DASH questionnaire for the analysis of musculoskeletal symptoms in industry workers: a validity and reliability study

Purpose

The disabilities of the arm, shoulder and hand (DASH) questionnaire is a self-administered region-specific outcome instrument developed as a measure of self-rated upper-extremity disability and symptoms. The aim of this study was to evaluate the reliability and the construct validity of the DASH questionnaire by establishing its correlation to the Medical Outcomes Study Short Form-36 (SF-36) in industry workers. Also we aimed to investigate whether the DASH can be used as a standardized questionnaire to evaluate the work-related musculoskeletal disorders (WMSDs) in upper extremity in industrial settings and epidemiological studies.

Material and methods

The Turkish version's reliability and construct validity were evaluated in 240 industry workers with upper-extremity musculoskeletal complaints. Workers were asked to complete a packet that included the DASH and the SF-36. Test-retest reliability was assessed in all workers who filled in the DASH questionnaire 15 days later. Construct validity was evaluated by comparing the overall and work component DASH scores with SF-36 summary and subscales.

Results

The mean DASH score for the textile workers whose duties were confection, dyeing, sewing, quality control and packaging was calculated as 65, 55, 68, 54 and 67, respectively. As a result of this study, pain intensity in shoulder, wrist and hand was significantly associated with the DASH score (p<0.05). Internal consistency of the DASH was high (Cronbach alpha 0.91). Test-retest reliability was excellent for the overall DASH (intraclass correlation coefficient (ICC) 0.92). Moderate correlations (p<0.05) were found between the overall and work component DASH and the SF-36 summary scales. Pearson correlation coefficients of the overall and work component DASH to the SF-36 subscales ranged from −0.33 to −0.82.

Conclusion

These results support that DASH is a reliable and valid instrument to measure functional disability and investigate the ergonomic risk factors in textile workers with upper-extremity musculoskeletal complaints.     

Risk of slaughterhouse workers developing work-related musculoskeletal disorders in different organizational working conditions

Job rotation is defined as workers rotating between tasks with different exposure levels and occupational demands. The aim of the present study was to analyze the risk factors for the development of upper-limb work-related musculoskeletal disorders (UL-WMSDs) in poultry slaughterhouse workers as well as compare the score of the OCRA Checklist in different organizational working conditions. In this cross-sectional study, 118 workers were involved, 68 women (32.3 ± 10.7 years) and 50 men (29.5 ± 10.5 years). Three organizational configurations (“without job rotation”, “with job rotation – tasks >1h” and “with job rotation - tasks <1h”) were evaluated using the OCRA Checklist method, totaling 36 tasks and 28 job rotation schemes composed of 2–3 tasks. The OCRA score of the right upper limbs (17.8 ± 3.2) was significantly higher (p = 0.046) relative to the left upper limbs (16.4 ± 3.6). The median score was significantly lower in the “with job rotation - tasks <1h” condition (18.6) when compared to the “job rotation – tasks >1h” (19.4) (p < 0.001) and the “without job rotation” (19.0) (p = 0.038) conditions. However, there was no significant difference between the condition “with job rotation - tasks >1h” and “without job rotation” (p = 0.155). Thus, job rotations with intervals <1h reduced the risk of developing UL-WMSDs. Job rotations with <1 h intervals in poultry slaughterhouses are recommended along with further studies to verify the effectiveness of rotations with more than two tasks, involving mild or non-repetitive tasks.     

