Questionnaire-based mechanical exposure indices for large population studies--reliability, internal consistency and predictive validity

The impact of environmental accidents on the green apparel purchase behavior of Generation Z

Introduction

This study examines the impact of environmental accidents on Generation Z's purchase behavior towards green apparel, integrating the Theory of Planned Behavior and the Norm Activation Theory to conceptualize how different dimensions of environmental accidents influence consumer behavior.

Methods

Employing focus groups and questionnaires, this research captures data on Generation Z's perceptions and behaviors towards green apparel in the context of environmental accidents. The collected data were analyzed using SPSS software, with structural equation modeling employed to test the research hypotheses.

Results

The findings indicate that the scale (H12  = 0.545), the degree of suddenness (H18  = 0.357), nature of the effect (H14  = 0.295), and duration (H17  = 0.289) of environmental accidents significantly influence Generation Z's awareness of consequences, behavioral attitudes, subjective norms, and perceived behavioral control regarding the purchase of green clothing. Notably, the scale of environmental accidents has a significant impact on perceived behavioral control, which in turn significantly affects Generation Z's intention to purchase green apparel (H3  = 0.5).

Discussion

This study elucidates the impact of environmental accidents on Generation Z's green apparel purchase intentions. The findings highlight Generation Z's environmental awareness and social responsibility, influencing their purchasing decisions. This research offers practical insights for brands to enhance green marketing strategies, focusing on product quality, transparency, and consumer education to align with Generation Z's values and expectations. Future research should explore additional factors affecting purchase behavior and strategies to bridge the intention-behavior gap.

The Influence of Virtual Idol Characteristics on Consumers’ Clothing Purchase Intention

In the context of a company actively using virtual idols to carry out marketing activities, it is very important to help the company understand the key factors affecting consumer purchase intention. In total, 459 eligible responses were collected via an online questionnaire survey. The psychometric properties of the model were examined by factor analysis, and the multiple regression method was applied to test the hypotheses. This paper empirically analyzes the influence of virtual idol characteristics on consumers’ willingness to buy brand clothing, with consumers’ attitudes as intermediary variables and clients’ involvement in virtual idolatry and adult playfulness as adjusting variables. A quasi-replication study method using both MRA and fsQCA found that the popularity, homogeneity, relevance and anthropomorphism of virtual idols enhance customers’ willingness to buy from big to small. Among them, attitude plays an intermediary role in the influence of popularity on purchase intention, and plays a complete intermediary role in the influence of relevance and homogeneity over purchase intention; consumer idolatry involvement positively regulates the relationship between professionalism, relevance and attitude; consumers’ adult playfulness positively regulates the relationship between popularity and consumer attitude. Finally, from the perspective of improving attitude and purchase intention, we provide suggestions for virtual idol creation applicable by operation teams and clothing brand companies.

Assessing physical workload among people with musculoskeletal disorders: validity and reliability of the physical workload questionnaire

Background

Demands of physical work are related to musculoskeletal disorders, and hence, important to assess. The Physical Workload Questionnaire (PWQ) is based on 26 items related to physical workload. The PWQ has been translated into Norwegian, but its psychometric properties have not yet been tested. The aim of this study was to assess the validity and reliability of the PWQ among patients with musculoskeletal disorders.

Methods

A cross-sectional study with a test-retest design was conducted to assess construct validity (structural validity and hypothesis testing) and reliability (internal consistency and test-retest reliability) among employed patients with musculoskeletal disorders. Exploratory factor analysis was performed to assess the structural validity and number of items to be included in the Norwegian version of the PWQ. Hypothesis testing was assessed by 14 a priori hypotheses (“known” group, convergent and discriminant validity). Internal consistency was evaluated using Cronbach’s alpha and test-retest reliability by Intraclass Correlation Coefficient (ICC_2.1), Standard Error of Measurement (SEM_agreement) and Smallest Detectable Change (SDC_95%ind).

Results

In total, 115 patients with a mean age (SD) of 46 (9) years were included, of which 48 were included in the reliability analyses. Exploratory factor analysis resulted in two subscales: “Heavy physical work” (15 items, range 0–100) and “Long-lasting postures and repetitive movements” (7 items, range 0–100). No floor or ceiling effects were seen in the subscales. Twelve of the 14 (85%) predefined hypotheses were confirmed. The internal consistency with Cronbach’s alpha was 0.94 and 0.85 on subscales 1 and 2, respectively. Test-retest reliability analyses demonstrated an ICC_2.1 of 0.96 (95% CI 0.88, 0.98) and 0.92 (95% CI 0.81, 0.96), SEM of 6.9 and 10.0 and SDC_95%ind of 19.2 and 27.7 of subscales 1 and 2, respectively.

Conclusions

The Norwegian version of the PWQ demonstrated good validity and reliability and can be used to evaluate physical workload in patients with musculoskeletal disorders.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12891-022-05222-y.

Determining the Efficiency of Ergonomic Belt During Patient Handling and its Effect on Reducing Musculoskeletal Disorders in Nurses

INTRODUCTION

Nursing personnel are always at risk for work-related musculoskeletal disorders, and patient transportation is one of the major risk factor for these disorders.

OBJECTIVE

The aim of this study was to evaluate the ergonomic belt to improve patient transferring conditions.

METHODS

The subjects included 60 health care workers (HCW) of a hospital with patient transfer experience. The ergonomic belt was examined to help move the patient from one bed to another. The prevalence of musculoskeletal disorders was assessed through the Nordic questionnaire, the degree of perceived exertion through the Borg criterion, and the patient's movement through the MAPO index before and after the intervention.

RESULTS

The results showed a significant decrease in Borg scale scores and MAPO index in two factors of education and auxiliary tools and overall scores of this index. We also saw a significant reduction in musculoskeletal disorders in the neck, shoulders and arms, waist, hands and wrists, thighs, knees and legs. There were no significant differences in the elbow and forearm before and after using the ergonomic belt.

CONCLUSION

In general, it can be concluded that the use of ergonomic belt had helped to reduce the risk of musculoskeletal disorders, as well as reducing the perceived exertion of nurses and other relevant personnel.

The impact of occupational and personal factors on musculoskeletal pain - a cohort study of female nurses, sonographers and teachers

Background

Musculoskeletal pain is common in the general population and constitutes a major public health problem. A large proportion of these conditions may be work related. The aim of this study was to explore the relative importance of physical, psychosocial and personal factors, in number of pain sites and in five specific pain sites, among women in common professions with a broad variety of occupational exposures.

