Trends in research and prevention policies for work-related musculoskeletal disorders at the European Agency for Safety and Health at Work (EU-OSHA)]

The European Agency for Safety and Health at Work (EU-OSHA) has been working on matters related to occupational health problems in 15 European Union (EU) member states. EU-OSHA established 10 topic centers on work and health research in 1998. One of the topic centers is assigned for research and information on work-related musculoskeletal disorders. The present report is written because such activities of EU-OSHA are scarcely known in Japan. Work-related musculoskeletal disorders have become a very serious problem in EU member states, i.e., 30% of workers complain of backache, and 17% complain of muscular pains in their arms and legs. The affected workers not only suffer at work but also in their home life. The economic costs of all work-related ill health range from 2.6 to 3.8% of the gross national product, and work-related musculoskeletal disorders constitute 40-50% of this. Therefore EU member states consider that prevention of work-related musculoskeletal disorders in itself is an extremely good economic policy. EU-OSHA published "Work-related neck and upper limb musculoskeletal disorders" in 1999, and "Research on work-related low back disorders" in 2000. These publications suggest various preventive methods which can be introduced in practice at work. One of the most remarkable things in EU-OSHA's activities for work-related musculoskeletal disorders is that EU-OSHA has been trying hard to introduce the results of its research into real policies for EU member states by several means, i.e., held a seminar participated in by policy makers, representatives of trade unions, and researchers from EU member states, and sent seminar resolutions to politicians who are responsible for employment and social affairs. Finally the resolution has been adopted in a new social affairs policy by the EU parliament and will be put into force during 2002. Work-related musculoskeletal disorders will remain one of the most serious occupational problems in EU member states, and EU-OSHA will continue to pay close attention to it.     

Under-reporting of work-related musculoskeletal disorders in the Veterans Administration

PURPOSE: Work-related musculoskeletal disorders following patient contact represent a major concern for health care workers. Unfortunately, research and prevention have been hampered by difficulties ascertaining true prevalence rates owing to under-reporting of these injuries. The purpose of this study is to determine the predictors for under-reporting work-related musculoskeletal injuries and their reasons. DESIGN/METHODOLOGY/APPROACH: Multivariate analysis using data obtained in a survey of Veterans Administration employees in the USA was used to determine underreporting patterns among registered nurses, licensed practical nurses and nursing assistants. Focus groups among health care workers were conducted at one of the largest Veterans Administration hospitals to determine reasons for under-reporting. FINDINGS: A significant number of workers reported work-related musculoskeletal pain, which was not reported as an injury but required rescheduling work such as changing shifts and taking sick leave to recuperate. The findings indicate that older health care workers and those with longer service were less likely to report as were those working in the evening and night shifts. Hispanic workers and personnel who had repetitive injuries were prone to under-reporting, as were workers in places that lack proper equipment to move and handle patients. Reasons for under-reporting include the time involved, peer pressure not to report and frustration with workers' compensation procedures. ORIGINALITY/VALUE: This study provides insights into under-reporting musculoskeletal injuries in a major US government organization. The research indicates that current reporting procedures appear to be overtly cumbersome in time and effort. More flexible work assignments are needed to cover staff shortfalls owing to injuries. Health education on the detrimental long-term effects of ergonomic injuries and the need for prompt attention to injuries should prove useful in improving rates of reporting.     

Musculoskeletal disorders among floor layers: is prevention possible?

The purpose of this study was to describe possibilities for the prevention of work-related musculoskeletal disorders among floor layers and to analyze the factors that promote or constrain innovation in prevention. A questionnaire study included 102 floor layers and 180 apprentice floor layers. Questionnaires were used to register musculoskeletal complaints, psychosocial factors, and proposals for prevention. Interviews were carried out of key persons from the trade, selected from the floor layers, employers, and their trade association, with the purpose of getting more knowledge about the barriers to innovation. The results indicate that musculoskeletal disorders are still a great problem in skilled floor layers, and also in apprentices. Primary prevention of work-related knee disorders and accompanying stress requires a reduction in work tasks performed in kneeling positions. Tools that can be used in standing positions for floor laying work tasks are considered useful for prevention of musculoskeletal disorders. Throughout their training, young apprentice floor layers slowly become socialized into the group, and absorb the same identity, attitude to problem-solving, and use of tools and working methods as the adult floor layers. Deep-rooted habits are very resistant to change. The intensity of the work, time pressures, frequent changes of work locations, and the trade's pattern of working in small firms are also factors that make it difficult to introduce good practice innovations in the floor laying trade. Work-related strain can be decreased in the trade by combining changes in tools, materials, and working methods. It is necessary to include educational training of apprentices and skilled floor layers, and also foremen and employers. Breaking down the barriers to change demands education and instruction by people who know the trade well, who can communicate effectively with the floor layers, and who are accepted by the trade.     