Prevalence of work-related musculoskeletal symptoms among grocery workers

Work-related musculoskeletal disorders (WMSDs) affect all sectors of the working population, and grocery workers have especially high rates. Although the incidence of WMSDs among any worker population can be estimated from workers' compensation claims, musculoskeletal symptom surveys can be used as a proxy estimate of WMSDs. The purposes of this cross-sectional study were to describe the prevalence of work-related musculoskeletal symptoms in grocery store employees from many different departments, and to determine the association between exposure to physical risk factors and presence of symptoms. Study participants (N = 254) were grocery store workers from five different stores in a medium sized grocery chain. Participants completed a self-administered survey consisting of demographic information and job history; the modified Nordic Questionnaire (MNQ); and physical component (PCS) and mental component (MCS) summary measures of the SF-36v2^®. Rodgers Muscle Fatigue Analysis (Rodgers) was used to assess exposure to physical risk factors in the most difficult tasks in certain store departments. Prevalence of musculoskeletal symptoms was estimated for each body region and for various subgroups, and multivariable logistic regression analysis was used to identify independent predictors of presence of musculoskeletal symptoms. Approximately 78% of grocery store workers reported work-related musculoskeletal symptoms in at least one body region, with most workers complaining of low back and feet symptoms. The high prevalence of foot symptoms has not been previously reported for this population. Approximately 11% of employees missed work because of symptoms and 25% sought medical care for symptoms. There were no differences among Rodgers rating groups for proportions reporting symptoms. SF-36v2^® scores were inconsequential predictors for musculoskeletal symptoms. Gender and age were both significant predictors of symptoms, and age predicted healthcare utilization. These findings are relevant to the grocery industry in order to target WMSD preventive interventions to specific body regions for high-risk activities within a grocery store position.     

Computer-telephone interactive tasks: predictors of musculoskeletal disorders according to work analysis and workers' perception

Sixty-two workers engaged in computer-telephone interactive tasks in an active telemarketing center and a telephone call center of an international bank subsidiary in S?o Paulo. Brazil, were assessed by means of a work analysis and a self-administered questionnaire aiming to determine the statistical relationship of ergonomic, organizational and psychosocial characteristics of their jobs with the report of symptoms in neck-shoulder and hand-wrist for more than 7 consecutive days and any time away from work during the current job due to musculoskeletal disorders (MSD). According to chi-square univariate tests and multiple logistic regression models, active telemarketing operations, duration in the job and the low level of satisfaction with the physical arrangement of the workstation emerged as the factors most related to neck-shoulder and hand-wrist MSD and MSD-induced time away from work. This study emphasizes the role of psychosocial factors and duration in the job in MSD occurrence and induced absenteeism among workers engaged in computer-telephone interactive tasks.     

Aviation deicing workers,global risk assessment of musculoskeletal injuries

Deicing technicians working from open baskets are exposed to ergonomic risks and fatigue. This study aims to assess the global risk of musculoskeletal injuries (MSIs) for this type of activity. An ergonomic study was conducted with the workers of a Canadian airport deicing operator during the winter of 2016–2017. Video recordings made it possible to observe the activities during the most intensive work shifts, as well as characterise and quantify (frequency and duration) the movements/postures of twelve human subjects. The resulting risk assessment identified the body structures submitted to exertion, analysed the efforts involved and globally assessed the forces exerted on the spine and upper limbs. This global risk assessment leads to the conclusion that the risks to the upper limbs are preoccupying and must be examined further.     

Ergonomic assessment and workstation design of shipping crane cabin in steel industry

Ergonomics plays vital role to improve health and productivity at workplace and in last two decades it find importance to redesign workplace. All Indian industries had taken initiative to redesign their workplace to overcome various musculoskeletal disorders (MSD) and work related injuries. In this context, the project has been carried out in an integrated steel plant located in central India where most of the crane operator was continuously suffering from muscular pain in different body parts. Risk of MSD was identified by detailed questionnaire from 27 crane operator. It was revealed that almost all crane operators were continuously suffering from some kind of MSD. Based on the anthropometric data of 50 percentile Indian male, ergonomic assessment, redesign and evaluation of crane cabin was carried out in CATIA-V5 software. To check the compatibility of the design, rapid upper limb assessment (RULA) for both existing as well as modified crane cabin was performed. This study shows that intervention of ergonomics in workplace reduces the mismatch between man and machine and makes workplace comfortable for work.     

