Why multi-tier surgical instrument table matters? An ergonomic analysis from mento-physical demand perspectives

Using traditional back tables (BT) in operating rooms (OR) can lead to high physical/cognitive demand on nurses due to repetitive manual material handling activities. A multi-tier table (MTT) has been developed to relieve such stressors by providing extra working surfaces to avoid stacking the instrument trays and facilitate access to surgical tools. In this study, sixteen participants performed lifting/lowering and instrument findings tasks on each table, where kinematics, kinetics, subjective, and performance-related measures were recorded. Results indicated that MTT required lesser shoulder flexion (p-value<0.001), ∼14% lower shoulder loads (0.012), task completion time (<0.001), and cognitive/physical workloads (<0.004). Although peak low-back demands were ∼15% higher using MTT, the number of lifts to complete the same task was 60% lower, leading to lower cumulative demand on the low-back musculature. Utilizing MTT in OR could reduce demand and increase nurses' efficiency, leading to reduced risk of WMSDs and the total time of surgery.

Classifying hazardous movements and loads during manual materials handling using accelerometers and instrumented insoles

Improper manual material handling (MMH) techniques are shown to lead to low back pain, the most common work-related musculoskeletal disorder. Due to the complex nature and variability of MMH and obtrusiveness and subjectiveness of existing hazard analysis methods, providing systematic, continuous, and automated risk assessment is challenging. We present a machine learning algorithm to detect and classify MMH tasks using minimally-intrusive instrumented insoles and chest-mounted accelerometers. Six participants performed standing, walking, lifting/lowering, carrying, side-to-side load transferring (i.e., 5.7 kg and 12.5 kg), and pushing/pulling. Lifting and carrying loads as well as hazardous behaviors (i.e., stooping, overextending and jerky lifting) were detected with 85.3%/81.5% average accuracies with/without chest accelerometer. The proposed system allows for continuous exposure assessment during MMH and provides objective data for use with analytical risk assessment models that can be used to increase workplace safety through exposure estimation.

Combined influence of transfer distance, pace, handled mass and box height on spine loading and posture

Work-related low back disorders are commonly associated with handling tasks. The objective of this study was to determine the combined influence of distance, pace, handled mass and height, on back loading and posture during free box transfer. Kinematics and kinetics of 17 handlers were recorded during a box transfer task between two pallets. Four-way repeated measures ANOVA were conducted on four lift-deposit height conditions (from lift and deposit of 0.16 or 1.16 m), three distances between pallets (1.5, 1.0 and 0.5 m), two handled masses (10 and 20 kg) and two paces (free and faster). The interaction between distance and height on back loading and posture (P < 0.001) showed that increasing distance to more than 1 m is not recommended to avoid unnecessary cumulative loading. The shorter distance of 0.5 m, which generally reduced the most spine loading, may increase it for transfers varying in height. The effect of pace to reduce spine cumulative loading and increase the peak asymmetric loading (P < 0.05) was accentuated by mass, height and distance. The combined factors revealed the importance of tradeoff between peak, cumulative and asymmetric loading.

Classifying diverse manual material handling tasks using a single wearable sensor

The use of inertial measurement units (IMUs) for monitoring and classifying physical activities has received substantial attention in recent years, both in occupational and non-occupational contexts. However, a "user-friendly" approach is needed to promote this approach to quantify physical demands in actual workplaces. We explored the use of a single IMU for extracting information about different manual material handling (MMH) tasks (i.e., specific type of task performed, and associated duration and frequency), using a bidirectional long short-term memory network for classification. Classification performance using single IMUs placed on several body parts was compared with performance using multiple IMU configurations (2, 3, and 17 IMUs). Overall, the use of a single sensor led to satisfactory results (e.g., median accuracy >97%) in classifying MMH tasks and estimating task duration and frequency. Limited benefits were obtained using additional sensors, and several sensor locations yielded similar outcomes. Classification performance, though, was relatively inferior for push/pull vs. other tasks.

