiotherapist after performing physiotherapy was greater than before physiotherapy and was positively correlated with the REBA distribution.

Conclusion

Our study creates an automatic tool to assess the ergonomic risk of physiotherapy practices and demonstrates unacceptable ergonomic risk in common practices. The high prevalence of musculoskeletal disorders and pains recommends that rehabilitation assistance devices should be optimized and standard ergonomic courses should be included in physiotherapists' training plans.

A Mixed-Methods Investigation of Occupational Health Specialists' Knowledge and Application of Pen-and-Paper Observational Methods for Ergonomics Assessment

OCCUPATIONAL APPLICATIONSErgonomic risk assessment is a key step in managing work-related musculoskeletal disorders. Diverse assessment methods exist, and errors may occur if inappropriate methods are selected. Understanding the level of knowledge, how to use methods, and exploring factors affecting erroneous usage of these methods, can provide useful information for health and safety regulatory authorities and decision-makers to identify problems and determine an action plan to eliminate them. We found that Iranian occupational health specialists have little knowledge about the types of pen-and-paper observational methods (OMs), and most of them use a limited number of these methods. Content analysis of interviews identified three main categories of influential factors and 12 subcategories. The main categories were educational, individual, and organizational factors. These results suggest the need for more effort to ensure that practitioners possess better knowledge and skills in the selection and application of pen-and-paper OMs.

Ergonomists' experiences of executing occupational health surveillance for workers exposed to hand-intensive work: a qualitative exploration

Background

In order to reduce work-related upper limb disorders, the Swedish Work Environment Authority introduced an occupational health surveillance targeting hand-intensive work. A process model, aimed at supporting the employers as well as the occupational health service provider (i.e., ergonomist) in the work process with the occupational health surveillance, was developed. The objective of this qualitative study was to explore ergonomists’ experiences of the execution of occupational health surveillance for hand-intensive work when following the novel process model as well as factors influencing the execution.

Methods

Semi-structured individual interviews were conducted with ten ergonomists on one occasion regarding their experience of following the work process. Qualitative content analysis with an inductive approach was used for analyzing the data.

Results

The ergonomists’ experiences were summarized in one theme “A joint roadmap supporting a participatory process” and two categories “Clear structure provided by the components” and “The process influenced by collaboration and context”. The ergonomists valued being guided by the systematics of the model, which provided structure and clarity in their work. Factors affecting the execution were related to communication deficiencies and uncertainties regarding expectations between different roles and functions (e.g., ergonomists and contact person, lack of information to workers). Additional factors, for instance, companies’ routines and the ergonomist’s intra-organizational support, such as access to IT-resources, could also affect the process.

Conclusions

The findings reveal that this process model facilitates the ergonomists’ work and cooperation with a client company. However, the process model needs to be developed and accompanied by a guideline with information related to the process, including e.g., description of a start-up meeting and of the roles/functions of the involved parties.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-022-08601-2.

Automatic Ergonomic Risk Assessment Using a Variational Deep Network Architecture

Ergonomic risk assessment is vital for identifying work-related human postures that can be detrimental to the health of a worker. Traditionally, ergonomic risks are reported by human experts through time-consuming and error-prone procedures; however, automatic algorithmic methods have recently started to emerge. To further facilitate the automatic ergonomic risk assessment, this paper proposes a novel variational deep learning architecture to estimate the ergonomic risk of any work-related task by utilizing the Rapid Entire Body Assessment (REBA) framework. The proposed method relies on the processing of RGB images and the extraction of 3D skeletal information that is then fed to a novel deep network for accurate and robust estimation of REBA scores for both individual body parts and the entire body. Through a variational approach, the proposed method processes the skeletal information to construct a descriptive skeletal latent space that can accurately model human postures. Moreover, the proposed method distills knowledge from ground truth ergonomic risk scores and leverages it to further enhance the discrimination ability of the skeletal latent space, leading to improved accuracy. Experiments on two well-known datasets (i.e., University of Washington Indoor Object Manipulation (UW-IOM) and Technische Universität München (TUM) Kitchen) validate the ability of the proposed method to achieve accurate results, overcoming current state-of-the-art methods.