Methods

A cohort of 1115 women responded to a questionnaire on ergonomic, psychosocial, personal and life-style factors, and the outcome measure of musculoskeletal pain (based on frequency and intensity of complaints at nine anatomical sites), at baseline and at follow-up. Sum scores of ergonomic and psychosocial factors were created. The importance of exposure at baseline for the number of pain sites at follow-up were estimated using ordinal regression. The importance of exposure at baseline for pain in the neck, shoulders, hands, lower back and feet at follow-up were estimated using multi-exposure Poisson regression models.

Results

High sum scores for ergonomic and psychosocial factors were of importance for a high number of pain sites, although the strongest risk factor was a high number of pain sites already at baseline. On the individual level, there was a large fluctuation in number of pain sites between the two time points. Eighteen percent reported persistent (or recurrent) ≥ four pain sites, while only 11 % did not report any pain at baseline or at follow-up. Among the specific pain sites, a high sum score of ergonomic factors was associated with pain in the neck, hands and feet. A high sum score of psychosocial factors was associated with neck and shoulder pain. The strongest risk factor was, however, pain at that specific anatomical site at baseline. Only a few of the personal and life-style factors were associated with pain.

Conclusions

An overwhelming majority of the women in common occupations were affected by musculoskeletal pain. Both ergonomic and psychosocial factors were predictive of a high number of pain sites and of specific pain sites. These findings indicate the need for preventive measures on the individual, organizational and societal level.

Wearable Sensor Network for Biomechanical Overload Assessment in Manual Material Handling

The assessment of risks due to biomechanical overload in manual material handling is nowadays mainly based on observational methods in which an expert rater visually inspects videos of the working activity. Currently available sensing wearable technologies for motion and muscular activity capture enables to advance the risk assessment by providing reliable, repeatable, and objective measures. However, existing solutions do not address either a full body assessment or the inclusion of measures for the evaluation of the effort. This article proposes a novel system for the assessment of biomechanical overload, capable of covering all areas of ISO 11228, that uses a sensor network composed of inertial measurement units (IMU) and electromyography (EMG) sensors. The proposed method is capable of gathering and processing data from three IMU-based motion capture systems and two EMG capture devices. Data are processed to provide both segmentation of the activity and ergonomic risk score according to the methods reported in the ISO 11228 and the TR 12295. The system has been tested on a challenging outdoor scenario such as lift-on/lift-off of containers on a cargo ship. A comparison of the traditional evaluation method and the proposed one shows the consistency of the proposed system, its time effectiveness, and its potential for deeper analyses that include intra-subject and inter-subjects variability as well as a quantitative biomechanical analysis.

Neck and upper extremity pain in sonographers - a longitudinal study

Background

Sonographers have reported a high occurrence of musculoskeletal pain for more than 25 years. Assessments of occupational risk factors have previously been based on cross-sectional surveys. The aim of this longitudinal study was to determine which factors at baseline that were associated with neck/shoulder and elbow/hand pain at follow-up.

Methods

A questionnaire was answered by 248 female sonographers at baseline and follow-up (85% of the original cohort). 208 were included in the analyses. Physical, visual, and psychosocial work-related conditions were assessed at baseline. Pain in two body regions (neck/shoulders and elbows/hands) was assessed at both baseline and follow up.

Results

Pain at baseline showed the strongest association with pain at follow-up in both body regions [prevalence ratio (PR) 2.04; 95% confidence interval (CI) 1.50–2.76], for neck/shoulders and (PR 3.45; CI 2.29–5.22) for elbows/hands. Neck/shoulder pain at follow-up was associated with inability of ergonomic adjustments at the ultrasound device (PR 1.25; CI 1.05–1.49), a high mechanical exposure index (PR 1.66; CI 1.09–2.52), and adverse visual conditions (PR 1.24; CI 1.00–1.54) at baseline. Moreover, among participants with no neck/shoulder pain at baseline, high job demands (PR 1.78; CI 1.01–3.12), and a high mechanical exposure index (PR 2.0; CI 0.98–4.14) predicted pain at follow-up. Pain in the elbows/hands at follow-up was associated with high sensory demands at baseline (PR 1.63; CI 1.08–2.45), and among participants without pain at baseline high sensory demands predicted elbow/hand pain at follow-up (PR 3.34; CI 1.53–7.31).

Conclusion

Pain at baseline was the strongest predictor for pain at follow-up in both body regions. We also found several occupational factors at baseline that were associated with pain at follow-up: inability to adjust equipment, adverse visual conditions, a high MEI, high job demands and high sensory demands. These results point at a possibility to influence pain with better ergonomics.

Longitudinal Associations between Anatomical Regions of Pain and Work Conditions: A Study from The SwePain Cohort

We investigated the time-based associations between workload (physical and mechanical), psychosocial work stressors (demands, control, and support), and the number of anatomical regions with pain (ARP). This population-based study with a two-year follow-up included 11,386 responders (5125 men, 6261 women; mean age: 48.8 years; SD: 18.5) living in south-eastern Sweden. Predictive associations were assessed through generalised linear models, and changes over time were examined using a generalised estimating equation. The results of both models were reported as parameter estimates (B) with 95% confidence interval (CIs). Mean changes in the number of ARP, workload, and psychosocial work stressors were stable over time. High mechanical workload and job demands were likely associated with the number of ARP at the two-year follow-up. In the reverse prospective model, we found that the number of ARP was also associated with high physical and mechanical workload and low job control and support. In the two time-based models of changes, we found a reciprocal association between number of ARP and mechanical workload. Our results add epidemiological evidence to the associations between work conditions and the extent of pain on the body. Components of work conditions, including job demands and mechanical strain, must be considered when organisations and health policy makers plan and employ ergonomic evaluations to minimise workplace hazards in the general population.

