The effects of occupational interventions on reduction of musculoskeletal symptoms in the nursing profession

The objective of the review was to gain more insight into the effects of occupational interventions for primary prevention of musculoskeletal symptoms in healthcare workers. The Cochrane Collaboration methodological guidelines for systematic reviews functioned as a starting point. Thirteen studies meeting the inclusion criteria were analysed for methodological quality and effects. Eight outcome effect areas were established and defined as areas in which an effect had been determined in at least two studies. A method based on levels of scientific evidence was then used to synthesize the information available. Strong scientific evidence for the beneficial effect of occupational interventions was found for the outcome effect areas physical discomfort, technical performance of transfers and frequency of manual lifting. Insufficient evidence was found for the effect areas absenteeism due to musculoskeletal problems, musculoskeletal symptoms, fatigue, perceived physical load and knowledge of risk factors at work and ergonomic principles. Training and education combined with an ergonomic intervention were found to be effective.     

Effectiveness of ergonomic training to reduce physical demands and musculoskeletal symptoms - An overview of systematic reviews

Work-related musculoskeletal disorders are associated with awkward postures, excessive force, manual material handling and repetitive movements. This risk factors can be minimized through interventions such as ergonomic training. The literature covers several studies involving the use of this type of intervention, but there is no consensus about the effectiveness of ergonomic training. The aim of this study was to identify the available evidence about the effectiveness of ergonomic training to reduce physical work demand and musculoskeletal symptoms through an overview of systematic reviews. The searches were carried out in Pubmed/Medline, Web of Science, CINAHL, Embase and Cochrane Library. The START (State of the Art through Systematic Review, v.1.06.2) platform aided the selection and evaluation of studies. The studies were evaluated for methodological quality through the AMSTAR (Assessing the Methodological Quality of Systematic Reviews) criteria and the implications for practice. This overview identified a large number of studies with a low to moderate level of evidence, indicating the ineffectiveness of ergonomic training alone or associated with another type of intervention in reducing physical demand and musculoskeletal symptoms in workers. The findings may have occurred due to four main factors: superficial identification of the ergonomic risk factors; lack of scientific evidence about the appropriate configurations of the types of ergonomic training; ambiguous results in the application of ergonomic training; and the difficulty in the effectiveness of the intervention. The study identified an inconsistency in the level of evidence of ergonomic training to reduce physical demand and musculoskeletal symptoms among workers.     

Effectiveness of participatory ergonomic interventions on health outcomes: a systematic review

The objective of this study was to conduct a systematic review of the literature on the effectiveness of participatory ergonomic (PE) interventions for improving workers' health. The search strategy targeted six electronic databases and identified 442 potential articles. Each article was examined by pairs of reviewers for relevance (assessed a participative ergonomic workplace intervention, with at least one health outcome, published in English in peer reviewed literature). Twenty-three articles met relevance criteria and were then appraised for methodological strength. Using a best evidence synthesis approach, 12 studies that were rated as 'medium' or higher provided partial to moderate evidence that PE interventions have a positive impact on: musculoskeletal symptoms, reducing injuries and workers' compensation claims, and a reduction in lost days from work or sickness absence. However, the magnitude of the effect requires more precise definition.     

Effect of Physical Ergonomics on VDT Workers' Health: A Longitudinal Intervention Field Study in a Service Organization

This article examines the effect of physical ergonomic work conditions on occupational health in video display terminal (VDT)-intensive work settings. A longitudinal intervention field study was conducted in a catalog retail service organization in the Midwest to explore the impact of ergonomic interventions. There were 3 levels of ergonomic interventions, each adding incrementally to the previous one. The 1st level was ergonomic training for all VDT users accompanied by workstation ergonomic analysis leading to specific customized adjustments (Group C). The 2nd level added specific workstation accessories supplied by Details, Inc. if the analysis indicated a need for them (Group B). The 3rd level added a Steelcase Criterion(tm) 453 Series chair (Group A). Health data were gathered from 80 volunteer participants by administering a survey before (baseline), 6 months after, and 12 months after interventions were put in place. The findings show that neck, back, and shoulders as well as wrists stand out in terms of self-reported musculoskeletal pain in VDT-intensive work. Reductions in self-reported musculoskeletal discomfort were found for all 3 levels of incremental ergonomic interventions. The number of cases showing improvement in health over time was significant for intervention Groups A and B, but not C.     

