Development and evaluation of RAMP II - a practitioner’s tool for assessing musculoskeletal disorder risk factors in industrial manual handling

Abstract RAMP II is an observation-based tool developed for assessing a wide range of musculoskeletal disorder risk factors related to industrial manual handling. RAMP II, which is part of the RAMP tool, is based on research studies and expert judgments. The assessment relies mainly on direct or video observations of the work being assessed, but additionally on measured push/pull forces and weights of handled objects, and on perceived workload and discomfort. Over 80 practitioners participated in the development of the tool. According to the evaluations, 73% of the assessment items evaluated had acceptable reliability, and the majority of the potential end-users reported that RAMP II is usable for assessing risks and as a decision base. It is concluded that this study provides support that RAMP II is usable for risk assessment of musculoskeletal disorder risk factors in industrial manual handling. Practitioner summary: RAMP II is an observation-based assessment tool for screening and assessing major musculoskeletal exposures in industrial manual handling jobs. Over 80 practitioners participated in the development of the tool. This study provides support that RAMP II is usable for risk assessment of musculoskeletal disorder risk factors in industrial manual handling. Abbreviations: CTS: carpal tunnel syndrome; HARM: the Hand Arm Risk Assessment method; IMP: intramuscular pressure; κw: linearly weighted kappa; LBD: lower back disorders; LBP: lower back pain; MAWL: maximum acceptable weight of lift; MHO: manual handling operations; MSD: musculoskeletal disorder; MNSD: neck-shoulder disorder; NSP: neck-shoulder pain; OCRA: the Occupational Repetitive Action methods; OHS: occupational health and safety; PABAK: prevalence and bias adjusted kappa; p0: proportion of agreement; RAMP: Risk Assessment and Management tool for manual handling Proactively; ROM: range of motion; RPL: risk and priority level; RSI: the Revised Strain Index; RULA: the Rapid Upper Limb Assessment; SWEA: Swedish Work Environment Authority; UEMSDs: upper-extremity work-related musculoskeletal disorders; WMSD: work-related musculoskeletal disorder; WRMSD: work-related musculoskeletal disorder; workday8h: eight hours workday

[1]  Anil Mital,et al.  Manual Materials Handling , 1989 .

[2]  Rolf P Ellegast,et al.  A technical support tool for joint range of motion determination in functional diagnostics - an inter-rater study , 2015, Journal of Occupational Medicine and Toxicology.

[3]  D. Chaffin Localized muscle fatigue--definiton and measurement. , 1973, Journal of occupational medicine. : official publication of the Industrial Medical Association.

[4]  A. Jamshidi,et al.  Squatting, sitting on the floor, or cycling: are life-long daily activities risk factors for clinical knee osteoarthritis? Stage III results of a community-based study. , 2009, Arthritis and rheumatism.

[5]  Mikael Forsman,et al.  Inter- and intra- observer reliability of risk assessment of repetitive work without an explicit method. , 2017, Applied ergonomics.

[6]  Don B. Chaffin,et al.  Working Postures and Movements: Tools for Evaluation and Engineering , 2005 .

[7]  W S Marras,et al.  Biomechanical risk factors for occupationally related low back disorders. , 1995, Ergonomics.

[8]  R Kadefors,et al.  Intramuscular pressure in the supraspinatus muscle , 1988, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[9]  Å. Kilbom,et al.  Repetitive work of the upper extremity: Part II — The scientific basis (knowledge base) for the guide , 1994 .

[10]  T R Waters,et al.  Accuracy of measurements for the revised NIOSH lifting equation. National Institute for Occupational Safety and Health. , 1998, Applied ergonomics.

[11]  J. Winkel,et al.  Occupational and individual risk factors for shoulder-neck complaints: Part II — The scientific basis (literature review) for the guide , 1992 .

[12]  Esa-Pekka Takala,et al.  Individual Factors, Occupational Loading, and Physical Exercise as Predictors of Sciatic Pain , 2002, Spine.