Workplace physical and psychosocial hazards: A systematic review of evidence informed hazard identification tools

Prevention of musculoskeletal disorders (MSDs) requires the identification of physical and psychosocial hazards. This systematic review aimed to identify accessible and validated tools, for the assessment of workplace physical and psychosocial hazards, and consolidate the results into a matrix for use by work health and safety (WHS) professionals. Web of Science, Medline, ProQuest Central, and PsychInfo electronic databases, along with grey literature, were searched (Jan 1990 to July 2020). Studies that included tools with evidence of validity for the identification of physical hazards, psychosocial hazards, or both were included. A total of 83 tools were identified and then reviewed to ensure the tools were accessible. The final matrix included a total of 26 tools (16 physical, 4 psychosocial, and 6 comprehensive [physical and psychosocial]). Evidence on best practice for MSD mitigation supports the need for a comprehensive approach; however, the current review identified limitations in the availability of such tools to support WHS professionals.

Comparison of LEBA and RULA Based on Postural Load Criteria and Epidemiological Data on Musculoskeletal Disorders

Various observational methods have been developed and applied in industrial settings with the aim of preventing musculoskeletal disorders (MSDs). This study aimed to compare the Rapid Upper Limb Assessment (RULA), a representative observational method, and the Loading on the Entire Body Assessment (LEBA), a newly developed tool for assessing postural loads and their association with MSDs. The two methods were compared in various categories, including general characteristics, risk levels, postural load criteria, association with MSDs, influencing factors, and inter- and intra-rater reliabilities based on relevant previous studies. The results showed that compared to the RULA, the LEBA was better at evaluating various factors affecting postural loads and assessing musculoskeletal loadings, was better correlated with various postural load criteria, could predict the association with MSDs more accurately, and had higher inter- and intra-rater reliabilities. Based on these comparisons, it seems that the LEBA may be better than the RULA for estimating postural stress and predicting the association with MSDs.

Systematic Comparison of OWAS, RULA, and REBA Based on a Literature Review

This study aimed to systematically compare three representative observational methods for assessing musculoskeletal loadings and their association with musculoskeletal disorders (MSDs): Ovako Working Posture Analysis System (OWAS), Rapid Upper Limb Assessment (RULA), and Rapid Entire Body Assessment (REBA). The comparison was based on a literature review without time limitations and was conducted on various factors related to observational methods. The comparisons showed that although it has a significant limitation of comprising only two classifications for the leg postures, (1) the RULA is the most frequently used method among the three techniques; (2) many studies adopted the RULA even in evaluation of unstable lower limb postures; (3) the RULA assessed postural loads as higher risk levels in most studies reviewed in this research; (4) the intra- and inter-reliabilities for the RULA were not low; and (5) the risk levels assessed by the RULA were more significantly associated with postural load criteria such as discomfort, MHTs and % capable at the trunk, and MSDs.

Accuracy of a markerless motion capture system for postural ergonomic risk assessment in occupational practice

Established methods for postural ergonomic risk assessment in occupational practice are mostly time-consuming and need to be conducted by experts. Use of technology could improve postural ergonomic risk assessments with regard to time efficiency and accuracy. A study was conducted to assess the accuracy of a markerless motion capture system (Microsoft Kinect V2) compared to a marker-based motion capture system (Vicon Bonita). Angles of different body segments were analysed. The results show major inaccuracies of the markerless motion capture system for capturing axial trunk rotation (mean angular deviation of 14.04°) indicating that potential health risks could be underestimated. Combined working postures of axial trunk rotation and arm anteversion show issues with self-occlusion. Based on the findings, it is discussed whether the detected inaccuracies for axial trunk rotation are likely to lead to overestimation or underestimation of potential health risks when conducting an ergonomic risk assessment.