The effect of age, prolonged seated work and sex on posture and perceived effort during a lifting task

The purpose of this investigation was to determine the effect of prolonged seated work, lift task, age and sex on normalized lumbar angles, thoracic angles, perceived effort and duration of lifts. A total of 17 young and 17 mature participants were recruited with an average (standard deviation) age of 23.8 (5.0) years and 63.7 (3.9) years, respectively. Participants completed 3 different floor to knuckle lifts before and following 90 min of seated work. The lifts included; (i) 7 kg symmetrical, (ii) 4.5 kg symmetrical and (iii) 4.5 kg asymmetrical. Prolonged seated work and age interacted to affect normalized peak lumbar angles (p = 0.0469) where older adults adopted 56(15)% flexion after seated work compared to 67(16)% among younger adults. Older adults took significantly longer to complete the lifting tasks compared to younger adults while age did not affect perceived effort across lifting tasks. Older workers may require age specific interventions given age specific responses.

Quantification of Postures for Low-Height Object Manipulation Conducted by Manual Material Handlers in a Retail Environment

Occupational Applications Manual material handlers performing stocking tasks spent substantial amounts of time in bent postures but used traditional stoops and squats infrequently. Instead, they often used split-legged stoops and squats, where one foot is further forward than the other, and one-legged ("golfer's") lifts. During object manipulation, the distance workers reached away from their body, and the height at which they manipulated objects, were correlated with the posture used by the worker. Workers also stayed in different postures for different lengths of time. It is likely that certain postures are more comfortable for the workers to remain in, provide additional mobility or operational radius, or require less energy to use. Understanding these factors in more detail could lead to improved worker training programs, where the postures taught not only have low injury risk but are comfortable so are actually adopted and used by the workers.

Workers' biomechanical loads and kinematics during multiple-task manual material handling

This study investigated the biomechanical loads and kinematics of workers during multiple-task manual material handling (MMH) jobs, and developed prediction models for the moments acting on a worker's body and their peak joint angles. An experiment was conducted in which 20 subjects performed a total of 3780 repetitions of a box-conveying task. This task included continuous sequential removing, carrying and depositing of boxes weighing 2-12 kg. The subjects' motion was captured using motion-capture technology. The origin/destination height was the most influencing predictor of the spinal and shoulder moments and the peak trunk, shoulder and knee angles. The relationship between the origin/destination heights and the above parameters was nonlinear. The mass of the box, and the subject's height and mass, also influenced the spinal and shoulder moments. A tradeoff between the moments acting on the L5/S1 vertebrae and on the shoulder joint was found. Compared to the models developed in similar studies that focused on manual material handling (albeit under different conditions), the high-order prediction equation for peak spinal moment formulated in the present study was found to explain between 10% and 48% more variability in the moments. This suggests that using a high-order equation in future studies might improve the prediction.

Sex differences in muscle activity and motor variability in response to a non-fatiguing repetitive screwing task

Background

Musculoskeletal disorders are more prevalent among women than among men, which may be explained by aspects of motor control, including neuromuscular requirements and motor variability. Using an exploratory approach, this study aimed to evaluate sex differences in neuromuscular responses and motor variability during a repetitive task performed on 3 days.

Methods

Thirty women and 27 men performed the non-fatiguing, repetitive, 1-h screwing task. For neuromuscular responses, the mean and difference values of static, median, and peak percentile muscle activity levels (normalized to a reference voluntary contraction force) and, for motor variability, the mean and difference values of relative and absolute cycle-to-cycle variability across days were compared between both sexes for each muscle. A mixed-design analysis of variance was used to assess differences between both sexes.

Results

The non-fatiguing character of the screwing task was confirmed by the absence of decreased force levels in maximal voluntary contractions performed before and after the task and by absence of electromyographic signs of muscle fatigue. The static and median muscle activity levels tended to be higher among women (on average 7.86 and 27.23 %RVE) than men (on average 6.04 and 26.66 %RVE). Relative motor variability of the flexor and biceps muscles and absolute motor variability of both upper arm muscles were lower in women (on average 0.79 and 29.70 %RVE) than in men (on average 0.89 and 37.55 %RVE). The median activity level of both upper arms muscles tended to decrease within days among women (on average - 2.63 %RVE) but increase among men (on average + 1.19 %RVE). Absolute motor variability decreased within days among women (on average - 5.32 to - 0.34%RVE), whereas it tended to decrease less or increase within days among men (on average - 1.21 to + 0.25 %RVE).