[13]  Alex Burdorf,et al.  Associations between work-related factors and the carpal tunnel syndrome--a systematic review. , 2009, Scandinavian journal of work, environment & health.

[14]  Thomas H. Christophel,et al.  Coupling between wrist flexion-extension and radial-ulnar deviation. , 2005, Clinical Biomechanics.

[15]  Helena Franzon,et al.  DEVELOPMENT, IMPLEMENTATION AND DISSEMINATION OF RAMP : RISK MANAGEMENT ASSESSMENT TOOL FOR MANUAL HANDLING PROACTIVELY , 2011 .

[16]  Alfred Franzblau,et al.  Review of Epidemiologic Studies on Occupational Factors and Lower Extremity Musculoskeletal and Vascular Disorders and Symptoms , 2005, Journal of Occupational Rehabilitation.

[17]  S H Snook,et al.  Psychophysical study of six hand movements , 2001, Ergonomics.

[18]  D Norbäck,et al.  Carpal tunnel syndrome (CTS) and exposure to vibration, repetitive wrist movements, and heavy manual work: a case-referent study. , 1989, British journal of industrial medicine.

[19]  Alain Delisle,et al.  Reproducibility and validity of workers' self-reports of physical work demands. , 2005, Scandinavian journal of work, environment & health.

[20]  W S Marras,et al.  Industrial wrist motions and incidence of hand/wrist cumulative trauma disorders. , 1994, Ergonomics.

[21]  Carl Mikael Lind,et al.  Pushing and pulling: an assessment tool for occupational health and safety practitioners , 2018, International journal of occupational safety and ergonomics : JOSE.

[22]  Maria Pia Cavatorta,et al.  An observational method for Postural Ergonomic Risk Assessment (PERA) , 2017 .

[23]  L McAtamney,et al.  RULA: a survey method for the investigation of work-related upper limb disorders. , 1993, Applied ergonomics.

[24]  Pascal Madeleine,et al.  Are forward bending of the trunk and low back pain associated among Danish blue-collar workers? A cross-sectional field study based on objective measures , 2015, Ergonomics.

[25]  A. J. Conger Integration and generalization of kappas for multiple raters. , 1980 .

[26]  D. Houy Range of Joint Motion in College Males , 1983 .

[27]  D. Anton Occupational biomechanics , 1986 .

[28]  J. Groothoff,et al.  Perceived job demands relate to self-reported health complaints. , 2008, Occupational medicine.

[29]  Jay Kapellusch,et al.  The Revised Strain Index: an improved upper extremity exposure assessment model , 2017, Ergonomics.

[30]  T D Cahalan,et al.  The relationship between wrist position, grasp size, and grip strength. , 1992, The Journal of hand surgery.

[31]  Jack P. Callaghan,et al.  Decision times and errors increase when classifying trunk postures near posture bin boundaries , 2008 .

[32]  Fredric Gerr,et al.  A prospective study of computer users: II. Postural risk factors for musculoskeletal symptoms and disorders. , 2002, American journal of industrial medicine.

[33]  Jason Devereux,et al.  The combined effect of physical, psychosocial/organisational and/or environmental risk factors on the presence of work-related musculoskeletal symptoms and its consequences. , 2014, Applied ergonomics.

[34]  Anne Moore,et al.  The effects of cycle time on the physical demands of a repetitive pick-and-place task. , 2007, Applied ergonomics.

[35]  S. G. Heuvel,et al.  Do work-related physical factors predict neck and upper limb symptoms in office workers? , 2006, International archives of occupational and environmental health.

[36]  Anil Mital,et al.  A guide to manual materials handling , 1993 .

[37]  Andrew Merryweather,et al.  The NIOSH Lifting Equation and Low-Back Pain, Part 1 , 2014, Hum. Factors.

[38]  J Ekholm,et al.  Intensity and character of pain and muscular activity levels elicited by maintained extreme flexion position of the lower-cervical-upper-thoracic spine. , 2020, Scandinavian journal of rehabilitation medicine.

