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Some Observations about Ergonomic Issues Surrounding Musculoskeletal Pain Cases
Abstract
A study was conducted using patients with musculoskeletal disorders, to aid with the development of a model system for providing work place ergonomic accommodations for elderly and disabled workers. An ergonomic assessment module was added to the multi-disciplinary quantified functional assessment of patients with musculoskeletal disorders. Thirty-eight patients (22 female, 16 male) were interviewed by an ergonomist. All of these patients had chronic back pain and other musculoskeletal problems such as leg, head, neck, shoulder or hand pain. The ergonomics module was a 30-minute interview in which information on the current or previous work tasks, equipment, frequency, forceful exertions, and work positions was collected. Observations based on interactions with the medical team providing service demonstrated that data gathered during the ergonomics module resulted in substantially more information about a person's interactions within the work environment than the standard clinical team's assessment.
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Occupational musculoskeletal disorders represent a major challenge to the injured worker, his or her family, the various health care, health and safety, and human resource professionals that work in this area as well as employers and the workers' compensation system. The epidemiology of the occupational musculoskeletal disorders and work disability indicate the problem is growing. Given the multiple factors that contribute to work disability and the complexity in the return to work process, the need to address the varied factors that contribute to work disability has become increasingly clear. Following a review of the magnitude of the problem, a conceptual framework that considers the multivariate nature of work disability is proposed as a heuristic for research and practice. Such an integrated approach argues for a broader consideration of work disability from a biomedical, biomechanical, and psychosocial framework. Last, this paper summarizes efforts to date in the areas of prevention, evaluation, and rehabilitation. The paper suggests that a number of factors have converged over the past 5–10 years that point to the need for a new approach to the problem of work disability, one that truly attempts to integrate the diverse groups and approaches of the past and seeks to develop new knowledge and strategies. It is expected that the Journal of Occupational Rehabilitation will facilitate such an integration.
Knowledge of physical work requirements is necessary for determining if a job can be performed by a given person or population. It is also necessary for assessing the risk of fatigue, discomfort and musculoskeletal disease. We have proposed a hierarchical job analysis system that includes four levels of analysis. Level I is based on worker and supervisor interviews and provides descriptions of work tasks, materials, equipment, work environment and activities that may challenge a given person's work capacity or result in excess risk of injury or illness. A Level II analysis is based on direct work site observations and measurements and provides additional quantification of the data obtained from Level I. A Level III analysis is based on expert ratings of ergonomic stresses: repetition, force, contact stress and posture of each task. A Level IV analysis uses instrumentation, e.g., goniometers, electromyography, force gages and accelerometers, to provide quantification of specific task attributes.
A model system is proposed to help understand the relationship between personal and work factors that affect participation in work. The proposed model includes a hierarchical open-ended format for considering worker and job properties with special emphasis on musculoskeletal disorders. The first level of the analysis is based on information that can be obtained from interviewing patients, workers, supervisors and health care providers, and provides broad categories of information that can be used to anticipate barriers to working and to plan further studies to evaluate and overcome barriers. The sequence and depth of subsequent analysis depends on the circumstances, e.g., finding a new job, returning to work following an injury, or a new job design. If the worker is undergoing medical treatment, the treating health care provider usually has final authority for the return to work decisions, although the decisions can be greatly influenced by job information provided. Two cases are presented to illustrate development and application of the model.
Therapeutics as diverse as surgery, manipulation, and behavior modification can be intended to restore function for people with spinal disorders. However, the term "functional restoration" was coined by Tom Mayer and Vert Mooney to specify interdisciplinary programmatic care geared toward minimizing disability. Functional restoration emphasizes physical and behavioral improvements over pain eradication and relies heavily on guidance from repeated quantification of function. Unlike a comprehensive review, this report is meant to briefly update the reader on selected issues in functional restoration and to suggest directions for future developments.
Several physical stressors, including repetitive, sustained, and forceful exertions, awkward postures, localized mechanical stress, highly dynamic movements, exposures to low temperatures, and vibration have been linked to increased risk of work-related musculoskeletal disorders. Repetitive exertions have been among the most widely studied of these stressors, but there is no single metric for assessing exposure to repetitive work. A new methodology enables repetitive hand activity to be rated based on observable characteristics of manual work. This method uses a series of 10-cm visual-analog scales with verbal anchors and benchmark examples. Ratings for repetition reflect both the dynamic aspect of hand movements and the amount of recovery or idle hand time. Trained job analysis experts rate the jobs individually and then agree on ratings. For a group of 33 jobs, repetition ratings using this system were compared to measurements of recovery time within the cycle, exertion counts, and cycle time. Amount of recovery time within the job cycle was found to be significantly correlated with the analysis ratings (r2 = 0.58), as were the number of exertions per second (r2 = 0.53). Cycle time was not related to the analyst ratings. Repeated analyses using the new method were performed 1 1/2 to 2 years apart on the same jobs with the same group of raters. Ratings for repetition differed less than 1 point (on the 10-cm scale), on average, among the different sessions. These results indicate that the method is sensitive to exertion level and recovery time, and that the decision criteria and benchmark examples allow for a consistent application of these methods over a period of time. This method of rating repetition can be combined with similar scales for other physical stressors.