Occupational musculoskeletal and mental health: Significance of rationalization and opportunities to create sustainable production systems – A systematic review

This literature review aims to identify occupational musculoskeletal and mental health effects of production system rationalization as well as organizational-level measures that may improve health outcome (“modifiers” in this review). A short review of the effect of ergonomic interventions is included as background and rationalization is discussed as a theoretical concept. Indicator variables for occupational musculoskeletal and mental health and related risk factors are presented. Variables with a generalized format were allowed in the literature searches (e.g., job satisfaction and absenteeism were accepted as risk factor and health indicator, respectively), suitable for the research fields of work sociology, organization science, human resource management (HRM) and economics research.One hundred and sixty-two studies of rationalization effects on health and risk factors and 72 organization-level modifier results were accepted into the final database. Entries were sorted by rationalization strategy and work life sector, and trends in outcome (positive, mixed, no effect, or negative effect on health and risk factors) were determined.Rationalizations have a dominant negative effect on health and risk factors (57% negative, 19% positive); the most negative effects were found for downsizing and restructuring rationalizations in general (71 studies negative, 13 positive) and for the health care sector in particular (36 studies negative, 2 positive). The rationalization strategy High Performance Work System (HPWS) was associated with the highest fraction positive outcome studies (6 of 10 studies). Other rationalization strategies (lean practices, parallel vs. serial production and mechanization level) reported intermediate results, in part dependent on work life sector, but also on the year when studies were carried out. Worker participation, resonant management style, information, support, group autonomy and procedural justice were modifiers with favourable influence on outcome.It is concluded that production system rationalization represents a pervasive work life intervention without a primary occupational health focus. It has considerable and mostly negative influence on worker health, but this can be reduced by attention to modifiers. The results create a basis for new priorities in ergonomic intervention research.     

Study protocol and baseline results for a quasi-randomized control trial: An investigation on the effects of ergonomic interventions on work-related musculoskeletal disorders,quality of work-life and productivity in knowledge-based companies

IntroductionWork-related musculoskeletal disorders (WMSDs) are the major causes of lost workdays, increased costs, and occupational diseases in all countries. The prevalence of WMSDs among the workers in small and medium-sized enterprises in Iran was reported as 73%. This paper aimed to describe the design of an interventional study to investigate the effects of ergonomic interventions on work-related musculoskeletal disorders, quality of work-life, and productivity among office workers of knowledge-based companies and introduce the results obtained from the baseline survey.Methods/designIt was a quasi-randomized control trial study on 313 participants with four parallel groups including ergonomic training intervention; management training and work changes intervention; ergonomic training, management training and work changes intervention; and non-interventional control group. The primary outcome was WMSDs, and the secondary outcomes were occupational stress factors, quality of work-life, and productivity. All primary and secondary outcomes were measured before the interventions, one, three, and six months after the interventions.ResultsAt this phase of study only baseline results were reported. 328 participants, with a mean age of 31.97 years (SD = 5.39), completed the baseline survey and entered the study. The highest prevalence of musculoskeletal disorders was found in neck (52.13%), right shoulder (41.16%) and right forearm (37.2%), respectively.ConclusionErgonomic interventions were conducted based on baseline data of the participants at individual and management levels. The focus of training program interventions was to reduce musculoskeletal disorders in upper limbs; in management training and work changes program, the focus was to increase social support.Trial registrationIRCT registration number: IRCT20181204041840N1 (date of registration: 2019-02-05).     

Musculoskeletal symptoms due to technical preconditions in long cycle time work in an automobile assembly plant: a study of prevalence and relation to psychosocial factors and physical exposure.

The aim was to evaluate the prevailing ergonomic conditions in a parallelized flow, long cycle time, assembly system. The evaluation focused on physical exposure, psychosocial factors and work-related musculoskeletal symptoms. A random sample of 67 assembly operators was included in a cross-sectional study mainly based on questionnaires. Hand/wrist symptoms were common and related to work exposure with hand-held powered tools. In general, the self-reported physical exposure showed only a few significant associations with musculoskeletal symptoms. This may in part be explained by the ergonomic conditions generally being good, with a relatively low duration of 'combined' extreme work postures. Significant associations were found between the psychosocial work environment and musculoskeletal symptoms.     