Conclusion

Women showed higher levels of muscle activity and lower initial relative and absolute motor variability than males when performing the same occupational task, implying women may have a higher risk for developing disorders and point to both sexes using different intrinsic motor control strategies in task performance. Clearly, biological aspects alone cannot explain why women would be at higher risk for developing disorders than men. Therefore, a wider range of individual and environmental factors should be taken into account for optimizing work station designs and organizations by taking into account sex differences.

Paramedic equipment bags: How their position during out-of-hospital cardiopulmonary resuscitation (CPR) affect paramedic ergonomics and performance

This study investigates how the positions of paramedic equipment bags affect paramedic performance and biomechanical loads during out-of-hospital Cardiopulmonary Resuscitation (CPR). An experiment was conducted in which 12 paramedic teams (each including two paramedics) performed in-situ simulations of a cardiac-arrest scenario. CPR quality was evaluated using five standard resuscitation measures (i.e., pre- and post-shock pauses, and compression rate, depth and fraction). The spinal loads while lifting, pulling and pushing the equipment bags were assessed using digital human modeling software (Jack) and prediction equation from previous studies. The results highlight where paramedics are currently choosing to position their equipment. They also demonstrate that the positions of the equipment bags affect CPR quality as well as the paramedics' work efficiency, physiological effort and biomechanical loads. The spinal loads ranged from 1901 to 4030N; furthermore, every occasion on which an equipment bag was lifted resulted in spinal forces higher than 3400N, thus exceeding the maximum threshold stipulated by the National Institute for Occupational Safety and Health. 72% of paramedics' postures were categorized as high or very high risk for musculoskeletal disorders by the Rapid Entire Body Assessment. Guidelines related to bag positioning and equipment handling might improve CPR quality and patient outcomes, and reduce paramedics' risk of injury.

Differences in spinal moments, kinematics and pace during single-task and combined manual material handling jobs

This study compared the spinal moments (i.e., peak and cumulative moments acting on the L5/S1 joint), kinematics (i.e., peak trunk and knee angles) and work pace of workers, when either removing a box from a shelf or depositing a box on a shelf, under two conditions: as a single task or as part of a combined task. An experiment was conducted, in which the subjects performed the tasks and were recorded using a motion capture system. An automated program was developed to process the motion capture data. The results showed that, when the removing and depositing tasks were performed as part of a combined task (rather than as single tasks), subjects experienced smaller peak and cumulative spinal moments and they performed the tasks faster. The results suggest that investigations into the separate tasks that comprise a combination have a limited ability to predict kinematics and kinetics during the combined job.

Occupational lifting predicts hospital admission due to low back pain in a cohort of airport baggage handlers

Purpose

To examine if occupational lifting assessed as cumulative years as a baggage handler is associated with first-time hospital diagnosis or treatment for low back disorders.

Methods

This study is based on the Copenhagen Airport Cohort consisting of male baggage handlers performing heavy lifting every day and a reference group of unskilled men from the greater Copenhagen area during the period 1990–2012. We followed the cohort in the National Patient Register and Civil Registration System to obtain information on diagnoses, surgery, mortality, and migration. The outcomes were first-time hospital diagnosis or surgery for (1) lumbar disc herniation or (2) low back pain (LBP).

Results

Baggage handlers (N = 3473) had a higher incidence rate of LBP, but not of lumbar disc herniation, compared to the reference group (N = 65,702). Baggage handlers with longer employment had a higher incidence of LBP compared to baggage handlers with shorter employment. The linear association of cumulative years as a baggage handler on LBP was significantly increased with an incidence rate ratio of 1.16 (95% CI 1.07–1.25) for a 5-year increase of employment as baggage handler.

Conclusions

In this large cohort study, we found an increased incidence of LBP among baggage handlers compared to the reference group with indications of a dose–response relationship between years of employment and the outcome. For baggage handlers working on the apron, the incidence was particularly increased before introduction of technical lifting equipment, suggesting that preventive measures to reduce cumulative work load may have a positive effect.