[Measuring work-related physical demand: factorial structure and reliability of items on posture, handling of loads and repetitiveness]

This study sought to analyze the dimensionality of a set of items that measure work-related physical demand, their internal consistency and their test-retest reliability. We carried out an exploratory factorial analysis of ten physical demand items in two populations, totaling 1,070 workers from the footwear industry and from urban cleaning, using weighted least squares means and adjusted variance with Promax oblique rotation. We measure internal consistency using Cronbach's alpha. The test-retest used a subsample of 121 workers, using quadratic weighted kappa. We identified two dimensions in urban cleaning and three in the footwear industry: (1) dynamic work with anomalous postures; (2) work that requires handling material; and (3) work that demands repetitive motions. Reliability was excellent for upright work posture, good for walking, moderate for lifting loads, squatting, rotated trunk and only regular for repetitive motions and arms above shoulders. The dimensions we identified through factorial analysis are compatible with the physical demands of urban cleaning and the footwear industry and, in general, showed good internal consistency. The 10 items' reliability was compatible with the literature, showing excellent to good reliability for general posture, moderate for specific body segment posture and regular for repetitiveness. Results reveal the specificity of each occupational group, which suggests a dimensionality of physical demand items, supporting their use for measuring physical exposure.

Prevalence of work-related musculoskeletal disorders among sonographers in China: results from a national web-based survey

Objectives:

The aims of present study were to determine the prevalence of work-related musculoskeletal disorders (WRMSDs) among sonographers in China and to provide evidence for appropriate intervention measures to be taken.

Methods:

A self-reported questionnaire was used to screen WRMSDs experienced by sonographers during the past 12 months. This questionnaire survey was created and hosted on the WeChat official account platform for sonographers.

Results:

In the present study, 567 sonographers from 521 medical institutions completed the questionnaire. The vast majority (99.3%) of respondents reported experiencing symptoms of WRMSDs for at least one body region during the past 12 months. Work-related musculoskeletal pain or discomfort was most frequently reported for the neck (95.1%), right shoulder (84.1%), lower back (82.4%), right wrist/hand (81.0%), upper back (78.1%), right forearm/elbow (72.0%), and left shoulder (66.1%). Scanning hours per day, number of patients per day, and years of experience were positively associated with the occurrence and frequency of experiencing WRMSDs of some common and specific anatomical regions. Taking a regular rest break during the scanning working day was associated with a reduction of WRMSDs of the right shoulder and right wrist/hand. Adopting a sitting posture while performing scanning was associated with a reduction of WRMSDs, particularly for the lower back and the neck. Performing regular physical activity during leisure time was associated with a reduction of WRMSDs of the neck.

Conclusions:

The prevalence of WRMSDs among sonographers in China was extremely high. It is necessary and essential to reduce the number of scanning hours and patients per day, adopt a sitting posture while performing scanning, schedule regular rest breaks during the scanning working day, and encourage performance of regular physical activity during leisure time to alleviate this WRMSD issue experienced by sonographers.

Neck and upper extremity pain in sonographers - Associations with occupational factors

Sonographers have a high risk of musculoskeletal disorders. This study explores the associations between working conditions and musculoskeletal pain based on the frequency and intensity of pain in the neck and upper extremities. A questionnaire was answered by 291 female sonographers. High prevalence of neck/shoulder pain was associated with eye complaints and headache related to work on the computer, dissatisfaction with the computer workstation, high mechanical exposure index (MEI) and high demands. The possibility to adjust the keyboard and chair, and adequately corrected eyesight were positive factors. High prevalence of elbow/hand pain was associated with performing echocardiography, computer-related eye complaints, high MEI and high job and sensory demands. In echocardiography, working with a straight wrist and holding the transducer with a two-handed grip or alternating hands was associated with a low prevalence of elbow/hand pain. Thus, further improvements in the working conditions are possible and are recommended.

Burnout among Swedish school teachers - a cross-sectional analysis

Background

Teachers are at high risk of stress-related disorders. This study aimed to examine the occurrence of burnout in a sample of Swedish school-teachers, to test a combined measure of three burnout dimensions on the individual level, to characterize associations between burnout and factors encountered during work and leisure time, and to explore any differences between the genders.

Methods

A questionnaire of occupational, sociodemographic and life-style factors was answered by 490 teachers in school years 4–9. Outcome measures were (a) the single burnout dimensions of exhaustion, cynicism and professional efficacy (Maslach Burnout Inventory-General Survey), and (b) a combined measure based on high or low values in the three dimensions. The combined measure was used to stratify the study population into four levels (0–3) of burnout. Multivariable Poisson regression was applied on level 2 + 3 vs. level 0 + 1, for variables that we considered as relevant risk factors for burn out.

Results

Half of the teachers reported low values in all three dimensions (level 0), whereas 15 were classified as having high burnout in at least two out of the three dimensions (level 2 + 3), and 4 % in all three dimensions (level 3). Almost all psychosocial factors were incrementally more unfavourably reported through the rising levels of burnout, and so were dissatisfaction with the computer workstation, pain, sleep problems and lack of personal recovery. There was no association between gender and rising levels of overall burnout (p > 0.30). Low self-efficacy, poor leadership, high job demands and teaching in higher grades were the variables most clearly associated with burnout in multivariable Poisson regression.

Conclusions

Even if circa 50 % of the teachers appear do well with respect to burnout, the results points to the need of implementing multifaceted countermeasures that may serve to reduce burnout.

Are Irish therapists at heightened risk for low back pain?

BACKGROUND

Within the international literature, no studies have been identified that compare prevalence rates of low back pain (LBP) in chartered physiotherapists, physical and athletic therapists and those in the national working population, making it unclear whether such therapists are an occupational group at high risk of developing LBP.

AIMS

To establish the prevalence of LBP among therapists (both employed and self-employed) in Ireland, to compare the employment status-, gender- and age-specific LBP prevalence rates between therapists and the national working population and to estimate the adjusted odds of developing LBP among therapists relative to the national working population.

METHODS

An analysis of data from the Health In Hand Intensive Tasks and Safety (HITS) study and the third national Survey on Lifestyle, Attitudes and Nutrition (SLÁN). The HITS study was a cross-sectional study investigating work-related musculoskeletal disorders in practising therapists. The SLÁN 2007 was a face-to-face interview study of adults.

RESULTS

LBP prevalence in therapists was 49% with no significant difference by employment status. Therapists had a much higher prevalence compared with the national working population across all demographic strata, with therapists nearly five times more likely to suffer from LBP than the national working population after careful adjustment for differences in sociodemographic factors.

CONCLUSIONS

Therapists in Ireland are an occupational group at high risk of developing LBP, warranting further research into their physical and psychosocial work-related risk factors.