Evaluation of musculoskeletal health outcomes in the context of job rotation and multifunctional jobs

Higher physical demands at work are associated with health outcomes such as discomfort, disorders and sick leave. Variations in work exposure patterns, introduced by multifunctional jobs and ergonomic interventions, bring confounders into the complex relation between occupational risks and musculoskeletal disorders. This study compared whole-body rating of perceived exertion (RPE), discomfort, ergonomic workplace analysis (EWA) and sick leave due to musculoskeletal disorders, among workers exposed to diversified work. The results showed that EWA performed by the observer differed from workers' ratings. There were no differences between groups of workers taking or not taking sick leave regarding RPE and discomfort at their current workstations. Workers significantly discriminated between progressive workload levels, and RPE scores for specific tasks were nonlinear during shifts. These differences might be associated with exposure variability. Thus, in the context of diversified work, the RPE scale seems more appropriate for evaluating acute effects of work variability.     

Assessing exposure to risk factors for work-related musculoskeletal disorders using Quick Exposure Check (QEC) in taxi drivers

Work-related musculoskeletal disorders (WMSDs) are a common health problem throughout the world. This study aimed to examine the risk factors that are involved in the development of WMSDs in taxi drivers. In total 382 taxi drivers were observed using Quick Exposure Check (QEC) observational tool, which allows practitioners and workers to assess four key areas of the body. Results of the QEC scores were found to be very high for the shoulder/arm, wrist/hand and neck, whereas the scores for the back were found to be high for static use and moderate for moving. The results also showed that the occupational risk factors for WMSDs were associated with restricted postures, repetitive movements, vibration, work related stress. Essential ergonomic interventions are needed to eliminate risk of exposures to WMSDs in taxi drivers.Relevance to industryThe study results have relevance for ergonomists, health and safety practitioners as well as the drivers themselves, and helpful for estimating the main physical risk factors for WMDSs before choosing a method prior to an ergonomic intervention in industry.     

Ergonomics interventions to reduce musculoskeletal risk factors in a truck manufacturing plant

Ergonomic interventions may potentially reduce MSDs, but the context of industries (barriers, ever-changing situations, dialogue processes) might play a significant role in the success of interventions. This study evaluates the effectiveness of ergonomic interventions including engineering/technical and organizational interventions, and the involvement of the stakeholders in reducing musculoskeletal risk factors/symptoms. A pre-post-test experimental study in non-randomized groups was performed over three years in a sector of a truck assembly plant. The mean age of the operators in the sector for the initial and second assessment time was 42.0 (±7.6) years and 39.0 (±8.7), respectively. The mean length of work experience in the current job was 15.2 (±7.2) years and 13.9 (±7.3) for the initial and second assessment times, respectively. Five engineering ergonomic solutions and organizational interventions were implemented after a comprehensive ergonomic analysis. The organizational interventions consisted mostly of transferring and redistributing the tasks, i.e., ergonomically balancing and redesigning of the workstations. Before performing the interventions, the findings of the ergonomic study were presented at several meetings to encourage the involvement of the stakeholders (including managers, engineers, and operators) in the interventions. This study showed that a combination of ergonomic measures—engineering and organizational interventions—could reduce physical workloads. Musculoskeletal symptoms decreased after interventions although the difference was not significant.     

Ergonomic interventions among waste collection workers: A systematic review

Waste collection workers are frequently exposed to significant occupational hazards. Even though ergonomic interventions can mitigate these occupational hazards, only a few studies have attempted to study the importance of the interventions. The current review identifies the gaps in ergonomic interventions among waste collection workers. A systematic review and a bibliometric analysis of the literature on the assessment of occupational hazards and ergonomic interventions in different countries were performed to identify the scope of the interventions. A literature search was carried out in Web of Science, PubMed and Scopus for articles published until December 2018. The search yielded seventy articles on the assessment of occupational health and ten articles on ergonomic interventions among waste collection workers. Based on the review, this paper proposes a hierarchical framework for the implementation of ergonomic interventions in waste associated occupations. The problems faced by formal and informal waste collectors are critical, particularly in developing countries and there is a growing need for low-cost interventions. It is suggested that the potential interventions have to be implemented based on the nature of occupational hazard considering social, cultural and economic factors.     

