The activation of mechanisms linking judgements of work design and management with musculoskeletal pain

Therapeutic and Preventive Efficacy of an Intervention on Workers in a Back School

Back pain and its ailments are the main cause of absenteeism and sick leave. Furthermore, the cause of pain and disability in a large number of workers is unknown, and treatments are not effective in controlling it. For this reason, the Back Schools (BSs) provide theoretical and practical training to workers so that they can acquire knowledge and skills that will allow them to adequately manage their back problems, enabling them to recover their autonomy and prevent relapses. The aim of the study is to analyse the efficacy of a BS by means of the evaluation of pain and disability scales in workers in different sectors and in construction. The most important clinical benefits obtained after the intervention of a BS are the reduction of pain and disability. Statistically significant and clinically relevant results have been observed between the initial assessment and the 6-month review. BS has been shown to be effective in reducing low back and neck pain and disability during the first 6 months of follow-up. Construction workers have pain and disability rates at the overall mean and with improvements between the initial assessment and the 6-month review. Their rates of improvement are clinically more relevant than for the overall population analysed.

Analysis of visual acuity and motion resolvability as measures for optimal visual perception of the workspace

For working tasks with high visual demand, ergonomic design of the working stations requires defining criteria for comparative evaluation and analysis of the visual perceptibility in different regions of the workspace. This paper provides kinematic models of visual acuity and motion resolvability as adopted measures of visual perceptibility of the workspace. The proposed models have been examined through two sets of experiments. The first experiment is designed to compare the models outputs with those from experiments. Time measurements of the participants' response to visual events are employed for calculation of the perceptibility measures. The overall comparison results show similar patterns and moderate statistical errors of the measured and kinematically modeled values of the parameters. In the second experiment, the proposed set of visual perceptibility measures are examined for a simulated industrial task of inserting electronic chips into slots of a working table, resembling a fine assembly line of transponders manufacturing. The results from ANOVA tests for the visual acuity and the motion resolvability justify the postures adopted by the participants using visual perceptibility measures for completing the insertion tasks.

Work factors related to psychological and health-related distress among employees with chronic illnesses

OBJECTIVE

This study examined specific psychosocial factors associated with psychological and health-related distress amongst employees reporting different chronic illnesses.

METHODS

The sample consisted of 1029 employees managing either musculoskeletal pain (n=324), arthritis and rheumatism (n=192), asthma (n=174), depression and anxiety (n=152), heart disease (n=96) or diabetes (n=91). Information on psychological distress, work limitations, illness management, disclosure, absence, presenteeism, support and demographic factors were obtained through self-administered questionnaires.

RESULTS

Both low psychological well-being and high health-related distress were associated with an increase in work limitations (beta=0.20, SE=.03; and beta=0.19, SE=.01, respectively), poorer management of illness symptoms at work (beta=-0.17, SE=.12; and beta=-0.13, SE=.02), high presentieesm (beta=0.19, SE=.25; and beta=0.14, SE=.05) and low workplace support (beta=-0.05, SE=.22; and beta=-0.12, SE=.05). Health-related distress was additionally associated with disclosure of illness at work (beta=0.18, SE=.08) and long-term sickness absence (beta=0.10, SE=.06).

CONCLUSIONS

To enable individuals to effectively manage both their illness and their work without serious repercussions, it is important for both healthcare professionals and employers alike, to improve the well-being of workers with chronic illness by supporting and facilitating their efforts to over-come health-related limitations at work.

Observational stress factors and musculoskeletal disorders in urban transit operators

Associations and pathways between observed (rather than self-reported) job stressors and musculoskeletal disorders in 66 transit operators were investigated to determine specific stressors and vulnerable body regions affected, while adjusting for physical workload. Job stressors, defined as barriers to progress with work, comprised 7 categories and the sum of stressors. Outcomes included back and neck pain, low back pain, neck pain, pain of the upper extremities and the lower extremities, and any combination of these. Stressors were significantly associated with the combined musculoskeletal disorders category (odds ratio [OR] = 1.55), back and neck pain (OR = 1.41), low back pain (OR = 1.46), and pain in the lower extremities (OR = 1.44) after controlling for confounders. Five barrier categories had at least 1 significant association with outcomes. Results provide specific intervention targets by avoiding common method variance bias.

Development and evaluation of a multifaceted ergonomics program to prevent injuries associated with patient handling tasks

PROBLEM STATEMENT

Nurses have one of the highest rates of work-related musculoskeletal injury of any profession. Over the past 30 years, efforts to reduce work-related musculoskeletal disorders in nurses have been largely unsuccessful.

SPECIFIC AIMS

The primary goal of this program was to create safer working environments for nursing staff who provide direct patient care. Our first objective was to design and implement a multifaceted program that successfully integrated evidence-based practice, technology, and safety improvement. The second objective was to evaluate the impact of the program on injury rate, lost and modified work days, job satisfaction, self-reported unsafe patient handling acts, level of support for program, staff and patient acceptance, program effectiveness, costs, and return on investment.