Associations of ergonomic and psychosocial work hazards with musculoskeletal disorders of specific body parts: A study of general employees in Taiwan

Background and aimsMusculoskeletal disorders (MSDs) are major occupational health concerns. This study examined the associations of ergonomic and psychosocial work hazards with the risks of MSDs of specific body parts and their distribution across a wide range of occupational groups.MethodsStudy participants comprised 8,937 male and 7,052 female employees aged 20–65 years from a nationwide survey in 2016. A self-report questionnaire was administered to obtain information regarding demographic characteristics, work conditions, ergonomic and psychosocial work hazards, and MSDs of different body parts in 12 months. Multivariate logistic regression models were used to estimate prevalence ratios of MSDs in relation to ergonomic and psychosocial work hazards.ResultsIn professionals and skilled workers, MSDs of the neck and shoulders were more prevalent, whereas in manual workers, MSDs of the hands, wrists, and lower back were more prevalent. Psychosocial work hazards, including high psychological demand and low workplace justice, were major work-related risk factors for shoulder and neck disorders, whereas ergonomic hazards were major work-related risk factors for lower back and wrist or hand disorders.ConclusionDifferent workplace hazards contribute to the risks of different MSDs. To prevent the development of MSDs, occupational health professionals should evaluate both ergonomic and psychosocial work hazards and develop health prevention programs tailored to the risk profiles of working populations.     

Comparison of ergonomic risk assessment outputs from OWAS and REBA in forestry timber harvesting

Globally, work-related (musculoskeletal disorders (MSDs) are one of the most important health problems encountered by ergonomists. Forest work, especially logging harvesting, is traditionally recognized as one of the most difficult types of physical work and has distinct characteristics. Harvesting works in forestry are composed of the following work stages: logging, skidding, and loading. This study aimed to examine risk factors of MSDs associated with different work postures during harvesting under variable external conditions by comparing work stages using the Ovako Working posture Assessment System (OWAS) and Rapid Entire Body Assessment (REBA). A statistically significant difference was observed between the two methods. While the difference in risk to the musculoskeletal system was statistically significant in different work stages using REBA, logging and skidding were assigned to the same risk level using OWAS. Easy-to-use ergonomic hand tools should be developed that are suitable for working conditions and help reduce MSD risk in forestry workers.     

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.     

Comparison of the Ovako Working Posture Analysis System,Rapid Upper Limb Assessment,and Rapid Entire Body Assessment based on the maximum holding times

The objectives of this study were to measure the maximum holding times (MHTs) for symmetric and asymmetric body postures and to compare three representative observational methods, i.e., Ovako Working Posture Analysis System (OWAS), Rapid Upper Limb Assessment (RULA), and Rapid Entire Body Assessment (REBA), based on the MHTs. An experiment was performed to obtain the MHTs, wherein the independent variables were the hand position, trunk rotation angle, and external load. The hand position was defined using the hand height as the percentage of the shoulder height and the hand distance as the percentage of the arm reach. While the four independent variables including the hand height, hand distance, trunk rotation angle, and external load significantly affected the MHTs and RULA grand score at α = 0.01, only three of them (except the external load) were significant on the OWAS action category and REBA score. RULA assessed the postures tested in the experiment more stressfully than the OWAS and REBA, and the RULA grand score was more sensitive to the MHTs. In addition, the RULA grand score had larger correlation coefficients with the MHTs and other criteria for postural loads, such as whole-body discomfort, compressive force at L5/S1, and percent capables at the shoulder and trunk, than the OWAS action category and REBA score. Based on the findings of this study, it is concluded that of the three observational methods, RULA may be better for assessing postural loads under the experimental conditions.Relevance to industryWork-related musculoskeletal disorders are a major worldwide problem in industries. For preventing their development owing to multiple risk factors, it is important to quantify exposure to such risk factors.     

A computerized method for assessment of musculoskeletal discomfort in the workforce: a tool for surveillance

A musculoskeletal discomfort survey was conducted to assess musculoskeletal discomforts among rural mail carriers in two post offices. Perceived musculoskeletal discomfort was collected directly from the workforce by means of a computerized discomfort assessment system (DAS). This investigation aimed at: (1)assessing the rural mail carrier's perception of DAS; and (2) assessing the rural mail carrier's musculoskeletal discomforts resulting from work. Most participants in the study found the computer tool easy to learn and easy to use. The information collected by DAS was used: (1) to determine the number of participating employees who were experiencing some kind of musculoskeletal problem; (2)to determine subtasks associated with discomfort; (3) to determine the body areas most affected by different subtasks; and (4) to investigate the patterns of discomfort that occurred with time.     