[39]  A Magora,et al.  Investigation of the relation between low back pain and occupation. 3. Physical requirements: sitting, standing and weight lifting. , 1972, IMS, Industrial medicine and surgery.

[40]  P M Bongers,et al.  Are neck flexion, neck rotation, and sitting at work risk factors for neck pain? Results of a prospective cohort study , 2001, Occupational and environmental medicine.

[41]  M Bovenzi,et al.  Health risks from occupational exposures to mechanical vibration. , 2006, La Medicina del lavoro.

[42]  A Garg,et al.  Revised NIOSH equation for the design and evaluation of manual lifting tasks. , 1993, Ergonomics.

[43]  Anne E. Moore,et al.  Effect of Cycle Time and Duty Cycle on Muscle Activity during a Repetitive Manual Task , 2000 .

[44]  S H Snook,et al.  Challenges in assessing risk factors in epidemiologic studies on back disorders. , 1997, American journal of industrial medicine.

[45]  J. Winkel,et al.  Hand strength: the influence of grip span and grip type. , 1991, Ergonomics.

[46]  A. J. van der Beek,et al.  Does musculoskeletal discomfort at work predict future musculoskeletal pain? , 2008, Ergonomics.

[47]  Yves Roquelaure,et al.  Risk factors for upper-extremity musculoskeletal disorders in the working population. , 2009, Arthritis and rheumatism.

[48]  E Viikari-Juntura,et al.  Longitudinal study on work related and individual risk factors affecting radiating neck pain , 2001, Occupational and environmental medicine.

[49]  Zong-Ming Li The influence of wrist position on individual finger forces during forceful grip. , 2002, The Journal of hand surgery.

[50]  S P Baker,et al.  Back injury in municipal workers: a case-control study. , 1999, American journal of public health.

[51]  R A Henning,et al.  Frequent short rest breaks from computer work: effects on productivity and well-being at two field sites. , 1997, Ergonomics.

[52]  David Coggon,et al.  Carpal tunnel syndrome and its relation to occupation: a systematic literature review. , 2006, Occupational medicine.

[53]  Pieter Coenen,et al.  Predictive validity of the Hand Arm Risk assessment Method (HARM) , 2014 .

[54]  R S Bridger,et al.  Postural adaptations to workbench modifications in standing workers. , 1995, Ergonomics.

[55]  T Nakagawa,et al.  Relation between overhead work and complaints of pear and apple orchard workers. , 1987, Ergonomics.

[56]  L. Punnett,et al.  Work-related musculoskeletal disorders: the epidemiologic evidence and the debate. , 2004, Journal of electromyography and kinesiology : official journal of the International Society of Electrophysiological Kinesiology.

[57]  Matthew P. Reed,et al.  Force-Exertion Postures with External Bracing in Industrial Tasks: Data from an Automotive Assembly Plant , 2008 .

[58]  Svend Erik Mathiassen,et al.  Systematic evaluation of observational methods assessing biomechanical exposures at work. , 2010, Scandinavian journal of work, environment & health.

[59]  Zong-Ming Li,et al.  Wrist circumduction reduced by finger constraints. , 2008, The Journal of hand surgery.

[60]  D Commenges,et al.  Prevalence and risk factors of recurrent cervical pain syndrome in a working population. , 1988, Neuroepidemiology.

[61]  Y. Roquelaure,et al.  Occupational and personal risk factors for carpal tunnel syndrome in industrial workers. , 1997, Scandinavian journal of work, environment & health.

[62]  J. Siemiatycki,et al.  0289 ”david´s cheese bread” method: workload quantitative exposure thresholds detection using adjusted hazard multivariate parametric modelling, useful in cumulative-trauma disorders prevention and within their causal assessment , 2017, Occupational and Environmental Medicine.

[63]  Alex Burdorf,et al.  Model for the work-relatedness of low-back pain. , 2003, Scandinavian journal of work, environment & health.

[64]  Vern Putz-Anderson,et al.  Cumulative trauma disorders : a manual for musculoskeletal diseases of the upper limbs , 1988 .

