Digital vibration threshold testing and ergonomic stressors in automobile manufacturing workers: a cross-sectional assessment

Upper extremity musculoskeletal disorders (UEMSDs) comprise a large proportion of work-related illnesses in the USA. Physical risk factors including manual force and segmental vibration have been associated with UEMSDs. Reduced sensitivity to vibration in the fingertips (a function of nerve integrity) has been found in those exposed to segmental vibration, to hand force, and in office workers. The objective of this study was to determine whether an association exists between digital vibration thresholds (VTs) and exposure to ergonomic stressors in automobile manufacturing. Interviews and physical examinations were conducted in a cross-sectional survey of workers (n = 1174). In multivariable robust regression modelling, associations with workers' estimates of ergonomic stressors stratified on tool use were determined. VTs were separately associated with hand force, vibration as felt through the floor (whole body vibration), and with an index of multiple exposures in both tool users and non-tool users. Additional associations with contact stress and awkward upper extremity postures were found in tool users. Segmental vibration was not associated with VTs. Further epidemiologic and laboratory studies are needed to confirm the associations found. The association with self-reported whole body vibration exposure suggests a possible sympathetic nervous system effect, which remains to be explored.     

Understanding the link between psychosocial work stressors and work-related musculoskeletal complaints

It is well established that psychosocial work stressors relate to employees' work-related musculoskeletal disorder (WRMSD) symptoms. Using a model investigating psychological strain as a mediator between work stressors and WRMSD complaints, this study demonstrated that high levels role conflict, low job control, and low safety-specific leadership are associated with increased employee strain. Strain, in turn, was related to higher levels of WRMSD symptoms of the wrist/hand, shoulders, and lower back. Partial mediation of some relationships was also found, suggesting that additional meditational mechanisms for the relationships between stressors and musculoskeletal symptoms are plausible. This work supports the notion that psychosocial stressors in the work environment have important links to employee health, especially WRMSDs.     

Bernardino Ramazzini's early observations of the link between musculoskeletal disorders and ergonomic factors

Bernardino Ramazzini (1633-1714) systematically studied the relationship between work and diseases. He realized that it was not possible to ascribe all workers' diseases to chemicals or physical agents and foresaw that other factors were involved. He observed that common diseases could originate following the maintenance either of prolonged stationary postures or of unnatural postures (e.g. bakers, workers who stand, sedentary worker, scribes, weavers) or following activities requiring heavy muscular performance (e.g. porters and woodworkers). Furthermore, Ramazzini recognized the need to undertake measures to prevent disorders from repetitive motions and manual lifting and anticipated the now accepted advice of moderation and recommendations of reduction of work duration for a number of hard jobs requiring a standing position or severe muscular effort. From his early writings therefore it is evident that Ramazzini realized the importance of assessing the ergonomic factors associated with the occurrence of work-related musculoskeletal disorders.     

Full shift arm inclinometry among dairy parlor workers: a feasibility study in a challenging work environment

Over the last 20 years, the US dairy industry has experienced a significant transformation from small farm operations to an industrialization of the milking process. This transformation has resulted in improvements in process efficiency and product quality. Milking tasks in large-herd parlors are highly-repetitive involving awkward postures and high muscle loads of the upper extremity. Field-based direct measures of physical exposures have been limited in challenging work settings such as dairies. This study evaluated full-shift exposures of posture and motion of the upper extremity among large-herd parlor milkers using wireless inclinometry. Results suggest large-herd parlor workers may be exposed to high exposure levels (posture, movement velocity, repetition, and inadequate rest) associated with the development of shoulder pathology. Compared to other high-risk occupations involving shoulder-intensive work, parlor workers may have higher exposure levels. These findings warrant the need for continued field-based research with larger sample sizes to facilitate the development of cost-effective intervention strategies.     

Standardized low-load repetitive work: evidence of different motor control strategies between experienced workers and a reference group

The purpose of this laboratory study was to evaluate the possible differences in motor strategies to a new standardized low-load repetitive work task in between healthy experienced workers and a reference group. Work task event duration, i.e. working rhythm, cutting forces, surface electromyographic (EMG) activity from four shoulder muscles, postural activity, and arm and trunk movements in 3D were recorded during low-load repetitive work simulation. The experienced group showed lower EMG activity and frequency contents (P<0.05), more abducted position of the upper arm and forward flexion of the trunk prior to work simulation (P<0.05), and increased arm and trunk range of motion (P<0.05) compared with the reference group. The results highlight that experienced butchers have a different motor strategy compared with a reference group, i.e. more variable form of coordination pattern. Furthermore, the initial implementation of a possible protective motor strategy by experienced workers might be a very important prognostic factor.     

