R H Westgaard’s research while affiliated with Norwegian University of Science and Technology and other places
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Background
Neck pain remains a persistent challenge in modern society and is frequently encountered across a wide range of occupations, particularly those involving repetitive and monotonous tasks. It might be expected that patterns of trapezius muscle activity at work, characterized by few breaks and prolonged periods of sustained muscle activity, are linked to neck pain. However, previous cross-sectional studies have generally failed to establish a definitive association. While some longitudinal studies have suggested that extended periods of heightened muscle activity could be a risk factor for neck pain, these findings often relied on limited participant numbers or specific professional groups. This study aimed to investigate the relationship between trapezius muscle activity and neck pain by pooling data from seven Scandinavian research institutes encompassing a diverse range of occupational backgrounds.
Methods
Electromyographic (EMG) data for the upper trapezius muscle, collected during working hours, were coupled with questionnaire responses pertaining to neck pain, individual characteristics, and potential confounding variables for a total of 731 subjects. Additionally, longitudinal data from 258 subjects were available. The various EMG datasets were consolidated into a standardized format, and efforts were made to harmonize inquiries about neck pain. Regression analyses, adjusting for sex and height, were conducted to explore the associations between muscle activity variables and neck pain. An exposure index was devised to quantify the cumulative neck load experienced during working hours and to differentiate between various occupational categories.
Results
The cross-sectional data displayed a distinct pattern characterized by positive associations for brief periods of sustained muscle activity (SUMA) and negative associations for prolonged SUMA-periods and neck pain. The longitudinal data exhibited a contrasting trend, although it was not as pronounced as the cross-sectional findings. When employing the exposure index, notable differences in cumulative muscle load emerged among occupational groups, and positive associations with longitudinal neck pain were identified.
Discussion
The results suggest that individuals with neck pain experience higher cumulative workloads and extended periods of muscle activity over the long term. In the short term, they appear to compensate by taking frequent short breaks, resulting in a lower cumulative workload. Regardless of their occupation, it is crucial to distribute work breaks throughout the workday to ensure that the cumulative load remains manageable.
Repetitive and monotonous work is often associated with neck pain, potentially resulting in sick leave and reduced productivity. Establishing appropriate muscle activity patterns, including duration and frequency of breaks that can prevent development of neck pain is important for providing workplace guidance. While several smaller studies of monotonous neck-loading work have indicated that such breaks can reduce the risk of neck pain, studies with a higher number of participants are necessary to confirm an association, and if so, to improve the precision of a possible association. The purpose of this protocol is to describe and discuss the background, methods and challenges of a study pooling several datasets with measurements of upper trapezius muscle activity during work and associated measurements of neck pain. Methods: Seven Scandinavian research institutes provided surface electromyographic (EMG) data of upper trapezius muscle activity recorded during working hours along with questionnaire data with information about neck pain and other health-related factors, from a total of 750 participants. The different data sets of the EMG data will be merged into a common format. Various questions on neck pain will be harmonized. Associations between EMG variables and neck pain will be examined with linear mixed model regressions controlled for various confounders. Discussion: Aiming to provide further insight into the possible association between trapezius muscle activity pattern and neck pain, this study protocol highlights the challenges that arise when creating a pooled data set. Solving these challenges may help to increase the knowledge about appropriate muscle activity patterns during work.
Musculoskeletal and psychological/mental disorders are major causes of sick leave, threatening the welfare of individuals and the economics of companies and societies. The prevailing research and development (R&D) of ergonomic interventions show minimal long-term effects on health and wellbeing while interventions to improve production seem to have a dominant negative effect, particularly in the health-care sector. Scientific evidence suggests that improved partnership is needed between stakeholders with different and often opposing aims, i.e., organizational productivity vs. worker wellbeing. In 2006 a Nordic R&D network, the NOVO Network, was established highlighting the need for a new approach, integrating work environment and production needs in intervention R&D. Our hypothesis is that such an integration is more readily established in the Nordic countries, largely due to their leading positions in the world in terms of social capital. Through annual symposia and other activities, the NOVO Network brings together scholars and practitioners to share knowledge and experience and to suggest and develop new areas of collaboration towards increased organizational sustainability in health care. A multicenter study conducted within the framework of the NOVO network resulted in a new, practical tool. This tool aims to facilitate partnership instead of the prevalent domination orientation, thereby combining consideration of work environment and production needs. Based on our experiences so far, this article highlights some key future challenges. As a result, we hope to see development of a stronger Nordic R&D tradition towards increased organizational sustainability in health care.
