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Versloot AHC, Jackson JA, van Rijn RM, Elbers RG, Søgaard K, Macri EM, Koes B, Burdorf A, Chiarotto A, Gerger H. Physical and psychosocial work-related exposures and the occurrence of disorders of the shoulder: A systematic review update. APPLIED ERGONOMICS 2024; 118:104277. [PMID: 38579494 DOI: 10.1016/j.apergo.2024.104277] [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: 07/21/2023] [Revised: 01/23/2024] [Accepted: 03/22/2024] [Indexed: 04/07/2024]
Abstract
This review is an update of a previous systematic review and assesses the evidence for the association of work-related physical and psychosocial risk factors and specific disorders of the shoulders. Medline, Embase, Web of Science Core Collection, Cochrane Central and PsycINFO were searched and study eligibility and risk of bias assessment was performed by two independent reviewers. A total of 14 new articles were added with the majority focusing on rotator cuff syndrome (RCS) with seven studies. Nine articles reported psychosocial exposures in addition to physical exposures. The strongest evidence was found for the association between elevation, repetition, force and vibration and the occurrence of SIS and tendinosis/tendonitis. Evidence also suggests that psychosocial exposures are associated with the occurrence of RCS and tendinosis/tendonitis. Other findings were inconsistent which prevents drawing strong conclusions.
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Affiliation(s)
- Annelotte H C Versloot
- Department of General Practice, Erasmus Medical Center, University Medical Center, Rotterdam, the Netherlands.
| | - Jennie A Jackson
- Centre for Musculoskeletal Research, Department of Occupational Health Sciences and Pychology, University of Gävle, Gävle, Sweden
| | - Rogier M van Rijn
- Codarts Rotterdam, University of the Arts, Rotterdam, the Netherlands; PErforming Artist and Athlete Research Lab (PEARL), Rotterdam, the Netherlands
| | - Roy G Elbers
- Department of General Practice, Erasmus Medical Center, University Medical Center, Rotterdam, the Netherlands
| | - Karen Søgaard
- Research Unit of General Practice, Department of Public Health & the Center for Muscle and Joint Health, University of Southern Denmark, Odense, Denmark; Dep of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Erin M Macri
- Department of General Practice, Erasmus Medical Center, University Medical Center, Rotterdam, the Netherlands; Department of Orthopaedics and Sports Medicine, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Bart Koes
- Department of General Practice, Erasmus Medical Center, University Medical Center, Rotterdam, the Netherlands; Research Unit of General Practice, Department of Public Health & the Center for Muscle and Joint Health, University of Southern Denmark, Odense, Denmark
| | - Alex Burdorf
- Department of Public Health, Erasmus Medical Center, University Medical Center, Rotterdam, the Netherlands
| | - Alessandro Chiarotto
- Department of General Practice, Erasmus Medical Center, University Medical Center, Rotterdam, the Netherlands
| | - Heike Gerger
- Department of General Practice, Erasmus Medical Center, University Medical Center, Rotterdam, the Netherlands
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Diener GL, Spahn G, Hofmann GO. Occupational Stress as a Possible Risk Factor for Rotator Cuff Damage - Systematic Review and Meta-analysis. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2024; 162:289-295. [PMID: 36473486 DOI: 10.1055/a-1957-6140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE In September 2021, the Federal Ministry of Labour and Social Affairs in Germany (BMAS) recommended recognising rotator cuff lesions caused by occupational long-term overhead work, repetitive movements, hand-arm-vibration and carrying and lifting heavy loads as an occupational disease. To gain a more detailed understanding of the correlation between occupational risk factors and lesions of the rotator cuff, a systematic literature review was carried out to determine their influence on the development of rotator cuff disease. MATERIAL AND METHOD A systematic literature review was used to search in the databases PubMed, Cochrane and Web-of-Science for papers dealing with occupational shoulder load and associated shoulder disorders. The influence of overhead work, repetitive movements, hand-arm-vibrations and carrying and lifting heavy loads were examined. RESULTS 58 studies were read in full text, of which 13 papers were included in the meta-analysis. In all risk factors, a significant association can be found with the strongest dose-response relationship in "overhead work" and "repetitive movements": overhead work: 2.23 (95% CI 1.98-2.52), repetitive movements: 2.17 (95% CI 1.92-2.46), hand-arm-vibration: 1.59 (95% CI 1.13-2.23), carrying and lifting heavy loads: 1.57 (95% CI 1.15-2.15). CONCLUSION Although a significant effect could be shown in our study for all the four risk factors examined, due to the low number of studies with high-quality study design and insufficient pathophysiological explanation for the development of a rotator cuff disease in these mechanical activities, no reliable correlation can currently be established.
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Affiliation(s)
- Greta-Linn Diener
- Praxisklinik für Unfallchirurgie und Orthopädie, Eisenach, Deutschland
| | - Gunter Spahn
- Praxisklinik für Unfallchirurgie und Orthopädie, Eisenach, Deutschland
- Klinik für Unfall,- Hand- und Wiederherstellungschirurgie, Universitatsklinikum Jena, Jena, Deutschland
| | - Gunther O Hofmann
- Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Friedrich-Schiller-Universität Jena, Jena, Deutschland
- Klinik für Unfall- und Wiederherstellungschirurgie, BG Kliniken Bergmannstrost, Halle, Deutschland
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3
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Lawrence RL, Soliman SB, Dalbøge A, Lohse K, Bey MJ. Investigating the multifactorial etiology of supraspinatus tendon tears. J Orthop Res 2024; 42:578-587. [PMID: 37814893 DOI: 10.1002/jor.25699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 05/23/2023] [Accepted: 10/05/2023] [Indexed: 10/11/2023]
Abstract
The purpose of this study was to develop a multivariable model to determine the extent to which a combination of etiological factors is associated with supraspinatus tendon tears. Fifty-four asymptomatic individuals (55 ± 4 years) underwent testing of their dominant shoulder. Diagnostic ultrasound was used to assess for a supraspinatus tendon tear. The etiological factors investigated included demographics (age and sex), tendon impingement during shoulder motion (via biplane videoradiography), glenohumeral morphology (via computed tomography imaging), family history of a tear (via self-report), occupational shoulder exposure (via shoulder job exposure matrix), and athletic exposure (via self-report). Univariate relationships between etiological predictors and supraspinatus tears were assessed using logistic regression and odds ratios (ORs), while multivariable relationships were assessed using classification and regression tree analysis. Thirteen participants (24.1%) had evidence of a supraspinatus tear. Individuals with a tear had a higher critical shoulder angle (OR 1.2, p = 0.028) and acromial index (OR 1.2, p = 0.016) than individuals without a tear. The multivariable model suggested that a tear in this cohort can be explained with acceptable accuracy (AUROC = 0.731) by the interaction between acromial index and shoulder occupational exposure: a tear is more likely in individuals with a high acromial index (p < 0.001), and in individuals with a low acromial index and high occupational exposure (p < 0.001). The combination of an individual's glenohumeral morphology (acromial index) and occupational shoulder exposure may be important in the development of supraspinatus tears.
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Affiliation(s)
- Rebekah L Lawrence
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, Missouri, USA
- Bone and Joint Center, Department of Orthopaedic Surgery, Henry Ford Health, Detroit, Michigan, USA
| | - Steven B Soliman
- Department of Radiology, Henry Ford Health, Detroit, Michigan, USA
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Annett Dalbøge
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Occupational Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Keith Lohse
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Michael J Bey
- Bone and Joint Center, Department of Orthopaedic Surgery, Henry Ford Health, Detroit, Michigan, USA
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Waslen A, Friesen KB, Lang AE. Do Sex and Age Influence Scapular and Thoracohumeral Kinematics During a Functional Task Protocol? J Appl Biomech 2024; 40:29-39. [PMID: 37917968 DOI: 10.1123/jab.2023-0085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 08/14/2023] [Accepted: 08/27/2023] [Indexed: 11/04/2023]
Abstract
There is mixed evidence on the role that biological sex plays in shoulder biomechanics despite known differences in musculoskeletal disorder prevalence between males and females. Additionally, advancing age may contribute to shoulder kinematic changes. The purpose of this study was to determine if sex and age influenced scapular and thoracohumeral kinematics during a range of functional tasks. Sixty healthy participants aged 19-63 years (30 males; 30 females) completed a functional task protocol while their upper limb motion was recorded. Scapular and humeral angles were calculated and compared with multiple linear regressions to assess the interaction effects of sex and age. Shoulder kinematics were not different between sex and age groups for many of the functional tasks. However, females had lower humeral external rotation in the overhead lift task (15°, P < .001), and less scapular anterior tilt angles in the forward transfer task (6°, P < .001) than males. Age was positively associated with humeral elevation (R2 = .330, P < .001) and scapular rotation (R2 = .299, P < .001) in the Wash Axilla task. There exist some kinematic differences between sex and with advancing age for select functional tasks, which should be considered for musculoskeletal disorder development.
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Affiliation(s)
- Alexander Waslen
- College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Kenzie B Friesen
- College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Angelica E Lang
- College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
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Trøstrup J, Frost P, Dalbøge A, Mikkelsen LR, Høybye MT, Jørgensen LB, Casper SD, Klebe TM, Svendsen SW. Reducing Shoulder Complaints in Employees with High Occupational Shoulder Exposures: A Cluster-Randomised Controlled Study (The Shoulder-Café Study). JOURNAL OF OCCUPATIONAL REHABILITATION 2023; 33:473-485. [PMID: 36512271 DOI: 10.1007/s10926-022-10086-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/15/2022] [Indexed: 06/17/2023]
Abstract
PURPOSE To evaluate if a group-based Shoulder-Café intervention could reduce shoulder complaints more effectively than an individual-based control intervention in employees with shoulder complaints and high occupational shoulder exposures. METHODS A cluster-randomised controlled study of 109 participants from 60 companies in Central Denmark Region. Companies were randomised and allocated to either Shoulder-Café or control intervention. Participants in both interventions received a pamphlet on home-based shoulder exercises and a pamphlet with general information on reducing occupational shoulder exposures. They also had their occupational shoulder exposures assessed. Shoulder-Café participants additionally received three café-meetings with casual discussion, clinical shoulder evaluation, education about shoulder anatomy and occupational shoulder exposures, supervised exercises, workplace-oriented counselling, and an optional workplace visit. The primary outcome measure was the Oxford Shoulder Score (OSS) at 6-month follow-up. Secondary outcome measures were the OSS at 12 months, Fear-Avoidance Beliefs Questionnaire - Physical Activity at 6 and 12 months, and Patients' Global Impression of Change at 6 months. The study also included seven supplementary outcome measures. RESULTS Both groups improved from baseline to 6 months with respect to the primary outcome (P < 0.01). No group differences were found for the primary outcome (mean difference (MD) [95% confidence interval]: 0.3 [- 1.6; 2.2]) or secondary outcomes. The supplementary outcomes "felt informed about handling shoulder complaints" and "felt informed about reducing occupational exposures" at 6 months, and "Patients' Global Impression of Change" and "overall satisfaction" at 12 months favoured the Shoulder-Café intervention. CONCLUSION The Shoulder-Café intervention did not reduce shoulder complaints more effectively than the control intervention. TRIAL REGISTRATION The trial was registered at Clinicaltrials.gov on 19 May 2017 (ID: NCT03159910).
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Affiliation(s)
- J Trøstrup
- Elective Surgery Centre, Silkeborg Regional Hospital, Falkevej 1-3, 8600, Silkeborg, Denmark.
| | - P Frost
- Centre for Social Medicine, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
- Danish Ramazzini Centre, Department of Occupational Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - A Dalbøge
- Danish Ramazzini Centre, Department of Occupational Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - L R Mikkelsen
- Elective Surgery Centre, Silkeborg Regional Hospital, Falkevej 1-3, 8600, Silkeborg, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - M T Høybye
- Elective Surgery Centre, Silkeborg Regional Hospital, Falkevej 1-3, 8600, Silkeborg, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - L B Jørgensen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Knowledge Centre for Neurorehabilitation of Western Denmark, Regional Hospital Central Jutland, Hammel, Denmark
| | | | - T M Klebe
- Elective Surgery Centre, Silkeborg Regional Hospital, Falkevej 1-3, 8600, Silkeborg, Denmark
| | - S W Svendsen
- Danish Ramazzini Centre, Department of Occupational Medicine, Gødstrup Hospital - University Research Clinic, Herning, Denmark
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Curti S, Mattioli S, Violante FS. Shoulder Tendinopathies and Occupational Biomechanical Overload: A Critical Appraisal of Available Evidence. LA MEDICINA DEL LAVORO 2023; 114:e2023033. [PMID: 37534424 PMCID: PMC10415850 DOI: 10.23749/mdl.v114i4.14537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 06/29/2023] [Indexed: 08/04/2023]
Abstract
BACKGROUND The aim of this study is to evaluate the association between occupational exposure to biomechanical risk factors and shoulder tendinopathies. METHODS We updated recent systematic reviews about specific shoulder disorders and work-related risk factors. MEDLINE was searched up to September 2022. Studies satisfying the following criteria were included: i) the diagnosis was based on physical examination plus imaging data (when available), and ii) the exposure assessment was based on video analysis and/or directly measured. RESULTS Five studies met the inclusion criteria: three cross-sectional studies identified from published systematic reviews and two cohort studies retrieved from the update. Two studies investigated shoulder tendinitis, one supraspinatus tendinitis, and the other two rotator cuff syndrome. The diagnosis was based on physical examination, not supported by imaging techniques for all the included studies. In four out of five studies, the exposure was assessed by experienced ergonomists with the support of video recordings. In two studies, the exposure assessment was further supplemented by force gauge measurements or direct measurements of upper arm elevation. Only the combined exposure of working with arms above shoulder level with forceful hand exertion appears to be associated with rotator cuff syndrome: i) a cohort study reported an HR=1.11 (95%CI 1.01-1.22) for each unit increase in forceful repetition rate when the upper arm is flexed ≥45° for ≥29% of the working time; and ii) a cross-sectional study showed an OR=2.43 (95%CI 1.04-5.68) for the combination of upper arm flexion ≥45° for more than 15% of the time with a duty cycle of forceful exertions more than 9% of the time. CONCLUSIONS There is moderate evidence of a causal association between shoulder tendinopathy and combined exposures of working above shoulder level with forceful hand exertion. The evidence is insufficient for any single biomechanical exposure on its own. High-quality cohort studies with direct exposure measures and objective diagnostic criteria are needed. The occupational origin of shoulder tendinopathies is still an open question that must be properly answered.
