Musculoskeletal Disorders and the Workplace Low Back and Upper Extremities (2001) / Chapter Skim
Currently Skimming:
Introduction
Introduction
Pages 17-37
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 17... ...
Estimated workers' compensation costs associated with these lost workdays range from $13 to $20 billion annually. However, in order to determine the total economic burden, indirect costs related to such factors as lost wages, lost productivity, and lost tax revenues must be added to the cost of compensation claims, leading to estimates as high as $45 to $54 billion annually for musculoskeletal disorders reported as work-related.
|
From page 18... ...
in lanuary 1999, to conduct a two-year study of the contribution of workplace physical and psychosocial factors to the occurrence of musculoskeletal disorders of the low back and upper extremities and to examine the effectiveness of various prevention strategies. The panel is composed of 19 experts representing the fields of biomechanics, epidemiology, hand surgery, human factors engineering, internal medicine, nursing, occupational medicine, orthopedics, physical medicine and rehabilitation, physiology, psychology, quantitative analysis, and rheumatology.
|
From page 19... ...
, epicondylitis, carpal tunnel syndrome, tendinitis, tenosynovitis of the hand and wrist (including DeQuervain's stenosing tenosynovitis, trigger finger, and others) , and a variety of nonspecific wrist complaints, syndromes, and regional discomforts lacking clinical specificity.
|
From page 20... ...
Personal characteristics and other environmental and sociocultural factors usually play a role as risk factors in work-related illnesses and diseases. These are more common than occupational diseases, which are at one end of the work-relatedness spectrum, whereby the relationship to specific causal factors at work has been fully established and the factors concerned can be identified, measured, and eventually controlled.
|
From page 21... ...
These criteria are detailed later in this chapter. APPROACH TO THE PROBLEM In responding to its charge, the panel conducted a comprehensive review of the scientific literature describing the biological responses to load on tissue; biomechanical models of static, dynamic, and repetitive motion and the effects of various forces and loads on the body; the relationships among the occurrence of musculoskeletal disorders and physical work, social and organizational factors, activities outside the workplace, and individual differences; changes in the workplace or the addition of workplace programs designed to reduce the risks for the occurrence of musculoskeletal disorders; and trends in workplace charac
|
From page 22... ...
one on economic and cultural context factors that influence the reporting and duration of these disorders. In addition, the panel was given the opportunity to observe work performed at two Ford Motor Company automobile plants and to hold discussions with union representatives, plant managers, and members of ergonomics teams.
|
From page 23... ...
The information gathered in the site visit to Ford Motor Company and in the presentations enriched the panel's discussions of workplace activities and the effectiveness of various intervention strategies in selected work environments. THE WHOLE PERSON: INJURY, ILLNESS, AND DISEASE We begin the discussion with some basic concepts that guided the panel's analysis of the scientific literature.
|
From page 24... ...
Such evidence may include the extent to which the patient's symptoms are characteristic of the disorder under consideration, the degree to which the findings on physical examination are consonant with it, the presence of predisposing factors and precipitating events sufficient to lend support to the diagnosis, and the level of confirmation available from objective studies, such as laboratory tests, electrocardiograms, and X-rays. Assessments lacking such objective medical evidence can sometimes achieve high degrees of diagnostic reliability, as is the case in some pain syndromes in other areas, for example, classic migraine headache, angina pectoris, and premenstrual syndrome, although in may instances presenting syndromes are less specific.
|
From page 25... ...
Clinical judgment, that is, the weighing of all of the evidence by the physician, is thus an important factor in arriving at a diagnostic conclusion. Not infrequently, pain syndromes related to the low back or upper extremities do not satisfy rigorous diagnostic criteria for well-defined clinical entities.
|
From page 26... ...
Although denial of requests for behavioral health evaluations may be based on claims adjusters' fears of adding a secondary "mental claim" to a primary "physical claim," related to a belief among claims adjusters that such an addition drives up the cost of the claim significantly, an analysis of detailed medical costs for back pain by private workers' compensation carriers indicates that psy
|
From page 27... ...
A similarly low percentage of health care costs was allocated to behavioral health services in a large group of federal workers diagnosed with carpal tunnel syndrome or tendinitis of the elbow managed within the federal workers' compensation system (Feuerstein et al., 1998~. Workplace and individual psychosocial factors can interact with ergonomic factors to affect clinical and functional outcomes even in those workers not receiving workers' compensation and actively working with pain.
|
From page 28... ...
Most research on musculoskeletal disorders in the workplace has focused on physical exposures and psychosocial factors, and indeed these factors are treated in greatest detail in this report. Here we briefly discuss the potential impact of economic incentives, workplace organizational policies, and research, because in our view these are important to any interpretation of the basic scientific data on the relationship between exposure and rates of worker disability.
|
From page 29... ...
~ 1 ~\ Mechanical Axis /\ / FIGURE 1.1 Risk factors for the injury, impairment, and disability attributed to musculoskeletal disorders in the individual. who would otherwise return to work to remain absent longer, lower rates may prompt others to return to work too early, while still symptomatic, and with significant functional limitations.
|
From page 30... ...
studied the role of organizational policies and practices on the frequency and duration of worker disability among employees of 220 companies in Michigan in 1991. Firms that reported maintaining safe equipment, investigating risks and accidents promptly, enforcing safety policies, and emphasizing safety in all aspects of operations had fewer lost workdays.
|
From page 31... ...
In addition, symptoms, disease, injury, and disability have varying meaning among individuals, reflecting a wide array of psychological and social responses. The spheres in Figure 1.1 represent individual risk factors for musculoskeletal disorders and their potential interaction with mechanical stressors one sphere contains the mix of the individual's psychological characteristics, such as coping strategies, and his or her social context; the second includes physiological characteristics of the individual, including tissue response to load, age, and the presence of medical comorbidities; and the third includes mechanical exposures, such as physical job demands resulting in external loading.
|
From page 32... ...
The mechanical exposure sphere represents factors associated with physical load arising in the environment physical work procedures and equipment as well as physical activity outside the workplace. Physical work procedures include activities such as lifting, reaching, bending, twisting, and repetitive motion, all of which affect the physical load experienced by body tissues.
|
From page 33... ...
Workplace factors include the external physical loads associated with job performance, as well as organizational factors, and social context variables. The person is identified as the central biological entity subject to biomechanical loading with the various physical, psychological, and social features associated with the individual that may influence the biological, clinical, and disability response.
|
From page 34... ...
For example, epidemiology typically searches for associations between external loading characteristics and reported outcomes, whereas the relationship between external loads and biomechanical loading is usually explored via biomechanical studies (adapted from National Research Council, l999b)
|
From page 35... ...
The arrows between workplace factors, the individual factors and the biomechanical loading mechanism provide a roadmap for the panel's analysis of the relationships that have been examined in the scientific literature. This framework is used throughout the book to structure the presentation and assessment of the evidence.
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.