The use of self-report questions to examine the prevalence of musculoskeletal problems: a test-retest study

Background

Case definition has long been an issue for comparability of results obtained for musculoskeletal pain prevalence, however the test-retest reliability of questions used to determine joint pain prevalence has not been examined. The objective of this study was to determine question reliability and the impact of question wording, ordering and the time between questions on responses.

Methods

A Computer Assisted Telephone Interviewing (CATI) survey was used to re-administer questions collected as part of a population-based longitudinal cohort study. On two different occasions questions were asked of the same sample of 203 community dwelling respondents (which were initially randomly selected) aged 18 years and over at two time points 14 to 27 days apart (average 15 days). Reliability of the questions was assessed using Cohen’s kappa (κ) and intraclass correlation coefficient (ICC) and whether question wording and period effects existed was assessed using a crossover design.

Results

The self-reported prevalence of doctor diagnosed arthritis demonstrated excellent reliability (κ = 0.84 and κ = 0.79 for questionnaires 1 and 2 respectively). The reliability of questions relating to musculoskeletal pain and/or stiffness ranged from moderate to excellent for both types of questions, that is, those related to ever having joint pain on most days for at least a month (κ = 0.52 to κ = 0.95) and having pain and/or stiffness on most days for the last month (κ = 0.52 to κ = 0.90). However there was an effect of question wording on the results obtained for hand, foot and back pain and/or stiffness indicating that the area of pain may influence prevalence estimates.

Conclusions

Joint pain and stiffness questions are reliable and can be used to determine prevalence. However, question wording and pain area may impact on estimates with issues such as pain perception and effect on activities playing a possible role in the recall of musculoskeletal pain.

Multisite musculoskeletal pain among young technical school students entering working life

Background

There is a need to investigate the occurrence of multisite pain in young adults and to determine potential factors contributing to the early course of multisite musculoskeletal pain. The aim of this prospective study was to assess the occurrence and change of prevalence in the number of pain sites. We also wanted to identify work-related and individual risk factors associated with the number of musculoskeletal pain sites.

Methods

We monitored musculoskeletal pain from 4 body regions, individual and work-related factors on 21 occasions over a 6.5 year period. The cohort consisted of 420 technical school students entering working life. Data were analyzed by generalized estimating equations (GEE).

Results

Pain from more than one body site was prevalent in this cohort of young adults (69 % at baseline), and the number of body sites in pain was found quite stable over the 6.5 year follow-up period. Women had higher number of pain sites compared with men and gender specific risk factors were identified. Increased mechanical workload and quantitative demands and low socioeconomic status were associated with increased number of musculoskeletal pain sites among women, while tobacco use was found as a risk factor among young men. Increased perceived muscle tension was the only factor significantly associated with increased number of pain sites in both genders.

Conclusion

The current study supports earlier findings and show that pain from multiple body sites are frequent also among young workers. The identification of gender specific risk factors in our study is important and may facilitate practical prevention and future research.

Cross-sectional associations between occupational factors and musculoskeletal pain in women teachers, nurses and sonographers

BACKGROUND

It is usually assumed that musculoskeletal pain is associated with both the physical workload and the psychosocial work environment, as well as with personal and lifestyle factors. This study aims to ascertain the prevalence of musculoskeletal pain in women with varying or different occupational exposures, and to explore the associations between musculoskeletal pain and the occupational and personal factors.

METHODS

A questionnaire on physical, psychosocial and individual factors was answered by 1591 women in five occupational groups with contrasting occupational exposures (teachers, anaesthetic, theatre, and assistant nurses, and sonographers). The outcome measure was musculoskeletal pain (in a new model based on frequency and intensity of complaints the preceding year) from the neck, shoulders, hands, lower back and feet.

RESULTS

Neck pain was equally frequent among teachers, assistant nurses and sonographers, and less frequent in anaesthetic and theatre nurses. The sonographers experienced the highest prevalence of shoulder pain, while the assistant nurses were the most affected in the wrists and hands, lower back, and feet. The teachers reported the highest scores in most of the psychosocial dimensions. The theatre nurses scored highest in strenuous work postures and movements (mechanical exposure index, MEI), and the assistant nurses in physical activity and lifting (physical exposure index, PHYI). Multivariable models in the total population showed that both the physical workload and the psychosocial work environment were associated with pain in all body regions, though different factors affected different regions. Pain in the neck, shoulders, hands and lower back was strongly associated with a high MEI and high job demands, while pain in the feet was associated with a high PHYI and a high BMI. A young age was associated with pain in the neck, and an older age was associated with pain in the hands and feet. Lack of time for personal recovery was associated with pain in the shoulders and lower back.

CONCLUSIONS

The occupational groups were affected differently and need different protective measures. For the teachers, the psychosocial work environment should be improved. The surgical staff and sonographers require measures to mitigate lifting and constrained postures.

Work-related musculoskeletal disorders among physical therapists: an online survey

PURPOSE

To evaluate the rates and characteristics of musculoskeletal disorders (MSDs) in physical therapists (PTs) according to their specialty and setting.

METHOD

Participants completed an online questionnaire including 15 demographic questions, 7 work-related and 8 injury-related questions for 9 different body parts.

RESULTS

Complete responses were obtained from 121 PTs; 96% reported MSD symptoms during the previous 12 months, 64% affecting at least 3 body parts. The body parts with the highest prevalence of symptoms were the low back (66%) and the neck (61%). For PTs specialized in acute care, geriatrics and pediatrics, the body part most commonly affected was the low back, while for PTs specialized in orthopedics and neurology, the body part most commonly affected was the neck. Regarding work settings, the low back was the most commonly affected for PTs working in skilled nursing facilities, outpatient clinics and hospitals, and the neck in PTs working in academic and home health settings.

CONCLUSIONS

MSDs are common among PTs; the body parts most often affected were the low back and neck. The prevalence and body parts affected varied by practice setting and specialty area. The findings can help informing the design of evidence-based rehabilitation, prevention, training and educational programs.

IMPLICATIONS FOR REHABILITATION

Rehabilitation of injured physical therapists needs to address the symptoms of the multiple body parts that are usually affected (e.g. back, wrists and hands). Rehabilitation of injured physical therapists needs to take into consideration their job demands, practice setting and specialty area. The findings can inform the design of rehabilitation, prevention, training and educational programs for physical therapists.