In a 2017 article published in the Scandinavian Journal of Work, Environment & Health (1), van der Beek and coworkers` make the point that workplace interventions have not been overly successful in preventing work-related musculoskeletal disorders (MSD). They present a research framework consisting of risk identification, consideration of underlying pathophysiological mechanisms, and the development, evaluation, and implementation of interventions to improve this situation. The article complements other papers that concur with the observation that there has been little progress in combating work-related MSD and pointing to deficient research strategies or risk factors insufficiently considered in past projects. In this Letter to the Editor, we argue that work-related MSD interventions based on the research framework of van der Beek et al (1) and others are unlikely to have much impact. This is based on the realization, as also expressed in an editorial in the Scandinavian Journal of Work, Environment & Health (2) that "... in real life, management and not the researcher controls the implementation of workplace interventions." Research during recent decades provides an empirical basis to state that the potential of rationalization of production systems to cause health problems is large, in contrast to the overall assessment of ergonomic interventions that seem to have limited health effects in the long-term (3). The fact that van der Beek et al (1) do not include this insight/evidence in their framework model illustrates a persistent, too-narrow approach to ergonomic intervention research among specific groups of researchers. Classical research on combating occupational MSD is rooted in the medical research tradition. The elimination of disease is the goal of most ergonomic intervention researchers recruited from the different health professions. They generally represent a research tradition whereby early investigations of risk factors and injury mechanisms are mostly physiological and/or biomechanical. Consequently, quality criteria for occupational intervention studies are adopted from medical research and randomized controlled trials (RCT) are the gold standard of occupational MSD intervention research, as detailed by Kristensen (4). This is also the position of van der Beek and coworkers (1). However, systematic reviews on ergonomic intervention research, which apply strict selection criteria including a strong focus on internal validity and the resulting data loss, may end up with conclusions of low utility. An example is Brewer et al`s systematic review (5), which described a rigorous search procedure that pruned >7000 articles down to 31 to draw conclusions on workplace interventions for computer users. Their conclusion of a positive health effect of alternative pointing devices among computer users is based on only two studies: one which tested a mouse design that has not been successful in practice and another that substituted a computer mouse with a "trackball". A similar more recent example is Oakman et al`s review (6), which identifies 2220 unique studies and ends up with only 17. These authors are aware of potential significant data loss by restricting their review to studies using RCT design. Thus, high internal validity of an ergonomic intervention study does not imply that the intervention works when implemented in practice; the external validity may be low, ie, not generalizable to other situations. The issue of "implementation of effective intervention(s)" is considered in box 6 of van der Beek et al`s model (1). They highlight the implementation process and its effects by mentioning "… two of the most extensive examples of MSD interventions implementation at the community level …". Both of these appeared to be unsuccessful. But, as indicated above, the most critical challenge to the implementation of interventions seems to occur at company level (3), and yet van der Beek et al (1) fail to discuss this. Production systems generally offer ever-changing environments, and a significant part of these changes interact with introduced ergonomic interventions (eg, 3, 7.). The RCT design does not allow for the study of these change processes. Occupational MSD intervention research, carried out in changing environments subject to various influences that are not always recognized, belongs more to the social than the medical domain. Research in the social science tradition tends to use observational or quasi-experimentation designs, often based on natural experiments. Our review of MSD health consequences of production system rationalizations (3) predominantly examined studies based on natural experiments. According to this, we adopted a "best evidence synthesis" approach (8-10) in preference to applying strict epidemiological quality criteria. In conclusion, most of the intervention research aimed at reducing occupational MSD seems to ignore the impact of interventions that aim to improve production system performance (3). This suggests that we need an expansion of the traditional MSD intervention research paradigm; ie, how to involve the stakeholders responsible for interventions that aim to improve production system performance. A key challenge is now to develop further the research framework presented by van der Beek et al (1) and others to make ergonomic intervention research relevant also to working life. High performance is a prerequisite for the survival of organizations, making production system rationalization a continuous and all-embracing process. We emphasize the wide-ranging impact of rationalizations on worker well-being and therefore suggest a change in the intervention research endpoint from "MSD prevention" to "organizational sustainability", defined as the joint consideration of competitive performance and working conditions in a long-term perspective (3). This needs to be developed in dialog with stakeholders particularly those responsible for production system development (3). The Nordic countries have a long tradition of collaboration between stakeholders with different primary objectives (work environment, efficient production systems, economic success, customer needs, etc), which seems to offer unique opportunities to carry out case studies investigating such issues (11). 