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.     

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.     

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.     

Ergonomic risk factors in glass artware industries and prevalence of musculoskeletal disorder

Glass artware manufacturing activities are highly repetitive, labor-intensive, and demand prolonged standing during the working shift. This leads to the development of musculoskeletal disorders (MSDs) symptoms among the workers. However, there is a scarce of study on the prevalence of MSDs symptoms and their associated risk factors among the glass artware workers. To address this research gap, this study aims to evaluate the prevalence of MSDs and working conditions among Indian glass artware workers. Discomfort data is collected using Cornell Musculoskeletal Discomfort Questionnaire and working posture data is collected through direct observations using Rapid Entire Body Assessment (REBA). Multiple logistic regression model is developed for each body region to study the relationship between the associated risk factors and MSDs symptoms with the help of collected data. The findings of this study are first, MSDs symptoms are highly prevalent and severe, particularly in the lower back, thigh, and foot. Second, the average REBA grand score is 7.22, which reveals the high-risk level of worker's posture while performing the task. Third, Job characteristics and individual factors are associated with MSD symptoms in multiple logistic regression models. The results highlight the prevalence and severity level of MSDs and illustrate the demand for ergonomic interventions to alleviate musculoskeletal symptoms among these working groups.Relevance to industryThis study draws attention to work-related and other associated risk factors, which would help the researchers and managers to understand the working environment of glass artware industry. These risk factors should be considered for designing and implementing ergonomic interventions to prevent and alleviate musculoskeletal discomfort among the glass artware workers.     

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.     

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 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.     

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.     

The effectiveness of a training method using self-modeling webcam photos for reducing musculoskeletal risk among office workers using computers

An intervention study was conducted to examine the effectiveness of an innovative self-modeling photo-training method for reducing musculoskeletal risk among office workers using computers. Sixty workers were randomly assigned to either: 1) a control group; 2) an office training group that received personal, ergonomic training and workstation adjustments or 3) a photo-training group that received both office training and an automatic frequent-feedback system that displayed on the computer screen a photo of the worker's current sitting posture together with the correct posture photo taken earlier during office training. Musculoskeletal risk was evaluated using the Rapid Upper Limb Assessment (RULA) method before, during and after the six weeks intervention. Both training methods provided effective short-term posture improvement; however, sustained improvement was only attained with the photo-training method. Both interventions had a greater effect on older workers and on workers suffering more musculoskeletal pain. The photo-training method had a greater positive effect on women than on men.     

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.     

Flexible workspace design and ergonomics training: impacts on the psychosocial work environment, musculoskeletal health, and work effectiveness among knowledge workers

A macroergonomics intervention consisting of flexible workspace design and ergonomics training was conducted to examine the effects on psychosocial work environment, musculoskeletal health, and work effectiveness in a computer-based office setting. Knowledge workers were assigned to one of four conditions: flexible workspace (n=121), ergonomics training (n=92), flexible workspace+ergonomics training (n=31), and a no-intervention control (n=45). Outcome measures were collected 2 months prior to the intervention and 3 and 6 months post-intervention. Overall, the study results indicated positive, significant effects on the outcome variables for the two intervention groups compared to the control group, including work-related musculoskeletal discomfort, job control, environmental satisfaction, sense of community, ergonomic climate, communication and collaboration, and business process efficiency (time and costs). However, attrition of workers in the ergonomics training condition precluded an evaluation of the effects of this intervention. This study suggests that a macroergonomics intervention is effective among knowledge workers in office settings.     

Evaluation of a participatory ergonomic intervention process in kitchen work

We evaluated a participatory ergonomic intervention process applied in 59 municipal kitchens. In groups of three to five kitchens, the workers participated in eight workshops, and generated and evaluated solutions to optimize musculoskeletal load in their work. An ergonomist initiated and supported the process. By the end, 402 changes were implemented. Evaluative data were collected using research diaries, questionnaires, and focus group interviews. The intervention model proved feasible and the participatory approach was mostly experienced as motivating. The workers’ knowledge and awareness of ergonomics increased, which improved their ability to tackle ergonomic problems by themselves. The changes in ergonomics were perceived to decrease physical load and improve musculoskeletal health. As hindering factors for implementation, lack of time and motivation, and insufficient financial resources were mentioned. In addition, the workers expressed a wish for more support from the management, technical staff, and ergonomists.     

The effects of an office ergonomics training and chair intervention on worker knowledge, behavior and musculoskeletal risk

A large-scale field intervention study was undertaken to examine the effects of office ergonomics training coupled with a highly adjustable chair on office workers’ knowledge and musculoskeletal risks. Office workers were assigned to one of three study groups: a group receiving the training and adjustable chair (n=96), a training-only group (n=63), and a control group (n=57). The office ergonomics training program was created using an instructional systems design model. A pre/post-training knowledge test was administered to all those who attended the training. Body postures and workstation set-ups were observed before and after the intervention. Perceived control over the physical work environment was higher for both intervention groups as compared to workers in the control group. A significant increase in overall ergonomic knowledge was observed for the intervention groups. Both intervention groups exhibited higher level behavioral translation and had lower musculoskeletal risk than the control group.     