Results from a Community-based Occupational Health Survey of Vietnamese-American Nail Salon Workers

A community-university collaborative partnership assessed self-reported work-related health effects and environmental factors in Boston's Vietnamese immigrant community via an interviewer-assisted survey. Seventy-one nail technicians responded. Musculoskeletal disorders, skin problems, respiratory irritation and headaches were commonly reported as work-related, as were poor air quality, dusts and offensive odors. The reporting of a work-related respiratory symptom was significantly associated with the reporting of exposure factors such as poorer air quality. Absence of skin disorders was associated with glove use and musculoskeletal symptoms were associated with years worked as a nail technician. Work-related health effects may be common in nail salon work. Chemical and musculoskeletal hazards should be reduced through product and equipment redesign.     

The impact of workplace screening on the occurrence of cumulative trauma disorders and workers' compensation claims

Work-related musculoskeletal pain, commonly referred to more specifically as musculoskeletal disorders or cumulative trauma disorders, has continued to occur despite efforts by employers, employees, health care providers, and the government to eradicate it. The National Institute for Occupational Safety and Health has encouraged employers to establish ergonomic prevention programs; however, many employers are concerned that screening, education, and focused attention on workplace pain will cause an increase in the number of OSHA 200 events and the incidence of workers' compensation claims. This prospective cohort study demonstrated that there was no increase in the number of OSHA 200 events and no increase in the incidence of workers' compensation claims after completion of an individual risk screening program that included education and employee awareness about work-related musculoskeletal pain. Incidence of cumulative trauma disorders has been most effectively reduced by use of individual risk-screening programs. Therefore, employers should be encouraged to develop and implement prevention programs that include individual risk screening.     

Disability Management Training for Supervisors: A Pilot Intervention Program

Proactive disability management practices among employers have been associated with reduced frequency and duration of disability. Supervisors have a critical role in disability prevention. However, few studies have evaluated training efforts to modify supervisor responses in order to improve disability outcomes. In this study, 108 supervisors representing seven employers were provided a 1.5-h training session to reinforce a proactive and supportive response to work-related musculoskeletal symptoms and injuries among employees. Pre- and post training results showed improvements in supervisor confidence to investigate and modify job factors contributing to injury, to get medical advice, and to answer employees' questions related to injury and treatment (p < .05). More supervisors reported decreases (38.5%) than increases (9.6%) in lost work time within their departments. These data provide evidence that this approach may improve disability outcomes of work-related musculoskeletal disorders. Controlled trials with disability outcome data are needed to confirm these results.     

Occupational health and safety in Australia

The focus of OHS in Australia is on workplace-based prevention rather than individual health care. Over the past decade, workers' compensation data have shown continuous improvement in work-related deaths, serious injuries and diseases. Injuries from work-related vehicle incidents are the leading cause of fatalities. There is a high incidence of on-road incidents in light vehicles; this problem is under-recognised, and better incidence data are required to support more effective interventions. Rates of many long-latency diseases such as cancers are underestimated, and again more reliable information is needed, particularly on work-related exposures to carcinogens. Disease-related deaths are largely confined to older workers. Musculoskeletal injuries and disorders are the most frequent and costly OHS problem, constituting a large majority of non-fatal injuries and diseases. There is growing recognition that their risk management should be more evidence based, integrating assessment and control of psychosocial and 'manual handling' hazards. A high rate of population ageing is increasing risk of chronic diseases, including musculoskeletal disorders, which is helping to raise awareness of the importance of protecting and promoting workforce health. Strategies to achieve this have been developed but implementation is at an early stage.     

Different risk factors for musculoskeletal complaints and musculoskeletal sickness absence

OBJECTIVES: The aim of this study was to investigate whether individual, work-related physical and psychosocial risk factors involved in the occurrence of musculoskeletal complaints also determine musculoskeletal sickness absence. METHODS: This cross-sectional study used a self-administered questionnaire to collect data on individual and work-related risk factors and the occurrence of musculoskeletal complaints and musculoskeletal sickness absence among 373 employees of laundry-works and dry-cleaning establishments (response rate 87%). Logistic regression models were used to determine associations between risk factors and the occurrence of musculoskeletal complaints and sickness absence due to these complaints. RESULTS: Both work-related physical and psychosocial factors showed strong associations with low-back pain and upper-extremity complaints. Work-related physical factors did not influence sickness absence, whereas psychosocial factors showed some associations with sickness absence. Sickness absence was associated with The Netherlands as the country of birth [odds ratio (OR) 0.3, 95% confidence interval (95% CI) 0.2-0.6], and female workers had an episode of sickness absence due to low-back pain less often (OR 0.5, 95% CI 0.3-0.9), but more often due to upper-extremity complaints (OR 2.2, 95% CI 1.14.5). CONCLUSIONS: Work-related physical and psychosocial factors largely determine the occurrence of low-back pain and upper-extremity complaints, whereas individual factors predominantly determine whether persons with these musculoskeletal complaints take sick leave.     

