Quantitative postural load assessment for whole body manual tasks based on perceived discomfort

Many Korean workers are exposed to repetitive manual tasks or prolonged poor working postures that are closely related to back pain or symptoms of musculoskeletal disorders. Workers engage in tasks that require not only handling of heavy materials, but also assuming prolonged or repetitive non-neutral work postures. Poor work postures that have been frequently observed in the workplaces of shipbuilding shops, manufacturing plants, automobile assembly lines and farms often require prolonged squatting, repetitive arm raising and wrist flexion and simultaneous trunk flexion and lateral bending. In most manufacturing industries, workers have to assume improper work postures repetitively, several hundreds of times per day depending on daily production rate. A series of psychophysical laboratory experiments were conducted to evaluate the postural load at various joints. A postural load assessment system was then developed based on a macro-postural classification scheme. The classification scheme was constructed based on perceived discomfort for various joint motions as well as previous research outcomes. On the basis of the perceived discomfort, postural stress levels for the postures at individual joints were also defined by a ratio scale to the standing neutral posture. Laboratory experiments simulating automobile assembly tasks were carried out to investigate the relationship between body-joint and whole-body discomfort. Results showed a linear relationship between the two types of discomfort, with the shoulder and low back postures being the dominant factor in determining the whole body postural stresses. The proposed method was implemented into a computer software program in order to automate the procedure of analysing postural load and to enhance usability and practical applicability.     

Quantitative postural load assessment for whole body manual tasks based on perceived discomfort

Many Korean workers are exposed to repetitive manual tasks or prolonged poor working postures that are closely related to back pain or symptoms of musculoskeletal disorders. Workers engage in tasks that require not only handling of heavy materials, but also assuming prolonged or repetitive non-neutral work postures. Poor work postures that have been frequently observed in the workplaces of shipbuilding shops, manufacturing plants, automobile assembly lines and farms often require prolonged squatting, repetitive arm raising and wrist flexion and simultaneous trunk flexion and lateral bending. In most manufacturing industries, workers have to assume improper work postures repetitively, several hundreds of times per day depending on daily production rate. A series of psychophysical laboratory experiments were conducted to evaluate the postural load at various joints. A postural load assessment system was then developed based on a macro-postural classification scheme. The classification scheme was constructed based on perceived discomfort for various joint motions as well as previous research outcomes. On the basis of the perceived discomfort, postural stress levels for the postures at individual joints were also defined by a ratio scale to the standing neutral posture. Laboratory experiments simulating automobile assembly tasks were carried out to investigate the relationship between body-joint and whole-body discomfort. Results showed a linear relationship between the two types of discomfort, with the shoulder and low back postures being the dominant factor in determining the whole body postural stresses. The proposed method was implemented into a computer software program in order to automate the procedure of analysing postural load and to enhance usability and practical applicability.     

Trunk posture: reliability, accuracy, and risk estimates for low back pain from a video based assessment method

It has been recently reported that both dynamic movement characteristics, as well as the duration of postures adopted during work, are important in the development of low back pain (LBP). This paper presents a video-based posture assessment method capable of measuring trunk angles and angular velocities in industrial workplaces. The inter-observer reliability, system accuracy, and the relationship of the measured exposures to the reporting of low back pain are reported. The video analysis workstation consisted of a desktop computer equipped with digital video capture and playback technology, a VCR, and a computer game type joystick. The operator could then use a joystick to track trunk flexion and lateral bending during computer-controlled video playback. The joystick buttons were used for binary input of twisting. The inter-observer reliability for peak flexion and percentage of time spent in posture category variables were excellent (ICC>0.8). Lower reliability levels were observed for peak and average velocity and movement related variables. The video analysis system time series data showed very high correlation to the criterion optoelectronic imaging system (r=0.92). Root mean square errors averaged 5.8° for the amplitude probability distribution function data. Trunk flexion variables including peak level, peak velocity, average velocity indicators, and percent time in flexion category indicators all showed significant differences between cases and controls in the epidemiological study. A model consisting of the measures peak trunk flexion, percent time in lateral bend and average lateral bending velocity emerged after multivariable analysis for relationship to low back pain.