Work with prolonged arm elevation as a risk factor for shoulder pain: a longitudinal study among young adults

This prospective study aimed at examining if work with prolonged arm elevation predicts shoulder pain among 41 young adults in their first years of working life. Fifteen hairdressers, 15 electricians, 5 students and 6 with various work were followed over a 2.5-year period (2006/7-2009). Arm elevation was measured with inclinometers during a full working day at baseline. Shoulder pain was reported at baseline and twice in the follow-up period. Data were analyzed by generalized estimating equations (GEE-analysis), stratified by gender and adjusted for time, mechanical workload, work demand, physical activity, tobacco use and prior shoulder pain. Work with prolonged arm elevation with angles >60° and >90° were associated with shoulder pain among women. Even though the shoulder pain levels are low the study suggests work with arms elevated as an early work-related risk factor among women, and indicates the importance of early prevention strategies.

Work status in patients with early rheumatoid arthritis: emphasis on shoulder function and mechanical exposure

OBJECTIVES

The aim of this study was to investigate work status and associated factors in patients with early rheumatoid arthritis (RA), with the emphasis on shoulder function, work-related mechanical exposure, and activity limitations related to the shoulder-arm-hand.

METHOD

Patients with early RA were provided with self-report questionnaires quantifying work-related mechanical exposure and activity limitations. Shoulder function (i.e. isometric muscle strength, shoulder-arm movement, and shoulder pain), hand-grip force, and number of tender and swollen joints were assessed.

RESULTS

The study comprised 135 patients (103 women and 32 men), with a mean age of 48 (SD 9.6) years, a mean disease duration of 21 (SD 9.6) months, and a mean Disease Activity Score using 28 joint counts (DAS28) of 3.7 (SD 1.4). The majority (75.6%) were working full- or part-time. Work hours correlated with work-related mechanical exposure (rs = -0.34, p < 0.001) and with physical work load (rs = 0.26, p = 0.0036). Work hours also correlated with shoulder function, that is shoulder-arm movement (rs = 0.34, p < 0.0001), shoulder strength (rs = 0.25, p = 0.0032), and activity-induced shoulder pain (rs = -0.45, p < 0.0001). Significant correlations were found between work hours and hand-grip force (rs = 0.45, p < 0.0001), activity limitations related to the shoulder-arm-hand (using the Disabilities of the Arm, Shoulder and Hand Questionnaire, DASH) (rs = -0.61, p < 0.0001), and DAS28 (rs = -0.43, p < 0.0001). DASH was found to be the only significant (p < 0.001) variable to independently explain the ability of working full-time [odds ratio (OR) 0.40, 95% confidence interval (CI) 0.29-0.55 per 10 increments, area under the receiver operating characteristic (ROC) curve (AUC) 0.81, 95% CI 0.74-0.89].

CONCLUSIONS

Work status in early RA is associated with shoulder function and activity limitations related to the shoulder-arm-hand accentuated by work-related mechanical exposure.

Riscos de distúrbios osteomusculares em punhos de trabalhadores de uma indústria de pescados

INTRODUÇÃO: Os distúrbios osteomusculares relacionadas ao trabalho são patologias muito frequentes no meio industrial, principalmente quando os trabalhadores se encontram expostos a fatores de risco como, por exemplo, posturas inadequadas, repetitividade, uso de força excessiva e a exposição a vibrações. OBJETIVO: Avaliar o risco de distúrbios osteomusculares nos punhos de trabalhadores de uma indústria de pescados da cidade de Recife (PE). METODOLOGIA: Utilizou-se metodologia qualitativa baseada no método Strain Index (SI), o qual resulta em uma pontuação numérica que aponta a probabilidade de desenvolvimento de distúrbios osteomusculares no punho. O índice é baseado na pontuação do SI, representado pela interação multiplicativa entre as variáveis da tarefa: intensidade do esforço, duração do esforço, frequência do esforço, postura da mão e punho, ritmo de trabalho e duração diária da tarefa. RESULTADOS: O valor encontrado foi de SI = 9 para ambos os punhos, classificando-o como uma atividade com alto risco para o desenvolvimento de distúrbios osteomusculares nos punhos dos trabalhadores. CONCLUSÃO: A indicação da presença dos riscos desses distúrbios nos punhos durante a realização da atividade de trabalho foi determinada pela pontuação do SI, sugerindo a necessidade de intervenção ergonômica.

Avaliação do risco ergonômico em trabalhadores da indústria têxtil por dois instrumentos: quick exposure check e job factors questionnaire

A análise dos fatores de risco ergonômicos presentes em indústrias têxteis auxilia no planejamento de estratégias que contribuem para a melhora das condições de trabalho e redução dos distúrbios osteomusculares. Este estudo se propôs a mensurar os níveis de exposição aos fatores de risco ergonômicos em trabalhadores de dois setores de produção de uma indústria têxtil. Para tanto, os instrumentos Job Factors Questionnaire (JFQ) e o Quick Exposure Check (QEC) foram aplicados em 107 trabalhadores. Os resultados foram analisados por estatística descritiva. O teste de Mann-Whitney foi utilizado para comparação dos resultados obtidos entre os setores de produção. O diagnóstico do nível de exposição ao risco ergonômico, obtido por ambos os instrumentos, foi moderado. Os fatores de risco considerados pelo JFQ como mais criticos estão relacionados à temperatura ambiental; postura mantida em longos períodos de tempo; posturas inadequadas para coluna e continuar trabalhando quando está com alguma dor ou com alguma lesão. O QEC identificou as regiões de coluna lombar e punhos/mãos como expostas ao alto risco. Não houveram diferenças estatisticamente significante entre os setores.

Innovative system for real-time ergonomic feedback in industrial manufacturing

This work presents a system that permits a real-time ergonomic assessment of manual tasks in an industrial environment. First, a biomechanical model of the upper body has been developed by using inertial sensors placed at different locations on the upper body. Based on this model, a computerized RULA ergonomic assessment was implemented to permit a global risk assessment of musculoskeletal disorders in real-time. Furthermore, local scores were calculated per segment, e.g. the neck region, and gave information on the local risks for musculoskeletal disorders. Visual information was fed back to the user by using a see-through head mounted display. Additional visual highlighting and auditory warnings were provided when some predefined thresholds were exceeded. In a user study (N = 12 participants) a group with the RULA feedback was compared to a control group. Results demonstrate that the real-time ergonomic feedback significantly decreased the outcome of both globally as well as locally hazardous RULA values that are associated with increased risk for musculoskeletal disorders. Task execution time did not differ between groups. The real-time ergonomic tool introduced in this study has the potential to considerably reduce the risk of musculoskeletal disorders in industrial settings. Implications for ergonomics in manufacturing and user feedback modalities are further discussed.