Low back and neck pain: objective and subjective measures of workplace psychosocial and physical hazards

OBJECTIVE

This study explored the role of occupational physical activity (OPA), physical demands and psychosocial work-related factors on low back pain (LBP) and neck-shoulder pain (NSP) amongst workers with physically demanding professions.

METHODS

Data from 331 participants within the service and manufacturing sector in the Flemish Employees' Physical Activity (FEPA) study were used, with objective measures of OPA and subjective measures of physical and psychosocial work environment. A modified Nordic questionnaire collected data on LBP and NSP.

RESULTS

LBP (> 30 days over a year) was reported by 25% of participants, NSP (> 30 days over a year) by 30% and the composite measure of LBP/NSP simultaneously by 17%. Objective measures of OPA were not significantly associated with any pain groups. In the final model, self-reported physical demands were associated with NSP (OR 2.03, 95% CI 1.30-3.18) and LBP/NSP (OR 2.00, 95% CI 1.16-3.45) but not LBP. Job control was negatively associated with LBP (OR 0.59, 95% CI 0.35-0.99) and LBP/NSP (OR 0.54, 95% CI 0.3-0.98).

CONCLUSION

Objective measures were not associated with LBP or NSP. Self-reported measures provided insights into potential workplace hazards such as physical demands and job control which can be used to inform future strategies to prevent the development of LBP and NSP.

Common errors in selecting and implementing pen-paper observational methods by Iranian practitioners for assessing work-related musculoskeletal disorders risk: a systematic review

Objectives. This study aimed to determine the types and frequency of pen-paper observational methods (OMs) used by Iranian practitioners and to identify their errors in selecting and implementing these methods. Methods. This was a systematic review and analytical study of papers in which the OMs had been used. Scientific databases were analyzed from September 1970 to September 2018. Errors were determined based on a list of wrong practices both in the selection and implementation of methods. Three ergonomists carried out the process of identifying errors independently. Results. The most frequently used methods were rapid upper limb assessment (RULA), quick exposure check (QEC) and rapid entire body assessment (REBA), respectively. Errors in selecting and implementing pen-paper OMs were 53.3 and 36.4%, respectively. Conclusions. Despite the abundant number of pen-paper OMs, Iranian practitioners use few of them. The high rate of errors can indicate a lack of knowledge and skills among practitioners for selecting and implementing OMs. The development of decision-making tools may help practitioners to select appropriate pen-paper OMs for assessing different types of tasks.

The Work Organisation Assessment Questionnaire: validation for use with community nurses and paramedics

AIM

The current study aimed to assess the suitability of the Work Organisation Assessment Questionnaire (WOAQ) for use in the healthcare sector, specifically for community nurses and paramedics. Community nurses and paramedics work in complex environments and are exposed to a range of psychosocial hazards linked with the development of musculoskeletal and mental health disorders. To reduce the incidence of these disorders, assessment and then control of psychosocial hazards is required. WOAQ addresses this need through an employee survey to identify key hazards, with the responses used to underpin a participative development of solutions.

METHOD

Using a bifactor model, the WOAQ and five nested factors were cross validated using a sample of 1255 community nurses and paramedics using data collected in 2011 and 2012.

RESULTS

The results of metric invariance testing demonstrated that the WOAQ is a valid tool across health organizations. Full invariance testing at mean constructs level also showed strong support of validity of the 'general score' of the WOAQ. However, minor mean differences were found between two nested factors (workload issues and the relationships with the coworkers).

CONCLUSION

The WOAQ is a valid assessment tool for application within the nursing and paramedic settings. Practical implications for these findings in healthcare settings are discussed.

A kinematic posture analysis of neurological assistants in their daily working practice-a pilot study

Background

The aim of this pilot study was to analyze postures during the work of neurologists with respect to their occupational activities.

