Development and validation of a cumulative exposure shoulder risk assessment tool based on fatigue failure theory

OBJECTIVE

To present a new risk assessment tool for shoulder intensive occupational tasks based on fatigue failure theory.

METHODS

The tool estimates cumulative damage (CD) based on shoulder moments and loading cycles using an S-N curve derived from in vitro tendon fatigue failure tests. If multiple shoulder tasks are performed, the CD for each is summed. In the validation, 293 workers were evaluated for five separate shoulder outcomes. Logistic regression was used to assess the log CD against five shoulder outcomes adjusted for covariates including age, sex, body mass index (BMI), and plant site.

RESULTS

Both crude and adjusted logistic regression results demonstrated strong dose-response associations between the log CD measure and all five shoulder outcomes (continuous ORs ranged from 2.12 to 5.20).

CONCLUSIONS

The CD measure of The Shoulder Tool demonstrated dose-response relationships with multiple health outcomes. This provides further support that MSDs may be the result of a fatigue failure process.

PRACTITIONER SUMMARY

This study presents a new, easy-to-use risk assessment tool for occupational tasks involving stressful shoulder exertions. The tool is based on fatigue failure theory. The tool was tested against an existing epidemiology study and demonstrated strong relationships to multiple shoulder outcomes.

ABBREVIATIONS

MSD: musculoskeletal disorder; NORA: national occupational research agenda; RULA: rapid upper limb assessment; REBA: rapid entire body assessment; S-N: stress-number of cycles; EDL: extensor digitorum longus; DPC: damage per cycle; CD: cumulative damage; UTS: ultimate tensile strength; FTOV: first time office visit; 3DSSPP: 3-dimensional static strength prediction program; AS: visual analogue scale; BMI: body mass index; CI: confidence interval; Nm: newton-metre; LiFFT: lifting fatigue failure tool; DUET: distal upper extremity tool; OMNI-RES: OMNI resistance exercise scale.

Development and validation of a cumulative exposure shoulder risk assessment tool based on fatigue failure theory

OBJECTIVE

To present a new risk assessment tool for shoulder intensive occupational tasks based on fatigue failure theory.

METHODS

The tool estimates cumulative damage (CD) based on shoulder moments and loading cycles using an S-N curve derived from in vitro tendon fatigue failure tests. If multiple shoulder tasks are performed, the CD for each is summed. In the validation, 293 workers were evaluated for five separate shoulder outcomes. Logistic regression was used to assess the log CD against five shoulder outcomes adjusted for covariates including age, sex, body mass index (BMI), and plant site.

RESULTS

Both crude and adjusted logistic regression results demonstrated strong dose-response associations between the log CD measure and all five shoulder outcomes (continuous ORs ranged from 2.12 to 5.20).

CONCLUSIONS

The CD measure of The Shoulder Tool demonstrated dose-response relationships with multiple health outcomes. This provides further support that MSDs may be the result of a fatigue failure process.

PRACTITIONER SUMMARY

This study presents a new, easy-to-use risk assessment tool for occupational tasks involving stressful shoulder exertions. The tool is based on fatigue failure theory. The tool was tested against an existing epidemiology study and demonstrated strong relationships to multiple shoulder outcomes.

ABBREVIATIONS

MSD: musculoskeletal disorder; NORA: national occupational research agenda; RULA: rapid upper limb assessment; REBA: rapid entire body assessment; S-N: stress-number of cycles; EDL: extensor digitorum longus; DPC: damage per cycle; CD: cumulative damage; UTS: ultimate tensile strength; FTOV: first time office visit; 3DSSPP: 3-dimensional static strength prediction program; AS: visual analogue scale; BMI: body mass index; CI: confidence interval; Nm: newton-metre; LiFFT: lifting fatigue failure tool; DUET: distal upper extremity tool; OMNI-RES: OMNI resistance exercise scale.

An Upper Extremity Risk Assessment Tool Based on Material Fatigue Failure Theory: The Distal Upper Extremity Tool (DUET)

OBJECTIVE

Musculoskeletal tissues repeatedly loaded in vitro fail in accordance with material fatigue failure theory, and there is evidence to suggest that the same process occurs in vivo. The current paper presents a new upper extremity risk assessment tool, the Distal Upper Extremity Tool (DUET), predicated on material fatigue failure theory.

METHODS

DUET requires an estimate of force exertion level and the number of repetitions performed to derive estimates of damage and probabilities of experiencing a distal upper extremity outcome. Damage accrued over multiple tasks may be summed to estimate the cumulative damage (CD) accrued over a workday. Validation of this tool was performed using five distal upper extremity (DUE) outcomes (involving medical visits and pain) from an existing epidemiological database involving data from six automotive manufacturing plants. Logistic regression was used to assess the association of the log of the DUET CD measure to DUE outcomes.

RESULTS

Results demonstrated that the log of the DUET CD measure was highly associated with all five DUE outcomes in both crude analyses and those adjusted for site, age, gender, and body mass index ( p < .01). A model relating the continuous DUET log CD score to the probability of the DUE outcome Injury + Pain Last Year was developed, which demonstrated a significant dose-response relationship.

CONCLUSIONS

Results suggest that fatigue failure-based risk assessment techniques are highly associated with DUE outcomes and provide support for the notion that an underlying fatigue failure process may be involved in the development of upper extremity musculoskeletal disorders.

Characterizing exposure to physical risk factors among reforestation hand planters in the Southeastern United States

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.

Development and validation of an easy-to-use risk assessment tool for cumulative low back loading: The Lifting Fatigue Failure Tool (LiFFT)

Recent evidence suggests that musculoskeletal disorders (MSDs) may be the result of a fatigue failure process in affected tissues. This paper describes a new low back exposure assessment tool (the Lifting Fatigue Failure Tool [LiFFT]), which estimates a "daily dose" of cumulative loading on the low back using fatigue failure principles. Only three variables are necessary to derive the cumulative load associated with a lifting task: the weight of the load, the maximum horizontal distance from the spine to the load, and the number of repetitions for tasks performed during the workday. The new tool was validated using two existing epidemiological databases: the Lumbar Motion Monitor (LMM) database, and a database from a U.S. automotive manufacturer. The LiFFT cumulative damage metric explained 92% of the deviance in low back disorders (LBDs) in the LMM database and 72-95% of the deviance in low back outcomes in the automotive database (depending on the outcome measure). Thus, LiFFT is practitioner friendly and its cumulative damage metric highly related to low back outcomes.