[65]  P. Bongers,et al.  Epidemiology of work related neck and upper limb problems: Psychosocial and personal risk factors (Part I) and effective interventions from a bio behavioural perspective (Part II) , 2006, Journal of Occupational Rehabilitation.

[66]  T. Armstrong,et al.  Cross-sectional study of the relationship between repetitive work and the prevalence of upper limb musculoskeletal disorders. , 1999, American journal of industrial medicine.

[67]  E Viikari-Juntura,et al.  A prospective study of work related factors and physical exercise as predictors of shoulder pain , 2001, Occupational and environmental medicine.

[68]  E N Corlett,et al.  Head posture and loading of the cervical spine. , 2002, Applied ergonomics.

[69]  Brian Shackel,et al.  Usability - Context, framework, definition, design and evaluation , 1991, Interact. Comput..

[70]  C J Snijders,et al.  A biomechanical model for the analysis of the cervical spine in static postures. , 1991, Journal of biomechanics.

[71]  Svend Erik Mathiassen,et al.  Reliability and criterion validity of an observation protocol for working technique assessments in cash register work , 2016, Ergonomics.

[72]  Kodak Ergonomic Design for People at Work , 1989 .

[73]  Matthew M. Marshall,et al.  The Effects of Complex Wrist and Forearm Posture on Wrist Range of Motion , 1999, Hum. Factors.

[74]  E. Vingård,et al.  Workplace factors and care seeking for low-back pain among female nursing personnel. MUSIC-Norrtälje Study Group. , 1998, Scandinavian journal of work, environment & health.

[75]  Ann Marie Dale,et al.  Biomechanical risk factors for carpal tunnel syndrome: a pooled study of 2474 workers , 2014, Occupational and Environmental Medicine.

[76]  Jörgen Winkel,et al.  Occupational and individual risk factors for shoulder-neck complaints: Part I — Guidelines for the practitioner , 1992 .

[77]  C Wiktorin,et al.  Work environment and neck and shoulder pain: the influence of exposure time. Results from a population based case-control study , 2002, Occupational and environmental medicine.

[78]  Sean Gallagher,et al.  Examining the Interaction of Force and Repetition on Musculoskeletal Disorder Risk , 2013, Hum. Factors.

[79]  Monique H W Frings-Dresen,et al.  Assessing the work-relatedness of nonspecific low-back pain. , 2005, Scandinavian journal of work, environment & health.

[80]  Etienne Grandjean,et al.  Fitting the Task to the Man: A Textbook of Occupational Ergonomics , 1988 .

[81]  Eira Viikari-Juntura,et al.  A population study on differences in the determinants of a specific shoulder disorder versus nonspecific shoulder pain without clinical findings. , 2005, American journal of epidemiology.

[82]  D Williams,et al.  Musculoskeletal back pain among dentists. , 1984, General dentistry.

[83]  Carl Mikael Lind,et al.  Development and evaluation of RAMP I – a practitioner’s tool for screening of musculoskeletal disorder risk factors in manual handling , 2019, International journal of occupational safety and ergonomics : JOSE.

[84]  R. Light Measures of response agreement for qualitative data: Some generalizations and alternatives. , 1971 .

[85]  M. Douwes,et al.  Development of a non-expert risk assessment method for hand-arm related tasks (HARM) , 2014 .

[86]  Hude Quan,et al.  Measuring agreement of administrative data with chart data using prevalence unadjusted and adjusted kappa , 2009, BMC medical research methodology.

[87]  J. Carlin,et al.  Bias, prevalence and kappa. , 1993, Journal of clinical epidemiology.

[88]  S. Azen,et al.  Normal range of motion of joints in male subjects. , 1979, The Journal of bone and joint surgery. American volume.

[89]  W. M. Keyserling,et al.  Back disorders and nonneutral trunk postures of automobile assembly workers. , 1991, Scandinavian journal of work, environment & health.