A multilayered ergonomic intervention program on reducing musculoskeletal disorders in an industrial complex: A dynamic participatory approach

Work-related musculoskeletal disorders (WMSDs) are closely identified with common complaints in different workplaces. This study aimed to implement an intervention program through which ergonomic measures were dynamically localized in industry. An interventional study, including three basic layers, namely, training workshops, participatory ergonomics (PE), and workstation redesign was fulfilled in an Iranian steel manufacturing complex from 2017 to 2020. A steering committee (SC) was formed following several meetings held for clarification of the project to the management team. The SC members then attended four organized workshops managed by an ergonomics specialist. Afterwards, the basics of ergonomics were transferred to action groups. After developing ergonomic assessment tools, the ergonomic problems were prioritized and numerous positive changes were made by the action groups. The findings of the tailored checklists revealed a load of WMSDs risk factors. All the three layers of the program were implemented as initiated. Ergonomics training workshops were then held and significant differences were observed between the participants' pre/posttest mean scores in all workshops (p < 0.001). Moreover, PE measures were exercised at all levels of the organization inducing enthusiastic motivation of the workforce to consider ergonomic requirements in the workplace. Consequently, the workers' innovative ideas and the managerial support yielded diverse workstation redesigns due to a growth in either the workers' ergonomics awareness or participatory culture grounding. A multilayered ergonomic intervention was implemented in this study. In conclusion, a multifaceted long-term follow-up intervention program could be applied to enhance workers’ health status and to raise system productivity.     

In-field instrumented ergonomic risk assessment: Inertial measurement units versus Kinect V2

Musculoskeletal disorders are a major category of nonfatal work-related diseases in the industry. Therefore, various risk factor assessment methods, such as Rapid Upper Limb Assessment (RULA), were proposed for preventing musculoskeletal disorders in industrial environments. Nevertheless, RULA measurements based on workers' self-report or external rater observation are subjective and suffer from low repeatability. Thus, the objective of this paper is to investigate the accuracy and reliability of (1) a wearable technology (using inertial measurement units) and (2) a marker-less optical technology (using Kinect V2) for RULA risk assessment tool against motion-capture cameras (reference) for different manual material handling tasks. The obtained RULA scores were compared against the reference system using the proportion agreement index (Po) and Cohen's Kappa coefficient (κ). The wearable technology showed a “substantial” agreement (κ > 0.6) with the motion-capture cameras. The marker-less technology showed inconsistency in the agreement with the motion-capture cameras ranging from “fair” (κ < 0.4) to “moderate” (κ > 0.4) agreements, caused by both self-occlusion and object occlusion. Therefore, wearable technology showed to be more suitable than marker-less optical technology for in-field ergonomic risk assessment.     

Effects of personal,psychosocial and occupational factors on low back pain severity in workers

Low back pain (LBP) remains the most common work-related musculoskeletal disorder (WMSD). While most of the LBP research has focused on occupational risk factors, other underlying causal mechanisms may exist since not all workers performing the same task develop an injury. Previous research has identified three primary risk factor categories for LBP (occupational, personal and psychosocial factors); however, few studies have investigated the impact of cross categorical risk factor interactions on LBP. The objective of this study was to investigate the effects of occupational, personal and psychosocial factors, and their interactions, on LBP severity in a population of workers currently suffering from LBP. Sixty LBP patients recruited for the study through local physicians and local announcements, completed questionnaires relating to identified occupational, personal and psychosocial risk factors, and completed an Oswestry Disability Index (ODI). Multiple regression models for predicting LBP severity were developed for each risk factor category and for a combined risk factor model (which included factors from all three risk factor categories) that included two-way interactions. Results showed that the final model consisted of both main effects and interaction terms between risk factor categories and had an adjusted R² value of 0.85, a significant improvement over models developed for the individual categories. These findings illustrate the need to consider all three broad categories of risk factors simultaneously in predicting injury status and in developing effective potential intervention efforts.     