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Affiliation(s)
- Stefania Curti
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.
| | - Stefano Mattioli
- Department of Environment and Prevention Sciences, University of Ferrara, Ferrara, Italy.
| | - Francesco Saverio Violante
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy; Occupational Medicine Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
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7
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Dickerson CR, McDonald AC, Chopp-Hurley JN. Between Two Rocks and in a Hard Place: Reflecting on the Biomechanical Basis of Shoulder Occupational Musculoskeletal Disorders. HUMAN FACTORS 2023; 65:879-890. [PMID: 31961724 DOI: 10.1177/0018720819896191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVE The aim was to review the biomechanical origins of occupational shoulder damage, while considering the complexity of shoulder mechanics and musculoskeletal consequences of diverse task demands. BACKGROUND Accessible measures of physical exposures are the primary focus of occupational shoulder assessments and analyses. This approach has led to guidelines and intervention strategies that are often inadequate for mitigating shoulder disorders amongst the complexity of modern workplace demands. Integration of complex shoulder mechanics into occupational assessments, analyses, and interventions is critical for reducing occupational shoulder injury risk. METHOD This narrative review describes shoulder biomechanics in the context of common injury mechanisms and consequent injuries, with a particular focus on subacromial impingement syndrome. Several modulators of shoulder injury risk are reviewed, including fatigue, overhead work, office ergonomics considerations, and pushing and pulling task configurations. RESULTS Relationships between work requirements, muscular demands, fatigue, and biomechanical tissue loads exist. This review highlights that consideration of specific workplace factors should be integrated with our knowledge of the intricate arrangement and interpersonal variability of the shoulder complex to proactively evaluate occupational shoulder demands and exposures. CONCLUSION A standard method for evaluating shoulder muscle exposures during workplace tasks does not exist. An integrated approach is critical for improved work design and prevention of shoulder tissue damage and accompanying disability. APPLICATION This review is particularly relevant for researchers and practitioners, providing guidance for work design and evaluation for shoulder injury prevention by understanding the importance of the unique and complex mechanics of the shoulder.
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Effect of intraarticular pressure on glenohumeral kinematics during a simulated abduction motion: a cadaveric study. BMC Musculoskelet Disord 2023; 24:105. [PMID: 36750786 PMCID: PMC9906871 DOI: 10.1186/s12891-023-06127-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 01/02/2023] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND The current understanding of glenohumeral joint stability is defined by active restrictions and passive stabilizers including naturally-occurring negative intraarticular pressure. Cadaveric specimens have been used to evaluate the role of intraarticular pressure on joint stability, although, while the shoulder's negative intraarticular pressure is universally acknowledged, it has been inconsistently accounted for. HYPOTHESIS During continuous, passive humeral abduction, releasing the native intraarticular pressure increases joint translation, and restoring this pressure decreases joint translations. STUDY DESIGN Descriptive Laboratory Study. METHODS A validated shoulder testing system was used to passively abduct the humerus in the scapular plane and measure joint translations for seven (n = 7) cadaveric specimens. The pressure within the glenohumeral joint was measured via a 25-gauge needle during passive abduction of the arm, which was released and subsequently restored. During motion, the rotator cuff muscles were loaded using stepper motors in a force feedback loop and electromagnetic sensors were used to continuously measure the position of the humerus and scapula. Joint translation was defined according to the instant center of rotation of the glenohumeral head according to the recommendations by the International Society of Biomechanics. RESULTS Area under the translation versus abduction angle curve suggests that releasing the pressure within the capsule results in significantly less posterior translation of the glenohumeral head as compared to intact (85-90˚, p < 0.05). Posterior and superior translations were reduced after 70˚ of abduction when the pressure within the joint was restored. CONCLUSION With our testing system employing a smooth continuous passive motion, we were able to show that releasing intraarticular pressure does not have a major effect on the path of humeral head motion during glenohumeral abduction. However, both violating the capsule and restoring intraarticular pressure after releasing alter glenohumeral translations. Future studies should study the effect of simultaneous external rotation and abduction on the relationship between joint motion and IAP, especially in higher degrees of abduction. CLINICAL RELEVANCE Thoroughly simulating the glenohumeral joint environment in the cadaveric setting may strengthen the conclusions that can be translated from this setting to the clinic.
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Liu YP, Chen HC, Hong WH, Weng WC. Effects of different tools and working height on physical workload in vertical cleaning tasks applying ambient control techniques. APPLIED ERGONOMICS 2022; 104:103818. [PMID: 35738213 DOI: 10.1016/j.apergo.2022.103818] [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: 11/29/2021] [Revised: 05/29/2022] [Accepted: 05/31/2022] [Indexed: 05/16/2023]
Abstract
This study aimed to investigate the effects of different tools and working heights on physical workloads in vertical cleaning tasks. Thirty healthy adults were recruited to use a rag and a long-handle tool (LHT) to simulate cleaning operations on the Wii Fit board surfaces of 3 different heights, respectively. Participants used a lower 50th percentile force but were required to spend a longer time to finish the task while using an LHT than using a rag. The tool preferences were the main factors considered for efficiency and personal subjective workload and physiological load. 76.6% of the participants preferred to use the LHT instead of the rag at a high task height, but 70% preferred to use the rag when working at a medium task height. For low workload cleaning tasks on vertical surfaces, employers should provide cleaners with different handle lengths tools to choose from to reduce the cleaner's workload.
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Affiliation(s)
- Yung-Ping Liu
- Department of Industrial Engineering and Management, Chaoyang University of Technology, Taichung, 413310, Taiwan
| | - Hsieh-Ching Chen
- Department of Industrial Engineering and Management, National Taipei University of Technology, Taipei, 106344, Taiwan
| | - Wei-Hsien Hong
- Department of Sports Medicine, China Medical University, Taichung, 406040, Taiwan.
| | - Wei-Chun Weng
- Department of Industrial Engineering and Management, National Taipei University of Technology, Taipei, 106344, Taiwan
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Tomar S, Tiwari RR, Verma G. Musculoskeletal symptoms and associated factors among beauty salon workers in Udupi, Karnataka, India. Work 2022; 73:301-307. [DOI: 10.3233/wor-210623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND: The Indian salon industry is increasing rapidly due to demand for various kinds of beauty and personal care products. Working ability and health conditions of salon workers may be affected by specific work-related activities. Prolonged non-neutral postures, repetitive movements, lack of adequate breaks during work, working at a fast pace, general distress or prolonged standing periods make them vulnerable to musculoskeletal symptoms. OBJECTIVE: The present study was carried out to assess work-related musculoskeletal symptoms among the beauty salon workers of Udupi taluk. METHOD: A total of 240 salon workers were recruited for the study. A semi-structured, interviewer-led questionnaire based on a modified Nordic questionnaire was used to collect data. RESULTS: As many as 80.4% study participants reported work related musculoskeletal pain in one or more body parts. The common body parts affected by pain were neck, shoulder, elbow, wrist/hand, upper back, lower back, legs and ankles/feet. The analysis according to work postures suggested that short repetitive movements, stretching of hands to reach objects, working in the same posture for a longer time and the lack of weekly break from work was significantly associated with musculoskeletal symptoms. CONCLUSION: The beauty salon workers are at risk of developing musculoskeletal symptoms which could benefit from preventive structural, operational and educational measures.
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Affiliation(s)
- Shubhi Tomar
- Prasanna School of Public Health, Manipal University, Manipal, India
| | | | - Garima Verma
- Prasanna School of Public Health, Manipal University, Manipal, India
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11
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Sierotowicz M, Brusamento D, Schirrmeister B, Connan M, Bornmann J, Gonzalez-Vargas J, Castellini C. Unobtrusive, natural support control of an adaptive industrial exoskeleton using force myography. Front Robot AI 2022; 9:919370. [PMID: 36172305 PMCID: PMC9510611 DOI: 10.3389/frobt.2022.919370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 07/26/2022] [Indexed: 11/18/2022] Open
Abstract
Repetitive or tiring tasks and movements during manual work can lead to serious musculoskeletal disorders and, consequently, to monetary damage for both the worker and the employer. Among the most common of these tasks is overhead working while operating a heavy tool, such as drilling, painting, and decorating. In such scenarios, it is desirable to provide adaptive support in order to take some of the load off the shoulder joint as needed. However, even to this day, hardly any viable approaches have been tested, which could enable the user to control such assistive devices naturally and in real time. Here, we present and assess the adaptive Paexo Shoulder exoskeleton, an unobtrusive device explicitly designed for this kind of industrial scenario, which can provide a variable amount of support to the shoulders and arms of a user engaged in overhead work. The adaptive Paexo Shoulder exoskeleton is controlled through machine learning applied to force myography. The controller is able to determine the lifted mass and provide the required support in real time. Twelve subjects joined a user study comparing the Paexo driven through this adaptive control to the Paexo locked in a fixed level of support. The results showed that the machine learning algorithm can successfully adapt the level of assistance to the lifted mass. Specifically, adaptive assistance can sensibly reduce the muscle activity’s sensitivity to the lifted mass, with an observed relative reduction of up to 31% of the muscular activity observed when lifting 2 kg normalized by the baseline when lifting no mass.
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Affiliation(s)
- Marek Sierotowicz
- Institute of Robotics and Mechatronics, German Aerospace Center (DLR), Erlangen, Germany
- Artificial Intelligence in Biomedical Engineering, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
- *Correspondence: Marek Sierotowicz,
| | - Donato Brusamento
- Institute of Robotics and Mechatronics, German Aerospace Center (DLR), Erlangen, Germany
| | | | - Mathilde Connan
- Institute of Robotics and Mechatronics, German Aerospace Center (DLR), Erlangen, Germany
| | - Jonas Bornmann
- Global Research, Ottobock SE and Co. KGaA, Duderstadt, Germany
| | | | - Claudio Castellini
- Institute of Robotics and Mechatronics, German Aerospace Center (DLR), Erlangen, Germany
- Artificial Intelligence in Biomedical Engineering, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
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12
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Garosi E, Mazloumi A, Jafari AH, Keihani A, Shamsipour M, Kordi R, Kazemi Z. Design and ergonomic assessment of a passive head/neck supporting exoskeleton for overhead work use. APPLIED ERGONOMICS 2022; 101:103699. [PMID: 35114511 DOI: 10.1016/j.apergo.2022.103699] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 01/22/2022] [Accepted: 01/24/2022] [Indexed: 06/14/2023]
Abstract
Overhead work is an important risk factor associated with musculoskeletal disorders of the neck and shoulder region. This study aimed to propose and evaluate a passive head/neck supporting exoskeleton (HNSE) as a potential ergonomic intervention for overhead work applications. Fourteen male participants were asked to perform a simulated overhead task of fastening/unfastening nut in 4 randomized sessions, characterized by two variables: neck extension angle (40% and 80% of neck maximum range of motion) and exoskeleton condition (wearing and not wearing the HNSE). Using the HNSE, significantly alleviated perceived discomfort in the neck (p-value = 0.009), right shoulder (p-value = 0.05) and left shoulder (p-value = 0.02) and reduced electromyographic activity of the right (p-value = 0.005) and left (p-value = 0.01) sternocleidomastoid muscles. However, utilizing the exoskeleton caused a remarkable increase in right (p-value = 0.04) and left (p-value = 0.05) trapezius electromyographic activities. Performance was not significantly affected by the HNSE. Although the HNSE had promising effects with respect to discomfort and muscular activity in the static overhead task, future work is still needed to investigate its effect on performance and to provide support for the generalizability of study results.