Ergonomics in Modern Dairy Practice: A Review of Current Issues and Research Needs

ABSTRACT

Dairy farming is an ancient occupation. Traditionally, cows have been manually milked while tethered in stalls or stanchions. In the latter half of the 20th century as machine milking emerged, the parlor milking system has become more popular, especially among larger dairy farms. The transition from manual milking to automatic milking systems as well as the transition from stanchion to parlor milking systems involved a dramatic change in milking tasks. These transitions have resulted in changing patterns of occupational exposure to risk factors for work-related musculoskeletal disorders among dairy workers. However, aspects of the milking task such as sanitization of teats, stripping milk from teats, and attachment and detachment of milking equipment have remained relatively the same. Work-related musculoskeletal symptoms have been reported in the low back, shoulders, hands/wrists, and knees. Research that has measured exposures to risk factors for work-related musculoskeletal disorders among dairy farm workers has been limited, especially when using ergonomic tools to directly measure exposure, such as electrogoniometry or electromyography. Self-reported exposure measures have been most commonly used. The interventions that have been tested to reduce exposure to risk factors for work-related musculoskeletal disorders include assisted lift-hold devices, use of lighter-weight equipment, adjustable flooring, and use of rubber mats. However, research evaluating potential solutions to reduce dairy farm worker exposure to risk factors for musculoskeletal disorders is scarce. Future research efforts should further characterize hazards while simultaneously testing viable solutions that fit within the business model of the dairy farm industry.     

Impact on the Quality of Life of an Educational Program for the Prevention of Work-Related Musculoskeletal Disorders: a randomized controlled trial

Background  

Work-related musculoskeletal disorders (WMSD) are a major cause for concern in public health and the main causes of sick leave. Treatments for WMSD have given disappointing results; prevention is the best strategy, but results of preventive measures have not been consistent. To the best of our knowledge there are few studies in literature that evaluated the impact of a specific program aimed at preventing WMSD on the quality of life of employed persons.     

Possibilities for regulatory actions in the prevention of musculoskeletal disorders

This review argues that there is a need for regulatory action against work-related musculoskeletal disorders. Designing such regulation is fraught with problems, such as insufficient knowledge about mechanisms and exposure-dose-response relationships, and lack of consensus on definitions. The multifactorial character of the disorders, especially risks involving work organization, further increases the problems. Nevertheless, regulation is necessary because of the poor results of voluntary prevention and the large costs of these disorders. Some major regulations are reviewed, and it is argued that there is insufficient scientific support for quantitative regulations proposed for some European norms. The recent Nordic ergonomic regulations for the prevention of work-related musculoskeletal disorders is a step forward, since they succeed in providing guidance, including some on work organizational issues, with only few quantitative measures. Researchers should become more involved in these activities, and priorities in future research that would benefit a more scientific approach to ergonomic regulation are indicated.     

Management of musculoskeletal pain in the workplace

Occupational Safety and Health Administration recordable upper-extremity musculoskeletal pains or disorders account for a significant number of work-related illnesses in the US workforce. Although the concept of musculoskeletal disorder prevention is appealing, little has been done to demonstrate the successful application and benefit of these programs. In 1995, an aircraft manufacturer established a unique risk-management program for new employees based on the CtdMAP individual risk assessment instrument. In 1998, a subgroup was prospectively studied for medical management on the basis of individual risk scores. Outcome measures were compared for the risk assessment group, the matched control group, and the total company. Employer-estimated savings in direct workers compensation costs were $2.42 million, and estimated indirect savings were over $13.5 million during the study.     