1. van der Beek AJ, Dennerlein JT, Huysmans MA, Mathiassen SE, Burdorf A, van Mechelen W et al. A research framework for the development and implementation of interventions preventing work-related musculoskeletal disorders. Scand J Work Environ Health 2017 Nov;43(6):526-39. https://doi.org/10.5271/sjweh.3671. 2. Takala EP. Ergonomic interventions and prevention - a need for better understanding of implementation [editorial]. Scand J Work Environ Health 2018 Mar;44(2):111-2. https://doi.org/10.5271/sjweh.3710. 3. Westgaard RH, Winkel J. Occupational musculoskeletal and mental health: significance of rationalization and opportunities to create sustainable production systems - A systematic review. Appl Ergon 2011 Jan;42(2):261-96. https://doi.org/10.1016/j.apergo.2010.07.002. 4. Kristensen TS. Intervention studies in occupational epidemiology. Occup Environ Med 2005 Mar;62(3):205-10. https://doi.org/10.1136/oem.2004.016097. 5. Brewer S, Van Eerd D, Amick BC 3rd, Irvin E, Daum KM, Gerr F et al. Workplace interventions to prevent musculoskeletal and visual symptoms and disorders among computer users: a systematic review. J Occup Rehabil 2006 Sep;16(3):325-58. https://doi.org/10.1007/s10926-006-9031-6. 6. Oakman J, Neupane S, Proper KI, Kinsman N, Nygård CH. Workplace interventions to improve work ability: A systematic review and meta-analysis of their effectiveness. Scand J Work Environ Health 2018 Mar;44(2):134-46. https://doi.org/10.5271/sjweh.3685. 7. Winkel J, Westgaard RH. A model for solving work related musculoskeletal problems in a profitable way. Appl Ergon 1996 Apr;27(2):71-7. https://doi.org/10.1016/0003-6870(95)00061-5. 8. Slavin RE. Best evidence synthesis: an intelligent alternative to meta-analysis. J Clin Epidemiol 1995 Jan;48(1):9-18. https://doi.org/10.1016/0895-4356(94)00097-A. 9. Mindell J, Boaz A, Joffe M, Curtis S, Birley M. Enhancing the evidence base for health impact assessment. J Epidemiol Community Health 2004 Jul;58(7):546-51. https://doi.org/10.1136/jech.2003.012401. 10. Ogilvie D, Egan M, Hamilton V, Petticrew M. Systematic reviews of health effects of social interventions: 2. Best available evidence: how low should you go? J Epidemiol Community Health 2005 Oct;59(10):886-92. https://doi.org/10.1136/jech.2005.034199. 11. Winkel J, Schiller B, Dellve L, Edwards K, Neumann WP, Öhrling T et al. Scientific evidence suggests a changed approach in ergonomic intervention research. In: Osvalder A-L, Blomé M, Bodnar H, editors. Conference Proceedings "Joy at Work". The Nordic Ergonomics and Human Factors Society (NES), Lund; 2017. p 430-36.
Ergonomic interventions have generally been unsuccessful in improving workers’ health, with concurrent rationalization efforts negating potentially successful intervention initiatives. We propose the two aims are considered simultaneously, aiming at the joint consideration of competitive performance and work environment in a long-term perspective (“organizational sustainability”). A prerequisite is a high level of dialogue between the different groups of stakeholders, and we argue that the Nordic countries, through high levels of trust and justice (social capital), have unique opportunity to carry out such research. The present authors bring forth the vision of “a Nordic Model for development of more sustainable production systems”.
Background:
The present study is a follow-up study of factors contributing to an undesirable quality of work environment and sick leave rate in the home care services in a Norwegian municipality. The underlying assumption is that organizational discrepancies in the perceptions and appraisals of significant factors and processes in an organization have detrimental effects on the management of the organization and on work environment conditions. Thus, the study aim is to explore potential organizational discrepancies in the appraisals of factors relating to home care workers' working conditions.
Methods:
The study, using a mixed-methods design, comprised six home care units. It included survey responses of home care workers (80 respondents, response rate 54 %) and qualitative descriptions of stakeholders' appraisals of organizational issues gathered through semi-structured interviews (33 interviews with stakeholders at three organizational levels).
Results:
Employees at different organizational levels in the home care services expressed divergent appraisals of factors related to the working conditions of home care workers, including impact of organizational measures (i.e. time pressure, work tasks, a new work program, organizational changes, budget model, budget allocation and coping strategies). Survey responses supported interview descriptions by home care workers. Results suggest that organizational discrepancy serve as an important barrier to a sustainable, well-functioning organization in general and to quality-enhancing changes to work procedures in particular.