Relevance to industry

Risk of injury for the low back is multifactorial. The trunk position and movement velocity are emerging as important parameters. This analysis confirms the importance of these factors and demonstrates the utility of a video-based method to measure them in industrial settings.     

Towards exposure limits for working postures and musculoskeletal symptoms – a prospective cohort study

Occupational postures are considered to be an important group of risk factors for musculoskeletal pain. However, the exposure-outcome association is not clear yet. Therefore, we aimed to determine the exposure-outcome association of working postures and musculoskeletal symptoms. Also, we aimed to establish exposure limits for working postures. In a prospective cohort study among 789 workers, intensity, frequency and duration of postures were assessed at baseline using observations. Musculoskeletal pain was assessed cross-sectionally and longitudinally and associations of postures and pain were addressed using logistic regression analyses. Cut-off points were estimated based on ROC-curve analyses. Associations were found for kneeling/crouching and low-back pain, neck flexion and rotation and neck pain, trunk flexion and low-back pain, and arm elevation and neck and shoulder pain. The results provide insight into exposure-outcome relations between working postures and musculoskeletal symptoms as well as evidence-based working posture exposure limits that can be used in future guidelines and risk assessment tools.

Practitioner Summary: Our study gives insight into exposure-outcome associations of working postures and musculoskeletal symptoms (kneeling/crouching and low-back pain, neck flexion/rotation and neck pain, trunk flexion and low-back pain, and arm elevation and neck and shoulder pain). Results furthermore deliver evidence-based postural exposure limits that can be used in guidelines and risk assessments.     

Development and evaluation of an observational Back-Exposure Sampling Tool (Back-EST) for work-related back injury risk factors

We developed and evaluated an observational Back-Exposure Sampling Tool. A literature review suggested 53 exposure variables; these were reduced to 20 following field trials. Kappas for agreement beyond chance between six observers assessing exposures in 72 photos ranged from 0.21 to 1.0, with the highest values for posture type, trunk angle, manual materials handling, hands on item, and load weight. Intraclass correlations for agreement between pairs observing 17 workers once per minute for a full-shift were >0.74 for most postural, trunk angle, and manual materials handling variables. In validity testing, the proportions of shifts in flexion/extension and lateral bending observed for 169 full-shifts were compared to inclinometer measurements. Pearson correlations were 0.42 for 45-60° flexion and 0.9 for >60° flexion, but only 0.11-0.19 for lateral bending and trunk flexion less than 45°. When lower flexion angles were collapsed to include trunk extension, correlations increased to >0.5.     

Evaluation of interrater reliability for posture observations in a field study

This paper examines the interrater reliability of a quantitative observational method of assessing non-neutral postures required by work tasks. Two observers independently evaluated 70 jobs in an automotive manufacturing facility, using a procedure that included observations of 18 postures of the upper extremities and back. Interrater reliability was evaluated using percent agreement, kappa, intraclass correlation coefficients and generalized linear mixed modeling. Interrater agreement ranged from 26% for right shoulder elevation to 99 for left wrist flexion, but agreement was at best moderate when using kappa. Percent agreement is an inadequate measure, because it does not account for chance, and can lead to inflated measures of reliability. The use of more appropriate statistical methods may lead to greater insight into sources of variability in reliability and validity studies and may help to develop more effective ergonomic exposure assessment methods. Interrater reliability was acceptable for some of the postural observations in this study.     