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.     

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).     

Effectiveness of an ergonomic intervention on work-related posture and low back pain in video display terminal operators: A 3 year cross-over trial

This study investigated the effectiveness of a workstation ergonomic intervention for work-related posture and low back pain (LBP) in Video Display Terminal (VDT) workers. 100 VDT workers were selected to receive the ergonomic intervention, whereas 100 were assigned to a control group. The two groups were then crossed-over after 30 months from baseline. Follow-ups were repeated at 5, 12, and 30 months from baseline and then at 6 months following crossover. Outcomes: Work-related posture and LBP point-prevalence using the Rapid Entire Body Assessment method and a Pain Drawing, respectively. The ergonomic intervention at the workstation improved work-related posture and was effective in reducing LBP point-prevalence both in the first study period and after crossover, and these effects persisted for at least 30 months. In conclusion, our findings contribute to the evidence that individualized ergonomic interventions may be able to improve work-related posture and reduce LBP for VDT workers.     

Office ergonomics training and a sit-stand workstation: Effects on musculoskeletal and visual symptoms and performance of office workers

Work Related Musculoskeletal Disorders (WMSDs) among office workers with intensive computer use is widespread and the prevalence of symptoms is growing. This randomized controlled trial investigated the effects of an office ergonomics training combined with a sit-stand workstation on musculoskeletal and visual discomfort, behaviors and performance. Participants performed a lab-based customer service job for 8?h per day, over 15 days and were assigned to: Ergonomics Trained (n?=?11) or Minimally Trained (n?=?11). The training consisted of: a 1.5-h interactive instruction, a sit/stand practice period, and ergonomic reminders. Ergonomics Trained participants experienced minimal musculoskeletal and visual discomfort across the 15 days, varied their postures, with significantly higher performance compared to the Minimally Trained group who had a significantly higher number of symptoms, suggesting that training plays a critical role. The ability to mitigate symptoms, change behaviors and enhance performance through training combined with a sit-stand workstation has implications for preventing discomforts in office workers.     

The impact of ergonomics intervention on psychosocial factors and musculoskeletal symptoms among office workers

Musculoskeletal disorders have a multi factorial etiology that includes not only physical risk factors but also psychosocial factors. This study aimed to investigate psychosocial risk factors and musculoskeletal symptoms among office workers of an Iranian oil refinery and also to examine the subsequent effects of ergonomics intervention on musculoskeletal discomfort and psychosocial risk factors.In this study, 73 office workers as a case group and 61 office workers as a control group from an Iranian oil refinery plant were randomly selected and examined. The Nordic Musculoskeletal Disorders Questionnaire and the Persian version of the Job Content Questionnaire (P-JCQ) were used as collecting data tools before and after the interventional program.Low back problem (28.8%) was found to be the most common problem among the office workers. Significant differences found between prevalence rates of reported musculoskeletal in upper back, lower back and feet/ankle regions before and after intervention. Our findings showed that psychosocial variables were not affected by the intervention. The only variables on the P-JCQ that were significantly different pre/post intervention are the physical variables: physical job demands, physical exertion and physical isometric load. None of the other psychosocial variables were found to be significant. With the top management support, improvements in all office workstation components were made successfully.

Relevance to industry

Recently, changes in the nature of work draw increased attention to the relation between psychosocial factors and musculoskeletal disorders. The results of the current study indicate that a well conducted implementation of an interventional program can lead to a decrease in musculoskeletal symptoms and to some extent in the psychosocial factors at work.     

Applying the K-nearest neighbor technique to the classification of workers according to their risk of suffering musculoskeletal disorders

The K-nearest neighbor (KNN) technique is a widely used classifier because of its simplicity and high efficiency. We adapted this technique and applied it with success to predict work-related musculoskeletal disorders. Among the general working population, the algorithm was able to identify workers that had reported work-related musculoskeletal complaints in the last twelve months. According to the model that was developed, poor lighting conditions, exposure to vibrations, an uncomfortable chair and a high mental demand are the factors that have the strongest influence on the development of this type of health problem.Relevance to industry:The approach described in this paper allows the KNN technique to be implemented for the prediction of musculoskeletal disorders among the general working population. The model is able to overcome the limitations of other traditional statistical learning techniques to predict this type of disorder with accuracy and effectiveness. The results may be used as a decision support tool for the prioritization of resources dedicated to ergonomic intervention programs.