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Affiliation(s)
- Ehsan Garosi
- Department of Occupational Health Engineering, School of Public Health, Tehran University of Medical Sciences, Iran; Department of Ergonomics, School of Public Health, Iran University of Medical Sciences, Iran
| | - Adel Mazloumi
- Department of Occupational Health Engineering, School of Public Health, Tehran University of Medical Sciences, Iran; Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran.
| | - Amir Homayoun Jafari
- Medical Physics & Biomedical Engineering Department, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Ahmadreza Keihani
- Medical Physics & Biomedical Engineering Department, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mansour Shamsipour
- Department of Research Methodology and Data Analysis, Institute for Environmental Research, Tehran University of Medical Sciences, Tehran, Iran
| | - Ramin Kordi
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Zeinab Kazemi
- Department of Ergonomics, School of Public Health, Iran University of Medical Sciences, Iran
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13
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Missiroli F, Lotti N, Tricomi E, Bokranz C, Alicea R, Xiloyannis M, Krzywinski J, Crea S, Vitiello N, Masia L. Rigid, Soft, Passive, and Active: A Hybrid Occupational Exoskeleton for Bimanual Multijoint Assistance. IEEE Robot Autom Lett 2022. [DOI: 10.1109/lra.2022.3142447] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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14
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McFarland TC, McDonald AC, Whittaker RL, Callaghan JP, Dickerson CR. Level of exoskeleton support influences shoulder elevation, external rotation and forearm pronation during simulated work tasks in females. APPLIED ERGONOMICS 2022; 98:103591. [PMID: 34628044 DOI: 10.1016/j.apergo.2021.103591] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 09/14/2021] [Accepted: 09/17/2021] [Indexed: 06/13/2023]
Abstract
Despite growing literature, limited research details the influence of passive upper limb exoskeletons on upper limb kinematics. Two bolting tasks and a tracing task were completed at two heights (overhead and between waist and overhead height) for four exoskeleton conditions (no exoskeleton, and 3 levels of exoskeleton assistance) by female participants. Motion capture data, ratings of perceived exertion and discomfort, and task duration were recorded. Exoskeleton condition increased minimum shoulder elevation by 35-36% (Δ10.5-10.7°) at 1.81 kg and 2.72 kg of support, mean shoulder external rotation by 316% (Δ24.6°) at 0.91 kg of support and mean forearm pronation by 30.9% (Δ14.6°) at 0.91 kg of support. Exoskeleton condition reduced ratings of perceived exertion and discomfort, but not significantly. Task duration was unaffected. Exoskeleton use at any of three different settings modestly affected some joint kinematics for the tasks examined, which may merit consideration when deciding on occupational exoskeleton implementation.
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Affiliation(s)
- Tasha C McFarland
- Department of Kinesiology, Faculty of Applied Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, Ontario, N2L 3G1, Canada
| | - Alison C McDonald
- Department of Kinesiology, Faculty of Applied Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, Ontario, N2L 3G1, Canada
| | - Rachel L Whittaker
- Department of Kinesiology, Faculty of Applied Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, Ontario, N2L 3G1, Canada
| | - Jack P Callaghan
- Department of Kinesiology, Faculty of Applied Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, Ontario, N2L 3G1, Canada
| | - Clark R Dickerson
- Department of Kinesiology, Faculty of Applied Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, Ontario, N2L 3G1, Canada.
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15
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Pérez-de la Cruz S. Use of a Portable Inertial Measurement Unit as an Evaluation Method for Supraspinatus Muscle: Proposed Normative Values. SENSORS 2021; 21:s21227723. [PMID: 34833798 PMCID: PMC8625058 DOI: 10.3390/s21227723] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 11/10/2021] [Accepted: 11/14/2021] [Indexed: 11/21/2022]
Abstract
Treatment protocols do not specify an appropriate weight for rehabilitating the shoulder joint. The purpose of this study was to establish normative values for the shoulder abduction range of motion and recommended weights to be used in the rehabilitation process after injury to the supraspinatus muscle. Fifty-eight volunteers were assessed using the DyCare system. A test was conducted by lifting the arm to a 90° angle and having the participants lift different weights. The range of motion was similar for both sexes, suggesting that sex had no influence on this variable. Regarding the use of weights, men did not show as much stability in their movement execution, with a high dispersion seen in values between zero and three kilograms of weight, reaching a maximum weight of six kilograms. However, women showed good joint stability from the beginning of the test, with values that remained constant as weight increased up to a maximum of five kilograms. In conclusion, no major differences were observed in supraspinatus muscle injury recovery according to sex. However, differences were observed in the amount of weight that was necessary and appropriate to allow the participants to recover their muscular strength and avoid relapses.
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Affiliation(s)
- Sagrario Pérez-de la Cruz
- Department of Nursing, Physical Therapy and Medicine, University of Almería, La Cañada de San Urbano, 04120 Almería, Spain
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16
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Saini G, Lawrence RL, Staker JL, Braman JP, Ludewig PM. Supraspinatus-to-Glenoid Contact Occurs During Standardized Overhead Reaching Motion. Orthop J Sports Med 2021; 9:23259671211036908. [PMID: 34646898 PMCID: PMC8504240 DOI: 10.1177/23259671211036908] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 05/13/2021] [Indexed: 01/03/2023] Open
Abstract
Background: Rotator cuff tears may result from repeated mechanical deformation of the cuff tendons, and internal impingement of the supraspinatus tendon against the glenoid is one such proposed mechanism of deformation. Purpose: To (1) describe the changing proximity of the supraspinatus tendon to the glenoid during a simulated overhead reaching task and (2) determine the relationship between scapular morphology and this proximity. Additionally, the patterns of supraspinatus-to-glenoid proximity were compared with previously described patterns of supraspinatus-to-coracoacromial arch proximity. Study Design: Descriptive laboratory study. Methods: Shoulder models were created from magnetic resonance images of 20 participants. Standardized kinematics were imposed on the models to simulate functional reaching, and the minimum distances between the supraspinatus tendon and the glenoid and the supraspinatus footprint and the glenoid were calculated every 5° between 0° and 150° of humerothoracic elevation. The angle at which contact between the supraspinatus and the glenoid occurred was documented. Additionally, the relationship between glenoid morphology (version and inclination) and the contact angle was evaluated. Descriptive statistics were calculated for the minimum distances, and glenoid morphology was assessed using Pearson correlation coefficients and simple linear regressions. Results: The minimum distances between the tendon and the glenoid and between the footprint and the glenoid decreased as elevation increased. Contact between the tendon and the glenoid occurred in all participant models at a mean elevation of 123° ± 10°. Contact between the footprint and the glenoid occurred in 13 of 20 models at a mean of 139° ± 10°. Less glenoid retroversion was associated with lower tendon-to-glenoid contact angles (r = –0.76; R2 = 0.58; P < .01). Conclusion: This study found that the supraspinatus tendon progressively approximated the glenoid during simulated overhead reaching. Additionally, all participant models eventually made contact with the glenoid by 150° of humerothoracic elevation, although anatomic factors influenced the precise angle at which contact occurred. Clinical Relevance: Contact between the supraspinatus and the glenoid may occur frequently within the range of elevation required for overhead activities. Therefore, internal impingement may be a prevalent mechanism for rotator cuff deformation that could contribute to cuff pathology.
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Affiliation(s)
- Gaura Saini
- Division of Rehabilitation Science, Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Rebekah L Lawrence
- Division of Rehabilitation Science, Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, Minnesota, USA.,Department of Orthopaedic Surgery, Henry Ford Health System, Detroit, Michigan, USA
| | - Justin L Staker
- Division of Rehabilitation Science, Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, Minnesota, USA.,Division of Physical Therapy, Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Jonathan P Braman
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Paula M Ludewig
- Division of Rehabilitation Science, Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, Minnesota, USA.,Division of Physical Therapy, Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, Minnesota, USA
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Barthelme J, Sauter M, Mueller C, Liebers F. Association between working in awkward postures, in particular overhead work, and pain in the shoulder region in the context of the 2018 BIBB/BAuA Employment Survey. BMC Musculoskelet Disord 2021; 22:624. [PMID: 34266451 PMCID: PMC8283940 DOI: 10.1186/s12891-021-04482-4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 06/10/2021] [Indexed: 11/29/2022] Open
Abstract
Background Musculoskeletal disorders are the leading cause of work-related sick leave and incur substantial socioeconomic costs. With the aging of our society and employees, the problem is exacerbating, and prevention is becoming increasingly important. According to previous studies, exposure to awkward postures, such as overhead work, is associated with musculoskeletal problems. Objective This study aimed to determine the current prevalence of employees who work in awkward postures, specifically overhead, stratified by age, gender and occupation in the context of the 2018 BIBB/BAuA Employment Survey and to analyze associations between awkward working postures, in particular overhead work, and pain in the shoulder region. Method The study is based on secondary data from the German 2018 BIBB/BAuA Employment Survey. We have included 14,327 of the 20,012 employees aged < 67 years who work at least 35 h per week who took part in the survey. The classification of participants in occupational groups is based on the Blossfeld classification. The multivariate analysis was conducted by applying robust Poisson regression models adjusted block by block to obtain the relation between the self-reported frequency of working in awkward postures, in particular overhead work, and the occurrence of arm pain and neck and shoulder pain. Prevalence ratios (PR) are reported as effect estimates. Results 12.7% of participants indicated that they are often exposed to awkward postures at work; 5.0% stated they often performed overhead work. The majority of these employees worked in agricultural, unskilled and skilled manual occupations. The crude prevalence is 17.4% for arm pain and 48.4% for neck and shoulder pain. If subjects reported that they often performed overhead work, the risk of arm pain increased by 18% (PR 1.18, CI 1.04–1.34, final model). Conclusion Working in awkward postures, especially overhead work, is a risk factor for upper extremity musculoskeletal disorders. The development of prevention strategies should focus on the workforce in agricultural, unskilled and skilled manual occupations. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-021-04482-4.
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Affiliation(s)
- Julia Barthelme
- Charité-Universitaetsmedizin Berlin, Berlin, Germany.,Federal Institute for Occupational Safety and Health (BAuA), Noeldnerstr 40/42, 10317, Berlin, Germany
| | - Martha Sauter
- Charité-Universitaetsmedizin Berlin, Berlin, Germany.,Federal Institute for Occupational Safety and Health (BAuA), Noeldnerstr 40/42, 10317, Berlin, Germany
| | - Charlotte Mueller
- Charité-Universitaetsmedizin Berlin, Berlin, Germany.,Federal Institute for Occupational Safety and Health (BAuA), Noeldnerstr 40/42, 10317, Berlin, Germany
| | - Falk Liebers
- Federal Institute for Occupational Safety and Health (BAuA), Noeldnerstr 40/42, 10317, Berlin, Germany.
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18
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de Vries AW, Krause F, de Looze MP. The effectivity of a passive arm support exoskeleton in reducing muscle activation and perceived exertion during plastering activities. ERGONOMICS 2021; 64:712-721. [PMID: 33402050 DOI: 10.1080/00140139.2020.1868581] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 12/18/2020] [Indexed: 06/12/2023]
Abstract
The supportive effect of arm-support exoskeletons has been mainly studied for single postures or movements. The aim of this study is to analyse the effect of such an exoskeleton on shoulder muscle activity and perceived exertion, in six tasks of plasterers, each including multiple arm movements. The tasks of 'applying gypsum', 'screeding' and 'finishing' were performed at a ceiling and a wall, with exoskeleton (Exo) and without (NoExo). EMG was recorded of six muscles involved in upper arm elevation, four agonists and two antagonists, and plasterers rated their perceived exertion (RPE). In all tasks, the EMG amplitudes of three agonist muscles, Trapezius and Medial Deltoid, and Biceps Brachii, were lower in Exo vs NoExo, while the agonist, Anterior Deltoid, showed lower EMG values in Exo in most tasks. None of the antagonists (Triceps Brachii, Pectoralis Major) showed increased EMG values in the Exo condition. RPE's were lower in Exo condition for all tasks, except for 'applying gypsum to the wall'. Overall, the exoskeleton seems to reduce loads in realistic plastering tasks. Practitioner summary: Exoskeletons are an emerging technology in the field of ergonomics. Passive arm support exoskeletons have mainly been tested in lab studies using continuous overhead work, involving one posture or movement. However, in reality, working tasks generally involve multiple movements. This study investigates the effectiveness of an arm support exoskeleton in work that requires multiple arm movements, specifically in plastering. Muscle activity, as well as perceived exertion were both reduced when working with an exoskeleton. Abbreviations: Exo: with exoskeleton; NoExo: without exoskeleton; RPE: rated perceived exertion; EMG: electromyography; Trap: upper trapezius; AD: anterior deltoid; MD: medial deltoid; BB: biceps brachii; TB: triceps brachii; PM: pectoralis major; RPD: rated perceived discomfort; p50: 50th percentile; p90: 90th percentile; MVC: maximum voluntary contraction; GEE: generalised estimated equations.