Task-specific postures in low-seam underground coal mining

The objective of this study was to determine low-seam mine worker exposure to various postures as they pertain to job classifications and job tasks. Sixty-four mine workers from four low-seam coal mines participated. The mine workers reported the tasks they were required to complete and the two postures they used most frequently to perform them. They were provided with a schematic of postures from which to select. The two postures reported most frequently were identified for each task along with the job classification of the workers performing the tasks. Of the 18 tasks reported, over two thirds were performed by at least two different job classifications and over one third were performed by four or more job classifications. Across tasks, the postures used appeared to vary greatly. However, when grouped by job classification, the most frequently reported posture across all job classifications was kneeling near full flexion. Operating the continuous miner was associated with frequent squatting and was likely used because it affords great mobility, allowing operators to move quickly to avoid hazards. However, for environments with a restricted vertical height such as low-seam mining, the authors recommend squatting be avoided as data demonstrates that large amounts of femoral rollback and high muscle activity for the extensors when performing lateral lifts in this posture. Kneeling near full flexion was reported as the most frequently used posture by all job classifications and was likely due to the fact that it requires the least amount of muscle activity to maintain and has reduced pressures at the knee. However, the authors recommend this posture be avoided when performing lateral lifting tasks. Like squatting, kneeling near full flexion results in increased femoral rollback and may increase the stresses applied to the meniscus. Unlike lateral lifting, maintaining a static posture results in knee loading and muscle activity such that the mine worker should consider kneeling near full flexion and sitting on their heels. Although kneeling near full flexion is associated with injuries, there are benefits to this posture that are realized when statically kneeling (minimal muscle activity, allows worker to maintain an upright torso in low heights, and decreased loading at the knee). However, cartilage is avascular and nourished by synovial fluid. Therefore, one should frequently rotate between postures, assuming a more upright kneeling posture when possible and frequently fully flexing and extending the knee allowing nutrients to the cartilage.Relevance to industryIn 2009, over one fourth of underground coal mines that produced coal in the United States were considered low seam with an average working height of <109.2 cm (MSHA, 2009) restricting workers to their knees. Data exists regarding the biomechanical implications of kneeling postures and demonstrates the possibility of detrimental consequences to varying degrees for each posture. With each posture posing a different level of exposure to musculoskeletal disorder risk factors, it is essential to determine the postures mine workers use to perform their job tasks and how their postural options are restricted by the low-seam underground mining environment.     

Measuring posture for epidemiology: Comparing inclinometry,observations and self-reports

The objective of this study was to use and evaluate three postural assessment methods for epidemiological studies of back disorders. The methods were: (1) a data-logging inclinometer; (2) observations by trained observers; (3) self-reports by employees. All methods were feasible in 50 heavy industry worksites. Inclinometry provided quantitative measures of flexion–extension (mean 17°, SD 11.2°), lateral flexion (mean 8.5°, SD 2.6°) and trunk movement speed (mean 14.3° per second, SD 4.9° per second). Observations and self-reports provided estimates of time spent in various trunk angles, general postures, materials handling and vehicles. Compared to observations, self-reports under-reported less common tasks, but over-reported task durations. In statistical modelling to determine if observations or self-reports could be used to estimate measured postures, observations accounted for 30 to 61% of the inclinometer measurement variance and self-reports for 33 to 40%. A combination of inclinometry and observations would be an ideal option to provide both depth and breadth of data on postures and other physical exposures for epidemiological research.     

Physical ergonomic hazards in highway tunnel construction: overview from the Construction Occupational Health Program

This report provides an overview of physical ergonomic exposures in highway construction work across trades and major operations. For each operation, the observational method “PATH” (Posture, Activity, Tools and Handling) was used to estimate the percentage of time that workers spent in specific tasks and with exposure to awkward postures and load handling. The observations were carried out on 73 different days, typically for about 4 h per day, covering 120 construction workers in 5 different trades: laborers, carpenters, ironworkers, plasterers, and tilers. Non-neutral trunk postures (forward or sideways flexion or twisting) were frequently observed, representing over 40% of observations for all trades except laborers (28%). Kneeling and squatting were common in all operations, especially tiling and underground utility relocation work. Handling loads was frequent, especially for plasterers and tilers, with a range of load weights but most often under 15 pounds. The results of this study provide quantitative evidence that workers in highway tunnel construction operations are exposed to ergonomic factors known to present significant health hazards. Numerous opportunities exist for the development and implementation of ergonomic interventions to protect the health and safety of construction workers.     