Methods

A total data material of 64.8 h (3885.74 min) of nine (three m/six f) neurologists (assistant physicians) was collected. Kinematic data were collected using the CUELA system (electro-goniometry). In addition, the occupational tasks performed on-site were subject to a detailed objective activity analysis. All activities were assigned to the categories “Office activities” (I), “Measures on patients” (II) and “Other activities” (III). The angle values of each body region (evaluation parameters) were evaluated according to ergonomic ISO standards.

Results

Only 3.4% of the working hours were spent with (II), while 50.8% of time was spent with (I) and 45.8% with (III). All tasks of category (II) revealed an increased ergonomic risk to the head, neck, trunk and back areas. During category (I) especially neck and back movements in the sagittal plane showed higher ergonomic risk levels.

Conclusion

Despite frequently performed awkward body positions in (II), the ergonomic risk is considered as rather low, since the percentage time share totaled only 3.4%. As a result, “Office activities” have been detected as high predictor to cause stress load on the musculoskeletal system in the daily work of neurologists.

An Evaluation of Posture Recognition Based on Intelligent Rapid Entire Body Assessment System for Determining Musculoskeletal Disorders

Determining the potential risks of musculoskeletal disorders through working postures in a workplace is expensive and time-consuming. A novel intelligent rapid entire body assessment (REBA) system based on convolutional pose machines (CPM), entitled the Quick Capture system, was applied to determine the risk levels. The aim of the study was to validate the feasibility and reliability of the CPM-based REBA system through a simulation experiment. The reliability was calculated from the differences of motion angles between the CPM-based REBA and a motion capture system. Results show the data collected by the Quick Capture system were consistent with those of the motion capture system; the average of root mean squared error (RMSE) was 4.77 and the average of Spearman’s rho (ρ) correlation coefficient in the different 12 postures was 0.915. For feasibility evaluation, the linear weighted Cohen’s kappa between the REBA score obtained by the Quick Capture system and those from the three experts were used. The result shows good agreement, with an average proportion agreement index (P₀) of 0.952 and kappa of 0.738. The Quick Capture system does not only accurately analyze working posture, but also accurately determines risk level of musculoskeletal disorders. This study suggested that the Quick Capture system could be applied for a rapid and real-time on-site assessment.

The RAMP package for MSD risk management in manual handling - A freely accessible tool, with website and training courses

In this paper the RAMP Package is presented with the objective to facilitate the application of the RAMP tool to systematically manage MSD risks. The package consists of the RAMP tool (Risk Assessment and Management tool for manual handling Proactively), the RAMP website, and free, globally available online, training courses (MOOCs). An Action module used for managing identified MSD risks is introduced. The tool, encompassing a wide range of risks, is applicable to the whole risk management process. Furthermore, RAMP is openly available for download, and free to use. The RAMP tool and training materials were developed using a participative iterative methodology including researchers and practitioners. RAMP was downloaded in 86 countries in the first 26 months since its' launch and over 2400 learners from high-, middle- and low-income countries have joined the MOOCs. The RAMP Package meets organisations' needs for an accessible, comprehensive risk assessment and management tool.

Evaluation of scapular dyskinesis and ergonomic risk level in office workers

Purpose. The purpose of this study is to evaluate the association between ergonomic risk level and scapular dyskinesis in office workers. Methods. This cross-sectional study included office workers aged 20-65 years. A lateral scapular slide test (LSST) was used to evaluate scapular dyskinesis, and the quick exposure check (QEC) method was used to analyze the ergonomic risk level. Results. In all, 37 (45.7%) participants were men and 44 (54.3%) participants were women. Of the participants with scapular dyskinesis in any of the three LSST positions, 10.3% had low, 20.6% had medium, 30.9% had high and 37.9% had very high ergonomic risk level (p = 0.001). A low, positive linear correlation was observed between ergonomic risk level and LSST-1, LSST-2 and LSST-3 values. Conclusion. These results indicate that patients with scapular dyskinesis have a high ergonomic risk level. We believe that our work will serve as a foundation for intervention studies assessing ergonomic risk management.