Standardised Nordic questionnaires for the analysis of musculoskeletal symptoms

Standardised questionnaires for the analysis of musculoskeletal symptoms in an ergonomic or occupational health context are presented. The questions are forced choice variants and may be either self-administered or used in interviews. They concentrate on symptoms most often encountered in an occupational setting. The reliability of the questionnaires has been shown to be acceptable. Specific characteristics of work strain are reflected in the frequency of responses to the questionnaires.     

Dutch Musculoskeletal Questionnaire: description and basic qualities.

A questionnaire ('Dutch Musculoskeletal Questionnaire', DMQ) for the analysis of musculoskeletal workload and associated potential hazardous working conditions as well as musculoskeletal symptoms in worker populations is described and its qualities are explored using a database of 1575 workers in various occupations who completed the questionnaire. The 63 questions on musculoskeletal workload and associated potentially hazardous working conditions can be categorized into seven indices (force, dynamic and static load, repetitive load, climatic factors, vibration and ergonomic environmental factors). Together with four separate questions on standing, sitting, walking and uncomfortable postures, the indices constitute a brief overview of the main findings on musculoskeletal workload and associated potentially hazardous working conditions. Homogeneity of the indices is satisfactory. The divergent validity of the indices is fair when compared with an index of psychosocial working conditions and discomfort during exposure to physical loads. Worker groups with contrasting musculoskeletal loads can be differentiated on the basis of the indices and other factors. With respect to the concurrent validity, it appears that most indices and factors show significant associations with low back and/or neck-shoulder symptoms. This questionnaire can be used as a simple and quick inventory for occupational health services to identify worker groups in which a more thorough ergonomic analysis is indicated.     

Dutch Musculoskeletal Questionnaire: description and basic qualities

A questionnaire (‘Dutch Musculoskeletal Questionnaire’, DMQ) for the analysis of musculoskeletal workload and associated potential hazardous working conditions as well as musculoskeletal symptoms in worker populations is described and its qualities are explored using a database of 1575 workers in various occupations who completed the questionnaire. The 63 questions on musculoskeletal workload and associated potentially hazardous working conditions can be categorized into seven indices (force, dynamic and static load, repetitive load, climatic factors, vibration and ergonomic environmental factors). Together with four separate questions on standing, sitting, walking and uncomfortable postures, the indices constitute a brief overview of the main findings on musculoskeletal workload and associated potentially hazardous working conditions. Homogeneity of the indices is satisfactory. The divergent validity of the indices is fair when compared with an index of psychosocial working conditions and discomfort during exposure to physical loads. Worker groups with contrasting musculoskeletal loads can be differentiated on the basis of the indices and other factors. With respect to the concurrent validity, it appears that most indices and factors show significant associations with low back and/or neck shoulder symptoms. This questionnaire can be used as a simple and quick inventory for occupational health services to identify worker groups in which a more thorough ergonomic analysis is indicated.     

Ergonomic intervention research for improved musculoskeletal health: A critical review

This literature review of ergonomic intervention studies aims to identify effective ergonomic interventions for improved musculoskeletal health in the workplace and to make recommendations for quality criteria in ergonomic intervention research. To avoid ambiguity in terminology a list of definitions of the ergonomic terms used in this paper is provided in an appendix. Models were developed for use in the classification of ergonomic intervention research and to illustrate the problems in interpreting ergonomic intervention data. The relevant literature was identified by a two-step process. First the relevant literature was identified by inclusion criteria, then, quality criteria were applied to identify studies of good quality for effective intervention. These appear to be firstly “organizational culture” and secondly modifier interventions, the former using multiple interventions with high stakeholder commitment to reduce identified risk factors, and the latter especially focusing workers at risk and using measures which actively involve the individual. A list of recommendations is provided.     

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.     