The impact of work-related musculoskeletal disorders on workers' caregiving activities

BACKGROUND: The purpose of the study was to describe and quantify the impact of work-related musculoskeletal disorders on workers' caregiving activities. METHODS: A cross-sectional study was conducted in which a telephone survey was administered to 187 lost-time workers' compensation claimants from Ontario, of whom 49.2% were women. Forty-eight percent of the injured workers were providing unpaid care prior to the injury. RESULTS: Injured workers providing caregiving reported an average reduction in time spent in caregiving activities of 5.5 hr/week, 8 months post-injury. A Sex X Return-to-work status ANCOVA was conducted with difference in caregiving hours as the dependent variable, and with the following covariates: Mean number of caregiving hours, comorbidities, site of injury, and education. Independent of weekly hours of caregiving, decreases in caregiving hours were significantly higher if the worker was a woman or had not returned to work. CONCLUSIONS: Work-related musculoskeletal disorders have a significant impact on workers' time spent in unpaid caregiving activities, an example of the social consequences of occupational injuries. Occupational and caregiving roles are limited by work-related disorders in a parallel fashion.     

Work-related musculoskeletal disorders: Comparison of data sources for surveillance

Work-related upper extremity musculoskeletal disorders “associated with repeated trauma” account for more than 60% of all newly reported occupational illness, 332,000 in 1994 according to the U.S. Department of Labor. These numbers do not include, for example, those disorders categorized as “injuries due to overexertion in lifting,” approximately 370,000. Early identification of potential disorders and associated risk factors is needed to reduce these disorders. There are a number of possible methods for conducting surveillance for work-related musculoskeletal disorders (WMDs) based on health outcome: workers' compensation, sickness and accident insurance, OSHA 200 logs, plant medical records, self-administered questionnaires, professional interviews, and physical examinations. In addition, hazard surveillance based on evaluation of job exposures to physical stressors by nonoccupational health personnel is possible. As part of a large labor-management-initiated intervention study to reduce the incidence of WMDs in four automotive plants, we were able to compare the strengths and limitations of each of these surveillance tools. University administered health interviews yielded the highest rate of symptoms; combined physical examinations plus interview (point prevalence) rates were similar to self-administered questionnaires (period prevalence) rates. Plant medical records yielded the lowest rate of WMDs. WMD status on self-administered questionnaire and on physical examination were associated with risk factor exposure scores. This study suggests that symptoms questionnaires associated with risk factor exposure scores. This study suggests that symptoms questionnaires and checklist-based hazard surveillance are feasible within the context of joint labor-management ergonomics programs and are more sensitive indicators of ergonomic problems than pre-existing data sources. Am. J. Ind. Med. 31:600–608, 1997. © 1997 Wiley-Liss, Inc.     

The role of imaging of work-related upper extremity disorders

Work-related upper extremity disorders can pose a diagnostic and management challenge because the nontraumatic disorders that are often believed to be caused by repetitive work activities can and do occur without any apparent provoking activity and can be caused or associated with many systemic medical conditions. One mainstay in the assessment of hand and arm disorders remains imaging. Imaging capabilities have made incredible advances with the advent of MRI, CT, ultrasound, bone scan, and numerous technologies that enable clinicians to view fine details of anatomy and pathology. This article reviews the potential imaging choices and clinical indications for work-related injuries of the elbow, hand, and wrist.     

Estimates of Annual Medical Costs of Work-related Low Back Pain in Japan

Little is reported regarding economic burden of work-related low back pain except for the United States. In the present study, annual medical cost of work-related low back pain in Japan was calculated based on the treatment fee per day, a total of days of treatment received for low-back pain of all causes, employment rates, and an estimated number of work-related low-back cases. The analysis indicated that, in 2011, the total annual medical cost for work-related low back pain was 82.14 billion yen, consisting of 26.48 and 55.66 billion yen for inpatients and outpatients, respectively. As well as for 2011, the costs were also estimated for 2008, 2005, and 2002. Whereas the total medical costs of work-related low back pain monotonically increased during 2002–2011, the costs for spine disorder (including spondylosis) have also increased in recent years. Work-related low back pain entails a considerable economic burden to Japanese society.     

Workers' compensation experiences of computer users with musculoskeletal disorders

BACKGROUND: Computer-related musculoskeletal disorders (MSDs) are of concern as computer use continues to increase. While MSDs are among the most disabling conditions in the United States, the workers' compensation (WC) experiences of individuals with these occupational disorders are not well described. METHODS: We conducted a study among 149 adults with work-related MSDs of the neck, upper back, or upper extremity related to computer use. Questionnaires were used to obtain information on subjective experiences with WC and economic issues. RESULTS: Seventy-four percent filed for WC. Twenty-five percent of all participants reported major financial difficulties after developing their MSD, though the majority filed for WC. Despite filing for WC, a large proportion relied partially on government, employer, or personal financial sources. Sixty-two percent reported that overall satisfaction with the WC insurer was poor. CONCLUSIONS: Findings indicate that a majority of participants filed for WC. Despite filing for WC financial difficulties after developing their MSD were considerable.     