Musculoskeletal disorders assessment using sick-leaves registers in a manufacturing plant in Spain

The incidence rates of sick-leave caused by musculoskeletal disorders (MSDs) were registered in 2013 in a Spanish manufacturing plant of electrical appliances applying a detailed analysis to the sick-leave data using Poisson regression considering the gender, age and working area.The adjusted incidence rates estimated using Poisson regression show a higher incidence for workers over age 50, and a higher incidence of neck-related MSDs sick-leave for working area of presses and veneers. As for back injuries, workers over age 50 and of assembly induction working area present the highest risk of sick-leave.Relevance for the industryThe results obtained in this study could be a reference to manufacturing plants of electrical appliances or similar to design MSDs' prevention policies, with the aim of reducing sick leaves and its associated costs. This information allows us to detect the working areas with higher incidence, more susceptible subjects as well as more sensitive areas of the body in order to target interventions towards those.     

The role of whole-body vibration in back pain: A cross-sectional study with agricultural pilots

ObjectiveA cross-sectional study was conducted to investigate the role of whole-body vibration as a risk factor for spinal musculoskeletal symptoms among agricultural pilots.MethodThe study was conducted in two stages that included measuring the pilots’ exposure to whole-body vibration during the flight procedures and applying a self-administered questionnaire about musculoskeletal symptoms of the spine.ResultsNone of the four aircraft texted exposed the pilot above the Exposure Limit Value (ELV) established by the standards. However, in a few specific situations, two of them exceeded the Exposure Action Value (EAV). About 62% of the pilots who operated these aircraft reported some musculoskeletal symptoms of the spine in the last few 12 months.ConclusionUsing the data from this study, it was possible to calculate the odds ratio of the agricultural pilot suffering low back pain, based on eight personal and work-related factors.Relevance for the industryBased on the results of the present study, it was possible to define strategies to reduce whole-body exposure in agricultural aircraft and, consequently, improve the pilots’ health. Strategies included management of the exposure and aircraft improvement.     

Two posture analysis approaches and their application in a modified Rapid Upper Limb Assessment evaluation

This paper presents two posture risk quantification methods: first, an event-based method where the most common and the worst postures are estimated in a task; second, a time-based method where posture distributions are calculated from random samples of observed postures in the task. A ‘click-on-screen’ posture data entry method was developed for the time-based posture analysis method to make the observation process easier and to reduce possible posture categorization bias. Both methods were used to quantify various work posture parameters among a study cohort of 733 subjects from a prospective epidemiological study of upper extremity musculoskeletal disorders. Composite posture indices using a modified Rapid Upper Limb Assessment (RULA) method were also computed using data obtained by the two posture analysis methods. Results showed that both methods were able to distinguish jobs with large differences in certain posture measures. However, they did not produce the same results and could not be used interchangeably. Risk evaluation criteria should be developed, either for specific posture parameters or as a composite index, with a well-defined postural analysis method, so that users can follow exact procedures and obtain comparable results. The event-based method is easy to use and may suit practitioners better, while the time-based method adds more information to the measurement and may suit users who want more detailed information about posture exposure.     

Vibration-reducing gloves: transmissibility at the palm of the hand in three orthogonal directions

Vibration-reducing (VR) gloves are commonly used as a means to help control exposures to hand-transmitted vibrations generated by powered hand tools. The objective of this study was to characterise the vibration transmissibility spectra and frequency-weighted vibration transmissibility of VR gloves at the palm of the hand in three orthogonal directions. Seven adult males participated in the evaluation of seven glove models using a three-dimensional hand–arm vibration test system. Three levels of hand coupling force were applied in the experiment. This study found that, in general, VR gloves are most effective at reducing vibrations transmitted to the palm along the forearm direction. Gloves that are found to be superior at reducing vibrations in the forearm direction may not be more effective in the other directions when compared with other VR gloves. This casts doubts on the validity of the standardised glove screening test.

Practitioner Summary: This study used human subjects to measure three-dimensional vibration transmissibility of vibration-reducing gloves at the palm and identified their vibration attenuation characteristics. This study found the gloves to be most effective at reducing vibrations along the forearm direction. These gloves did not effectively attenuate vibration along the handle axial direction.     