Occupational Risk Evaluation Through Infrared Thermography: Development and Proposal of a Rapid Screening Tool for Risk Assessment Arising from Repetitive Actions of the Upper Limbs

Risk analysis is one of the main tools for preventing the occurrence of Work-Related Musculoskeletal Disorders. New methods of risk analysis should seek to be more agile and simplified, encouraging them to be widely applied in work environments. This paper aimed to develop a rapid tool for assessing the risk of developing Work-Related Musculoskeletal Disorders (WMSDs) arising from repetitive actions of the upper limbs, while using a thermographic camera to measure skin temperature variation. A workstation was developed in an environmentally controlled laboratory, representing the five levels of risk presented by the Occupational Repetitive Actions Index (OCRA) Index, which were performed by 32 participants for 20 min. each level. There was a significant change in forearm skin temperature at all risk levels (p < 0.001), with a positive linear correlation (r = 0.658 and p < 0.001), which led the authors to perform linear regression analysis for the forearm region. The Predicted OCRA Index calculation equation was successfully developed (R = 0.767 and R² = 0.588), while using as independent variables: air temperature and temperature variation of the forearm skin. The Predicted OCRA Index can be applied as a screening tool for large numbers of workers in the same company or sector, due to its speed of application and the determination of risk level, but it does not replace the original OCRA Index.

Towards an Ergonomic Assessment Framework for Industrial Assembly Workstations—A Case Study

Work-related musculoskeletal disorders (WMSD) are one of the main occupational health problems. The best strategy to prevent them lies on ergonomic interventions. The variety of industrial processes and environments, however, makes it difficult to define an all-purpose framework to guide these ergonomic interventions. This undefinition is exacerbated by recurrent introduction of new technologies, e.g., collaborative robots. In this paper, we propose a framework to guide ergonomics and human factors practitioners through all stages of assessment and redesign of workstations. This framework was applied in a case study at an assembly workstation of a large furniture enterprise. Direct observation of work activity and questionnaires were applied to characterize the workstations, the process, and the workers’ profiles and perceptions. An ergonomic multi-method approach, based on well-known and validated methods (such as the Finnish Institute of Occupational Health and Rapid Upper Limb Assessment), was applied to identify the most critical risk factors. We concluded that this approach supports the process redesign and tasks’ allocation of the future workstation. From these conclusions, we distill a list of requirements for the creation of a collaborative robot cell, specifying which tasks are performed by whom, as well as the scheduling of the human-robot collaboration (HRC).

An Overview of REBA Method Applications in the World

The objective of this work is to review literature, worldwide, in which the Rapid Entire Body Assessment (REBA) ergonomic assessment method was applied and count the number of times that REBA was applied together with other methods and subsequent incidence. The database used was the "Web of Science-Core Collection". Only scientific articles and bibliographic reviews were included, analysing a total of 314 documents and selecting only 91. The use of the REBA method is indicated in terms of knowledge, country, year and journal sectors. It was most used in the knowledge areas of "Manufacturing" (24.18%), "Agriculture, forestry and fishing" (21.98%) and in "Other activities" (19.78%). One of the benefits of REBA is that it evaluates different body parts: upper limbs (arm, forearm and wrist), lower extremities, trunk and neck. It is a useful method to identify the forced postures adopted by workers to thus develop improvement measures if necessary. It is concluded that REBA method use has increased over the last decade, probably due to the digitization of knowledge. It is almost always applied in combination with other methods, and its use can be a positive indicator of company sustainability.

On the OCRA Measurement: Automatic Computation of the Dynamic Technical Action Frequency Factor

OCRA (OCcupational Repetitive Action) is currently one of the most widespread procedures for assessing biomechanical risks related to upper limb repetitive movements. Frequency factor of the technical actions represents one of the OCRA elements. Actually, the frequency factor computation is based on workcycle video analysis, which is time-consuming and may lead to up to 30% of intra-operator variability. This paper aims at proposing an innovative procedure for the automatic counting of dynamic technical actions on the basis of inertial data. More specifically, a threshold-based algorithm was tested in four industrial case studies, involving a cohort of 20 workers. Nine combinations of the algorithm were tested by varying threshold values related to time and amplitude. The computation of frequency factor showed an average relative error lower than 5.7% in all industrial-based case studies after the appropriate selection of the time and amplitude threshold values. These findings open the possibility to use the threshold-based algorithm proposed here for the automatic computation of OCRA frequency factor, avoiding the time efforts in video analysis.