Evaluation and management of chronic work-related musculoskeletal disorders of the distal upper extremity

This clinical review will describe the epidemiology, clinical presentation, and management of the following work-related musculoskeletal disorders (WMSDs) of the distal upper extremity: deQuervain's disease, extensor and flexor forearm tendinitis/tendinosis, lateral and medial epicondylitis, cubital tunnel syndrome, and hand-arm vibration syndrome (HAVS). These conditions were selected for review either because they were among the most common WMSDs among patients attending the New York State Occupational Health Clinics (NYSOHC) network, or because there is strong evidence for work-relatedness in the clinical literature. Work-related carpal tunnel syndrome is discussed in an accompanying paper. In an attempt to provide evidence-based treatment recommendations, literature searches on the treatment of each condition were conducted via Medline for the years 1985-1999. There was a dearth of studies evaluating the efficacy of specific clinical treatments and ergonomic interventions for WMSDs. Therefore, many of the treatment recommendations presented here are based on a consensus of experienced public health-oriented occupational medicine physicians from the NYSOHC network after review of the pertinent literature. A summary table of the clinical features of the disorders is presented as a reference resource.     

职业病病人经济风险分担机制探讨

通过对我国当前职业病病人经济风险分担机制及其问题进行剖析发现,我国职业病病人经济风险分担机制是用人单位为主要负担者、政府保基本、个人或非盈利组织为补充,但实践中还存在诊断和鉴定过程比较繁琐、落实工伤待遇比较困难、赔偿和其他保障救助不到位等问题。建议更加重视应对职业病病人经济风险,诊断鉴定过程中让劳动者少跑路、少等待、少提供材料、少额外开销,施行《工伤保险条例》时让劳动者应参保尽参保、应赔付尽赔付、保障水平“就高不就低”,同时,充分利用现有大病救助制度,鼓励利用市场机制分散病人经济风险,拓宽救助渠道,提高救助精准性。     

Global Estimates of the Burden of Injury and Illness at Work in 2012

This article reviews the present indicators, trends, and recent solutions and strategies to tackle major global and country problems in safety and health at work. The article is based on the Yant Award Lecture of the American Industrial Hygiene Association (AIHA) at its 2013 Congress. We reviewed employment figures, mortality rates, occupational burden of disease and injuries, reported accidents, surveys on self-reported occupational illnesses and injuries, attributable fractions, national economic cost estimates of work-related injuries and ill health, and the most recent information on the problems from published papers, documents, and electronic data sources of international and regional organizations, in particular the International Labor Organization (ILO), World Health Organization (WHO), and European Union (EU), institutions, agencies, and public websites. We identified and analyzed successful solutions, programs, and strategies to reduce the work-related negative outcomes at various levels. Work-related illnesses that have a long latency period and are linked to ageing are clearly on the increase, while the number of occupational injuries has gone down in industrialized countries thanks to both better prevention and structural changes. We have estimated that globally there are 2.3 million deaths annually for reasons attributed to work. The biggest component is linked to work-related diseases, 2.0 million, and 0.3 million linked to occupational injuries. However, the division of these two factors varies depending on the level of development. In industrialized countries the share of deaths caused by occupational injuries and work-related communicable diseases is very low while non-communicable diseases are the overwhelming causes in those countries. Economic costs of work-related injury and illness vary between 1.8 and 6.0% of GDP in country estimates, the average being 4% according to the ILO. Singapore's economic costs were estimated to be equivalent to 3.2% of GDP based on a preliminary study. If economic losses would take into account involuntary early retirement then costs may be considerably higher, for example, in Finland up to 15% of GDP, while this estimate covers various disorders where work and working conditions may be just one factor of many or where work may aggravate the disease, injury, or disorders, such as traffic injuries, mental disorders, alcoholism, and genetically induced problems. Workplace health promotion, services, and safety and health management, however, may have a major preventive impact on those as well. Leadership and management at all levels, and engagement of workers are key issues in changing the workplace culture. Vision Zero is a useful concept and philosophy in gradually eliminating any harm at work. Legal and enforcement measures that themselves support companies and organizations need to be supplemented with economic justification and convincing arguments to reduce corner-cutting in risk management, and to avoid short- and long-term disabilities, premature retirement, and corporate closures due to mismanagement and poor and unsustainable work life. We consider that a new paradigm is needed where good work is not just considered a daily activity. We need to foster stable conditions and circumstances and sustainable work life where the objective is to maintain your health and work ability beyond the legal retirement age. We need safe and healthy work, for life.