[90]  Jessica Ramsey,et al.  A prospective study of carpal tunnel syndrome: workplace and individual risk factors , 2013, Occupational and Environmental Medicine.

[91]  Waldemar Karwowski,et al.  Ranking systems for evaluation of joint and joint motion stressfulness based on perceived discomforts. , 2003, Applied ergonomics.

[92]  W. E. Hoogendoorn,et al.  Flexion and Rotation of the Trunk and Lifting at Work Are Risk Factors for Low Back Pain: Results of a Prospective Cohort Study , 2000, Spine.

[93]  Stephen Bao,et al.  Quantitative exposure-response relations between physical workload and prevalence of lateral epicondylitis in a working population. , 2009, American journal of industrial medicine.

[94]  Kensei Nagata,et al.  Cervical spine disorders in farm workers requiring neck extension actions , 2006, Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association.

[95]  Peter Buckle,et al.  The development of the Quick Exposure Check (QEC) for assessing exposure to risk factors for work-related musculoskeletal disorders. , 2008, Applied ergonomics.

[96]  H. Morgenstern,et al.  Dose-response relations between occupational exposures to physical and psychosocial factors and the risk of low back pain , 2004, Occupational and Environmental Medicine.

[97]  A J van der Beek,et al.  Working postures and activities of lorry drivers: a reliability study of on-site observation and recording on a pocket computer. , 1992, Applied ergonomics.

[98]  I. Kingma,et al.  Cumulative Low Back Load at Work as a Risk Factor of Low Back Pain: A Prospective Cohort Study , 2012, Journal of Occupational Rehabilitation.

[99]  M Thoresen,et al.  Musculoskeletal, visual and psychosocial stress in VDU operators before and after multidisciplinary ergonomic interventions. , 1998, Applied ergonomics.

[100]  J P Bonde,et al.  Risk factors for hand-wrist disorders in repetitive work , 2007, Occupational and Environmental Medicine.

[101]  Robert J. Marley,et al.  Grip Strength as a Function of Forearm Rotation and Elbow Posture , 1992 .

[102]  Yves Roquelaure,et al.  Personal, biomechanical, and psychosocial risk factors for rotator cuff syndrome in a working population. , 2011, Scandinavian journal of work, environment & health.

[103]  Yves Roquelaure,et al.  Comparison of risk factors for shoulder pain and rotator cuff syndrome in the working population. , 2012, American journal of industrial medicine.

[104]  Reiner Rugulies,et al.  The impact of work-related psychosocial stressors on the onset of musculoskeletal disorders in specific body regions: A review and meta-analysis of 54 longitudinal studies , 2011 .

[105]  Peter J. Keir,et al.  Guidelines for Wrist Posture Based on Carpal Tunnel Pressure Thresholds , 2007, Hum. Factors.

[106]  Istvan Balogh,et al.  Exposure-response relationships in work-related musculoskeletal disorders in elbows and hands - A synthesis of group-level data on exposure and response obtained using uniform methods of data collection. , 2013, Applied ergonomics.

[107]  Waldemar Karwowski,et al.  Psychophysical basis for maximum pushing and pulling forces: A review and recommendations. , 2014, International journal of industrial ergonomics.

[108]  F Spaans,et al.  Risk factors for carpal tunnel syndrome. , 1990, American journal of epidemiology.

[109]  Rocio Poveda-Bautista,et al.  Influences on the use of observational methods by practitioners when identifying risk factors in physical work , 2015, Ergonomics.

[110]  P. Buckle,et al.  Current techniques for assessing physical exposure to work-related musculoskeletal risks, with emphasis on posture-based methods. , 1999, Ergonomics.

[111]  Don B. Chaffin,et al.  Working Postures and Movements , 2004 .

[112]  Peter Herberts,et al.  Intramuscular pressure and muscle blood flow in supraspinatus , 2004, European Journal of Applied Physiology and Occupational Physiology.

[113]  Andreas Seidler,et al.  Work-related lesions of the supraspinatus tendon: a case–control study , 2011, International archives of occupational and environmental health.