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Affiliation(s)
- Aijse Willem de Vries
- Sustainable Productivity and Employability, Healthy Living, TNO, Leiden, The Netherlands
| | - Frank Krause
- Sustainable Productivity and Employability, Healthy Living, TNO, Leiden, The Netherlands
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Reist RM, Bath BL, Jelinski MD, Erickson NEN, Clark CR, Trask CM. Ergonomic assessment of veterinarians during performance of bovine reproductive examinations. J Am Vet Med Assoc 2021; 258:1243-1253. [PMID: 33978445 DOI: 10.2460/javma.258.11.1243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To identify and quantify potential ergonomic hazards associated with routine reproductive examinations of cattle. SAMPLE 7 bovine veterinarians. PROCEDURES Each veterinarian was observed and videotaped during 2 bovine reproductive examination appointments. During each appointment, a force-matching protocol was used to estimate the entry force used by the veterinarian to insert an arm into a cow's rectum. Veterinarian posture and repetitive movements and the work environment were assessed and quantified during review of the video recordings. Descriptive data were generated. RESULTS Of the 14 appointments observed, 9 and 5 involved examination of beef and dairy cows, respectively. For all veterinarians, an arm inclination ≥ 60° was observed during most reproductive examinations. The number of examinations performed per hour ranged from 19.1 to 116.8. The estimated entry force ranged from 121 to 349 N. During all 9 appointments involving beef cows, the veterinarian participated in other tasks (eg, operating overhead levers, opening gates, or assisting with cattle handling) that represented ergonomic hazards. CONCLUSIONS AND CLINICAL RELEVANCE Results confirmed that reproductive examination of cattle exposes veterinarians to various ergonomic hazards involving awkward positions and repetitive and forceful exertions that can contribute to musculoskeletal discomfort and injury, particularly of the upper extremities (neck, shoulders, upper back, arms, elbows, wrists, and hands). Veterinarians frequently participated in other tasks during reproductive examination appointments that exposed them to additional ergonomic hazards. Risk mitigation strategies should prioritize minimizing exposure of veterinarians to tasks not directly associated with the reproductive examination procedure to decrease their overall ergonomic hazard burden.
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20
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Schall MC, Zhang X, Chen H, Gallagher S, Fethke NB. Comparing upper arm and trunk kinematics between manufacturing workers performing predominantly cyclic and non-cyclic work tasks. APPLIED ERGONOMICS 2021; 93:103356. [PMID: 33454432 PMCID: PMC9298156 DOI: 10.1016/j.apergo.2021.103356] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 12/30/2020] [Accepted: 01/04/2021] [Indexed: 05/27/2023]
Abstract
Musculoskeletal disorders (MSDs) are common among manufacturing workers. Exposure to non-neutral postures and high movement speeds associated with MSDs among manufacturing workers may depend on the extent of the variability in the work tasks performed (i.e., predominantly "cyclic" versus "non-cyclic" work). The objectives of this study were to (i) compare mean levels of full-shift exposure summary metrics based on both posture and movement speed between manufacturing workers performing predominantly cyclic (n = 18) and non-cyclic (n = 17) tasks, and (ii) explore patterns of between- and within-worker exposure variance and between-minute (within-shift) exposure level and variation within each group. Inertial sensors were used to measure exposures for up to 15 full shifts per participant. Results indicated (i) substantially higher upper arm and trunk movement speeds among workers performing predominantly cyclic tasks relative to workers performing non-cyclic tasks despite similar postures, and (ii) greater exposure variability both between and within workers in the non-cyclic group.
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Affiliation(s)
- Mark C Schall
- Auburn University, Department of Industrial and Systems Engineering, 3323F Shelby Center for Engineering Technology, Auburn, AL, 36849-5346, USA.
| | - Xuanxuan Zhang
- Marshall University, Department of Applied Sciences and Technology, One John Marshall Drive, Huntington, 25755, WV, USA.
| | - Howard Chen
- Auburn University, Department of Mechanical Engineering, 1418 Wiggins Hall, Auburn, AL, 36849-5346, USA.
| | - Sean Gallagher
- Auburn University, Department of Industrial and Systems Engineering, 3304 Shelby Center for Engineering Technology, Auburn, AL, 36849-5346, USA.
| | - Nathan B Fethke
- University of Iowa, Department of Occupational and Environmental Health, S347 College of Public Health Building, Iowa City, IA, 52242, USA.
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21
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Skals S, Bláfoss R, Andersen MS, de Zee M, Andersen LL. Manual material handling in the supermarket sector. Part 1: Joint angles and muscle activity of trapezius descendens and erector spinae longissimus. APPLIED ERGONOMICS 2021; 92:103340. [PMID: 33340719 DOI: 10.1016/j.apergo.2020.103340] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 10/27/2020] [Accepted: 12/01/2020] [Indexed: 06/12/2023]
Abstract
Work-related musculoskeletal disorders are highly prevalent in the supermarket sector with manual material handling being one of the most commonly identified occupational risk factors. This cross-sectional study applied inertial motion capture and electromyography (EMG) to measure full-body kinematics and muscle activity of trapezius descendens and erector spinae longissimus during 50 manual material handling tasks performed by 17 workers in two supermarkets. The handling of bread and cucumbers to high shelf heights showed the highest trapezius muscle activity (from 47% to 59% peak normalized EMG), while the handling of bananas as well as lifting milk, bread and cucumbers from low to high positions showed the highest erector spinae activity (from 59% to 71%). Twenty-two tasks involved flexing the shoulders and trunk more than 90° and 50°, respectively. Based on these results, several manual handling practices in supermarkets should be reconsidered to reduce the physical work demands.
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Affiliation(s)
- Sebastian Skals
- Musculoskeletal Disorders and Physical Workload, National Research Centre for the Working Environment, Lersø Parkallé 105, 2100, Copenhagen East, Denmark; Sport Sciences - Performance and Technology, Department of Health Science and Technology, Aalborg University, Fredrik Bajers Vej 7 D2, 9220, Aalborg East, Denmark.
| | - Rúni Bláfoss
- Musculoskeletal Disorders and Physical Workload, National Research Centre for the Working Environment, Lersø Parkallé 105, 2100, Copenhagen East, Denmark; Research Unit for Muscle Physiology and Biomechanics, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark.
| | - Michael Skipper Andersen
- Department of Materials and Production, Aalborg University, Fibigerstræde 16, 9220, Aalborg, Denmark.
| | - Mark de Zee
- Sport Sciences - Performance and Technology, Department of Health Science and Technology, Aalborg University, Fredrik Bajers Vej 7 D2, 9220, Aalborg East, Denmark.
| | - Lars Louis Andersen
- Musculoskeletal Disorders and Physical Workload, National Research Centre for the Working Environment, Lersø Parkallé 105, 2100, Copenhagen East, Denmark; Sport Sciences - Performance and Technology, Department of Health Science and Technology, Aalborg University, Fredrik Bajers Vej 7 D2, 9220, Aalborg East, Denmark.
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Kim JY, Park JS, Kim DJ, Im S. Evaluation of fatigue patterns in individual shoulder muscles under various external conditions. APPLIED ERGONOMICS 2021; 91:103280. [PMID: 33166914 DOI: 10.1016/j.apergo.2020.103280] [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: 02/20/2020] [Revised: 09/29/2020] [Accepted: 10/02/2020] [Indexed: 06/11/2023]
Abstract
For shoulder muscle prevention, we investigated individual shoulder muscle performance and fatigue patterns in various external conditions, including three different % maximum voluntary contractions, six shoulder angles and 60-s durations of exertion. The rating of perceived exertion was also measured for comparison. The upper trapezius (UT), middle deltoid (MD), pectoralis major (PM), latissimus dorsi (LD) and serratus anterior (SA) were selected for assessment. Normalized median power frequency electromyograms were calculated for quantitative fatigue evaluation in ten participants. UT muscle was severely fatigued by extreme flexion angle rather than weight. MD muscle was the most rapidly fatigued after 15 s duration. SA muscle was more fatigued at 0° than 30° adduction. LD and PM muscle fatigue were mostly due to external workload. This muscle specific outcome could help practitioners to design an intervention program targeting particular shoulder injury.
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Affiliation(s)
- Jung Yong Kim
- Department of Human Computer Interaction, Hanyang University, ERICA Campus, Ansan, South Korea
| | - Ji Soo Park
- Department of Industrial Engineering, Hanyang University, Seoul, South Korea.
| | - Dong Joon Kim
- Department of Industrial and Management Engineering, Hanyang University, ERICA Campus, Ansan, South Korea
| | - Sungkyun Im
- Department of Industrial and Management Engineering, Hanyang University, ERICA Campus, Ansan, South Korea
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Can a metric combining arm elevation and trapezius muscle activity predict neck/shoulder pain? A prospective cohort study in construction and healthcare. Int Arch Occup Environ Health 2020; 94:647-658. [PMID: 33278002 PMCID: PMC8068682 DOI: 10.1007/s00420-020-01610-w] [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: 06/06/2020] [Accepted: 11/09/2020] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To determine whether a composite metric of arm elevation and trapezius activity (i.e. neck/shoulder load) is more strongly associated with the 2-year course of neck and shoulder pain intensity (NSPi) among construction and healthcare workers than each exposure separately. METHODS Dominant arm elevation and upper trapezius muscle activity were estimated in construction and healthcare employees (n = 118) at baseline, using accelerometry and normalized surface electromyography (%MVE), respectively. At baseline and every 6 months for 2 years, workers reported NSPi (score 0-3). Compositions of working time were determined for arm elevation (< 30°; 30-60°; > 60°), trapezius activity (< 0.5%; 0.5-7.0%; > 7.0%MVE), and a composite metric "neck/shoulder load" (restitution, low, medium, and high load). Associations between each of these three compositions and the 2-year course of NSPi were determined using linear mixed models. RESULTS Associations between exposure compositions and the course of NSPi were all weak and in general uncertain. Time spent in 0.5-7.0%MVE showed the largest and most certain association with changes in NSPi during follow-up (β = - 0.13; p = 0.037; corresponding to a -0.01 change in NPSi every 6 months). Among pain-free workers at baseline, medium (β = - 0.23; p = 0.039) and high (β = 0.15; p = 0.031) neck/shoulder load contributed the most to explaining changes in NSPi. CONCLUSION The composite metric of neck/shoulder load did not show a stronger association with the course of NSPi than arm elevation or trapezius activity alone in the entire population, while some indications of a stronger association were found among those who were pain-free at baseline.
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Design and Experimental Evaluation of a Semi-Passive Upper-Limb Exoskeleton for Workers With Motorized Tuning of Assistance. IEEE Trans Neural Syst Rehabil Eng 2020; 28:2276-2285. [DOI: 10.1109/tnsre.2020.3014408] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Kim JH, Ari H, Madasu C, Hwang J. Evaluation of the biomechanical stress in the neck and shoulders during augmented reality interactions. APPLIED ERGONOMICS 2020; 88:103175. [PMID: 32678782 DOI: 10.1016/j.apergo.2020.103175] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 05/20/2020] [Accepted: 05/26/2020] [Indexed: 06/11/2023]
Abstract
This study aimed to characterize the biomechanical stresses in the neck and shoulder, self-reported discomfort, and usability by different target distance or size during augmented reality (AR) interactions. In a repeated-measures laboratory-based study, 20 participants (10 males) performed three standardized AR tasks (3-dimensional (3-D) cube, omni-directional pointing, and web-browsing tasks) with three target distances (0.3, 0.6, and 0.9 m from each participant denoted by near, middle, far targets) for the 3-D cube and omni-directional pointing tasks or three target sizes: small (30% smaller than default), medium (default: 1.0 × 1.1 m), and large (30% larger than default) for the web-browsing task. Joint angle, joint moment, muscle activity, self-reported discomfort and comfort in the neck and shoulders; and subjective usability ratings were measured. The results showed that shoulder angle (flexion and abduction), shoulder moment (flexion), middle deltoid muscle activity significantly increased as the target distance increased during the 3-D cube task (p's < 0.001). Self-reported neck and shoulder discomfort significantly increased after completing each task (p's < 0.001). The participants preferred the near to middle distance (0.3-0.6 m) or the medium to large window size due to task easiness (p's < 0.005). The highest task performance (speed) was occurred at the near distance or the large window size during the 3-D cube and web-browsing tasks (p's < 0.001). The results indicate that AR interactions with the far target distance (close to maximum reach envelop) may increase the risk for musculoskeletal discomfort in the shoulder regions. Given the increased usability and task performance, the near to middle distance (less than 0.6 m) or the medium to large window size (greater than 1.0 × 1.1 m) would be recommended for AR interactions.
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Affiliation(s)
- Jeong Ho Kim
- School of Biological and Population Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, USA
| | - Hemateja Ari
- Department of Industrial and Systems Engineering, College of Engineering and Engineering Technology, Northern Illinois University, DeKalb, IL, USA
| | - Charan Madasu
- Department of Industrial and Systems Engineering, College of Engineering and Engineering Technology, Northern Illinois University, DeKalb, IL, USA
| | - Jaejin Hwang
- Department of Industrial and Systems Engineering, College of Engineering and Engineering Technology, Northern Illinois University, DeKalb, IL, USA.