Factors determining workers' pace while conducting continuous sequential lifting, carrying, and lowering tasks

To plan a new manual material handling work process, it is necessary to predict the times required to complete each task. Current time prediction models lack validity when the handled object's mass exceeds 2 kg. In this study, we investigated the effect of workplace design parameters on continuous sequential lifting, carrying, and lowering of boxes weighing from 2 kg to 14 kg. Both laboratory and field experiments were conducted. Results revealed that the box's weight and the lifting and lowering heights influenced the tasks' times. Further, the time to perform a task was influenced by the performance of other tasks in the same work process. New time prediction models were developed using the laboratory experiment data. Our models were found to be more accurate on average than the Maynard Operation Sequence Technique (MOST) and Methods Time Measurement (MTM-1) by 42% and 20%, respectively, for predicting the times of real workers at an actual workplace.

Can experience modulate handler responses to boxes designed to decrease musculoskeletal load?

Biomechanical load during the handling of commercial (cardboard box with and without cut out) and non-commercial boxes (cardboard box with a retreat on the bottom edges), on experienced compared to inexperienced subjects was evaluated. Thirty-seven inexperienced and 21 experienced workers handled all boxes at shoulder and ground levels. Biomechanical load on upper limb was investigated through posture and electromyography (EMG) recordings. Comfort and effort were assessed immediately after each handling. In general, experienced workers had low range of motion. On the other hand, EMG was similar between both groups, except when non-commercial boxes were handled in non-favourable heights. Comfort was higher when a non-commercial box was handled versus a commercial one, regardless of the group. Both groups had a lower biomechanical load when handling the non-commercial boxes compared to the commercial ones. However, experienced workers did not have the same advantage as inexperienced subjects when handling those new boxes. Practitioner Summary: Box designs favouring intuitive hand coupling and more efficient postures have potential to reduce the risk of upper-limb musculoskeletal disorders in inexperienced subjects. However, ergonomist has to deal with workers on different levels of experience. Results of this study can support the development of effective recommendations for the working context.

Difference between male and female workers lifting the same relative load when palletizing boxes

A few biomechanical studies have contrasted the work techniques of female and male workers during manual material handling (MMH). A recent study showed that female workers differed from males mostly in the strategy they used to lift 15-kg boxes from the ground, especially regarding task duration, knee and back postures and interjoint coordination. However, the lifting technique difference observed in females compared to males was perhaps due to a strength differences. The objective of this study was to test whether female workers would repeat the same lifting technique with a load adjusted to their overall strength (females: 10 kg; males: 15 kg), which can be considered a "relative load" since the overall back strength of females is 2/3 that of males. The task for the participants consisted in transferring boxes from one pallet to another. A dynamic 3D linked segment model was used to estimate the net moments at L5/S1, and different kinematic variables were considered. The results showed that the biomechanics of the lifting techniques used by males and females were similar in terms of task duration and cumulative loading, but different in terms of interjoint coordination pattern. The sequential interjoint coordination pattern previously seen in females with an absolute load (15 kg) was still present with the relative load, suggesting the influence of factors more intrinsically linked to sex. Considering that the female coordination pattern likely stretched posterior passive tissues when lifting boxes from the ground, potentially leading to higher risk of injury, the reason for this sex effect must be identified so that preventive interventions can be proposed.

Obesity-related changes in prolonged repetitive lifting performance

Despite the rising prevalence of obesity, little is known about its moderating effects on injury risk factors, such as fatigue, in occupational settings. This study investigated the effect of obesity, prolonged repetitive lifting and their interaction on lifting performance of 14 participants, 7 obese (mean body mass index (BMI): 33.2 kg m(-2)) and 7 non-obese (mean BMI: 22.2 kg m(-2)) subjects. To present a physically challenging task, subjects performed repetitive lifting for 1 h at 120% of their maximum acceptable weight of lift. Generalized linear mixed models were fit to posture and acceleration data. The obese group bent to a ∼10° lower peak trunk sagittal flexion angle, had 17% lower root mean square (RMS) jerk and took 0.8 s longer per lift. Over time, the obese group increased their trunk transverse and sagittal posterior accelerations while the non-obese maintained theirs. Although the majority of lifting variables were unaffected by BMI or its interaction with prolonged lifting duration, the observed differences, combined with a greater upper body mass, necessitate a more cautious use of existing psychophysical lifting limits for individuals who are obese, particularly when fatigued.