[114]  Dohyung Kee,et al.  Quantitative postural load assessment for whole body manual tasks based on perceived discomfort , 2005, Ergonomics.

[115]  D B Chaffin,et al.  Shoulder disorders and postural stress in automobile assembly work. , 2000, Scandinavian journal of work, environment & health.

[116]  F Gerr,et al.  Upper extremity musculoskeletal symptoms among female office workers: associations with video display terminal use and occupational psychosocial stressors. , 1996, American journal of industrial medicine.

[117]  A. Silman,et al.  Association of occupational physical demands and psychosocial working environment with disabling shoulder pain. , 2001, Annals of the rheumatic diseases.

[118]  K. Messing,et al.  Studying the relationship between low back pain and working postures among those who stand and those who sit most of the working day , 2009, Ergonomics.

[119]  G. Verbeke,et al.  The role of physical workload and pain related fear in the development of low back pain in young workers: evidence from the BelCoBack Study; results after one year of follow up , 2005, Occupational and Environmental Medicine.

[120]  Myung-Chul Jung,et al.  Relationship between prolonged standing and symptoms of varicose veins and nocturnal leg cramps among women and men , 2012, Ergonomics.

[121]  Y. Xu,et al.  Work environment and low back pain: the influence of occupational activities. , 1997, Occupational and environmental medicine.

[122]  David Rempel,et al.  1st place, PREMUS best paper competition: workplace and individual factors in wrist tendinosis among blue-collar workers--the San Francisco study. , 2011, Scandinavian journal of work, environment & health.

[123]  Dan Högberg,et al.  Prevention of Work: Related Musculoskeletal Disorders Using Smart Workwear - The Smart Workwear Consortium , 2018, IHSED.

[124]  Jack P. Callaghan,et al.  Determining the optimal size for posture categories used in video-based posture assessment methods , 2009, Ergonomics.

[125]  Mark S. Young,et al.  Kodak's Ergonomic Design for People at Work , 2009 .

[126]  Thomas J. Armstrong,et al.  A Longitudinal Study of Industrial and Clerical Workers: Predictors of Upper Extremity Tendonitis , 2005, Journal of Occupational Rehabilitation.

[127]  I. Richard,et al.  Biomechanical constraints remain major risk factors for low back pain: results from a prospective cohort study in French male employees , 2011, Occupational and Environmental Medicine.

[128]  Jack P Callaghan,et al.  The impact of a sloped surface on low back pain during prolonged standing work: a biomechanical analysis. , 2010, Applied ergonomics.

[129]  E. Occhipinti OCRA: a concise index for the assessment of exposure to repetitive movements of the upper limbs. , 1998, Ergonomics.

[130]  Thomas Kraus,et al.  Longitudinal evidence for the association between work-related physical exposures and neck and/or shoulder complaints: a systematic review , 2012, International Archives of Occupational and Environmental Health.

[131]  Alex Burdorf,et al.  Modelling the effects of exposure to whole-body vibration on low-back pain and its long-term consequences for sickness absence and associated work disability , 2006 .

[132]  D Coggon,et al.  Occupational activity and osteoarthritis of the knee. , 1994, Annals of the rheumatic diseases.

[133]  Carl Mikael Lind,et al.  Factors influencing ergonomists’ use of observation-based risk-assessment tools , 2019, Work.

[134]  W Karwowski,et al.  The effects of neutral posture deviations on perceived joint discomfort ratings in sitting and standing postures. , 1993, Ergonomics.

[135]  L Punnett,et al.  PATH: a work sampling-based approach to ergonomic job analysis for construction and other non-repetitive work. , 1996, Applied ergonomics.

[136]  Å. Kilbom Repetitive work of the upper extremity: Part I–Guidelines for the practitioner * , 2000 .

[137]  Å. Kilbom,et al.  Repetitive work of the upper extremity: Part I—Guidelines for the practitioner , 1994 .

[138]  E. Asmussen,et al.  Recuperation after muscular fatigue by “diverting activities” , 1978, European Journal of Applied Physiology and Occupational Physiology.