Are the postures adopted according to requested linguistic categories similar to those classified by the recording protocols?

Knowledge on how workers perceive and associate their postures for trunk flexion with respect to linguistic categories, could allow for the development of simple and valid instruments for self-assessment and for more effective postural training. Considerable time and expense could be saved if reliable self-assessments were available. This study describes the anterior flexion angles of the trunk adopted by individuals according to linguistic categories (mild, moderate and severe) and registered by photograph. The postures were compared with postural recording protocols. Twenty sedentary individuals (10 male and 10 female) and 12 industrial female workers (6 healthy and 6 low back sufferers) participated. Subjects were capable of discriminating linguistic postural categories, since they adopted different trunk postures when distinct categories were requested (p< 0.0001). However, the individual variability was high for each category estimated. This could explain, at least in part, the low level of agreement between self-assessment and observational studies.     

Are posture data from simulated tasks representative of field conditions? Case study for overhead electric utility workers

Many ergonomics studies are conducted in laboratory-simulated work environments to assess risks for the development of musculoskeletal disorders under more controlled conditions. However, the simulated conditions could be of questionable validity with respect to reproduction of field conditions involving risk factors. The objective of this study was to verify whether the postures recorded for neck extension/flexion and upper arm elevation of overhead electric utility workers in a simulated environment were similar to those recorded in a field environment. Of the three frequently performed tasks analysed, two presented similar exposure in both conditions. However, differences were identified for a more complex task (relay replacement). These results suggest that simulated tasks may be more representative for more standardised tasks. This may indicate that researchers investigating risks should avoid simplifying complex tasks when reproducing field posture exposure in laboratories, since omitting extra subtasks may lead to an inaccurate reproduction of field exposure.

Practitioner Summary: Studies comparing results from field and simulated environments are necessary to evaluate to what degree postural exposure reproduced in laboratory is representative of the exposure occurring in real work situations. This is particularly relevant for tasks involving training in simulated environment due to safety constraints.     

Paramedics on the job: Dynamic trunk motion assessment at the workplace

Many paramedics' work accidents are related to physical aspects of the job, and the most affected body part is the low back. This study documents the trunk motion exposure of paramedics on the job. Nine paramedics were observed over 12 shifts (120 h). Trunk postures were recorded with the computer-assisted CUELA measurement system worn on the back like a knapsack. Average duration of an emergency call was 23.5 min. Sagittal trunk flexion of >40° and twisting rotation of >24° were observed in 21% and 17% of time-sampled postures. Medical care on the scene (44% of total time) involved prolonged flexed and twisted postures (∼10 s). The highest extreme sagittal trunk flexion (63°) and twisting rotation (40°) were observed during lifting activities, which lasted 2% of the total time. Paramedics adopted trunk motions that may significantly increase the risk of low back disorders during medical care and patient-handling activities.     

Interaction with a smartphone under different task and environmental conditions: Emergence of users’ postural strategies

Nowadays, interactions with smartphones are constantly increasing. These devices are used in a wide variety of situations by performing various tasks. The purpose of this study is to determine whether one or more strategies emerge when subjects freely send message and browse on the web in three environmental conditions: sitting with or without support and standing. Therefore, a hierarchical cluster analysis (HCA) was applied to the angular parameters of the neck and trunk as well as to the distance between the face and the telephone. These 3D motion analysis data were also processed taking into account the ergonomic recommendations from the Rapid Upper Limb Assessment in order to qualify the postural strategies highlighted by the HCA. The findings showed that there are three different postural strategies adopted by the subjects especially in the sagittal plane: a first one involves the neck without implying the trunk; a second one strongly mobilizes the trunk flexion without involving the neck; and a third postural strategy which combines these two behaviors. These three postural strategies depend on the environmental condition. Indeed, the postural strategy involving the trunk is associated with the presence of a support while the one involving the neck only appears in conditions without support. It is also observed that smartphone users mainly adopt harmful postures, whether due to excessive flexion of the neck, trunk or both. Even when subjects place themselves in the least harmful postures, there are always risks of musculoskeletal disorders in the short or long term.     

