Musculoskeletal Disorder (MSD) Prevention
Centre of Research Expertise for the Prevention of Musculoskeletal Disorders CRE-MSDwww.cre-msd.uwaterloo.ca
Presented by Richard Wells, Ph.D.CRE-MSD, IWH
Presentation to the Minister of Labour’s Ergonomics Sub-Committee of the Manufacturing Panel , May 5th, 2005
MSDs: The Problem
MSDs are a problem in Ontario Reported MSDs greatly underestimate the burden MSDs have a substantial work component
What are MSDs?
“Musculoskeletal disorders (MSD) are injuries and disorders of the musculoskeletal system…
…where exposure to various risk factors present in the workplace…
…may have either contributed to the disorders' development, or aggravated a pre-existing condition”
(OHSCO MSD Strategy Development Committee, 2005)
MSDs are a problem in Ontario
For the period 1996-2002, MSD accounted for: (a) more than 40% of all lost time claims; (b) more than 48% of all lost time claim related
lost time days; and, (c) more than 42% of all lost time benefit claim
costs (averaged over the period).
Source: WSIB’s Information Warehouse and Prevention Strategy For Musculoskeletal Disorders (MSD) In Ontario
Reported MSDs greatly underestimate the burden in OntarioOffice Environment. In the last year due to MSD…
Lost days at work
Pain > 12 times or > 7 days in last year, moderate intensity
Reported to workplace
Saw health practitioner
Work aggravates pain to some extent
Any neck or upper limb pain
15%
20%
22%
29%
51%
60%
Polanyi et al 1997
Reported MSDs greatly underestimate the burden in Ontario
Not only is there a burden on the individual, but there is an Not only is there a burden on the individual, but there is an decrease in their outputdecrease in their output
Amongst the 51% of office workers who reported that Amongst the 51% of office workers who reported that their neck and upper limb pain was aggravated by their neck and upper limb pain was aggravated by work:work:
•7% had difficulty sticking to their work routine or 7% had difficulty sticking to their work routine or scheduleschedule•9% had difficulty concentrating on work9% had difficulty concentrating on work•16% had difficulty using pens, computer 16% had difficulty using pens, computer keyboards etc. for at least half of the workdaykeyboards etc. for at least half of the workday
Polanyi et al 1997
MSDs Have a Substantial Work Related Component
Risk factors for upper limb RSI/MSD in a large Canadian office
0 1 2 3 4 5
WORK ORGANIZATIONAL/ PSYCHOSOCIALFACTORS
PHYSICALFACTORS
Low skill utilization
High psychological demandsLow social supportDeadlines - weekly
Poor screen positionTime on keyboard (5h vs. 1.5h)
Female vs. Male
Relative Risk of Having ‘RSI’
Polanyi et al., (1998)
INDIVIDUALFACTORS
MSDs Have a Substantial Work Related Component
Risk factors for Low Back Pain in a Canadian auto assembly plant
0 1 2 3 4 5
Relative Risk of Low Back Pain
Work Organizational/ PsychosocialFactors
Self rated physical demands
Cumulative disk compressionPeak hand forcePeak shear
PhysicalFactors
Job satisfactionSocial support
Over-education
Social environment
Low job control
Norman et al., 1998, Kerr et al., 2001 Hagberg et al (1995), Bernard (1997), NRC/IOM (2001)
Prevention
OH&S System knows enough to prevent MSDs now; research frontiers continue to expand
Ontario needs to consider physical and work organizational factors for prevention
Different kinds of prevention activities needed at different stages of MSD
Different organizations need different supports Guidelines and Regulations Why Participatory Ergonomics? Don’t reinvent the wheel! Programs to prevent MSD
We know enough to prevent MSDs now!
Occupational risk factors can be addressed
Work organizational/ psychosocial AND physical factors are associated with high rates of MSDs
THIS IS GOOD NEWS We can change identified organizational and
physical workplace factors Individual factors are likely not as changeable
Example: Approaches to Prevention of Low Back MSD
Many approaches are talked about…
Back belts? Product redesign?
Job enlargement? Rebalancing?
Exercise programs? Lift Tables? Back school? Adjustable Platforms?
Stretching programs? Job rotation? Adjustable furniture
Hoists? Health promotion?
Teams? Improved Tools?