[139]  N. Fallentin,et al.  Evaluation of Physical Workload Standards/Guidelines from a Nordic Perspective , 2000, Scandinavian journal of work, environment & health.

[140]  E Occhipinti,et al.  Exposure assessment of upper limb repetitive movements: a consensus document developed by the Technical Committee on Musculoskeletal Disorders of International Ergonomics Association (IEA) endorsed by International Commission on Occupational Health (ICOH). , 2001, Giornale italiano di medicina del lavoro ed ergonomia.

[141]  C M Haslegrave,et al.  Seated work postures for manual, visual and combined tasks. , 1999, Ergonomics.

[142]  Irvin Emanuel,et al.  A STATISTICAL EVALUATION OF JOINT RANGE DATA , 1957 .

[143]  L. Forcier,et al.  Work related musculoskeletal disorders (WMSDs) : a reference book for prevention , 1995 .

[144]  J. H. Andersen,et al.  Risk factors for more severe regional musculoskeletal symptoms: a two-year prospective study of a general working population. , 2007, Arthritis and rheumatism.

[145]  J. Sluiter,et al.  Criteria document for evaluating the work-relatedness of upper-extremity musculoskeletal disorders. , 2001, Scandinavian journal of work, environment & health.

[146]  Patrick G. Dempsey,et al.  The influence of gender, grasp type, pinch width and wrist position on sustained pinch strength , 1996 .

[147]  Anil Mital,et al.  Design, selection and use of hand tools to alleviate trauma of the upper extremities: Part II — The scientific basis (knowledge base) for the guide , 1992 .

[148]  E Grandjean,et al.  Postural and visual loads at VDT workplaces. I. Constrained postures. , 1981, Ergonomics.

[149]  Jerome J Congleton,et al.  A prospective field study of the relationship of potential occupational risk factors with occupational injury/illness. , 2003, AIHA journal : a journal for the science of occupational and environmental health and safety.

[150]  P G Dempsey,et al.  Influence of measurement accuracy on the application of the 1991 NIOSH equation. , 2001, Applied ergonomics.

[151]  Karen Messing,et al.  Distal lower-extremity pain and work postures in the Quebec population. , 2008, American journal of public health.

[152]  Carl Lind,et al.  Shifting to proactive risk management : Risk communication using the RAMP tool , 2016 .

[153]  Jim R. Potvin,et al.  Predicting Maximum Acceptable Efforts for Repetitive Tasks , 2012, Hum. Factors.

[154]  H Sakakibara,et al.  Overhead work and shoulder-neck pain in orchard farmers harvesting pears and apples. , 1995, Ergonomics.

[155]  H J Wilke,et al.  Multiple muscle force simulation in axial rotation of the cervical spine. , 1999, Clinical biomechanics.

[156]  A. Burdorf The role of assessment of biomechanical exposure at the workplace in the prevention of musculoskeletal disorders. , 2010, Scandinavian journal of work, environment & health.

[157]  E Viikari-Juntura,et al.  Role of physical load factors in carpal tunnel syndrome. , 1999, Scandinavian journal of work, environment & health.

[158]  Esa-Pekka Takala,et al.  A Video-Based Observation Method to Assess Musculoskeletal Load in Kitchen Work , 2009, International journal of occupational safety and ergonomics : JOSE.

[159]  B Nilsson,et al.  Musculoskeletal disorders among visual display terminal workers: individual, ergonomic, and work organizational factors. , 1995, Ergonomics.

[160]  L. Haugh,et al.  Assessment of Postural Discomfort , 1990 .

[161]  Ayako Hashizume JIS Z 8530 Human-Centred Design for Interactive Systems , 2021 .

[162]  J P Bonde,et al.  Risk factors in the onset of neck/shoulder pain in a prospective study of workers in industrial and service companies , 2003, Occupational and environmental medicine.

[163]  James Deddens,et al.  Workplace and individual risk factors for carpal tunnel syndrome , 2011, Occupational and Environmental Medicine.