Symptoms and risks for musculoskeletal disorders among male and female footwear industry workers

BackgroundConsidering the growing participation of woman in the labor market and the high prevalence of the musculoskeletal disorders (MSD) in the footwear industry workers, the aim of this study was to evaluate and compare female and male footwear industry workers in relation to their demographics, occupational characteristics, stress levels, MSD symptoms prevalence, physical activity levels, alcohol and tobacco use.MethodsThe study included 175 female and 182 male footwear industry workers. Data was collected using the Perceived Stress Scale – 10, the Standardized Nordic Questionnaire, the International Physical Activity Questionnaire, the Alcohol Use Disorders Identification Test, and the Fagerstrom test for Nicotine Dependence.ResultsThe female workers were younger, had less time in the company and in the current job. They reported more stress (p = 0.001), had less time for physical activity (p = 0.004), higher prevalence of MSD symptoms in the last 12 months (p = 0.003), and consumed less alcohol (p = 0.006) than the male workers.ConclusionsFemale and male footwear industry workers presented significant differences in their demographics, occupational characteristics, stress levels, MSD prevalence, physical activity levels, alcohol and tobacco use. These differences should be taken into consideration in the implementation of intervention programs for optimum outcomes.Relevance to industryFemale footwear industry workers were more stressed, presented higher prevalence of MSD symptoms, and reported less time for physical activity than male footwear industry workers. The differences between male and female workers should be taken into consideration in the implementation of MSD prevention programs.     

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.     

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).     

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.     

Perceived demands and musculoskeletal symptoms among employees of an Iranian petrochemical industry

As a part of a comprehensive ergonomics program, this study was conducted among employees of an Iranian petrochemical industry to determine the prevalence of musculoskeletal symptoms and to examine the relationship between perceived demands and reported symptoms. In this cross-sectional study, 928 randomly selected employees, corresponding to nearly 40% of all employees participated. Nordic Musculoskeletal Disorder Questionnaire and Job Content Questionnaire were used as collecting data tools. The results showed that 73% of the study population had experienced some form of symptoms from the musculoskeletal system during the last 12 months. Knees and lower back symptoms were the most prevalent problem among the employees studied. The results revealed that perceived physical demands were significantly associated with musculoskeletal symptoms (OR ranged from 1.45 to 2.33). Among the perceived physical demands, awkward working postures were most frequently associated with reported musculoskeletal symptoms. Association was also found between perceived psychological demands and reported symptoms. Conflicting demands, waiting on work from other people or departments, interruption that other make, working very fast and time pressure were psychological factors retained in the regression models with OR ≥ 1.49. Based on the findings, it could be concluded that any interventional program for preventing or reducing musculoskeletal symptoms among the petrochemical employees studied had to focus on reducing physical demands, particularly awkward working postures as well as psychological aspect of working environment.

Relevance to industry

In petrochemical industry where employees are involved in both static and dynamic activities, determination of musculoskeletal symptoms contributing factors can be considered as a basis for planning and implementing interventional ergonomics program for preventing musculoskeletal symptoms and improving working conditions.     

Estimation of the relative risks of musculoskeletal injuries in the Andalusian manufacturing sector

BackgroundHigher injury rates of workers with specific characteristics can show areas of interest for intervention. Worker characteristics can be a risk factor because there is a differential distribution of exposure or because a particular worker characteristic affects the worker's behavior and the effects of work in the musculoskeletal system.ObjectiveTo estimate the relative risk for the most frequent accident mechanisms and to present the usefulness of the information from the Continuous Sample of Working Lives for a better estimation of the relative risk based on epidemiological analysis of specific types of accident controlling for possible confounders.Materials and methodsThe most frequent accident mechanisms were identified by analyzing the official accident notifications. To estimate the exposed workers, the Continuous Sample of Working Lives dataset is used. The dataset contains employment variables such as occupational levels, sector of activity, contract type and duration of employment. It also includes relevant variables related to demographics such as location, age, sex and nationality.ResultsAdjusted relative risk confirms that female workers, foreign, non-manual and older workers have lower injury rates.ConclusionsThe use of the Continuous Sample of Working Lives is useful in the analysis of the risk factors for particular types of accidents and allows a better estimation of the relative risks of accident.     