The APHIRM toolkit: an evidence-based system for workplace MSD risk management

Musculoskeletal disorders (MSDs) continue as one of the largest occupational health and safety problems worldwide. One reason for this situation is that current workplace risk management practices fail to meet some important evidence-based requirements for effective reduction of MSD risk. In particular: they largely fail to address risk arising from psychosocial hazards; do not allow sufficient participation by workers; and often fail to control risk at its sources.

To address these deficiencies, A Participative Hazard Identification and Risk Management (APHIRM) toolkit has been formulated in accordance with both a framework developed by the World Health Organisation and implementation science principles. It comprises a set of online tools that include automated data analysis and reporting modules, and procedures to guide users through the five stages of the conventional risk management cycle. Importantly, it assesses both hazard and risk levels for groups of people doing a particular job, focusing on the job overall rather than only on tasks deemed to be hazardous. Its intended users are workplace managers and consultants responsible for occupational health and safety, with active participation from workers also. Resultant risk control interventions are customized to address the main physical and psychosocial hazards identified for the target job, and repetitions of the risk management cycle enables ongoing evaluation of outcomes in terms of both hazard and risk levels.

Whole body biomechanical burden of healthcare workers: proposal for a complementary risk assessment and management tool (HOARA)

Introduction:

We have developed a new tool, named Holistic Approach Risk Assessment (HOARA), to support occupational safety and health professionals (OSH) in risk assessment and management when evaluating the biomechanical load of healthcare workers.

Objectives:

The primary aim of the HOARA is to support OSH in risk assessment and management of biomechanical hazards in healthcare facilities. This tool ensures a superior level of analysis by targeting independently various body compartments during all activities completed throughout the work shift. These include: head, neck, back and upper and lower limbs.

Methods:

For each body segment, ergonomic determinants were defined on the basis of previous literature, according to which task and job analyses were performed. Upon direct observation, ergonomic factors were given a score based on their temporal extent. Subsequently, action-body segment raw indices and weighted indices were calculated.

Results:

Results of the application of the method are shown. Of note, a relational database was set up to improve its usability.

Conclusions:

From an occupational health perspective, the HOARA, integrated with other methods, is expected to allow a more effective management of human resources, especially when assigning workers to specific jobs or tasks. Overall, the HOARA will be instrumental in assessing the impact of fitness for work judgments on work organization and its resources, in compliance with the guidelines from the Società Italiana di Medicina del Lavoro (SIML).

Investigation of observational methods assessing workload of static working postures based on surface electromyography

BACKGROUND:

A large number of different methods are available to identify and assess working postures. Although observation-based methods are most commonly used in practise, investigations showed different results regarding validity of such methods.

OBJECTIVE:

To investigate validity of one of the most commonly used observation-based assessment method in ergonomics, the Ovako Working Posture Analysing System (OWAS) and the European standard EN 1005-4 for evaluation of working postures, an experimental laboratory study was conducted.

METHODS:

Muscle activity was measured under combinations of static working postures of trunk inclination and shoulder flexion to compare these measurements and observation-based assessments according to OWAS and EN 1005-4. In order to investigate the magnitude of correspondence between muscle activity and observation-based assessments, Spearman rank correlation coefficients (r_s) were calculated.

RESULTS:

Significant correlations were found between OWAS and muscle activity (range from r_s² = 0.17 r_s² = 0.55). Significant correlations were found between EN 1005-4 and muscle activity (range from r_s² = 0.34 to r_s² = 0.74).

