Copyright P.Buckle 2000 Robens Centre for Health Ergonomics University of Surrey Europe and...

Copyright P.Buckle 2000

Robens Centre for Health ErgonomicsUniversity of Surrey

Europe and work-related neck and upper limb musculoskeletal disorders

Peter Buckle


Structure of the presentation

• Methods used to prepare review• Nature, size & cost of the disorders • Relationship between work and neck and upper

limb disorders– Biological pathology, epidemiological

evidence,workplace interventions• Strategies for Prevention

– risk assesment, existing practice, surveillance• Action and Conclusions


• Contemporary scientific literature• Expert opinion• Existing framework of Member state,

European and International Directives, standards and guidance

• Existing Practice• The needs and capacities of those who may

use the ergonomic actions that are suggested

Approaches Used


The Nature of the Disorders


Classification and Diagnosis of the Conditions

• With some conditions there is general agreement as to the nature of the disorder despite a lack of standardisation in agreed diagnostic criteria.

• In contrast, there are also predominantly symptom based conditions, where there is difficulty in identifying precisely the tissue(s) responsible.


Setting diagnostic criteria

• Different diagnostic criteria may be required dependent on the setting

• Sensitive criteria (low false negative rate) may be necessary in an occupational setting

• More highly specific criteria are required in secondary or tertiary care situations to avoid over-diagnosis


Consensus on Disorder Diagnosis

• Recognition of recent sources (e.g. Harrington et al, 1998; Coronel Institute, Amsterdam, Netherlands, 2000)

• Debate over the need for higher specificity of outcome versus the requirement to initiate common pathways for prevention with a generic approach


Size of the Problem


Guildford

155 million workers


WRULDS in the EUSize of the problem

COUNTRY STUDY/ ORGANISATION

PREVALENCE OUTCOME DEFINITION

TheNetherlands

Belgium

TNO Work &Employment

Amsterdam 1999 Blatter & Bongers 1999

Blatter et al., 1999

30.5%

39.7%

Great Britain

SWI The Health & Safety

Executive J ones et al. 1998

17%

Self-reported Symptoms ofthe neck andupper limbsin the last 12months


Percentage of self-reported muscular pain in the arms or legs

0

5

10

15

20

25

30

35

40

Per

cen

tag

e o

f re

spo

nd

ents

European Survey of Working Conditions (European Foundation, 1997)


Pathogenesis

Evidence of work causation and biological plausibility

• Biological plausibility• National Academy of Science report 1998

• Epidemiological basis• National Institute of Occupational Health and Safety report 1997


Pathomechanisms• Understanding varies across WRULDs

• Impressive knowledge (e.g. CTS)

• Knowledge base is derived from– biomechanics– mathematical modelling– direct measurement of tissue pathology

• Forms a coherent argument for biomechanically induced pathogenesis


Work-Relatedness• Epidemiological evidence shows a

strong positive relationship between WRULDs and work

– Especially for high levels of exposure

• Psychosocial and work organisation factors are also important


Force Posture (static/dynamic)VibrationCombinations of factors

DurationRepetitionIntensity/Ampl.How much? How often? How long?


Psychological and Work Organisational Risk Factors

• Evidence for a relationship between psychosocial work factors and some neck and upper limb disorders

• Definitions for these factors required

• Guidance may include job decision latitude, job demands and social support


Posture

Force

Vibration (Buff./Vacuums)

Diff. keeping up with work

Moving furniture

Repetitive work

Poor work environment

Multifactorial problem


Is there evidence that workplace interventions would reduce the risks associated with these

disorders?


Potential for intervention

• suitable evidence from both controlled and uncontrolled studies that work system interventions were effective for reducing the problem

• such interventions most likely to be successful amongst workers in high/risk exposure groups


Successful interventions• Focus should be on work organisation

interventions and work place interventions, not solely on worker interventions (i.e. training/work hardening)

• Also prudent to reduce discomfort and fatigue


Existing Directives, Standards and Guidance

• Framework for risk identification and prevention(89/391)

• Prevention of manual handling risks (90/269)

• Risks from DSE (90/270)• Min. Standards w/places

(89/654)• Working time (93/104)• Common CEN standards


Prevention Strategies• Assessment of risk factors

– postural, force applications, vibration, direct pressure, cold, psychosocial and work organisational factors

– prudent to consider fatigue as a potential precursor of WRULDs

– considered the ability of practitioners assessing risks


Main criteria for exposure assessment methods

• Cheap, easy to learn and quick to use

• Applicable to all

• Methods should not interfere with the work

• Method needs high validity, reliability and

sensitivity

• Easy coding/analysis of data


Prevention Strategies• Assessment of risk factors

– postural, force applications, vibration, direct pressure, cold, psychosocial and work organisational factors

– prudent to consider fatigue as a potential precursor of WRULDs

– considered the ability of practitioners assessing risks

• Health and surveillance programmes• A 3-zone model for action


3 Zone Model for Action

1 High Risk This zone identifies those at highest risk for thedevelopment of upper limb disorders and whereaction is almost certainly required.

2 Medium risk Work factors require close attention and remedialactions may be necessary.

3 Low Risk Areas of least concern, although some actionmay be prudent. Assessment may provide usefulinformation to inform workplace interventionselsewhere. Routine assessment and surveillanceshould be extended to this group.


Conclusions Report download http://osha.eu.int

• WRULDs are a significant problem in the EU• Biomechanical pathogenesis for some WRULDs• Epidemiological evidence shows a strong

positive relationship between (some) WRULDs and a number of work factors

• The potential benefits from work system interventions is supported by scientific knowledge …action is needed


The University of Surrey “Understanding the real world”

Robens Centre for Health Ergonomics

www.surrey.ac.uk

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