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Work above shoulder level and shoulder complaints: a systematic review. Int Arch Occup Environ Health 2020; 93:925-954. [PMID: 32572582 PMCID: PMC7519900 DOI: 10.1007/s00420-020-01551-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 05/09/2020] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To investigate the association and the exposure-response relationship between work above shoulder height and shoulder pain or disorders. METHODS A systematic search was performed in Medline, Embase, and Health and Safety Science Abstracts. Included were articles with prospective cohort, case-control, cross-sectional, or intervention study designs. Quality assessment was based on an evaluation scheme adjusted to study design and normalized to 100%. The cut-off for sufficient quality to include articles was above 40% and cut-off for high-quality articles was above 50% of maximal score. The level of strength of evidence for an association between exposure and effect was assessed according to the GRADE guidelines. RESULTS Thirty-four articles were included. Articles that document large effects (higher risk estimates; OR ≥ 2) have higher quality score, include analyses of severe arm elevation, more often use clinical outcome, and report an exposure-response relationship compared to studies reporting lower risk estimates. The studies that reported large effects were all significant. An exposure-response relationship was found in many high-quality studies when relating exposure intensity of arm elevation (level of arm elevation, amplitude) as well as duration of arm elevation, especially > 90°. CONCLUSION We conclude on a limited evidence for an association between arm elevation at work and shoulder disorders. Severe arm elevation with elbows above shoulder level (i.e., > 90°) shows a moderate evidence for an association with shoulder disorders.
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Laurent A, Plamondon R, Begon M. Central and Peripheral Shoulder Fatigue Pre-screening Using the Sigma-Lognormal Model: A Proof of Concept. Front Hum Neurosci 2020; 14:171. [PMID: 32508608 PMCID: PMC7248386 DOI: 10.3389/fnhum.2020.00171] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Accepted: 04/20/2020] [Indexed: 12/11/2022] Open
Abstract
Background Clinical tests for detecting central and peripheral shoulder fatigue are limited. The discrimination of these two types of fatigue is necessary to better adapt recovery intervention. The Kinematic Theory of Rapid Human Movements describes the neuromotor impulse response using lognormal functions and has many applications in pathology detection. The ideal motor control is modeled and a change in the neuromuscular system is reflected in parameters extracted according to this theory. Objective The objective of this study was to assess whether a shoulder neuromuscular fatigue could be detected through parameters describing the theory, if there is the possibility to discriminate central from peripheral fatigue, and which handwriting test gives the most relevant information on fatigue. Methods Twenty healthy participants performed two sessions of fast stroke handwriting on a tablet, before and after a shoulder fatigue. The fatigue was in internal rotation for one session and in external rotation during the other session. The drawings consisted of simple strokes, triangles, horizontal, and vertical oscillations. Parameters of these strokes were extracted according to the Sigma–Lognormal model of the Kinematic Theory. The evolution of each participant was analyzed through a U-Mann–Whitney test for individual comparisons. A Hotelling’s T2-test and a U-Mann–Whitney test were also performed on all participants to assess the group evolution after fatigue. Moreover, a correlation among parameters was calculated through Spearman coefficients to assess intrinsic parameters properties of each handwriting test. Results Central and peripheral parameters were statistically different before and after fatigue with a possibility to discriminate them. Participants had various responses to fatigue. However, when considering the group, parameters related to the motor program execution showed significant increase in the handwriting tests after shoulder fatigue. The test of simple strokes permits to know more specifically where the fatigue comes from, whereas the oscillations tests were the most sensitive to fatigue. Conclusion The results of this study suggest that the Sigma–Lognormal model of the Kinematic Theory is an innovative approach for fatigue detection with discrimination between the central and peripheral systems. Overall, there is a possibility to implement the setting for clinics and sports personalized follow-up.
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Affiliation(s)
- Anaïs Laurent
- Laboratoire Scribens, Département de Génie Électrique, Programme de Génie Biomédical, Polytechnique Montréal, Montreal, QC, Canada
| | - Réjean Plamondon
- Laboratoire Scribens, Département de Génie Électrique, Polytechnique Montréal, Montreal, QC, Canada
| | - Mickael Begon
- Laboratoire de Simulation et de Modélisation du Mouvement, School of Kinesiology and Physical Activity Sciences, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada.,CHU Sainte-Justine, Montreal, QC, Canada
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Lind CM, Forsman M, Rose LM. Development and evaluation of RAMP II - a practitioner's tool for assessing musculoskeletal disorder risk factors in industrial manual handling. ERGONOMICS 2020; 63:477-504. [PMID: 31885328 DOI: 10.1080/00140139.2019.1710576] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 11/05/2019] [Indexed: 06/10/2023]
Abstract
RAMP II is an observation-based tool developed for assessing a wide range of musculoskeletal disorder risk factors related to industrial manual handling. RAMP II, which is part of the RAMP tool, is based on research studies and expert judgments. The assessment relies mainly on direct or video observations of the work being assessed, but additionally on measured push/pull forces and weights of handled objects, and on perceived workload and discomfort. Over 80 practitioners participated in the development of the tool. According to the evaluations, 73% of the assessment items evaluated had acceptable reliability, and the majority of the potential end-users reported that RAMP II is usable for assessing risks and as a decision base. It is concluded that this study provides support that RAMP II is usable for risk assessment of musculoskeletal disorder risk factors in industrial manual handling. Practitioner summary: RAMP II is an observation-based assessment tool for screening and assessing major musculoskeletal exposures in industrial manual handling jobs. Over 80 practitioners participated in the development of the tool. This study provides support that RAMP II is usable for risk assessment of musculoskeletal disorder risk factors in industrial manual handling. Abbreviations: CTS: carpal tunnel syndrome; HARM: the Hand Arm Risk Assessment method; IMP: intramuscular pressure; κw: linearly weighted kappa; LBD: lower back disorders; LBP: lower back pain; MAWL: maximum acceptable weight of lift; MHO: manual handling operations; MSD: musculoskeletal disorder; MNSD: neck-shoulder disorder; NSP: neck-shoulder pain; OCRA: the Occupational Repetitive Action methods; OHS: occupational health and safety; PABAK: prevalence and bias adjusted kappa; p0: proportion of agreement; RAMP: Risk Assessment and Management tool for manual handling Proactively; ROM: range of motion; RPL: risk and priority level; RSI: the Revised Strain Index; RULA: the Rapid Upper Limb Assessment; SWEA: Swedish Work Environment Authority; UEMSDs: upper-extremity work-related musculoskeletal disorders; WMSD: work-related musculoskeletal disorder; WRMSD: work-related musculoskeletal disorder; workday8h: eight hours workday.
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Affiliation(s)
- Carl Mikael Lind
- Division of Ergonomics, School of Engineering Sciences in Chemistry, Biotechnology and Health, KTH Royal Institute of Technology, Stockholm, Sweden
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Mikael Forsman
- Division of Ergonomics, School of Engineering Sciences in Chemistry, Biotechnology and Health, KTH Royal Institute of Technology, Stockholm, Sweden
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Linda Maria Rose
- Division of Ergonomics, School of Engineering Sciences in Chemistry, Biotechnology and Health, KTH Royal Institute of Technology, Stockholm, Sweden
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Nelson AJ, Hall PT, Saul KR, Crouch DL. Effect of Mechanically Passive, Wearable Shoulder Exoskeletons on Muscle Output During Dynamic Upper Extremity Movements: A Computational Simulation Study. J Appl Biomech 2020; 36:59-67. [PMID: 31968306 DOI: 10.1123/jab.2018-0369] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 12/12/2019] [Accepted: 12/12/2019] [Indexed: 10/27/2023]
Abstract
Wearable passive (ie, spring powered) shoulder exoskeletons could reduce muscle output during motor tasks to help prevent or treat shoulder musculoskeletal disorders. However, most wearable passive shoulder exoskeletons have been designed and evaluated for static tasks, so it is unclear how they affect muscle output during dynamic tasks. The authors used a musculoskeletal model and Computed Muscle Control optimization to estimate muscle output with and without a wearable passive shoulder exoskeleton during 2 simulated dynamic tasks: abduction and upward reach. To an existing upper extremity musculoskeletal model, the authors added an exoskeleton model with 3-dimensional representations of the exoskeleton components, including a spring, cam wheel, force-transmitting shoulder cable, and wrapping surfaces that permitted the shoulder cable to wrap over the shoulder. The exoskeleton reduced net muscle-generated moments in positive shoulder elevation by 28% and 62% during the abduction and upward reach, respectively. However, muscle outputs (joint moments and muscle effort) were higher with the exoskeleton than without at some points of the movement. Muscle output was higher with the exoskeleton because the exoskeleton moment opposed the muscle-generated moment in some postures. The results of this study highlight the importance of evaluating muscle output for passive exoskeletons designed to support dynamic movements to ensure that the exoskeletons assist, rather than impede, movement.
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Affiliation(s)
- Allison J Nelson
- University of Tennessee
- Virginia Polytechnic Institute and State University
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Seidler A, Romero Starke K, Freiberg A, Hegewald J, Nienhaus A, Bolm-Audorff U. Dose-Response Relationship between Physical Workload and Specific Shoulder Diseases-A Systematic Review with Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17041243. [PMID: 32075183 PMCID: PMC7068556 DOI: 10.3390/ijerph17041243] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 02/09/2020] [Accepted: 02/10/2020] [Indexed: 11/16/2022]
Abstract
Several epidemiological studies have found an association between shoulder-loaded work activities and specific shoulder diseases. No study has derived the dose-response relationship and resulting doubling dose, important for the recognition of occupational diseases. This systematic review is an update of the van der Molen et al. (2017) review. Based on its methodologies, we identified new studies published up to November 2018. The dose-response relationship between physical occupational demands (hands at/above shoulder level, repetitive movements, forceful work, hand-arm vibrations) and specific shoulder diseases (defined as ICD-10 M 75.1-5: rotator cuff syndrome, bicipital tendinitis, calcific tendinitis, impingement, and bursitis) was derived. No evidence for sex-specific differences in the dose-response relationship was found. If there were at least two studies with comparable exposures, a meta-analysis was carried out. The pooled analysis resulted in a 21% risk increase (95% CI 4–41%) per 1000 h of work with hands above shoulder level. A meta-analysis was not possible for other occupational burdens due to the low number of studies and differing exposure measurements; an estimate of the doubling dose was made based on the cohort study of Dalbøge et al. (2014). To conclude, the present systematic review with meta-analysis contributes to knowledge of the level of exposure at which specific shoulder diseases—particularly rotator cuff lesions—should be recognized as an occupational disease.
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Affiliation(s)
- Andreas Seidler
- Institute and Policlinic of Occupational and Social Medicine (IPAS), Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany; (K.R.S.); (A.F.); (J.H.)
- Correspondence: ; Tel.: +49-351-3177-441
| | - Karla Romero Starke
- Institute and Policlinic of Occupational and Social Medicine (IPAS), Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany; (K.R.S.); (A.F.); (J.H.)
| | - Alice Freiberg
- Institute and Policlinic of Occupational and Social Medicine (IPAS), Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany; (K.R.S.); (A.F.); (J.H.)
| | - Janice Hegewald
- Institute and Policlinic of Occupational and Social Medicine (IPAS), Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany; (K.R.S.); (A.F.); (J.H.)
| | - Albert Nienhaus
- Department of Occupational Medicine, Public Health and Hazardous Substances, Statutory Accident Insurance and Prevention in the Health and Welfare Services, 22089 Hamburg, Germany;
- Competence Centre for Epidemiology and Health Services Research for Healthcare Professionals (CVcare), University Medical Centre Hamburg-Eppendorf (UKE), 20246 Hamburg, Germany
| | - Ulrich Bolm-Audorff
- Division of Occupational Health, Department of Occupational Safety and Environment, Regional Government of South Hesse, 65197 Wiesbaden, Germany;
- Institute and Outpatient Clinic for Occupational and Social Medicine, University Medical Center Gießen, Justus-Liebig-University, 35392 Gießen, Germany
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Fethke NB, Schall MC, Chen H, Branch CA, Merlino LA. Biomechanical factors during common agricultural activities: Results of on-farm exposure assessments using direct measurement methods. JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HYGIENE 2020; 17:85-96. [PMID: 32069181 PMCID: PMC8256625 DOI: 10.1080/15459624.2020.1717502] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Agricultural work is associated with increased risk of adverse musculoskeletal health outcomes. The purpose of this study was to quantify exposure to biomechanical factors among a sample (n = 55) of farmers in the Midwest region of the U.S. while they performed a variety of routine agricultural activities, and to compare exposure levels between these activities. Surface electromyography was used to estimate activity levels of the erector spinae, upper trapezius, forearm flexor, and forearm extensor muscle groups. Simultaneously, inertial sensors were used to measure kinematics of the trunk, upper arm, and wrist. In general, lower muscle activity levels, less extreme postures, and slower movement speeds were observed during activities that involved primarily the use of agricultural machinery in comparison to manual activities, suggesting a potential advantage of mechanization relative to musculoskeletal health. Median wrist movement speeds exceeding recently proposed exposure thresholds were also observed during many manual activities, such as milking animals and repairing equipment. Upper arm postures and movement speeds did not appear to confer excessive risk for shoulder-related outcomes (on the whole), but interpretation of the results is limited by a sampling approach that may not have captured the full extent of exposure variation. Not surprisingly, substantial variation in exposure levels were observed within each agricultural activity, which is related to substantial variation in the equipment, tools, and work practices used by participants. Ultimately, the results of this study contribute to an emerging literature in which the physical demands of routine agricultural work have been described on the basis of sensor-based measurements rather than more common self-report or observation-based approaches.