Examination of postures and frequency of musculoskeletal disorders among manual workers in Calcutta, India

BACKGROUND

Manual material handling (MMH) activities require workers to adopt various awkward postures leading to the development of musculoskeletal disorders (MSD).

OBJECTIVES

To investigate the postures adopted during heavy load handling and the frequency of MSDs among MMH workers in Calcutta, India.

METHODS

We conducted a cross-sectional study with 100 MMH workers. MSD frequency was assessed via the Standardized Nordic Questionnaire. The Ovako Working Posture Assessment System (OWAS) was used to analyze working posture. We used logistic regression to predict MSD risk factors.

RESULTS

Ninety five percent of workers reported a MSD in at least one body part in the past 12 months. According to OWAS results, 83% of the analysed work postures require immediate corrective measures for worker safety. The most harmful posture was carrying a heavy load overhead. Carrying more than 120 kg increased the odds of low back and neck pain by 4.527 and 4.555, respectively.

CONCLUSIONS

This sample had a high frequency of reported MSDs, likely attributed to physiologically strenuous occupational activities repeated on average of 30-40 times daily. Ergonomic interventions, such as the use of handcarts, and occupational training are urgently needed.

Comparison of trunk muscle activities in lifting and lowering tasks at various heights

[Purpose] Biomechanical data for manual material handling are important for appropriate engineering design. The goal of this study was to investigate differences in trunk muscle activity in lifting and lowering tasks at various heights. [Subjects and Methods] Thirty healthy, young adult subjects performed 6 asymmetrical lifting and lowering tasks at various heights. Trunk muscle activity of the abdominal external oblique muscle (EO), rectus abdominis muscle (RA), and lumbar erector spinae muscles (ES) were recorded using surface electromyography (EMG). [Results] The EMG activities of the bilateral ES differed significantly among heights. The left EO activity in the ankle to knee lifting task was significantly increased compared with that of the knee to ankle lowering task. However, there were no significant differences in the right EO, bilateral ES, or RA between lifting and lowering tasks. [Conclusion] The results show that the optimal range for manual material handling was at trunk height, not only for lifting but also for lowering tasks.

Effect of a worktable position on head and shoulder posture and shoulder muscles in manual material handling

BACKGROUND

According to a recent research, manual working with high levels of static contraction, repetitive loads, or extreme working postures involving the neck and shoulder muscles causes an increased risk of neck and shoulder musculoskeletal disorders.

OBJECTIVE

We investigated the effects of the forwardly worktable position on head and shoulder angles and shoulder muscle activity in manual material handling tasks.

METHODS

The forward head and shoulder angles and the activity of upper trapezius, levator scapulae, and middle deltoid muscle activities of 15 workers were measured during performing of manual material handling in two tasks that required different forward head and shoulder angles.

RESULTS

The second manual material task required a significantly increased forward head and shoulder angle. The upper trapezius and levator scapulae muscle activity in second manual material task was increased significantly compared with first manual material task. The middle deltoid muscle activity in second manual material task was not significantly different compared with first manual material task.

CONCLUSIONS

Based on this result, the forward head and shoulder angles while performing manual work need to be considered in selection of the forward distance of a worktable form the body. The high level contractions of the neck and shoulder muscles correlated with neck and shoulder pain. Therefore, the forward distance of a worktable can be an important factor in preventing neck and shoulder pain in manual material handling workers.

Sex differences in lifting strategies during a repetitive palletizing task

Forty-five manual material handlers (15 females, 15 expert males and 15 novice males) performed series of box transfers under conditions similar to those of large distribution centers. The objective of the study was to verify whether sex differences in joint motions and in back loading variables (L5/S1 moments) exist during multiple box transfers. The task consisted in transferring 24 15-kg boxes from one pallet to another (4 layers of boxes; 6 boxes/layer: 3 in the front row, 3 in the back) at a self-determined pace and then at an imposed pace of 9 lifts/min. Full-body 3D kinematic data were collected as well as external foot forces. A dynamic 3D linked segment model was used to estimate the net moments at L5/S1. The results show that the peak L5/S1 moment during lifting for females was significantly lower than for males, but once normalized to body size the difference disappeared. In general, the female workers were very close to the posture adopted by the novice males at the instant of the peak resultant moment. However, females were closer to the box than the male workers. One major sex difference was seen when lifting from the ground, with the use of interjoint coordination analyses. Female workers showed a sequential motion initiated by the knees, followed by the hip and the back, while expert males showed a more synchronized motion. The lifting strategy of females likely stretches lumbar spine passive tissues, which in turn put them at greater risk of back injuries. As observed in our previous studies, these differences between expert males, novice males and females are especially notable when the box is lifted from the ground.