Eliminate/ Substitute
Engineering Controls
Administrative Controls
Personal Protective Equipment
Training
Increase workers’ capacity
Redesign (Product)
Platforms, Hoists, Rebalancing (Process) Job enlargement, Job rotation, Teams, etc
Back belts, etc
Back school, etc
Health Promotion, Exercise programs, Stretching programs, etc
Strategies to prevent low back MSD
One Root Cause of Low Back Pain
High cumulative loads on the low back
Lifting/pushing/pulling of light to moderate loads many times per shift
Holding non-upright trunk postures for long duration x 500+
http://www.ahs.uwaterloo.ca/~wells/NAACL.ppt
Interventions for Low Back Pain
Re-position load (PRODUCT- PROCESS)PROCESS)
Reduce forces (PRODUCT –PROCESS)PROCESS)
Reduce proportion of cycle loaded or total time loaded
(PRODUCT-PROCESS-ADMIN)
Reduce number of movements (PRODUCT-PROCESS-
ADMIN)
http://www.ahs.uwaterloo.ca/~wells/NAACL.ppt
Research shows we can prevent MSDs now
Mechanical lift-assists installed in acute and chronic care facilities
Earlier return to work when lift assists used
Newer ceiling lifts likely to produce even larger reductions
#Lost Time
012345678
Lift Used Lift Not Used
/100 F
TE
Pre
Post
Lost Days
0
0.51
1.5
2
2.53
3.5
Lift Used Lift Not Used
/100 F
TE
Pre
Post
Evanoff et al 2003, Engst et al 2005
Ontario needs to consider physical and work organizational factors
Because there are both physical and work environment (psychosocial) factors that contribute to disability: Physical: e.g., Forces, postures repetition Work Environment: e.g., Job Control, Supervisor
Support
Ontario needs to consider physical and work organizational factors in prevention activities
NRC/IOM (2001)
Need to consider physical and work organizational factors
Example: Garage mechanics Injured mechanics are told to change working
techniques and use lifting equipment Mechanics coped best when they were supported
by managers and supervisors Achieving positive results from MSD prevention
activities requires that organizations create positive attitudes towards work modifications.
TORP, et al 1999
Primary, Secondary and Tertiary Prevention of MSDs
"...provide workplaces that are comfortable when we are well and accommodating when we are ill." (Morken et al 2002)
Combining primary and secondary preventive interventions can yield greater impact than the sum of impacts from separately implemented interventions. (Frank et al 2005)
"...clinical management + ergonomic modification best combination..." (Loisel et al 1997 Sherbrooke Model of Workplace Disability Prevention)
Time, weeks
Sym
ptom
s/ D
isab
ility
Primary Secondary Tertiary Secondary
Reduce MSD risk factors to prevent creation or aggravation of MSD and permit the largest possible workforce to perform job… work smarter not harder
Primary, Secondary and Tertiary Prevention of MSDs
Monitoring and reporting schemes to detect MSD and initiate abatement of risk factors and restoration of health
Disability resulting in Lost Time triggering abatement of risk factors, accommo-dation to disability, restoration of musculoskeletal health and early and safe return to work
Monitoring and reporting schemes to detect MSD and initiate abatement of risk factors and restoration of health
At work, little disability or limitations
At work, some disability and
limitations
Off work, substantial
disability and limitations
At work, some disability and
limitations
?
Primary, Secondary and Tertiary Prevention of MSDs
Address all three prevention strategies simultaneously
It may not be helpful to think only in terms of these three classic types of prevention activities: MSDs tend to have a variable history A large proportion of the population will have an
MSD at some point in their life (especially low back pain)
Who benefits from (1°, 2°, 3°) prevention initiatives?
Workers whose symptoms developed as a direct result of current work
Workers who have cumulative damage from previous work experiences
Workers who develop back pain after a weekend’s yard work or caring for their small children… they have responsibilities outside work.
Workers who have age related changes
Effective Prevention…
Effective prevention of MSDs requires that workplaces need to be simultaneously performing activities that: Detect MSD’s Reduce risk factors, Accommodate disability, Facilitate restoration of musculoskeletal health Participate in early and safe return to work
You don’t have to reinvent the wheel!
MSD prevention builds on the same foundations as other workplace health and safety prevention programs… Leadership Participation Policy Training Hazard Identification Hazard Control Resources
You don’t have to reinvent the wheel!
MSD Prevention Program
Health Promotion Stress
Prevention
ABC
DF
Production Engineering
Examples:
A) Reducing vibration for LBP & HAVS
B) Improving manual materials handling for slips and falls
C) Maintaining adequate lighting for tasks
D) Improving social support for accommodation
E) Designing for lower forces and improved postures
____________________
F) Adding stretching exercises for flexibility
E
Safety Occupational Hygiene
Different organizations need different approaches to facilitate prevention
Inspections? Guidance? Recognition?
Very resistant to even consider the issue, let alone change. No real resources devoted to H&S.
They are at least willing to listen. Limited resources available.
Recognises case for prevention of MSDs Limited resources available.
Leadership commitment to take small cautious steps to reduce MSDs on a trial basis. Some resources have been made available.
Firms still need encouragement to maintain success and to integrate ergonomics as a way of doing business.
They are industry leaders in ergonomics, as well as other aspects of health, safety. Plenty of resources for H&S and ergonomics.
Organizations’ Readiness to Change
Guidelines and Regulation: Issues
“Trigger” for ActionCases of MSD Identified HazardCal OSHA BC
Specification PerformanceCEN/ISO 1005-3 CSA Office Ergonomics Forces in Machinery
Hierarchy of ControlsNone Hierarchy Identified
Specification or Performance/Process
Guidelines and Regulation: Issues
Assessment of Hazard/RiskSingle Risk Factors Multiple Risk FactorsWeight NIOSH equation
ParticipationNone Specified Full Participation
ScopeSectoral “Universal”Forestry, Manufacturing Office, Manual Handling
SizeLarge Single-Site Small Multi-SiteAuto Assembly Residential Construction
Specification or Performance?