Conclusions:
It is recommended to improve communication channels and facilitate the exchange of information across levels to ensure a common understanding of matters significant to the organization of the home care services and to the work environment of home care workers. The prevalence and impact of organizational discrepancy should be included in organization research, particularly when exploring explanatory factors of an unhealthy organization.
Adapted from: Lømo T, Westgaard RH, Hennig R, Gundersen K. The response of denervated muscle to long-term electrical stimulation, In: Carraro U, Angelini C, eds. Proceedings of the First Abano Terme Meeting on Rehabilitation, 1985 August 28-30, Abano Terme, Padova, Italy, An International Symposium, Satellite Meeting of the XIII World Congress of Neurology, Hamburg 1985. Cleup Padova 1985. pp 81–90.
... The study found a significant positive correlation between fewer breaks and higher symptom intensity, meaning that participants who took fewer breaks reported more intense symptoms. This result is consistent with previous studies showing that frequent breaks, particularly when standing or stretching, can help reduce the accumulation of physical strain [32,33]. In contrast, individuals who remain sedentary for extended periods are more likely to experience discomfort and fatigue. ...
... The data from each institute had previously been used in publications and met specific quality standards for sensor placement, measurements, and data processing [52,53]. An overview of the EMG measurement specifications for the various datasets can be found in the protocol paper for this study [54]. ...
... It is imperative to maintain a continuous dialogue between scholars, military subject matter experts (SMEs), and ergonomic professionals to ensure the development and implementation of effective ergonomic interventions that are both scientifically rigorous and practically feasible within the unique and demanding environments of military operations. Research conducted byWinkel and Westgaard (2019) underscores the necessity of expanding traditional intervention research paradigms to include considerations of organizational sustainability alongside the prevention of musculoskeletal disorders (MSDs), which necessitates collaboration with stakeholders responsible for the development of production systems. In addition,Lundsgaard-Hansen et al. (2024) emphasize the importance of worker participation in interventions, highlighting the significance of clearly defined roles, adequate resources, and managerial commitment. ...
... Differing EMG frequencies corresponding to various oscillatory drives have been explored [32], and LF EMG features can provide insight into various parts of the brain. Low-frequency oscillations in trapezius muscle EMG have been suggested as a tool to study neural mechanisms including slow-wave cortical oscillations represented in the descending corticospinal pathways and monoaminergic pathways originating in brain stem reticular formation [33]. Consequently, the 0.5-4 Hz range has revealed neurophysiological regularities in patients with Parkinson's disease [34] suggesting the possibility for improved diagnostic capabilities of cognitive functioning. ...
... As stated, one of the common problems among workers of many industries is the awkward posture, manual handling of loads, poor bending and turning in the lumbar region. Research has shown that the prevalence of musculoskeletal disorders in many industries can be reduced by well-planned ergonomic interventions implemented through engineering and management approaches aimed at reducing awkward postures, load weight, and load carrying time, which also improve the working environment [7,8]. The commitment to an integrated approach consisting of engineering, educational and management interventions to improve the ergonomic conditions of the work environment not only reduces the incident of musculoskeletal disorders, but also increases productivity [9,10]. ...
... For example, studies have shown that under low-frequency stimulation, the contraction speed of soleus (Sol) and extensor digitorum longus (Edl) muscles exhibit significant differences due to the inherent differences in their muscle fibers. This internal variation may explain why similar nerve impulse, innervation, or hormones can have varying effects on different types of muscle fibers [48]. Additionally, type I fibers are believed to be particularly sensitive to unloading [49]. ...
... However, it primarily emphasizes eco-nomic indicators [21], often neglecting the implications for employees [22]. Rigorous ap-plication of lean manufacturing has been associated with an increase in MSDs and work stress for workers [22][23][24][25], as certain activities that are deemed non-value-adding can serve as periods of physical and mental recovery for employees [22,23,26]. Therefore, human factor analysis should be incorporated when implementing lean manufacturing [27]. ...
... These are two useful tools because they are lowcost and affordable for occupational safety professionals (9,10). However, these methods can be inaccurate because they are based on the subjective interpretation of those who make the observations and self-report (10,11). Other evaluation methods, such as Surface Electromyography (sEMG), can be used in the workplace and improve accuracy (9). ...
... Measurement of postural risks can be accomplished using standardized observation-based protocols such as the Ovako Working posture Assessment System (OWAS), Quick Exposure Check (QEC), Rapid Entire Body Assessment (REBA) and Rapid Upper Limb Assessment (RULA), but none of these tools are specific to computer work that occurs in office settings [15][16][17]. OWAS was developed for the steel industry and its risk assessment includes the weight of load handled, entire body posture and frequency of exposure. Sampling occurs using fixed-time intervals for evaluation [17]. ...