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Affiliation(s)
- Nathan B Fethke
- Occupational and Environmental Health, University of Iowa, Iowa City, Iowa
| | - Mark C Schall
- Industrial & Systems Engineering, Auburn University, Auburn, Alabama
| | - Howard Chen
- Mechanical Engineering, Auburn University, Auburn, Alabama
| | | | - Linda A Merlino
- Occupational and Environmental Health, University of Iowa, Iowa City, Iowa
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Hallbeck MS, Law KE, Lowndes BR, Linden AR, Morrow M, Blocker RC, Cain SM, Degnim AC, Hieken TJ, Jakub JW, Racz JM, Farley DR, Nelson H, Boughey JC. Workload Differentiates Breast Surgical Procedures: NSM Associated with Higher Workload Demand than SSM. Ann Surg Oncol 2020; 27:1318-1326. [PMID: 31916090 PMCID: PMC7138769 DOI: 10.1245/s10434-019-08159-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Indexed: 01/02/2023]
Abstract
Background Breast surgery has evolved with more focus on improving cosmetic outcomes, which requires increased operative time and technical complexity. Implications of these technical advances in surgery for the surgeon are unclear, but they may increase intraoperative demands, both mentally and physically. We prospectively evaluated mental and physical demand across breast surgery procedures, and compared surgeon ergonomic risk between nipple-sparing (NSM) and skin-sparing mastectomy (SSM) using subjective and objective measures. Methods From May 2017 to July 2017, breast surgeons completed modified NASA-Task Load Index (TLX) workload surveys after cases. From January 2018 to July 2018, surgeons completed workload surveys and wore inertial measurement units to evaluate their postures during NSM and SSM cases. Mean angles of surgical postures, ergonomic risk, survey items, and patient factors were analyzed. Results Procedural duration was moderately related to surgeon frustration, mental and physical demand, and fatigue (p < 0.001). NSMs were rated 23% more physically demanding (M = 13.3, SD = 4.3) and demanded 28% more effort (M = 14.4, SD = 4.6) than SSMs (M = 10.8, SD = 4.7; M = 11.8, SD = 5.0). Incision type was a contributing factor in workload and procedural difficulty. Left arm mean angle was significantly greater for NSM (M = 30.1 degrees, SD = 6.6) than SSMs (M = 18.2 degrees, SD = 4.3). A higher musculoskeletal disorder risk score for the trunk was significantly associated with higher surgeon physical workload (p = 0.02). Conclusion Nipple-sparing mastectomy required the highest surgeon-reported workload of all breast procedures, including physical demand and effort. Objective measures identified the surgeons’ left upper arm as being at the greatest risk for a work-related musculoskeletal disorder, specifically from performing NSMs.
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Affiliation(s)
- M Susan Hallbeck
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA. .,Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA. .,Department of Surgery, Mayo Clinic, Rochester, MN, USA.
| | - Katherine E Law
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA.,Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Bethany R Lowndes
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA.,Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, USA
| | - Anna R Linden
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Melissa Morrow
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA.,Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Renaldo C Blocker
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA.,Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Stephen M Cain
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Amy C Degnim
- Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | - Tina J Hieken
- Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | - James W Jakub
- Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | | | | | - Heidi Nelson
- Department of Surgery, Mayo Clinic, Rochester, MN, USA
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Trøstrup J, Mikkelsen LR, Frost P, Dalbøge A, Høybye MT, Casper SD, Jørgensen LB, Klebe TM, Svendsen SW. Reducing shoulder complaints in employees with high occupational shoulder exposures: study protocol for a cluster-randomised controlled study (The Shoulder-Café Study). Trials 2019; 20:627. [PMID: 31718683 PMCID: PMC6852773 DOI: 10.1186/s13063-019-3703-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 09/05/2019] [Indexed: 11/27/2022] Open
Abstract
Background In Denmark, exercise therapy in combination with work modification is the first-choice treatment for persons with shoulder complaints and high occupational shoulder exposures. To obtain this treatment they must visit several healthcare providers, which makes usual care fragmented and uncoordinated. Therefore, we developed a new intervention which unifies the expertise that is needed. The main hypotheses are that a group-based Shoulder-Café intervention will more effectively reduce (1) shoulder complaints and (2) occupational shoulder exposures than an individual-based Shoulder-Guidance intervention (active control – enhanced usual care). Methods A cluster-randomised trial is conducted including 120 employees with high occupational shoulder exposures. Companies (clusters) are randomised to either Shoulder-Café or Shoulder-Guidance with a 1:1 allocation ratio. Participants are 18–65 years old and have an Oxford Shoulder Score (OSS) ≤ 40. Both interventions include a home-based shoulder-exercise programme, assessment of shoulder exposures by technical measurements and self-report, and general information on how to reduce shoulder exposures. The Shoulder-Café course also includes three café meetings with physiotherapist-supervised exercises, clinical shoulder evaluation, education on shoulder anatomy, workplace-orientated counselling, and an opportunity for a workplace visit by a health and safety consultant. The primary outcomes are the OSS at 6-month follow-up (hypothesis I), and the mean number of min/day with the arm elevated > 60° shortly after the end of the intervention (hypothesis II). We will use a mixed-model analysis that allows for company clustering, and data will be analysed according to the intention-to-treat principle. Discussion Persons with shoulder complaints and high occupational shoulder exposures are an obvious target group for secondary prevention efforts. We developed the Shoulder-Café to reduce shoulder complaints and shoulder exposures while unifying the expertise that is needed to evaluate and treat shoulder complaints. If the intervention is effective, it would warrant widespread implementation. Trial registration Clinicaltrials.gov, ID: NCT03159910. Registered on 18 May 2017
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Affiliation(s)
- Jeanette Trøstrup
- Elective Surgery Centre, Silkeborg Regional Hospital, 8600, Silkeborg, Denmark. .,Danish Ramazzini Centre, Department of Occupational Medicine, Regional Hospital West Jutland - University Research Clinic, Herning, Denmark.
| | - Lone Ramer Mikkelsen
- Elective Surgery Centre, Silkeborg Regional Hospital, 8600, Silkeborg, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Poul Frost
- Danish Ramazzini Centre, Department of Occupational Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Annett Dalbøge
- Danish Ramazzini Centre, Department of Occupational Medicine, Regional Hospital West Jutland - University Research Clinic, Herning, Denmark.,Danish Ramazzini Centre, Department of Occupational Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Mette Terp Høybye
- Elective Surgery Centre, Silkeborg Regional Hospital, 8600, Silkeborg, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | | | - Lene Bastrup Jørgensen
- Elective Surgery Centre, Silkeborg Regional Hospital, 8600, Silkeborg, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Thomas Martin Klebe
- Elective Surgery Centre, Silkeborg Regional Hospital, 8600, Silkeborg, Denmark
| | - Susanne Wulff Svendsen
- Danish Ramazzini Centre, Department of Occupational Medicine, Regional Hospital West Jutland - University Research Clinic, Herning, Denmark
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McFarland T, Fischer S. Considerations for Industrial Use: A Systematic Review of the Impact of Active and Passive Upper Limb Exoskeletons on Physical Exposures. IISE Trans Occup Ergon Hum Factors 2019. [DOI: 10.1080/24725838.2019.1684399] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Tasha McFarland
- Department of Kinesiology, University of Waterloo, Waterloo, CA, USA
| | - Steven Fischer
- Department of Kinesiology, University of Waterloo, Waterloo, CA, USA
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Alabdulkarim S, Kim S, Nussbaum MA. Effects of exoskeleton design and precision requirements on physical demands and quality in a simulated overhead drilling task. APPLIED ERGONOMICS 2019; 80:136-145. [PMID: 31280797 DOI: 10.1016/j.apergo.2019.05.014] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 05/16/2019] [Accepted: 05/23/2019] [Indexed: 06/09/2023]
Abstract
We compared three passive exoskeleton designs in a mock drilling task under three precision requirements levels, defined by required hole sizes, in terms of physical demands (perceived exertion and muscular activation) and quality. The investigated designs were: 1) an upper-body exoskeleton mainly supporting the shoulder; and both 2) full-body, and 3) upper-body exoskeletons, each with connected supernumerary arms. At a fixed pace, participants (n = 12) repeated "drilling" two same-sized holes for 2 min. A fairly consistent result across exoskeleton designs was that higher precision demands increased some muscle activation levels and deteriorated quality. Designs with supernumerary arms led to the largest reductions in quality and increased physical demands overall, mainly in the low back. The shoulder-focused exoskeleton reduced shoulder demands but appeared to reduce quality with the highest precision requirement. Although future work is needed under more diverse/realistic scenarios, these results might be useful to (re)design occupational exoskeletons.
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Affiliation(s)
- Saad Alabdulkarim
- Industrial Engineering Department, College of Engineering, King Saud University, Riyadh, Saudi Arabia
| | - Sunwook Kim
- Department of Industrial and System Engineering, Virginia Tech, 250 Durham Hall (0118), Blacksburg, VA, 24061, USA
| | - Maury A Nussbaum
- Department of Industrial and System Engineering, Virginia Tech, 250 Durham Hall (0118), Blacksburg, VA, 24061, USA; Virginia Tech - Wake Forest School of Biomedical Engineering and Sciences, Blacksburg, VA, USA.
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36
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Pritchard SE, Tse CTF, McDonald AC, Keir PJ. Postural and muscular adaptations to repetitive simulated work. ERGONOMICS 2019; 62:1214-1226. [PMID: 31150301 DOI: 10.1080/00140139.2019.1626491] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 04/29/2019] [Indexed: 06/09/2023]
Abstract
Complex repetitive tasks are common in the workplace and have been associated with upper extremity disorders. The purpose of this study was to examine the progressive effects of highly repetitive work on joint kinematics and muscle activity of the trunk and upper extremity. Fifteen healthy men performed 60 one-minute cycles of 4 simulated automotive-related tasks. Electromyography of eight muscles and kinematics of the trunk and right upper extremity were collected. Data were analysed at 12-min intervals and divided into a complete work cycle. The time to complete the work cycle decreased by 6.3 s over the trials. Peak shoulder flexion decreased and peak elbow flexion increased during the work cycle. Muscle activity magnitude and variability was influenced by time during the repetitive tasks. This study found adaptations to highly repetitive but light work in only 1 h; redistributing muscle demands within the shoulder over time may reduce muscle fatigue development. Practitioner Summary: While the work was not strenuous, we were able to demonstrate muscular and postural adaptations in a single hour of simulated work. By evaluating both the whole work cycle and the sub-tasks, we aim to develop new methods for evaluating the risk of complex tasks in prolonged repetitive work.
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Affiliation(s)
- Samantha E Pritchard
- a Occupational Biomechanics Laboratory, Department of Kinesiology, McMaster University , Hamilton , ON , Canada
| | - Calvin T F Tse
- a Occupational Biomechanics Laboratory, Department of Kinesiology, McMaster University , Hamilton , ON , Canada
| | - Alison C McDonald
- a Occupational Biomechanics Laboratory, Department of Kinesiology, McMaster University , Hamilton , ON , Canada
| | - Peter J Keir
- a Occupational Biomechanics Laboratory, Department of Kinesiology, McMaster University , Hamilton , ON , Canada
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Kozak A, Wirth T, Verhamme M, Nienhaus A. Musculoskeletal health, work-related risk factors and preventive measures in hairdressing: a scoping review. J Occup Med Toxicol 2019; 14:24. [PMID: 31428183 PMCID: PMC6698044 DOI: 10.1186/s12995-019-0244-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 08/08/2019] [Indexed: 11/10/2022] Open
Abstract
Background Hairdressers are exposed to various work-related biomechanical and organizational risk factors. To date, there has been no overview of the evidence for this occupational group. The purpose of this scoping review is to gain insight into the current state of research on work-related musculoskeletal disorders (MSD) in hairdressing. Methods Studies published up to November 2018 were identified by a systematic search using electronic databases (MEDLINE, PUBMED, CINAHL, Web of Science, LIVIVO), Google Scholar and reference lists of articles. Studies were screened by two researchers and synthesized in a descriptive manner. Results Overall 44 studies with different study designs, scopes and approaches were included. Nineteen studies provided data on MSD prevalence in at least one body site. The prevalence values between the studies varied considerably. On average, the highest 12-month prevalence was reported for the lower back (range 13-76%), neck (range 9-58%), shoulder (range 28-60%) and hand/wrist (range 11-53%). In comparison to other occupational groups, hairdressers reported more frequent MSD in all body regions or exhibited a greater risk of leaving the profession for health reasons. Common risk factors include working with arms above shoulder level, repetitive movements, forceful exertion of upper extremities, awkward back postures and movements, high mechanical workload and standing. In addition to physical stress, lack of adequate breaks, overtime, and general distress may deteriorate health and performance of hairdressers. Three rehabilitative and three preventive interventional studies were found. Only the rehabilitative studies showed positive effects on the management of physical and mental strain and resulted in significant pain reduction, increased physical capacity and knowledge of potential risk factors for MSD. Conclusion This data provides some evidence for work-related risk factors for MSD in hairdressers and indicate that there should be an intense focus on preventive measures. High quality and long-term interventional studies are needed to clarify the effectiveness of complex preventive concepts in hairdressing.