Comparison of lifting and bending demands of the various tasks performed by daycare workers

The objective of this study was to evaluate lifting and trunk postural demands of the tasks performed by daycare workers. Twenty-four caregivers were monitored for approximately 3.5 h. Eleven tasks were identified. Posture was monitored by a dosimeter with sensors at T1 and S1. Flexion-extension, lateral bending and torsion angles were investigated using Exposure Variation Analyses (EVA).Most of the lifting, in both weight lifted and repetitions, was performed during two tasks: “Preparation” (0.6 lifts/min) and “Changing diapers” (0.8 lifts/min).EVA allowed identifying the most demanding tasks in sagittal flexion for both amplitude and duration.The most asymmetric tasks (large lateral bending) were “Caring,” “Changing diapers” and “Cleaning”. All the tasks listed as demanding for posture or duration also had a low level of variability.RelevanceThis study was able to identify the most physically stressful tasks in terms of lifting and postural demands. These tasks should be redesigned in priority taking into account this information and the specific context of individual daycare centres to improve the work context of workers.     

Posture variation among office workers when using different information and communication technologies at work and away from work

Office workers perform tasks using different information and communication technologies (ICT) involving various postures. Adequate variation in postures and muscle activity is generally believed to protect against musculoskeletal complaints, but insufficient information exists regarding the effect on postural variation of using different ICT. Thus, this study among office workers aimed to determine and compare postures and postural variation associated with using distinct types of ICT. Upper arm, head and trunk postures of 24 office workers were measured with the Physiometer® over a whole day in their natural work and away-from-work environments. Postural variation was quantified using two indices: APDF_(90-10) and EVA_(sd). Various ICT had different postural means and variation. Paper-based tasks had more non-neutral, yet also more variable postures. Electronics-based tasks had more neutral postures, with less postural variability. Tasks simultaneously using paper- and electronics-based ICT had least neutral and least variable postures. Tasks without ICT usually had the most posture variability. Interspersing tasks involving different ICT could increase overall exposure variation among office workers and may thus contribute to musculoskeletal risk reduction.     

The effect of pallet distance on torso kinematics and low back disorder risk

Intervention research for prevention of occupational low back injuries has focused on the effects of reducing extreme torso flexion and the external moment. Little is known about prevention strategies for torso twisting and lateral bending. The objective of this study was to assess the effect of pallet distance with regard to a constant lift origin on the torso kinematics and a measure of low back disorder risk. Fifteen male participants transferred 11.3?kg boxes from a constant origin to six different regions on a pallet. Two pallet distances with regard to the lift origin were investigated. ANOVA indicated that increasing the pallet distance resulted in increases in torso kinematics (velocities and accelerations) as well as a measure of risk of low back disorder. The increases in torso kinematics (e.g. twisting and lateral awkward postures and bending velocities) occurred mostly at the lower height regions on the pallet. It is concluded that increasing the pallet distance with regard to the lifting origin, with the intention to influence the participant to take a step during a palletizing task does not appear to be an effective intervention strategy to reduce the risk of low back disorder associated with torso kinematics.     