Evaluation of team lifting on work demands, workload and workers' evaluation: an observational field study

The objective of this study was to assess differences in work demands, energetic workload and workers' discomfort and physical effort in two regularly observable workdays in ironwork; one where loads up to 50kg were handled with two persons manually (T50) and one where loads up to 100kg were handled manually with four persons (T100). Differences between these typical workdays were assessed with an observational within-subject field study of 10 ironworkers. No significant differences were found for work demands, energetic workload or discomfort between T50 and T100 workdays. During team lifts, load mass exceeded 25kg per person in 57% (T50 workday) and 68% (T100 workday) of the lifts. Seven ironworkers rated team lifting with two persons as less physically demanding compared with lifting with four persons. When loads heavier than 25kg are lifted manually with a team, regulations of the maximum mass weight are frequently violated.

STATEMENT OF RELEVANCE

Loads heavier than 25kg are frequently lifted during concrete reinforcement work and should be lifted by a team of persons. However, the field study showed that loads above 25kg are most of the time not lifted with the appropriate number of workers. Therefore, loads heavier than 25kg should be lifted mechanically.

Lifting strategies of expert and novice workers during a repetitive palletizing task

Thirty manual material handlers (15 experts and 15 novices) were invited to perform series of box transfers under conditions similar to those of large distribution centers. The objective of the present study was to verify whether multiple box transfers leading to fatigue would also lead to differences between expert and novice workers in joint motions and in back loading variables (L5/S1 moments). The task consisted in transferring 24 15-kg boxes from one pallet to another (4 layers of boxes; 6 boxes/layer: 3 in the front row, 3 in the back) at a self-determined pace and then at an imposed pace of 9 lifts/min for a total of 240 lifts. The underlying idea was to set a challenging task that would force the experts to use their skills. Full-body 3D kinematic data were collected as well as external foot forces. A dynamic 3D linked segment model was used to estimate the net moments at L5/S1. The results clearly show that the experts bent their lumbar spine less (10° less) and were closer (4 cm) to the box than novice workers. Knee flexions were similar in both groups except when the box was lifted from ground level (expert ≈ 71°, novice ≈ 48°). The peak resultant moment was not statistically different (expert = 168 Nm, novice = 184 Nm) although experts had lower values on average than novices when lifting heights (and deposit heights) of the boxes increased. Therefore, experts differed from novice workers mostly in the posture-related variables. These differences are especially important to consider when the box is located on the ground, as the back posture and back loading are then at their greatest magnitude and could have a major impact on the distribution of internal forces on the spine.

Effects of restrictive clothing on lumbar range of motion and trunk muscle activity in young adult worker manual material handling

The objective of this study was to examine the effect of wearing restrictive trousers on lumbar spine movement, trunk muscle activity and low back discomfort (LBD) in simulations of manual material handling (MMH) tasks. Twenty-eight young adults participated in the study performing box lifting, liquid container handling while squatting, and forward reaching while sitting on a task chair when wearing tight pants (sizes too small for the wearer) vs. fit pants (correct size according to anthropometry). Each task was repeated three times and video recordings were used as a basis for measuring lumbar range of motion (LRoM). The response was normalized in terms on baseline hip mobility. Trunk muscle activity of rectus abdominis (RA) and erector spinae (ES) muscles were also measured in each trial and normalized. At the close of each trial, participants rated LBD using a visual analog scale. Results revealed significant effects of both pants and task types on the normalized LRoM, trunk muscle activity and subjective ratings of LBD. The LRoM was higher and trunk muscle (ES) activity was lower for participants when wearing tight pants, as compared to fit pants. Discomfort ratings were significantly higher for tight pants than fit. These results provide guidance for recommendations on work clothing fit in specific types of MMH activities in order to reduce the potential of low-back pain among younger workers in industrial companies.