Work-site musculoskeletal pain risk estimates by trained observers--a prospective cohort study

Work-related musculoskeletal pain (MSP) risk assessments by trained observers are often used in ergonomic practice; however, the validity may be questionable. We investigated the predictive value of work-site MSP risk estimates in a prospective cohort study of 1745 workers. Trained observers estimated the risk of MSP (neck, shoulder or low-back pain) using a three-point scale (high, moderate and low risk) after observing a video of randomly selected workers representing a task group. Associations of the estimated risk of pain and reported pain during a three-year follow-up were assessed using logistic regression. Estimated risk of neck and shoulder pain did (odds ratio, OR: 1.45 (95% confidence interval, CI: 1.01-2.08); 1.64 (95% CI: 1.05-2.55)), however, estimated risk of low-back pain did not significantly predict pain (OR: 1.27 (95% CI: 0.91-1.79)). The results show that observers were able to estimate the risk of shoulder and neck pain, whereas they found it difficult to estimate the risk of low-back pain. Practitioner Summary: Work-related musculoskeletal pain risk assessments by observers are often used in ergonomic practice. We showed that observers were able to estimate shoulder and neck pain risk, but had difficulties to estimate the risk of low-back pain. Therefore, observers' risk estimates might provide a useful method for musculoskeletal pain risk assessments.

LER/DORT: que métodos de avaliação do risco?

O processo de seleção dos métodos observacionais de avaliação do risco de LER/DORT é complexo, mas fundamental para a gestão do risco. Em Setúbal, no período de 2004 a 2005, numa empresa portuguesa da indústria automobilística, onde a avaliação do risco foi previamente efetuada, reaplicou-se o método OCRA checklist (avaliação do risco de LER/DORT ao nível dos membros superiores) em postos de trabalho (n=152) - montagem final e pintura - classificados de risco moderado/elevado (OCRA >16,5). Nas situações em que se reconfirmou a presença de risco (n=71), aplicaram-se três outros métodos: RULA, SI e HAL. Registraram-se sequências em vídeo da atividade de trabalho para avaliar a validade preditiva dos métodos. Revelam-se divergências entre os métodos na classificação dos postos de trabalho de risco elevado: OCRA - 34 postos; HAL - 35 postos; SI - 31 postos; RULA - 7 postos. A análise do efeito de cada variável independente (fator de risco) nos scores finais dos métodos (regressão linear multivariada) revela distintos contributos e processos de ponderação/avaliação do risco de LER/DORT. A análise dos registros em vídeo evidencia diversas validades preditivas relativamente aos fatores de risco integrantes dos métodos aplicados. Os resultados indicam a necessidade de uma seleção do método de avaliação do risco de LER/DORT adequada a cada situação (real) de trabalho, baseada no maior conhecimento dos métodos.

A prospective study of neck, shoulder, and upper back pain among technical school students entering working life

PURPOSE

The aim of this prospective study was to relate the prevalence of neck, shoulder, and upper back pain to occupational and individual risk factors among a population of technical school students in their transition from school to working life. In addition, we wanted to assess the changes in pain prevalence during follow-up.

METHODS

A cohort consisting of 173 technical school students was followed up during a 3-year period, from their last year of school through their first years of working life. Data on self-reported neck, shoulder, and upper back pain and factors such as mechanical exposure, perceived stress, and physical activity in leisure time were collected.

RESULTS

A high prevalence of pain in the neck, shoulder, and upper back among the technical school students was found. There were however few students reporting severe pain. Reporting pain at baseline gave over three times higher risk of reporting it at follow-up. A high level of physical activity outside working hours gave a lower risk of reporting neck, shoulder, and upper back pain at follow-up. High and moderate levels of mechanical exposure and high stress level were not found to be risk factors for pain after entering working life.

CONCLUSION

Neck, shoulder, and upper back pain are common among adolescents and may persist into working life. These results may give potential for preventive efforts at a young age. There is still much uncertainty about the factors leading to musculoskeletal pain, and more research is needed on this topic.

Interrater reliability of posture observations

OBJECTIVE

The aims of this research were (a) to study the interrater reliability of a posture observation method, (b) to test the impact of different posture categorization systems on interrater reliability, and (c) to provide guidelines for improving interrater reliability.

BACKGROUND

Estimation of posture through observation is challenging. Previous studies have shown varying degrees of validity and reliability, providing little information about conditions necessary to achieve acceptable reliability.

METHOD

Seven raters estimated posture angles from video recordings. Different measures of interrater reliability, including percentage agreement, precision, expression as interrater standard deviation, and intraclass correlation coefficients (ICC), were computed.

RESULTS

Some posture parameters, such as the upper arm flexion and extension, had ICCs > or = 0.50. Most posture parameters had a precision around the 10 degrees range. The predefined categorization and 300 posture categorization strategies showed substantially better agreement among the raters than did the 10 degrees strategy.

CONCLUSIONS

Different interrater reliability measures described different aspects of agreement for the posture observation tool. The level of agreement differed substantially between the agreement measures used. Observation of large body parts generally resulted in better reliability. Wider width angle intervals resulted in better percentage agreement compared with narrower intervals. For most postures, 30 degrees-angle intervals are appropriate. Training aimed at using a properly designed data entry system, and clear posture definitions with relevant examples, including definitions of the neutral positions of the various body parts, will help improve interrater reliability.

APPLICATION

The results provide ergonomics practitioners with information about the interrater reliability ofa postural observation method and guidelines for improving interrater reliability for video-recorded field data.

Prevalence of widespread pain and associations with work status: a population study

Background

This population study based on a representative sample from a Swedish county investigates the prevalence, duration, and determinants of widespread pain (WSP) in the population using two constructs and estimates how WSP affects work status. In addition, this study investigates the prevalence of widespread pain and its relationship to pain intensity, gender, age, income, work status, citizenship, civil status, urban residence, and health care seeking.