CONCLUSIONS:

Results emphasise a need for further developments of observation-based methods, since the two investigated methods showed a variance of validity ranging from small to large. Such improvements may also form a better basis for the ergonomic improvement of working conditions in practise, which is highly necessary due to a constantly high prevalence of MSDs in the last decades.

Comparing the Effectiveness of Three Ergonomic Risk Assessment Methods-RULA, LUBA, and NERPA-to Predict the Upper Extremity Musculoskeletal Disorders

Background:

Musculoskeletal disorders are a major problem in all jobs. Several methods are available for assessing the exposure to risk factors associated with musculoskeletal disorders. This study is aimed at comparing three different ergonomic risk assessment methods—rapid upper limb assessment (RULA), loading on the upper body assessment (LUBA), and new ergonomic posture assessment (NERPA) method—to predict upper extremity musculoskeletal disorders.

Materials and Methods:

The study was conducted on 210 workers from three different industries including pharmaceutical, automotive, and assembly in the Isfahan province. A Nordic questionnaire was used for determining the levels of musculoskeletal disorders. Then, selected postures were evaluated with RULA, LUBA, and NERPA methods. Finally, data were analyzed with Kolmogorov–Smirnov test to check the normality distribution of data, Spearman's correlation test to investigate the correlation between the assessed levels with musculoskeletal disorders, and Wilcoxon test to identify significant differences between the values with SPSS version 16.

Results:

Wilcoxon test revealed a significant difference between the values related to NERPA and RULA (P < 0.001), whereas no significant relation between LUBA and RULA was shown by this test (P = 0.914). The correlation coefficients of the musculoskeletal disorders' level with RULA level, NERPA level, and LUBA level were 0.74, 0.73, and 0.69, respectively.

Conclusion:

Low-risk levels in NERPA, medium-risk levels in LUBA, and high-risk levels in RULA are evaluated better. The results showed that RULA was the best method for assessing musculoskeletal disorders among the three methods.

Real time RULA assessment using Kinect v2 sensor

The evaluation of the exposure to risk factors in workplaces and their subsequent redesign represent one of the practices to lessen the frequency of work-related musculoskeletal disorders. In this paper we present K2RULA, a semi-automatic RULA evaluation software based on the Microsoft Kinect v2 depth camera, aimed at detecting awkward postures in real time, but also in off-line analysis. We validated our tool with two experiments. In the first one, we compared the K2RULA grand-scores with those obtained with a reference optical motion capture system and we found a statistical perfect match according to the Landis and Koch scale (proportion agreement index = 0.97, k = 0.87). In the second experiment, we evaluated the agreement of the grand-scores returned by the proposed application with those obtained by a RULA expert rater, finding again a statistical perfect match (proportion agreement index = 0.96, k = 0.84), whereas a commercial software based on Kinect v1 sensor showed a lower agreement (proportion agreement index = 0.82, k = 0.34).

Musculoskeletal disorders: OWAS review

The prevention of musculoskeletal disorders (MSD) is very important in the world. Governments and companies are the most interested. The objective of the present work is to review the literature on the applications of the OWAS method in the diverse sectors or fields of knowledge and countries from its publication to March 2017. The use of OWAS method has been classified by categories of knowledge, by country and by year. The search was made by selecting only the main collection of the Web of Science. This was selected by the option "Advanced search" using the term OWAS (ts=OWAS) for the time period of 1900 to 2017. A total of 166 results were found, consisting of conference papers and articles in scientific journals. In conclusion, the OWAS has been applied mainly in two sectors: "Manufacturing industries" and "Healthcare and Social assistance activities". This method needs to be complemented with other indirect or direct methods. Also, whenever the OWAS has been used, whether individually or together with other methods, musculoskeletal disorders risks have been detected, this perhaps being an indicator to review the evaluation parameters because overestimating the risk.