Validity of the Acti4 software using ActiGraph GT3X+accelerometer for recording of arm and upper body inclination in simulated work tasks

The validity of inclinometer measurements by ActiGraph GT3X+ (AG) accelerometer, when analysed with the Acti4 customised software, was examined by comparison of inclinometer measurements with a reference system (TrakStar) in a protocol with standardised arm movements and simulated working tasks. The sensors were placed at the upper arm (distal to the deltoid insertion) and at the spine (level of T1-T2) on eight participants. Root mean square errors (RMSEs) values of inclination between the two systems were low for the slow- and medium-speed standardised arm movements and in simulated working tasks. Fast arm movements caused the inclination estimated by the AG to deviate from the reference measurements (RMSE values up to ～10°). Furthermore, it was found that AG positioned at the upper arm provided inclination data without bias compared to the reference system. These findings indicate that the AG provides valid estimates of arm and upper body inclination in working participants.     

Physical and mental workload interactions in a sterile processing department

Work in healthcare facilities has been categorized as a high-risk job for developing Work-Related Musculoskeletal Disorders (WMSDs). Little attention has been given to the Sterile Processing Department (SPD) employees who are exposed to both mentally and physically demanding conditions, factors that may impose an elevated risk in the development of WMSDs. Previous studies have shown that WMSDs can be a result of complex interactions between physical, psychosocial, biological, and individual characteristics. However, the evidence of specific associations is still inconclusive. The objective of this study was to determine if the perception of mental workload causes workers to adopt more risky body postures. The study was carried out in four phases: 1) identification of musculoskeletal disorders using customized Nordic questionnaires, 2) ergonomic assessment of SPD using REBA method, 3) mental workload assessment of SPD using NASA-TLX, and 4) interaction between physical (postural risk) and mental workload through the performance of a task at two different levels of workload conducted through a controlled experiment. The findings indicate that increases in REBA scores and NASA-TLX indices were associated with days and conditions with higher workloads. Results showed evidence that increments on mental workload are related to worsening postures, increasing the risk of developing musculoskeletal disorders. These results serve to raise awareness and warn employees about the need to pause and analyze the way they perform their duties under high levels of workload in an attempt to reduce WMSDs risk in healthcare sector employees.     

Process and implementation of participatory ergonomic interventions: a systematic review

Participatory ergonomic (PE) interventions may vary in implementation. A systematic review was done to determine the evidence regarding context, barriers and facilitators to the implementation of participatory ergonomic interventions in workplaces. In total, 17 electronic databases were searched. Data on PE process and implementation were extracted from documents meeting content and quality criteria and synthesised. The search yielded 2151 references. Of these, 190 documents were relevant and 52 met content and quality criteria. Different ergonomic teams were described in the documents as were the type, duration and content of ergonomic training. PE interventions tended to focus on physical and work process changes and report positive impacts. Resources, programme support, ergonomic training, organisational training and communication were the most often noted facilitators or barriers. Successful PE interventions require the right people to be involved, appropriate ergonomic training and clear responsibilities. Addressing key facilitators and barriers such as programme support, resources, and communication is paramount.

Statement of Relevance: A recent systematic review has suggested that PE has some effect on reducing symptoms, lost days of work and claims. Systematic reviews of effectiveness provide practitioners with the desire to implement but do not provide clear information about how. This article reviews the literature on process and implementation of PE.     

Factors affecting the perception of whole-body vibration of occupational drivers: an analysis of posture and manual materials handling and musculoskeletal disorders

Due to the high cost of conducting field measurements, questionnaires are usually preferred for the assessment of physical workloads and musculoskeletal disorders (MSDs). This study compares the physical workloads of whole-body vibration (WBV) and awkward postures by direct field measurements and self-reported data of 45 occupational drivers. Manual materials handling (MMH) and MSDs were also investigated to analyse their effect on drivers' perception. Although the measured values for WBV exposure were very similarly distributed among the drivers, the subjects' perception differed significantly. Concerning posture, subjects seemed to estimate much better when the difference in exposure was significantly large. The percentage of measured awkward trunk and head inclination were significantly higher for WBV-overestimating subjects than non-overestimators; 77 and 80% vs. 36 and 33%. Health complaints in terms of thoracic spine, cervical spine and shoulder–arm were also significantly more reported by WBV-overestimating subjects (42, 67, 50% vs. 0, 25, 13%, respectively). Although more MMH was reported by WBV-overestimating subjects, there was no statistical significance in this study.     