Methods

A cross-sectional survey using a postal questionnaire was sent to a representative sample (n = 9952) of the target population (284,073 people, 18–74 years) in a county (Östergötland) in the southern Sweden. The questionnaire was mailed and followed by two postal reminders when necessary.

Results

The participation rate was 76.7% (n = 7637); the non-participants were on the average younger, earned less money, and male. Women had higher prevalences of pain in 10 different predetermined anatomical regions. WSP was generally chronic (90–94%) and depending on definition of WSP the prevalence varied between 4.8–7.4% in the population. Women had significantly higher prevalence of WSP than men and the age effect appeared to be stronger in women than in men. WSP was a significant negative factor – together with age 50–64 years, low annual income, and non-Nordic citizen – for work status in the community and in the group with chronic pain. Chronic pain but not the spreading of pain was related to health care seeking in the population.

Conclusion

This study confirms earlier studies that report high prevalences of widespread pain in the population and especially among females and with increasing age. Widespread pain is associated with prominent effects on work status.

Work-related musculoskeletal disorders in physical therapists: a prospective cohort study with 1-year follow-up

BACKGROUND

Work-related musculoskeletal disorders (WMSDs) have a significant impact on physical therapists, but few studies have addressed the issue. Research is needed to determine the scope of the problem and the effects of specific risk factors.

OBJECTIVES

The objectives of this study were: (1) to determine the 1-year incidence rate of WMSDs in physical therapists and (2) to determine the effects of specific risk factors.

DESIGN

This was a prospective cohort study with 1-year follow-up.

METHODS

Subjects were randomly selected American Physical Therapy Association members (N=882). Exposure assessment included demographic data, physical risk factors, job strain, and specific physical therapy tasks. The primary outcome was WMSDs, with a severity rating of at least 4/10 and present at least once a month or lasting longer than a week.

RESULTS

The response rate to the baseline questionnaire was 67%. Ninety-three percent of the subjects who responded to the baseline questionnaire responded to the follow-up questionnaire. The 1-year incidence rate of WMSDs was 20.7%. Factors that increased the risk for WMSDs included patient transfers, patient repositioning, bent or twisted postures, joint mobilization, soft tissue work, and job strain.

LIMITATIONS

The primary limitation of this study was the number of therapists who had a change in their job situation during the follow-up year.

CONCLUSIONS

Work-related musculoskeletal disorders are prevalent in physical therapists. Physical therapy exposures, patient handling, and manual therapy, in particular, increase the risk for WMSDs.

Selected questions on biomechanical exposures for surveillance of upper-limb work-related musculoskeletal disorders

OBJECTIVE

Questionnaires for assessment of biomechanical exposure are frequently used in surveillance programs, though few studies have evaluated which key questions are needed. We sought to reduce the number of variables on a surveillance questionnaire by identifying which variables best summarized biomechanical exposure in a survey of the French working population.

METHODS

We used data from 2002 to 2003 French experimental network of Upper-limb work-related musculoskeletal disorders (UWMSD), performed on 2,685 subjects in which 37 variables assessing biomechanical exposures were available (divided into four ordinal categories, according to the task frequency or duration). Principal Component Analysis (PCA) with orthogonal rotation was performed on these variables. Variables closely associated with factors issued from PCA were retained, except those highly correlated to another variable (rho > 0.70). In order to study the relevance of the final list of variables, correlations between a score based on retained variables (PCA score) and the exposure score suggested by the SALTSA group were calculated. The associations between the PCA score and the prevalence of UWMSD were also studied. In a final step, we added back to the list a few variables not retained by PCA, because of their established recognition as risk factors.

RESULTS

According to the results of the PCA, seven interpretable factors were identified: posture exposures, repetitiveness, handling of heavy loads, distal biomechanical exposures, computer use, forklift operator specific task, and recovery time. About 20 variables strongly correlated with the factors obtained from PCA were retained. The PCA score was strongly correlated both with the SALTSA score and with UWMSD prevalence (P < 0.0001). In the final step, six variables were reintegrated.

CONCLUSION

Twenty-six variables of 37 were efficiently selected according to their ability to summarize major biomechanical constraints in a working population, with an approach combining statistical analyses and existing knowledge.

Differences in physical workload, psychosocial factors and musculoskeletal disorders between two groups of female hospital cleaners with two diverse organizational models

OBJECTIVES

To clarify if differences in the physical workload, the psychosocial factors and in musculoskeletal disorders can be attributed to work organizational factors.

METHODS

The physical workload (muscular activity of m. trapezius, positions and movements of the head, upper arms and wrists and heart rate) was assessed in 24 female hospital cleaners working in a traditional work organization (TO) and in 22 working in an extended one (i.e. with an enlarged work content and more responsibilities; EO). The psychosocial work environment was assessed as job demand, decision latitude and social support in 135 (TO) and 111 (EO) cleaners, and disorders of the neck and upper extremity by a physical examination.

RESULTS

The EO group was associated with lower physical workload, in terms of heart rate ratio (23 vs 32; P<0.001), head and upper arm positions and movements (right upper arm, 50th percentile, 35 degrees/s vs 71 degrees/s; P<0.001) and wrist movements (20 degrees/s vs 27 degrees/s; P=0.001), than the TO group. The EO group reported higher decision latitude and lower work demand than the TO one, while we found no difference in social support. The prevalence of complaints and diagnoses in neck/shoulders were lower in the EO group (diagnoses 35% vs 48%; P=0.04). Moreover, the prevalence of subjects with at least ten physical finding in elbows/hands was lower in the EO group (10 vs 29; P<0.001).

CONCLUSION

Hospital cleaners have a high prevalence of neck and upper limb disorders and a high physical workload. Comparing two groups of cleaners, with differences in the way of organizing the work, lower physical workload, more beneficial psychosocial factors and a better musculoskeletal health was found in the group with an extended organization. Hence, the differences found can be attributed to the organizational factors.

Medium- and long-term reproducibility of self-reported exposure to physical ergonomics factors at work

INTRODUCTION

The literature is sparse on reproducibility of self-reported exposure to physical ergonomics risk factors for musculoskeletal disorders (MSDs). Aims of this study were to evaluate, in a cohort of workers interviewed up to three times: 1-year test-retest reliability; and 5- and 6-year recall of physical exposures. We also examined whether reproducibility was influenced by the presence of UE MSD or by technological changes introduced between the last two surveys.