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Affiliation(s)
- Agnessa Kozak
- 1Competence Centre for Epidemiology and Health Services Research for Healthcare Professionals (CVcare), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Tanja Wirth
- 1Competence Centre for Epidemiology and Health Services Research for Healthcare Professionals (CVcare), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | | | - Albert Nienhaus
- 1Competence Centre for Epidemiology and Health Services Research for Healthcare Professionals (CVcare), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.,3Department of Occupational Medicine, Hazardous Substances and Public Health, Institution for Statutory Accident Insurance and Prevention in the Health and Welfare Services (BGW), Hamburg, Germany
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Palm P, Gupta N, Forsman M, Skotte J, Nordquist T, Holtermann A. Exposure to Upper Arm Elevation During Work Compared to Leisure Among 12 Different Occupations Measured with Triaxial Accelerometers. Ann Work Expo Health 2019; 62:689-698. [PMID: 29945157 PMCID: PMC6037214 DOI: 10.1093/annweh/wxy037] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 06/21/2018] [Indexed: 01/15/2023] Open
Abstract
Regarding prevention of neck and shoulder pain (NSP), unsupported arm elevation is one factor that should be taken into account when performing work risk assessment. Triaxial accelerometers can be used to measure arm elevation over several days but it is not possible to differentiate between supported and unsupported arm elevation from accelerometers only. Supported arm elevation is more likely to exist during sitting than standing. The aim of the study was to evaluate the use of whole workday measurements of arm elevation with accelerometers to assess potentially harmful work exposure of arm elevation, by comparing arm elevation at work with arm elevation during leisure, in a population with diverse work tasks, and to assess how the exposure parameters were modified when upper arm elevation during sitting time was excluded. The participants, 197 workers belonging to 12 occupational groups with diverse work tasks, wore triaxial accelerometers on the dominant arm, hip, and back for 1–4 days to measure arm elevation and periods of sitting. None of the groups were found to have higher exposure to arm elevation during work compared to leisure. Even though some occupations where known to have work tasks that forced them to work with elevated arms to a large extent. A high proportion of arm elevation derived from sitting time, especially so during leisure. When arm elevation during sitting time was excluded from the analysis, arm elevation was significantly higher at work than during leisure among construction workers, garbage collectors, manufacturing workers, and domestic cleaners. Together this illustrates that it is not suitable to use whole workday measurments of arm elevation with accelerometer as a sole information source when assessing the risk for NSP due to arm elevation. Information on body posture can provide relevant contextual information in exposure assessments when it is known that the potential harmful exposure is performed in standing or walking.
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Affiliation(s)
- Peter Palm
- Department of Medical Sciences Occupational and Environmental Medicine, Dag Hammarsjköldsväg, Uppsala, Sweden.,Occupational and Environmental Medicine, Akademiska sjukhuset, Dag Hammarsjköldsväg, Uppsala, Sweden
| | - Nidhi Gupta
- National Research Centre for the Working Environmnent, Lersø Parkallé, Copenhagen Ø, Denmark
| | - Mikael Forsman
- IMM Institute of Environmnental Medicine, Nobels väg, Stockholm, Sweden.,Centre for Occupational and Environmental Medicine, Solnavägen, Stockholm, Sweden
| | - Jørgen Skotte
- National Research Centre for the Working Environmnent, Lersø Parkallé, Copenhagen Ø, Denmark
| | - Tobias Nordquist
- Department of Medical Sciences Occupational and Environmental Medicine, Dag Hammarsjköldsväg, Uppsala, Sweden
| | - Andreas Holtermann
- National Research Centre for the Working Environmnent, Lersø Parkallé, Copenhagen Ø, Denmark.,Department of Sports Science and Clinical Biomechanics, University of Odense, Campusvej, Odense, Denmark
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Balogh I, Arvidsson I, Björk J, Hansson GÅ, Ohlsson K, Skerfving S, Nordander C. Work-related neck and upper limb disorders - quantitative exposure-response relationships adjusted for personal characteristics and psychosocial conditions. BMC Musculoskelet Disord 2019; 20:139. [PMID: 30935374 PMCID: PMC6444852 DOI: 10.1186/s12891-019-2491-6] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 03/04/2019] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND We have previously reported quantitative exposure-response relationships between physical exposures recorded by technical methods, and complaints and diagnoses in the neck/shoulders, and the elbows/hands, based on group data. In the present study the number of workers was doubled, and information on individual factors, and psychosocial working conditions was used. Relationships between various kinds of exposure and response have been analysed in this larger and more detailed sample. METHODS The prevalence of complaints (Nordic Questionnaire) and diagnoses (clinical examination) were recorded in a number of occupational groups within which the participants had similar work tasks, 34 groups of female employees (N = 4733 women) and 17 groups of male employees (N = 1107 men). Age and other individual characteristics were recorded, as well as psychosocial work environment factors (job-content questionnaire) for most participants. Postures and velocities (inclinometry) of the head (N = 505) and right upper arm (N = 510), right wrist postures and velocities (electrogoniometry; N = 685), and muscular activity (electromyography; EMG) in the right trapezius muscle (N = 647) and forearm extensors (N = 396) were recorded in representative sub-groups. Exposure-response relationships between physical exposure and musculoskeletal disorders, adjusted for individual factors with Poisson regression were then calculated. The effect of introducing psychosocial conditions into the models was also assessed. RESULTS Associations were found between head velocity, trapezius activity, upper arm velocity, forearm extensor activity and wrist posture and velocity, and most neck/shoulder and elbow/hand complaints and diagnoses. Adjustment for age, other individual characteristics and psychosocial work conditions had only a limited effect on these associations. For example, the attributable fraction for tension neck syndrome among female workers with the highest quintile of trapezius activity was 58%, for carpal tunnel syndrome versus wrist velocity it was 92% in men in the highest exposure quintile. CONCLUSIONS Based on the findings, we propose threshold limit values for upper arm and wrist velocity.
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Affiliation(s)
- Istvan Balogh
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Medicon Village, SE-223 81, Lund, Sweden
| | - Inger Arvidsson
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Medicon Village, SE-223 81, Lund, Sweden
| | - Jonas Björk
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Medicon Village, SE-223 81, Lund, Sweden
| | - Gert-Åke Hansson
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Medicon Village, SE-223 81, Lund, Sweden
| | - Kerstina Ohlsson
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Medicon Village, SE-223 81, Lund, Sweden
| | - Staffan Skerfving
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Medicon Village, SE-223 81, Lund, Sweden
| | - Catarina Nordander
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, Medicon Village, SE-223 81, Lund, Sweden.
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Could long-term overhead load in painters be associated with rotator cuff lesions? A pilot study. PLoS One 2019; 14:e0213824. [PMID: 30875391 PMCID: PMC6420001 DOI: 10.1371/journal.pone.0213824] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 03/03/2019] [Indexed: 12/30/2022] Open
Abstract
Background Use of the arm above shoulder level has been described as a risk factor for developing rotator cuff tears (RCT). There is a lack of information regarding the frequency and distribution of RCT in a population using their arms above shoulder level during daily work. The aim of this study was to analyze clinical and radiographic findings in a population of painters working more than 10 years and to compare the results with a control group (CG) Materials and methods 100 individuals working more than 10 years as a painter were compared to 100 matched controls without using their arms above shoulder level. MRI scans were performed in all participants. Clinically, the Constant score, DASH score and range of motion (ROM) of the shoulders were analyzed. Results In the painter group (PG) a tear of the supraspinatus tendon was detected in 45% (10%full-thickness; 35% partial) compared to 8% in the (CG) (3% full-thickness; 5%partial; p<0.001). Impingement test was painful in 52% of PG and 7% of CG (p<0.001). The Constant score in the PG was significantly lower compared to the CG (62 vs. 93 points; p<0.001). PG had significantly worse DASH scores and inferior active and passive ROM of the dominant shoulders. In the multivariable logistic regression analysis, three risk factors (smoking, sports activity, and handedness) showed no effect. However, group membership (PG/CG) and age revealed a significant effect. Conclusion Long-term occupational load on the shoulders in painters seems to be associated with an increased risk for developing RCT. Our findings may provide support for developing preventive strategies for this unique cohort. Level of evidence: III
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Kim S, Nussbaum MA. A Follow-Up Study of the Effects of An Arm Support Exoskeleton on Physical Demands and Task Performance During Simulated Overhead Work. IISE Trans Occup Ergon Hum Factors 2019. [DOI: 10.1080/24725838.2018.1551255] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Sunwook Kim
- Department of Industrial and Systems Engineering, Virginia Tech, Blacksburg, VA, USA
| | - Maury A. Nussbaum
- Department of Industrial and Systems Engineering, Virginia Tech, Blacksburg, VA, USA
- Virginia Tech—Wake Forest School of Biomedical Engineering and Sciences, Blacksburg, VA, USA
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Dahlqvist C, Nordander C, Forsman M, Enquist H. Self-recordings of upper arm elevation during cleaning - comparison between analyses using a simplified reference posture and a standard reference posture. BMC Musculoskelet Disord 2018; 19:402. [PMID: 30442141 PMCID: PMC6238373 DOI: 10.1186/s12891-018-2328-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 10/29/2018] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND To reduce ergonomic risk factors in terms of awkward and constrained postures and high velocities, it is important to perform adequate risk assessments. Technical methods provide objective measures of physical workload. These methods have so far mainly been used by researchers. However, if written instructions how to apply the sensors and how to adopt the reference posture are provided, together with triaxial accelerometers, it may be possible for employees to record their own physical workload. The exposure in terms of e.g. upper arm elevations could then easily be assessed for all workers in a workplace. The main aims of this study were: 1) to compare analyses for self-recording of upper arm elevation during work using a simplified reference posture versus using a standard reference posture, and 2) to compare the two reference postures. METHODS Twenty-eight cleaners attached an accelerometer to their dominant upper arm and adopted a simplified reference according to a written instruction. They were thereafter instructed by a researcher to adopt a standard reference. Upper arm elevations were recorded for 2 or 3 days. Each recording was analysed twice; relative to the simplified reference posture and relative to the standard reference posture. The group means of the differences in recorded upper arm elevations between simplified and standard reference analyses were assessed using Wilcoxon signed ranks test. Furthermore, we calculated the group mean of the differences between the simplified reference posture and the standard reference posture. RESULTS For arm elevation during work (50th percentile), the group mean of the differences between the two analyses was 0.2° (range -7 - 10°). The group mean of the differences between the two references was 9° (range 1 - 21°). The subjects were able to follow the instructions in the protocol and performed self-recording of upper arm elevation and velocity. CONCLUSIONS The small difference between the two analyses indicates that recordings performed by employees themselves are comparable, on a group level, with those performed by researchers. Self-recordings in combination with action levels would provide employers with a method for risk assessment as a solid basis for prevention of work-related musculoskeletal disorders.
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Affiliation(s)
- Camilla Dahlqvist
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, SE-221 85 Lund, Sweden
| | - Catarina Nordander
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, SE-221 85 Lund, Sweden
| | - Mikael Forsman
- Division of Ergonomics, KTH Royal Institute of Technology, SE-141 57 Huddinge, Sweden
| | - Henrik Enquist
- Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, SE-221 85 Lund, Sweden
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Lang AE, Maciukiewicz JM, Vidt ME, Grenier SG, Dickerson CR. Workstation configuration and container type influence upper limb posture in grocery bagging. APPLIED ERGONOMICS 2018; 73:206-213. [PMID: 30098637 DOI: 10.1016/j.apergo.2018.07.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 07/17/2018] [Accepted: 07/20/2018] [Indexed: 06/08/2023]
Abstract
INTRODUCTION Repetitive movements and awkward postures are two persistent injury risk factors for grocery store cashiers. Due to the recent rise in popularity of environmentally-friendly grocery bagging options, current recommendations for cashiers are likely outdated. Correspondingly, the objective of this study was to examine the effects of cashier-specific work demands, workstation configuration, and container type on upper limb postures during typical job activities. METHODS Fifteen experienced cashiers bagged groceries at varying combinations of workstation height (low, medium, high) and container type (reusable bins, reusable bags, plastic bags). Upper limb movement was quantified with motion capture and amplitude probability distribution functions of humeral elevation and humeral axial internal rotation were used to assess the static (10th percentile), median (50th percentile), and peak (90th percentile) postural demands, which were then interpreted in the context of existing postural guidelines. RESULTS High workstation height and reusable bags increased right arm elevation at peak posture by 15.7° compared to the low workstation height and reusable bin combination. However, reusable bins increased internal rotation demands of the right arm by 4.3° compared to other container types. Left arm elevation and internal rotation were consistently lower than right arm angles. CONCLUSION Cashiers are encouraged to adjust the workstation to decrease the arm elevation and internal rotation required by higher workstation heights and tall containers, and to use both arms for scanning and packing, when possible, to reduce undesirable arm postures.
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Affiliation(s)
- Angelica E Lang
- Department of Health Sciences, University of Saskatchewan, Saskatoon, SK, Canada
| | | | - Meghan E Vidt
- Department of Biomedical Engineering, The Pennsylvania State University, State College, PA, USA; Department of Physical Medicine and Rehabilitation, Penn State Milton S. Hershey College of Medicine, Hershey, PA, USA
| | - Sylvain G Grenier
- School of Human Kinetics, Laurentian University, Sudbury, ON, Canada
| | - Clark R Dickerson
- Department of Health Sciences, University of Saskatchewan, Saskatoon, SK, Canada; Department of Kinesiology, University of Waterloo, Waterloo, ON, Canada.