The effect of pallet distance on torso kinematics and low back disorder risk

Intervention research for prevention of occupational low back injuries has focused on the effects of reducing extreme torso flexion and the external moment. Little is known about prevention strategies for torso twisting and lateral bending. The objective of this study was to assess the effect of pallet distance with regard to a constant lift origin on the torso kinematics and a measure of low back disorder risk. Fifteen male participants transferred 11.3 kg boxes from a constant origin to six different regions on a pallet. Two pallet distances with regard to the lift origin were investigated. ANOVA indicated that increasing the pallet distance resulted in increases in torso kinematics (velocities and accelerations) as well as a measure of risk of low back disorder. The increases in torso kinematics (e.g. twisting and lateral awkward postures and bending velocities) occurred mostly at the lower height regions on the pallet. It is concluded that increasing the pallet distance with regard to the lifting origin, with the intention to influence the participant to take a step during a palletizing task does not appear to be an effective intervention strategy to reduce the risk of low back disorder associated with torso kinematics.     

Static and dynamic lifting strength at different reach distances in symmetrica] and asymmetrical planes

Postural and therefore biomechanical standardization in strength testing has not been rigorously and consistently applied. To develop a quantitative relationship between strength and posture (body position, symmetry, and reach) 30 normal subjects (18 male and 12 females) were required to stoop and squat lift or exert in the relevant posture against a standardized instrumented handle. The isometric lifting efforts and isokinetic lifts were studied. The isokinetic lifts were done at a linear velocity of 50cm/s of the hand displacement from the floor to the knuckle heights of the respective subjects in stoop and squat postures. The isometric stoop lifting efforts were exerted in two standardized postures: (a) with 60° hip flexion; and (b) with 90° hip flexion. The isometric squat lifting efforts were also exerted in two standardized postures: (a) with 90° knee flexion; and (b) with 135° knee flexion. All isometric lifting efforts and isokinetic lifts were performed at half, three-quarters, and full horizontal reach in sagitally symmetrical, 30° left lateral, and 60° left lateral planes. Isometric stoop and squat lifting efforts were also measured in self-selected optimal postures. These 56 conditions were tested in random order. The analysis of variance revealed that the gender, the mode of lifting, the postural asymmetry and reach of lifting affected the strength significantly (p<0·0001). Most two-way and three-way interactions were significant (p<0·01). Of 108 prediction regression equations, 103 were significant with up to 90% of the variation explained by anthropometric variables and sagittal plane strength. The reach affected the strength most profoundly followed by postural asymmetry and the mode of lifting.     

Static and dynamic lifting strength at different reach distances in symmetrical and asymmetrical planes.

Postural and therefore biomechanical standardization in strength testing has not been rigorously and consistently applied. To develop a quantitative relationship between strength and posture (body position, symmetry, and reach) 30 normal subjects (18 male and 12 females) were required to stoop and squat lift or exert in the relevant posture against a standardized instrumented handle. The isometric lifting efforts and isokinetic lifts were studied. The isokinetic lifts were done at a linear velocity of 50cm/s of the hand displacement from the floor to the knuckle heights of the respective subjects in stoop and squat postures. The isometric stoop lifting efforts were exerted in two standardized postures: (a) with 60 degrees hip flexion; and (b) with 90 degrees hip flexion. The isometric squat lifting efforts were also exerted in two standardized postures: (a) with 90 degrees knee flexion; and (b) with 135 degrees knee flexion. All isometric lifting efforts and isokinetic lifts were performed at half, three-quarters, and full horizontal reach in sagitally symmetrical, 30 degrees left lateral, and 60 degrees left lateral planes. Isometric stoop and squat lifting efforts were also measured in self-selected optimal postures. These 56 conditions were tested in random order. The analysis of variance revealed that the gender, the mode of lifting, the postural asymmetry and reach of lifting affected the strength significantly (p less than 0.0001). Most two-way and three-way interactions were significant (p less than 0.01). Of 108 prediction regression equations, 103 were significant with up to 90% of the variation explained by anthropometric variables and sagittal plane strength. The reach affected the strength most profoundly followed by postural asymmetry and the mode of lifting.     

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.