Transcript Musculoskeletal Disorder (MSD) Prevention

Musculoskeletal Disorder (MSD)
Prevention
Centre of Research Expertise for the Prevention of Musculoskeletal
Disorders CRE-MSD
www.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
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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).
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Source: WSIB’s Information Warehouse and Prevention Strategy For Musculoskeletal
Disorders (MSD) In Ontario
Reported MSDs greatly
underestimate the burden in Ontario
Office Environment. In the last
year due to MSD…
Lost days at work
15%
Pain > 12 times or > 7 days in
last year, moderate intensity
20%
Reported to workplace
22%
Saw health practitioner
29%
Work aggravates pain to some
extent
51%
Any neck or upper limb pain
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
decrease in their output
Amongst the 51% of office workers who reported that
their neck and upper limb pain was aggravated by
work:
•7% had difficulty sticking to their work routine or
schedule
•9% had difficulty concentrating on work
•16% had difficulty using pens, computer
keyboards 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
Deadlines - weekly
Low social support
High psychological demands
Low skill utilization
WORK
ORGANIZATIONAL/
PSYCHOSOCIAL
FACTORS
Time on keyboard (5h vs. 1.5h)
Poor screen position
INDIVIDUAL
FACTORS
Female vs. Male
0
1
2
3
4
PHYSICAL
FACTORS
5
Relative Risk of Having ‘RSI’
Polanyi et al., (1998)
MSDs Have a Substantial Work
Related Component
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Risk factors for Low Back Pain in a Canadian auto assembly plant
Self rated physical demands
Cumulative disk compression
Peak hand force
Peak shear
Job satisfaction
Social support
Work
Organizational/
Psychosocial
Factors
Over-education
Social environment
Low job control
0
1
2
3
4
Physical
Factors
5
Relative Risk of Low Back Pain
Norman et al., 1998, Kerr et al., 2001 Hagberg et al (1995), Bernard (1997), NRC/IOM (2001)
Prevention
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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?
Strategies to prevent low back MSD
Eliminate/ Substitute
Redesign (Product)
Engineering Controls
Platforms, Hoists,
Rebalancing (Process)
Job enlargement, Job
rotation, Teams, etc
Administrative Controls
Personal Protective
Equipment
Back belts, etc
Training
Back school, etc
Increase workers’
capacity
Health Promotion,
Exercise programs,
Stretching programs, etc
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)
 Reduce forces
(PRODUCT –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
8
7
6
5
4
3
2
1
0
Pre
Post
Lift Used
3.5
3
2.5
2
1.5
1
0.5
0
Pre
Post
Lift Used
Evanoff et al 2003, Engst et al 2005
Lift Not Used
Lost Days
/100 FTE
 Mechanical liftassists installed in
acute and chronic
care facilities
 Earlier return to
work when lift
assists used
 Newer ceiling lifts
likely to produce
even larger
reductions
/100 FTE
#Lost Time
Lift Not Used
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)
Primary, Secondary and Tertiary
Prevention of MSDs
Symptoms/ Disability
Primary
Reduce MSD risk
factors to prevent
creation or
aggravation of MSD
and permit the
largest possible
workforce to perform
job… work smarter
not harder
At work, little
disability or
limitations
Secondary
Monitoring and
reporting schemes
to detect MSD and
initiate abatement
of risk factors and
restoration of
health
At work, some
disability and
limitations
Tertiary
Secondary
Disability resulting in
Lost Time triggering
abatement of risk
factors, accommodation 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
Off work,
substantial
disability and
limitations
At work, some
disability and
limitations
?
Time, weeks
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:
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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!
Examples:
A) Reducing vibration for LBP
Safety
Occupational
& HAVS
Hygiene
B) Improving manual
C
materials handling for
B
A
slips and falls
C) Maintaining adequate
Production
lighting for tasks
MSD Prevention
Engineering E
D) Improving social support
Program
for accommodation
E) Designing for lower forces
D
F
and improved postures
Health
____________________
Stress
Promotion
Prevention
F) Adding stretching
exercises for flexibility
Different organizations need different
approaches to facilitate prevention
Organizations’ Readiness to Change
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.
Inspections?
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.
Guidance?
Firms still
need
encouragem
ent 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.
Recognition?
Guidelines and Regulation: Issues
Specification or Performance/Process
Specification
Performance
CEN/ISO 1005-3
Forces in Machinery
CSA Office Ergonomics
“Trigger” for Action
Cases of MSD
Cal OSHA
Identified Hazard
BC
Hierarchy of Controls
None
Hierarchy Identified
Guidelines and Regulation: Issues
Assessment of Hazard/Risk
Single Risk Factors
Weight
Multiple Risk Factors
NIOSH equation
Participation
None Specified
Full Participation
Size
Large Single-Site
Auto Assembly
Small Multi-Site
Residential Construction
Scope
Sectoral
Forestry, Manufacturing
“Universal”
Office, Manual Handling
Specification or Performance?
Specification
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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
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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
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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
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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
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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
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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