INTERVENTION

The intervention included six program elements: (1) Ergonomic Assessment Protocol, (2) Patient Handling Assessment Criteria and Decision Algorithms, (3) Peer Leader role, "Back Injury Resource Nurses", (4) State-of-the-art Equipment, (5) After Action Reviews, and (6) No Lift Policy.

METHODS

A pre-/post design without a control group was used to evaluate the effectiveness of a patient care ergonomics program on 23 high risk units (19 nursing home care units and 4 spinal cord injury units) in 7 facilities. Injury rates, lost work days, modified work days, job satisfaction, staff , and patient acceptance, program effectiveness, and program costs/savings were compared over two nine month periods: pre-intervention (May 2001-January 2002) and post-intervention (March 2002-November 2002). Data were collected prospectively through surveys, weekly process logs, injury logs, and cost logs.

RESULTS

The program elements resulted in a statistically significant decrease in the rate of musculoskeletal injuries as well as the number of modified duty days taken per injury. While the total number of lost workdays decreased by 18% post-intervention, this difference was not statistically significant. There were statistically significant increases in two subscales of job satisfaction: professional status and tasks requirements. Self-reports by nursing staff revealed a statistically significant decrease in the number of 'unsafe' patient handling practices performed daily. Nurses ranked program elements they deemed to be "extremely effective": equipment was rated as most effective (96%), followed by No Lift Policy (68%), peer leader education program (66%), ergonomic assessment protocol (59%), patient handling assessment criteria and decision algorithms (55%), and lastly after action reviews (41%). Perceived support and interest for the program started at a high level for managers and nursing staff and remained very high throughout the program implementation. Patient acceptance was moderate when the program started but increased to very high by the end of the program. Although the ease and success of program implementation initially varied between and within the facilities, after six months there was strong evidence of support at all levels. The initial capital investment for patient handling equipment was recovered in approximately 3.75 years based on annual post-intervention savings of over $200,000/year in workers' compensation expenses and cost savings associated with reduced lost and modified work days and worker compensation.

CONCLUSIONS

This multi-faceted program resulted in an overall lower injury rate, fewer modified duty days taken per injury, and significant cost savings. The program was well accepted by patients, nursing staff, and administrators. Given the significant increases in two job satisfaction subscales (professional status and task requirements), it is possible that nurse recruitment and retention could be positively impacted.

Dealing with self-management of chronic illness at work: predictors for self-disclosure

This paper explores the role of self-management of chronic illness at work, as a predictor for self-disclosure. The study reports findings from a survey sent to all staff at a UK university, of which 610 employees reported managing a chronic illness: arthritis, musculoskeletal pain, diabetes, asthma, migraine, heart disease, irritable bowel syndrome and depression. The study found that discrete self-management factors predicted different levels of disclosure: partial self-disclosure (employees informing line managers about the presence of a chronic illness) and full self-disclosure (employees informing line managers how that chronic illness affected them at work). For partial disclosure, a greater reported experience of chronic illness by employees was positively associated with self-disclosure. For full-disclosure, employees were more likely to report disclosure to line managers if they had already disclosed to colleagues, and if they perceived receiving support from their line managers in relation to their chronic illness as important. Except for academics who were least likely to disclose, occupational groups did not emerge as significant predictors for either partial or full disclosure. Except for diabetes, chronic illness itself was not a significant predictor or barrier to self-disclosure. Our findings suggest that chronically ill employees adopt a disclosure strategy specifically related to different self-management needs of chronic illness at work.

Further studies of shoulder and neck pain and exposures in customer service work with low biomechanical demands

The aim of the study was to establish insight into work exposures that cause shoulder and neck pain among occupational groups that have low biomechanical exposure and experience work stress from client/customer contact, among other exposures. Four occupational groups were studied, in health care (n = 20), retail (n = 22), banking (n = 26), and university secretaries (n = 26), a total of 94 volunteers. Thirty-nine were classified as pain-afflicted in the shoulder and neck, while 55 were pain-free. The subjects' perceptions of biomechanical and psychosocial exposures were established by use of quantitative questionnaires and by explorative interviews with open-ended questions, covering the same themes. Heart rate and trapezius EMG were recorded over a full workday and the following leisure period. Trapezius median and static activity during work were 3.3% and 0.3% EMG(max), only marginally higher than trapezius activity in the leisure period (2.7% and 0.2% EMG(max)). The quantitative questionnaire did not identify any variable that correlated with shoulder and neck pain except perceived general tension. The interviews established that the interaction with clients or customers was an important source of work stress. Such stress appeared to be a complex entity not easily characterized by established psychosocial questionnaires. The physiological variables were at most weakly elevated in periods with high stress as compared to periods with low stress. The authors caution against relying on standardized quantitative questionnaires and/or physiological recordings to characterize work stress in occupations with emotional stress through client/customer service work.