METHODS

A cohort of automobile manufacturing employees was interviewed at baseline, one and six years later about work history, physical and psychosocial exposures at work, upper limb symptoms, injury and medical history, and demographics. Agreement between interviews was evaluated by intraclass correlation and Spearman coefficients. Differences in exposure between 1- and 6-year follow-up were analyzed by Wilcoxon matched-pairs signed-ranks test.

RESULTS

Large and significant decreases in work pace and physical effort were observed from baseline, although an upper extremity composite index was quite stable in the total population. One-year test-retest reliability was fair to good for the composite exposure index (ICC=0.58), whole-body vibration, handling parts, and tool use, but poor for the other variables considered. Long-term reproducibility, from baseline or 1-year follow-up to 6-year follow-up, was poor for the composite index and almost all single items. UE MSD case status influenced 1-year test-retest reliability, with subjects who changed case status from baseline displaying higher reliability, but not reproducibility of recalled exposures. A strong regression to the mean effect was observed on exposures reported at follow-up surveys.

CONCLUSIONS

Recalled ergonomics exposures could be employed in retrospective cohort studies as a somewhat reliable and unbiased estimate of the self-reported exposures that would have been obtained up to one year earlier, but not over a longer period (5-6 years). These longer-term results may have been limited by difficulty in matching jobs between interviews; also the regression to the mean effect likely contributed to reduce agreement. Changes in production technology and work organization produced a decrease in physical workload intensity and job pace, but did not have a substantial impact on an exposure index for the upper limb.

Measuring the physical demands of work in hospital settings: design and implementation of an ergonomics assessment

BACKGROUND

Assessing the physical demands of the heterogeneous jobs in hospitals requires appropriate and validated assessment methodologies.

METHODS

As part of an integrated assessment, we adapted Rapid Entire Body Assessment (REBA), using it in a work sampling mode facilitated by a hand-held personal digital assistant, expanding it with selected items from the UC Computer Use Checklist, and developed a scoring algorithm for ergonomics risk factors for the upper (UB) and lower body (LB).

RESULTS

The inter-rater reliability kappa was 0.54 for UB and 0.66 for LB. The scoring algorithm demonstrated significant variation (ANOVA p<0.05) by occupation in anticipated directions (administrators ranked lowest; support staff ranked highest on both scores). A supplemental self-assessment measure of spinal loading correlated with high strain LB scores (r=0.30; p<0.001).

CONCLUSION

We developed and validated a scoring algorithm incorporating a revised REBA schema adding computer use items, appropriate for ergonomics assessment across a range of hospital jobs.

Self-assessed and directly measured occupational physical activities--influence of musculoskeletal complaints, age and gender

This study compares questionnaire assessed physical activity with direct technical measurements among cleaners and office workers, stratified regarding age, gender and self-reported neck/shoulder complaints. During two full working days number of steps was recorded by a pedometer, sitting/standing positions by a posimeter and heart rate by a Sport-Tester. In addition the subjects kept a work task diary for 10 days. There were high intra-individual variations in exposure between the days. Subjects with complaints rated their exposure higher than those without, although they in fact showed lower direct measured exposure. This may imply underestimation of exposure-effect relationships. Rate of perceived exertion showed low correlation with heart rate ratio within the two occupational groups, but high, 0.64 when the two groups were combined. Age and complaints explained 31% of the variance for the cleaners.

A participatory approach to the study of lifting demands and musculoskeletal symptoms among Hong Kong workers

AIMS

To investigate the use of a worker based methodology to assess the physical stresses of lifting tasks on effort expended, and to associate this loading with musculoskeletal outcomes (MO).

METHODS

A cross sectional study was conducted on 217 male manual handling workers from the Hong Kong area. The effects of four lifting variables (weight of load, horizontal distance, twisting angle, and vertical travel distance) on effort were examined using a linguistic approach (that is, characterising variables in descriptors such as "heavy" for weight of load). The numerical interpretations of linguistic descriptors were established. In addition, the associations between on the job effort and MO were investigated for 10 body regions including the spine, and both upper and lower extremities.

RESULTS

MO were prevalent in multiple body regions (range 12-58%); effort was significantly associated with MO in 8 of 10 body regions (odds ratios with age adjusted ranged from 1.31 for low back to 1.71 for elbows and forearm). The lifting task variables had significant effects on effort, with the weight of load having twice the effect of other variables; each linguistic descriptor was better described by a range of numerical values rather than a single numerical value.

CONCLUSIONS

The participatory worker based approach on musculoskeletal outcomes is a promising methodology. Further testing of this approach is recommended.

Workers' assessments of manual lifting tasks: cognitive strategies and validation with respect to objective indices and musculoskeletal symptoms

OBJECTIVES

To determine the different cognitive strategies adopted by workers in assessing the effects of lifting-task parameters on effort, and to validate workers' assessments.

METHODS

Questionnaires were administered to 217 male workers with varied levels of experience in manual handling. Workers were asked to assess the effects of lifting on perceived effort, using linguistic descriptors (e.g., light, heavy), and to determine the physical meaning of such descriptors. In addition, each worker assessed on-the-job effort, perceived risk of injury and work dissatisfaction, and musculoskeletal outcomes in a cross-sectional design.

RESULTS

Perceived physical effort was significantly associated with lifting variables. Results indicated that the three-cluster strategy is the best performer. Weight of load emerged as the most influential factor that impacted on effort in the most dominant cluster (close to 50% of the observations). The second cluster (25% of the observations) demonstrated that weight, horizontal distance, and twisting angle, contributed equally to effort, and the third cluster had weight and vertical travel distance as the most important variables (with travel distance being more important). Perceived effort was significantly associated with objective indices (i.e., biomechanical lifting equivalent and NIOSH lifting index), and musculoskeletal symptoms in eight body parts.

CONCLUSIONS

Cognitive reasoning of experienced workers may be used as an active device for the evaluation of strenuous physical activities such as lifting tasks. Lifting activities are significantly associated with musculoskeletal symptoms, not only in the lower-back region, but also in seven other body parts; and effort may integrate the effects of both physical (lifting tasks) and non-physical (i.e., work dissatisfaction) factors, as well as perception of risk.