A model for solving work related musculoskeletal problems in a profitable way

Interventions against occupational musculoskeletal disorders are usually performed by ergonomists. An overview of the literature shows that ergonomists often are unsuccessful; musculoskeletal disorders may be prevalent at workplaces where large ergonomic resources have been put in, thus illustrating the significance of other factors in addition to those against which the intervention is applied. It is claimed that some modern rationalization strategies may offer a potential for 'good' ergonomics. Thus, prevailing management approaches often now focus on team building, flat organizations, training of multiple skills and so on. The main scope of the present issue of Applied Ergonomics is to throw light on this possibility of 'achieving ergonomics impact through management intervention'. This present paper presents a historical overview of occupational physical work load as a function of ergonomics, as well as rationalizations and concludes with a more elaborate discussion of the present intervention concept for solving work related musculoskeletal problems in a profitable way. Rationalization and guidelines for physical work load are the basic parameters in the present intervention concept. Due to this the present special issue also presents historical overviews of the development of these parameters (Westgaard and Winkel; Bjorkman). 'Achieving ergonomics impact through management intervention' is illustrated through two case studies (Kadefors et al and Bao et al). They demonstrate an obvious ergonomic potential offered by the presented intervention concept. However, the two case studies also describe several practical obstacles which need to be further investigated in future intervention research.     

Occupational stress factors in visual display terminal (VDT) operation: a review of empirical research

A review of the literature involving empirical research (experimental and field investigations) on stressful aspects of visual display terminal (VDT) operation is presented. Studies reviewed included assessment of visual fatigue and/or performance, musculoskeletal symptoms and operator attitudes towards job demands and quality of working life. In addition, some investigation included discussions and evaluations of the physical attributes of VDT workplaces; including ergonomic factors (task lighting, glare conditions, anthropometric configuration of VDT and accompanying furniture), environmental factors (temperature, humidity, radiation) and psychosocial factors (job demand, work content, work-rest schedules).

The literature reveals that levels of visual and musculoskeletal complaints among VDT operators are high. Moreover, ergonomic field assessment of VDT workplaces indicate that the majority of those examined were suboptimal with respect to existing recommendations regarding lighting, glare control and anthropometric dimensions of screen, keyboard, desk and chair. Nevertheless, evidence of causal linkages between specific ergonomic attributes of the workplace and specific patterns of symptomatology are lacking.

Finally, work demand and task structure attributes to the VDT operation were demonstrated to have strong effects on incidences of reports of visual and postural symptoms as well as on psychosocial attitudinal indicators. Hence, it is argued that approaches toward stress reduction must include job content as well as ergonomic factors.     

Prevention of musculoskeletal disorders at work: Validation and reliability in a multicenter intervention study

During the years 1986–1989 The Finnish Work Environment Fund initiated a multicenter, intervention study (programme) to prevent musculoskeletal disorders at work. The programme consisted of four different projects comprising methodological, epidemiological, and interventive themes. The main results were as follows: (1) More than half of the occupational physiotherapists and physicians involved in the project felt that they did not have adequate training for testing the performance capacity of the musculoskeletal system. Several of the most commonly used musculoskeletal tests had either poor validity in predicting future musculoskeletal troubles or had poor reliability. (2) A controlled intervention study showed that active training of neck-shoulder muscles can prevent musculoskeletal troubles, even more than ergonomic actions. (3) It is possible to reduce sick-leave due to low-back disorders by intervention measures directed toward both the work (environment, tools) and the workers (working methods, positive attitude to work, preparedness to keep fit). (4) The identification of ergonomic hazards with the help of teamwork proved to be feasible. The practical improvements, however, were difficult to implement in the prevailing conditions. Some of the improvements increased the work load and the stress of the workers. This aspect needs further consideration.     

Ergonomic analysis of musculoskeletal discomforts among conversational VDT operators

VDT tasks are rapidly increasing as the office automation prevails. Despite its numerous benefits, occupational hazards such as visual fatigue, eye strain, radiation and musculoskeletal stresses have emerged as an important issue. This study was designed to investigate the effects of work postures and anthropometric differences upon the musculoskeletal stresses experience by operators involved in conversational VDT tasks. Evaluation of the level of muscoloskeletal discomfort was performed for 297 VDT operators from three divisions of telecommunication company in Korea. The ergonomic variables of the VDT tasks and the operators' anthropometric variables were evaluated for 70 out of the 297 VDT operators. Factor analysis is used for identifying underlying pattern of discomfort and multiple regression analysis were performed to examine the relationship between the measured ergonomic variables and the musculoskeletal discomfort. This study indicates that the ergonomic variables have influences on the musculoskeletal discomfort. It is important to provide the workers with fully adjustable workstations so that they can maintain their work postures most suitable for the sustained VDT work. Furthermore, in order to achieve the best working conditions, VDT operators should be given a proper training for the adjustment of their workstations.