Relationship between work constraints and the development of musculoskeletal disorders of the wrist: A prospective study

A 2-year prospective study was conducted on 184 workers about the relationship between the development of musculoskeletal wrist disorders (WD) and the occupational constraint parameters at their job (wrist angles, forces, repetitiveness and angular velocities), taking into account personal and occupational confounding factors. The results demonstrate a greater probability of developing WD for the workers suffering from chronic diseases, from psychological disorders, practising a sport involving the upper limbs and judging their work tiring.All occupational constraint factors are correlated except for the angles. Logistic correlation analyses show that the most significant associations with a greater probability of developing WD are observed for the mean relative EMG value recorded on the finger and hand flexors and the time during which the velocity in flexion–extension is greater than 50°/s. None of the angular parameters shows any association.Relevance to industryThe study shows that the main factor on which to act in order to reduce the risk of WD is clearly the forces exerted by the hand.The objective of the control measures should be to reduce the muscular activity of the finger and hand flexors below 15% of the maximum activity corresponding to the maximum voluntary contraction of the finger flexors.A reduction of these forces appears to be associated with a reduction of the angular velocities of the wrist and of the repetitiveness.     

Heavy load carrying and musculoskeletal health: An exploratory study of biomechanical risk factors among sand miners in Pokhara,Kaski District,Nepal

BackgroundTrends in urbanization contribute to the growing global demand for raw construction materials. The health effects of load carrying among occupational groups that mine and carry sand and stone used for construction of roads and buildings remains poorly understood.MethodsWe conducted an exploratory cross-sectional study among a convenience sample of sand miners working at an excavation site on the Seti River in Pokhara, Nepal. Load carrying weight, duration, and frequency were used to categorize miners as having “low” or “high” load-carrying exposures. Musculoskeletal disorders (MSDs) were identified using self-reported symptoms of moderate to severe musculoskeletal pain, as well as physical examinations.ResultsThe average loads carried by female and male sand miners weighed 66 kg and 87 kg, respectively. Among all participants (N = 42), 45% reported moderate to severe musculoskeletal pain in at least one body region and 16 (38%) had MSDs identified using specified case criteria. The prevalence of MSDs was lower among miners carrying, on average, heavier loads compared to those carrying lighter loads (OR = 0.18; 95% CI: 0.04, 0.7), possibly indicative of the healthy worker survival effect. Miners carrying loads for longer durations had higher odds of MSDs compared with those carrying for shorter durations.ConclusionThis study has provided data on the extraordinary loads carried by sand miners in Nepal and preliminary evidence of health impacts associated with these loads. However, larger epidemiologic studies are needed to justify action to protect the health and safety of these unrecognized and understudied groups.     

Risk of neck musculoskeletal disorders among males and females in lifting exertions

Work-related neck disorders are common among various occupational groups. Despite clear epidemiological evidence for the association of these disorders with forceful arm exertions, the effect of such exertions on the biomechanical behavior of the neck muscles is currently not well understood. In this study, the effect of lifting tasks on the biomechanical loading of neck muscles was investigated for males and females. Twenty-six participants (13 males and 13 females) performed bi-manual isometric lifting tasks at knuckle, elbow, shoulder, and overhead heights by exerting 25%, 50%, and 75% of their maximum strength. The activity of the cervical trapezius and sternocleidomastoid muscles was recorded bilaterally using surface electromyography. Higher activity of the cervical trapezius muscle (10% MVC–43% MVC) compared to the sternocleidomastoid muscle (4% MVC–18% MVC) was observed. Females tend to use the sternocleidomastoid muscle to a greater extent than males, whereas, higher cervical trapezius muscle activation was observed for males than females. The main effect of weight and height, and weight by height interaction on the activity of neck muscles was statistically significant (all p < 0.001). The results of this study demonstrate that the neck muscles play an active role during lifting activities and may influence development of musculoskeletal disorders due to resulting physiological changes.