Contextual factors affecting task distribution in two participatory ergonomic interventions: a qualitative study

This article provides an analysis of the evolution of the division of labour in participatory ergonomics (PE) programmes in two worksites. The analysis is based on interviews and field observations in the worksites. In both settings there was meaningful participation by both worker and management members of ergonomic change teams (ECTs) in the hazard assessment and solution identification stages, but as the teams moved to the implementation stage, worker representatives were marginalised and the participatory nature of the programmes was severely curtailed. The removal of workers from the process was the outcome of the interplay among the type of activities pursued in the implementation stage, the skills and knowledge required to carry out those activities, and workers’ limited influence in the organisational hierarchies. Findings highlight the salience of the social context in which participatory programmes are located and the importance of examining participatory programmes as they evolve over time.

Statement of Relevance: This article contributes to a growing literature on the process and implementation of PE programmes. The article's focus on social and organisational factors that affect the division of labour and attention to the evolution of involvement over time extend current understandings of participation in ergonomics programmes.     

Effects of stretch reflex on back muscle response during sinusoidal whole body vibration in sitting posture: A model study

This study seeks to examine human vibration response using a musculoskeletal model that appropriately considers stretch reflex. The stretch reflex is modeled with a feedback control approach, and integrated into a generic musculoskeletal model to study the active muscle forces during seated whole body vibration. The model is used to investigate the effects of stretch reflex gain, vibration frequency and vibration magnitude on transmissibility from the seat to upper body and lower body and on muscle activations.The overall model is validated by comparison with thoracic and lumbar muscle activities measured in human participants during whole body vibration. The simulation results were consistent with the experimental results that the peak transmissibility occurred at resonance frequency of 5–6 Hz, and were in line with other experimental studies that found a primary resonance of 4–6 Hz. Furthermore, the peak normalized Electromyography (EMG) level accorded with the activation level for both thoracic and lumbar regions. What's more, an increase of primary resonance frequency was observed with increasing gains of stretch reflex. In contrary, the peak seat transmissibility of the upper body and lower body had a significant reduction.The major contribution of this model is that the proposed stretch reflex model provides a useful method to consider muscle active response in whole body vibration simulation. This may be used in future studies to better understand how stretch reflex affects spinal loading in a variety of conditions.     

Quantitative and qualitative assessment of musculoskeletal disorders and socioeconomic issues of workers of brick industry in Pakistan

Brick industry, in Pakistan, is prominent and provides job to 3.1 million people only in one province. The industry hires different percentage of workers for different stages of brick formation and these stages trigger musculoskeletal disorders (MSDs) in workers. This study identifies relation between 5 work stages and MSDs in 9 body parts and also finds socioeconomic sufferings inflicted by the industry and removal of research gap at national level. We conducted both qualitative and quantitative research. 105 men and 45 women from 15 brick kilns were selected as subject. Rapid Upper Limb Assessment (RULA) and Rapid Entire Body Assessment (REBA) sheets, Standard Nordic MSDs Questionnaire along with general questionnaire, still photography and video recording were used to carry out the study. About 96% workers involved in mixing & molding complained tiredness at end of day. Similarly, 90% male and 83% female staff performing spreading task suffered tiredness after their duty hours. Workers engaged in different tasks reported varying levels of pain in observed body parts. Digging and carrying jobs caused significant pain in body parts including neck, upper back, shoulders, lower back and hips. Mixing and molding emerged most dangerous activities for most of the body parts and exhibited 7 score on RULA. Furthermore, mixing and molding demonstrated high to very high risk level by showing 9 and 13 higher score on REBA, respectively. The current study divulged that all observed work tasks during manufacturing and transportation of bricks are equally dangerous for pain generation in lower back. Many socioeconomic issues like residency of workers in muddy house (83%) low monthly income (<90.3 $) of 83% workers, higher tendency of alcoholism and smoking in men, lack of health facilities and higher illiteracy rate were also identified. The enhanced musculoskeletal disorders during brick making process render the brick industry unhealthy for work. This dismal picture requires an improvement in quality of life and occupational environment of workers of the industry. Well organized duty timings, modified working posture, job rotation and preliminary training perhaps manage these miseries and the output of the brick industry may increase many fold.