Musculoskeletal Disorders and the Workplace Low Back and Upper Extremities (2001) / Chapter Skim
Currently Skimming:
Interventions in the Workplace
Interventions in the Workplace
Pages 301-329
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From page 301... ...
. Although there is significant overlap between secondary and tertiary prevention strategies, we have not addressed the extremely complex issues regarding the medical management of or workplace accommodations for those with chronic musculoskeletal disabilities.
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This conceptual model is also useful to understand how workplace interventions are used to control potentially adverse conditions. Primary and secondary interventions may prevent adverse outcomes by reducing or eliminating external loads, changing organizational factors, altering the social environment, improving individual stress-coping skills, or matching the physical demands of the job with the employee's physical capacities.
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Interpersonal relationships among employees and supervisors may also influence physical stress exposure. For example, physical stresses in a cooperative work environment often are reduced when employees informally assist one other.
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in response to the outcomes. Emerging evidence indicates that work-related musculoskeletal disorders and associated disability are the consequence of a complex interplay among medical, social, work organizational, biomechanical, and workplace and individual psychosocial factors.
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, and they may elucidate features of the physical work environment, work tasks, work organization, psychosocial environment, and worker characteristics relevant to intervention (see Figure 1.2~. Intervention can be indicated by case, data, and risk factors identified through surveillance.
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When risk factors are identified, job design or redesign, including engineering or administrative controls, is used for eliminating or reducing work-related risk factors or exposure to those factors. lob analysis consists of a work methods analysis, based on traditional techniques of time-and-motion study to determine the work content of the job, and a systematic analysis of risk factors (Armstrong et al., 1986~.
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Such interventions are often categorized as engineering controls, administrative or production controls, or personal modifiers. Although risk factors are frequently cited in the literature, acceptable exposure levels have not yet been determined for all individual and combined factors.
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documentation in English. In addition to these inclusion criteria, this review selected interventions based on seven quality criteria.
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Collectively, the data in these six reviews indicate that certain engineering controls (e.g., ergonomic workplace redesign) , administrative controls (specifically, adjusting organizational culture)
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These findings are consistent with the literature reviews discussed in the previous section. The findings of the six secondary intervention studies were also in agreement with the literature reviews described above in reporting that engineering controls, exercise (two of three studies)
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Review of this table further indicates that administrative controls were also used, often in conjunction with engineering controls, and these cases quite often reported a positive impact on low back pain. The administrative controls reported consisted of worker rotation and ramping in of work, lifting teams for patient transfer in health care, and process control.
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Considering the mechanisms by which various interventions influence the sequence of events described in the model illustrated in Figure 1.2, one can identify the consistent logical pathways that correspond to the interventions judged effective by both the high-quality and best practices assessments. For example, on one hand, engineering and administrative controls would be expected to affect the physical exposure to structure loading, thereby reducing risk.
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The prominent physical risk factors reported include excessive force, repetitive movements, vibration, and cold temperatures, separately and together. The prominent psychosocial factors reported are not so easily characterized, but standardized measures that have been associated with upper extremity musculoskeletal disorders include high job stress; high job demands; nonwork-related worry, tension, and psychological distress; perceptions of the degree of support from supervisors and coworkers; and perceived lack of control over high work demands.
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That review grouped primary and secondary interventions to reduce the incidence of upper extremity musculoskeletal disorders into three general categories: engineering controls, administrative controls, and modifier interventions. Engineering Controls There have been several studies of interventions in circumstances in which the initial physical exposures to the upper extremities are high (e.g., repetition rate, grip force, and posture extremes)
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Recent Intervention Studies Several pre-/postintervention studies have been conducted since the review by Westgaard and Winkle. These studies have evaluated various primary and secondary interventions that could affect upper extremity musculoskeletal disorders.
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Taken together, these studies provide some limited evidence that reducing sustained awkward postures, a risk factor among computer users identified in the epidemiology chapter (Appendix Table 4.6) , can lead to a reduction in pain in the associated region of the upper extremity and neck.
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(1988) , in a more controlled study of the effects of in-plant exercise on musculoskeletal symptoms, found no statistically significant difference in localized posture discomfort scores between employees who did and did not participate in an on-thejob exercise program aimed at controlling musculoskeletal symptoms of the neck and upper limb.
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Conditioning exercise programs may make participants feel better about themselves (Silverstein, 1988; Moore and Garg, 1998) and may encourage workers to attend to physical activity.
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In particular, engineering controls and administrative controls, such as periodic rest breaks and job rotation, were most frequently accompanied by employee involvement, management support, and training. All programs included either engineering or administrative controls in addition to personal modifiers (such as exercise, training, light duty, or medical management)
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From page 321... ...
. A continuing program of cooperative research would provide further understanding of the features of specific interventions that best account for their effectiveness (e.g., elucidating the characteristics of relevant work organizational factors, assessing the effect of job rotation as an intervention, and clarifying the mechanisms whereby psychosocial factors, individual worker characteristics, and organizational culture interact with interventions.
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322 MUSCULOSKELETAL DISORDERS AND THE WORKPLACE TABLE 8.4 Case Study Best Practices Observations Upper Extremities and Neck Focus Personal Modifiers Engineering Administrative/ Exercise/ Light Environment/Industry Controls Production Stretching Duty Large Manufacturing 3M ./ ./ Process PPG ./ ./ Process Hay & Forge ./ ./ Process Ford ./ ./ Process Samsonite ./ ./ Process ~ Frito-Lay ./ ./ Process/Rotation -' Construction Bechtel TDC Apparel Red Wing Shoe Sequins International Field crest-C annon Sara Lee Knit Products Small Manufacturing Rocco Enterprises Charleston Forge Lunt Silversmiths Perdue, Inc. Woodpro Cabinetry Farmland Foods Maritime Bath Iron Works Newport News Shipbuilding Utilities PG&E Montana Power Warehousing Murphy Warehousing Co.
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INTERVENTIONS IN THE WORKPLACE emities 323 Personal Modifiers Positive Exercise/ Light Multiple Employee Management Medical Impact Stretching Duty Interventions Involvement Support Training Management Reported / fir
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, a set of analytical techniques is available to address questions of cost outcome. These techniques include: cost-benefit analysis, which expresses both costs and benefits in monetary terms; cost-effectiveness analysis, which expresses outcomes in terms that may not be monetary (e.g., lost work days, reported pain)
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The combined framework (see Box 8.1) is augmented by factors described in existing cost-outcome studies for musculoskeletal disorders; this framework identifies types of costs and benefits that can be considered as part of future efforts toward the development of an accepted methodology that will permit comparison across alternative interventions.
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in understanding and utilizing the range of possible workplace interventions designed to reduce musculoskeletal disorders. Expanding continuing education for a broad range of professionals concerning risk factors for musculoskeletal disorders in and out of the workplace and concerning interventions would also be useful.
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The weight and pattern of the evidence supports the conclusion that primary and secondary prevention interventions to reduce the incidence, severity, and consequences of musculoskeletal injuries in the workplace are effective when properly implemented. The evidence suggests that the most effective strategies involve a combined approach that takes into account the complex interplay between physical stressors and the policies and procedures of industries.
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6. Study of the relationship between exposure to physical and psychosocial risk factors and musculoskeletal disorders has been constrained by inadequate techniques for quantitative measurement of "dose," analogous to available measures for noise or chemicals.
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