Posture analysis among Flemish secondary school teachers: difference between the use of chalkboards and electronic school boards during classroom teaching

The aim of this study was to (i) make a posture analysis of teachers during theoretical classroom teaching; (ii) to estimate the risk for the development of musculoskeletal problems (MSP); (iii) test the hypotheses that an electronic school board (EB) has more ergonomic advantages for teachers. Thirty-five secondary school teachers, of which 15 used an EB and 20 used chalkboards, were selected by convenience sampling and filmed during 30 min of a theoretical course. Posture analysis of back, arms, legs and risk assessment was performed using the Ovako Working Posture Analysis System. Most of the teachers' postures did not indicate a higher risk for MSP. However, some postures may be harmful when accumulated for several hours of teaching a day; especially, long periods of standing and standing with a bended back. Results also indicated that currently the use of an EB does not improve teachers' posture. Practitioner Summary: The relationship between objectively measured physical work load and risk for injuries among teachers was not analysed so far. In this study teachers' posture was analysed using the OWAS method. Prolonged standing and forward bending were identified as risk postures. Also, using an electronic school board currently does not improve posture.

Evaluation of the Impact of the Revised National Institute for Occupational Safety and Health Lifting Equation

OBJECTIVE

The objective of this article is to evaluate the impact of the Revised National Institute for Occupational Safety and Health Lifting Equation (RNLE).

BACKGROUND

The RNLE has been used extensively as a risk assessment method for prevention of low back pain (LBP). However, the impact of the RNLE has not been documented.

METHODS

A systematic review of the literature on the RNLE was conducted. The review consisted of three parts: characterization of the RNLE publications, assessment of the impact of the RNLE, and evaluation of the influences of the RNLE on ergonomic standards. The literature for assessing the impact was categorized into four research areas: methodology, laboratory, field, and risk assessment studies using the Lifting Index (LI) or Composite LI (CLI), both of which are the products of the RNLE.

RESULTS

The impact of the RNLE has been both widespread and influential. We found 24 studies that examined the criteria used to define lifting capacity used by the RNLE, 28 studies that compared risk assessment methods for identifying LBP, 23 studies that found the RNLE useful in identifying the risk of LBP with different work populations, and 13 studies on the relationship between LI/CLI and LBP outcomes. We also found evidence on the adoption of the RNLE as an ergonomic standard for use by various local, state, and international entities.

CONCLUSION

The review found 13 studies that link LI/CLI to adverse LBP outcomes. These studies showed a positive relationship between LI/CLI metrics and the severity of LBP outcomes.

Wrist rotations about one or two axes affect maximum wrist strength

Most wrist strength studies evaluate strength about one axis, and postural deviations about that same axis. The purpose of this study was to determine if wrist posture deviations about one axis (e.g. flexion/extension), or two axes (e.g. flexion/extension and pronation/supination), affect the strength about another axis (e.g. ulnar deviation). A custom-built instrumented handle was used to measure maximum static isometric torque exertions at 18 wrist postures (combinations of flexion/extension, radial/ulnar deviation, and pronation/supination). Ulnar deviation torques were highest when the wrist was in neutral. This pattern was not maintained for the other torque directions; the generated torque tended to be highest when the wrist posture was not neutral. The effects were similar for male and female subjects, although male subjects exerted significantly larger torques in all directions. This study illustrates that there is a complex relationship between wrist posture and maximal wrist torques.

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.

Fatigue and recovery during and after static loading

Subjectively assessed endurance time (ET), resumption time (RT) and perceived discomfort, pain or fatigue (PD), and objectively measured maximum force-exerting capacity were investigated for varying loads and durations of a pushing task with two repeated trials. Beyond the main results quantifying how the load scenario affected ET, RT and PD, three additional results are of note: (1) although the maximum pushing force did not change between trials, shorter ET, longer RT and higher PD indicated accumulation of fatigue in Trial 2; (2) the PD ratings showed a trend with a linear increase during loading and a curvilinear decrease during recovery; and (3) the RT and the load level for different relative loading times were found to have an unexpected U-shaped relationship, indicating lowest fatigue at the intermediate load level. These results can be used to model a more sustainable and productive work-recovery ratio.