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Forman GN, Breitner V, Shivpaul R, Murczek D, Holmes MWR. Upper extremity posture and muscle activity during IV pole interaction. INTERNATIONAL JOURNAL OF OCCUPATIONAL SAFETY AND ERGONOMICS 2018; 26:413-422. [PMID: 29667514 DOI: 10.1080/10803548.2018.1466526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Background. The physical demands associated with patient handling activities have been well documented in healthcare. However, many activities contribute to the physical demands of caregivers. Our purpose was to evaluate upper extremity muscle activity and kinematics during intravenous (IV) pole interaction. Materials and methods. Muscle activity was measured from six muscles using surface electromyography and joint kinematics were measured using motion capture. Participants performed two IV pole tasks: loading an IV bag and a medical device onto the pole. Two poles were evaluated: a traditional IV pole and a redesigned pole with ergonomic considerations. Results. Cervical extensor activity was significantly greater for the bag task with the traditional pole (43.29 ± 5.10% maximal voluntary exertion) compared to the redesigned pole (28.55 ± 3.42% maximal voluntary exertion). Peak right shoulder flexion was reduced from 102.88° ± 32.42° with the traditional pole to 55.44° ± 19.59° with the redesigned pole. Conclusion. Interactions with a traditional pole are comparable to upper extremity muscle activity during manual patient handling transfers. The redesigned pole reduced shoulder flexion during bag attachment, leading to less time in an overhead posture. Caregivers frequently interact with IV poles and reducing the physical demands associated with pole use could aid in a reduction of musculoskeletal disorders.
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Affiliation(s)
| | - Victoria Breitner
- Faculty of Health Sciences, University of Ontario Institute of Technology, Canada
| | - Ryan Shivpaul
- Faculty of Health Sciences, University of Ontario Institute of Technology, Canada
| | - Donna Murczek
- Occupational Health & Safety, Lakeridge Health, Canada
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Møller SP, Brauer C, Mikkelsen S, Alkjær T, Koblauch H, Pedersen EB, Simonsen EB, Thygesen LC. Risk of subacromial shoulder disorder in airport baggage handlers: combining duration and intensity of musculoskeletal shoulder loads. ERGONOMICS 2018; 61:576-587. [PMID: 28925318 DOI: 10.1080/00140139.2017.1382721] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 09/14/2017] [Indexed: 06/07/2023]
Abstract
Musculoskeletal shoulder load among baggage handlers measured by combining duration and intensity based on biomechanical and epidemiological information may be a stronger predictor of subacromial shoulder disorders than baggage handler seniority. In 2012, a cohort of baggage handlers employed at Copenhagen Airport in 1990-2012, and a cohort of unskilled otherwise employed men answered a survey. Self-reported information on work tasks during employment in the airport in combination with work task specific biomechanically modelled forces in the shoulder joint was used to estimate shoulder load. Exposure measures were accumulated shoulder abduction moment, accumulated shoulder compression force, accumulated supraspinatus force and baggage handler seniority. The outcome was subacromial shoulder disorder registered in the Danish National Patient Register. When analyses were adjusted by all confounders except age, exposure variables showed close to significant associations with subacromial shoulder disorder. Results could not confirm our hypothesis that combined information on work task duration and shoulder load intensity was stronger associated with subacromial shoulder disorder than seniority. Practitioner Summary: In this study we sought to identify if the exposure to work-related musculoskeletal shoulder loading including duration and intensity among baggage handlers was associated with subacromial shoulder disorder. We found that there was an association but this was not stronger than that between baggage handler seniority and subacromial shoulder disorder.
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Affiliation(s)
- Sanne Pagh Møller
- a National Institute of Public Health, University of Southern Denmark , Copenhagen , Denmark
| | - Charlotte Brauer
- b Department of Occupational and Environmental Medicine , Copenhagen University Hospital , Copenhagen , Denmark
| | - Sigurd Mikkelsen
- b Department of Occupational and Environmental Medicine , Copenhagen University Hospital , Copenhagen , Denmark
| | - Tine Alkjær
- c Department of Biomedical Sciences , University of Copenhagen , Copenhagen , Denmark
- d The Department of Physical and Occupational Therapy , Copenhagen University Hospital Bispebjerg-Frederiksberg , Copenhagen , Denmark
| | - Henrik Koblauch
- e Center for Neuroscience , University of Copenhagen , Copenhagen , Denmark
| | - Ellen Bøtker Pedersen
- b Department of Occupational and Environmental Medicine , Copenhagen University Hospital , Copenhagen , Denmark
| | - Erik B Simonsen
- e Center for Neuroscience , University of Copenhagen , Copenhagen , Denmark
| | - Lau Caspar Thygesen
- a National Institute of Public Health, University of Southern Denmark , Copenhagen , Denmark
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Granzow RF, Schall MC, Smidt MF, Chen H, Fethke NB, Huangfu R. Characterizing exposure to physical risk factors among reforestation hand planters in the Southeastern United States. APPLIED ERGONOMICS 2018; 66:1-8. [PMID: 28958420 DOI: 10.1016/j.apergo.2017.07.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 05/18/2017] [Accepted: 07/21/2017] [Indexed: 05/27/2023]
Abstract
Low back and neck/shoulder pain are commonly reported among reforestation hand planters. While some studies have documented the intensive cardiovascular demands of hand planting, limited information is available regarding exposures to physical risk factors associated with the development of musculoskeletal disorders (MSDs) among hand planters. This study used surface electromyography (EMG) and inertial measurement units (IMUs) to characterize the muscle activation patterns, upper arm and trunk postures, movement velocities, and physical activity (PA) of fourteen Southeastern reforestation hand planters over one work shift. Results indicated that hand planters are exposed to physical risk factors such as extreme trunk postures (32.5% of time spent in ≥45° trunk flexion) and high effort muscle exertions (e.g., mean root-mean-square right upper trapezius amplitude of 54.1% reference voluntary exertion) that may place them at increased risk for developing MSDs. The findings indicate a need for continued field-based research among hand planters to identify and/or develop maximally effective interventions.
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Affiliation(s)
- Robert F Granzow
- Department of Industrial and Systems Engineering, Auburn University, 3301 Shelby Center for Engineering Technology, Auburn, AL 36849, USA.
| | - Mark C Schall
- Department of Industrial and Systems Engineering, Auburn University, 3301 Shelby Center for Engineering Technology, Auburn, AL 36849, USA.
| | - Mathew F Smidt
- School of Forestry and Wildlife Sciences, Auburn University, 3423 School of Forestry and Wildlife Sciences, Auburn, AL 36849, USA.
| | - Howard Chen
- Department of Occupational and Environmental Health, University of Iowa, UI Research Park #164 IREH, Iowa City, IA 52242, USA.
| | - Nathan B Fethke
- Department of Occupational and Environmental Health, University of Iowa, S347 CPHB, Iowa City, IA 52242, USA.
| | - Rong Huangfu
- Department of Industrial and Systems Engineering, Auburn University, 3301 Shelby Center for Engineering Technology, Auburn, AL 36849, USA.
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Lang AE, Dickerson CR. Normative kinematics of reaching and dexterity tasks: moving towards a quantitative baseline for Functional Capacity Evaluations (FCEs). Int Biomech 2017. [PMCID: PMC7857447 DOI: 10.1080/23335432.2017.1326843] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Purpose: This work generates a comprehensive description of upper extremity and torso kinematics of a healthy population during reaching and dexterity Functional Capacity Evaluation (FCE) tasks. Methods: Upper limb and torso kinematic data were collected from 30 young, healthy participants as they performed three common FCE tasks: repetitive reaching, fingertip dexterity, and hand and forearm dexterity. Kinematic profiles were created for all clinically relevant angles of the torso, shoulder, elbow, and wrist. Results: These provocative tasks require large ranges of motion and create high demand postures for the upper limb, specifically at the shoulder. Arm elevation was up to 90°, while humeral internal rotation of 25° was observed. Torso angles were typically below 30° from neutral and elbow flexion remained within 90°–120° for nearly all tasks. Wrist ulnar deviation ranged from 0° to 26° for both wrists. Conclusion: The normative data created in this investigation provide a description of healthy motion during reaching and dexterity tasks. These normative curves are the initial step towards understanding movement that would contraindicate return to work during an FCE. This work supports a future clinical goal of being able to identify persons at risk of further injury or disability if returned to work too early.
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Affiliation(s)
- Angelica E. Lang
- Department of Health Science, University of Saskatchewan, Saskatoon, Canada
| | - Clark R. Dickerson
- Faculty of Applied Health Sciences, Department of Kinesiology, University of Waterloo, Waterloo, Canada
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Association of objectively measured arm inclination with shoulder pain: A 6-month follow-up prospective study of construction and health care workers. PLoS One 2017; 12:e0188372. [PMID: 29176761 PMCID: PMC5703553 DOI: 10.1371/journal.pone.0188372] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 10/30/2017] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES The aim was to determine the association of occupational arm inclination with shoulder pain in construction and health care workers. METHODS Arm inclination relative to the vertical was measured with an accelerometer placed on the dominant upper arm for up to four full days at baseline in 62 construction workers and 63 health care workers. The pain intensity in the shoulder and mechanical and psychosocial work factors were measured by self-reports at baseline and prospectively after 6 months. The associations between exposures and shoulder pain were analyzed with multilevel mixed-effects linear regressions. RESULTS For the total study population working with the dominant arm at inclinations > 30° and >120° was associated with lower levels of shoulder pain both cross-sectionally and after 6 months. Associations were attenuated when adjusting for individual and social factors, psychological state, and exposure during leisure time, especially for the high inclination levels. Analyses, only including subjects with no pain at baseline revealed no significant associations. While stratified analysis showed negative associations in the construction worker group, there were no significant association in health care workers. Compared to the number of hypotheses tested, the number of significant findings was low. Adjustment by Bonferroni-correction made almost all findings insignificant. CONCLUSIONS All analyses reflected a negative association between arm inclination and shoulder pain, but few analyses showed these associations to be statistically significant. If there is a relationship between arm inclination and shoulder pain, these findings could indicate that pain-avoidance may modify how workers perform their tasks.
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Yang L, Grooten WJA, Forsman M. An iPhone application for upper arm posture and movement measurements. APPLIED ERGONOMICS 2017; 65:492-500. [PMID: 28274467 DOI: 10.1016/j.apergo.2017.02.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 11/28/2016] [Accepted: 02/16/2017] [Indexed: 05/27/2023]
Abstract
There is a need for objective methods for upper arm elevation measurements for accurate and convenient risk assessments. The aims of this study were (i) to compare a newly developed iOS application (iOS) for measuring upper arm elevation and angular velocity with a reference optical tracking system (OTS), and (ii) to compare the accuracy of the iOS incorporating a gyroscope and an accelerometer with using only an accelerometer, which is standard for inclinometry. The iOS-OTS limits of agreement for static postures (9 subjects) were -4.6° and 4.8°. All root mean square differences in arm swings and two simulated work tasks were <6.0°, and all mean correlation coefficients were >0.98. The mean absolute iOS-OTS difference of median angular velocity was <13.1°/s, which was significantly lower than only using an accelerometer (<43.5°/s). The accuracy of this iOS application compares well to that of today's research methods and it can be useful for practical upper arm measurements.
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Affiliation(s)
- Liyun Yang
- Unit of Ergonomics, School of Technology and Health, KTH Royal Institute of Technology, Stockholm, Sweden.
| | - Wilhelmus J A Grooten
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Mikael Forsman
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
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Oyama S, Sosa A, Campbell R, Ortega C, Douphrate DI. Evaluation of upper body kinematics and muscle activity during milking attachment task. INTERNATIONAL JOURNAL OF INDUSTRIAL ERGONOMICS 2017; 61:101-106. [PMID: 36060530 PMCID: PMC9434597 DOI: 10.1016/j.ergon.2017.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The objective of the study was to evaluate the effects of udder height on upper body kinematics and muscle activity during a simulated attachment task in a parallel parlor set up, and the effects of udder access method (back or side) on the task biomechanics. Twenty males performed the task under conditions that simulated three udder heights and two udder access methods. The muscular load and kinematics during the task confirmed that milking is a physically demanding task. Trunk flexion angle increased with decreasing udder height, and the erector spinae activation was higher when the udder was below shoulder height compared to at or above. Compared to accessing the udder from side of the cow (herringbone parlor style), accessing from behind (Parallel parlor style) was associated with lower trunk flexion, greater shoulder horizontal adduction, lower shoulder elevation, and greater anterior deltoid activation. Milking in herringbone parlor style and with the udder at or above shoulder level may help reduce strain on the trunk/neck.
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Affiliation(s)
| | | | | | - Catherine Ortega
- University of Texas Health Science Center at San Antonio, United States
| | - David I Douphrate
- University of Texas, Health Science Center at Houston, School of Public Health in San Antonio, San Antonio Regional Campus, United States
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