Specification Heights, Weights moved Force Angles, Time, …
Performance Who participates Stages and
checkpoints Training ….
Specification Standard
PRO Know better when in/ not in
compliance Know when problem is
fixed
CON could limit intervention
flexibility may not apply well to our
situation Sector specific rules may
be needed… may not have enough data?
TLV may be too high or too low
Promotes approach of “just achieving compliance”?
Can be used to argue that if workplace below TLV, injuries not work- related
Performance Standard
PRO Harder to tell if in/ not in
compliance Harder to enforce? Harder to tell if the problem
has been fixed
CON Process oriented Matches business
approaches Flexible; can handle many
sectors, firm sizes, complexity of jobs etc
Does not require so many details of limits, hazard controls etc
There are many ways to fix hazards… this approach allows flexibility
Participatory Ergonomics
“The involvement of people in planning and controlling a significant amount of their own work activities, with sufficient knowledge and power to influence both processes and outcomes in order to achieve desirable goals.”
(Haines et al., 2001)
Why Participatory Ergonomics?
Participation of workers and managers makes sense and is effective in making change (Cole et al., 2005)
Ergonomics involves the relationships between people and the (work) environment... workers experience this interaction directly and thus are experts about its strengths and weaknesses ...conversely, managers are responsible for resource allocation.
Prevention Programs
Awareness... MSDs are real, cost a lot of money, MSD risk factors exist in Ontario workplaces, but something can be done
Making the case for prevention... businesses in “your” sector can and are making changes to prevent MSDs
Programs to use... here are some approaches that are incorporated into organizations
Regulations... this is what must be done as a minimum
Programs To Prevent MSD
Hazard Identification
Hazard Evaluation Control Strategy
Engineering Administrative Personal
Protective Equipment
Training and Education
Participation
Prevention
OH&S System knows enough to prevent MSDs now; research frontiers continue to expand
Ontario needs to consider physical and work organizational factors for prevention
Different kinds of prevention activities needed at different stages of MSD
Different organizations need different supports Guidelines and Regulations Why Participatory Ergonomics? Don’t reinvent the wheel! Programs to prevent MSD
Sources Cited
Cole DC, Rivilis I, Van Eerd D, Cullen K, Irvin E, Kramer D. Effectiveness of Participatory Ergonomic Interventions, a Systematic Review. A report to the Ontario Workplace Safety and Insurance Board. January, 2005
Engst, C., Chokar, R., Miller, A., Tate, R.B., Yassi, A Effectiveness of Overload Lifting Devices in Reducing the Risk of Injury to Care Staff in Extended Care Facility Ergonomics 48 : 48(2):187-199 2005.
Evanoff, B., Wolf, L., Aton, E., Canos, J., Collins, J. Reduction in Injury Rates in Nursing Personnel through Introduction of Mechanical Lifts in the Workplace, American Journal of Industrial Medicine 44(5): 451 – 457, 2003
Haines Frank, F., Cullen, K., IWH Ad Hoc Working Group* Preventing Injury, Illness and Disability at Work:
The View from Canada, IWH Working Paper Kerr, M.S., Frank, S.W., Shannon, H.S., Norman, R.W., Wells, R.P., Neumann, W.P., and Bombardier,
C. and the OUBPS group. Biomechanical and psychosocial risk factors for low-back pain at work. American Journal of Public Health, 91:1069-1075, 2001.
Loisel P, Abenhaim L, Durand P, Esdaile JM, Suissa S, Gosselin L et al. A population-based, randomized
clinical trial on back pain management. Spine 1997; 22(24):2911-2918. Morken, T., et al. Effects of a Training Program to Improve Musculoskeletal Health among Industrial
Workers - Effects of Supervisor's Role in the Intervention International Journal of Industrial Ergonomics 30(2):115-12, 2002.
National Research Council /Institute of Medicine, Musculoskeletal disorders and the workplace, National Academy Press, Washington, DC, 2001.
Norman, R., Wells, R., Neumann, P*., Frank, J., Shannon, H. and Kerr, M. A Comparison of Peak vs Cumulative Physical Loading Factors for Reported Low Back Pain in the Automobile Industry, Clinical Biomechanics, 13(8): 561-573, 1998.
Sources Cited
OHSCO MSD Strategy Development Committee. PREVENTION STRATEGY FOR MUSCULOSKELETAL DISORDERS (MSD) IN ONTARIO. February, 2005
Polanyi, M., Cole, D., Beaton, D., Chung, J*., Wells, R., Abdolell, M., Beech-Hawley, L*., Ferrier, S., Mondlock, M.., Sheilds, S., Smith. J. and Shannon, H. Upper-limb Work Related Musculoskeletal Disorders Among Newspaper Employees: Cross-sectional Survey Results. American Journal of Industrial Medicine, 1997, (32):620-628.
Torp, S., Riise, T., Moen, B.E. How the Psychosocial Work Environment of Motor Vehicle Mechanics May Influence Coping with Musculoskeletal Symptoms Work and Stress 13(3):193 - 203,1999
Recommended