[164]  V. H. Hildebrandt,et al.  Psychosocial factors at work and musculoskeletal disease , 1993 .

[165]  W. E. Hoogendoorn,et al.  High physical work load and low job satisfaction increase the risk of sickness absence due to low back pain: results of a prospective cohort study , 2002, Occupational and environmental medicine.

[166]  Ann Marie Dale,et al.  Associations between workplace factors and carpal tunnel syndrome: A multi-site cross sectional study. , 2015, American journal of industrial medicine.

[167]  W. E. Hoogendoorn,et al.  Physical load during work and leisure time as risk factors for back pain. , 1999, Scandinavian journal of work, environment & health.

[168]  P. Hakkarainen,et al.  Reliability and usability of the ergonomic workplace method for assessing working environments , 2011 .

[169]  Paulien M Bongers,et al.  Are psychosocial factors, risk factors for symptoms and signs of the shoulder, elbow, or hand/wrist?: A review of the epidemiological literature. , 2002, American journal of industrial medicine.

[170]  A Genaidy,et al.  Ranking of static non-neutral postures around the joints of the upper extremity and the spine. , 1995, Ergonomics.

[171]  Katharina Wagner,et al.  Working Postures And Movements Tools For Evaluation And Engineering , 2016 .

[172]  A Magora,et al.  Investigation of the relation between low back pain and occupation. , 1970, IMS, Industrial medicine and surgery.

[173]  Leslie G. Portney Dpt PhD Fapta,et al.  Foundations of Clinical Research: Applications to Practice , 2015 .

[174]  T S Kristensen,et al.  Standing at work and varicose veins. , 2000, Scandinavian journal of work, environment & health.

[175]  W. M. Keyserling,et al.  Observational Analysis of the Hand and Wrist: A Pilot Study , 1991 .

[176]  K. An,et al.  Functional ranges of motion of the wrist joint. , 1991, The Journal of hand surgery.

[177]  W Karwowski,et al.  LUBA: an assessment technique for postural loading on the upper body based on joint motion discomfort and maximum holding time. , 2001, Applied ergonomics.

[178]  Yves Roquelaure,et al.  Risk factors for de Quervain's disease in a French working population. , 2011, Scandinavian journal of work, environment & health.

[179]  Shrawan Kumar A computer desk for bifocal lens wearers, with special emphasis on selected telecommunication tasks , 1994 .

[180]  J. Congleton,et al.  Occupational Risk Factors and Back Injury , 2013, International journal of occupational safety and ergonomics : JOSE.

[181]  Sigurd Mikkelsen,et al.  Risk of shoulder tendinitis in relation to shoulder loads in monotonous repetitive work. , 2002, American journal of industrial medicine.

[182]  R. Kadefors,et al.  Intramuscular pressure of the infra- and supraspinatus muscles in relation to hand load and arm posture , 2000, European Journal of Applied Physiology.

[183]  Anders Fuglsang-Frederiksen,et al.  Reversible median nerve impairment after three weeks of repetitive work. , 2017, Scandinavian journal of work, environment & health.

[184]  M J Griffin,et al.  Prevalence and occupational associations of neck pain in the British population. , 2001, Scandinavian journal of work, environment & health.

[185]  Jörgen Eklund,et al.  A practitioner model for assessing manual lifting and lowering operations : included in the RAMP tool , 2015 .

[186]  K. Kroemer Fitting the task to the human , 1997 .

[187]  Jeremy Ferreira,et al.  Development of an assessment tool for repetitive tasks of the upper limbs (ART). , 2009 .

[188]  J P Bonde,et al.  Work related shoulder disorders: quantitative exposure-response relations with reference to arm posture , 2004, Occupational and Environmental Medicine.

[189]  J. R. Landis,et al.  The measurement of observer agreement for categorical data. , 1977, Biometrics.

[190]  John Rosecrance,et al.  Reliability of assessing upper limb postures among workers performing manufacturing tasks. , 2009, Applied ergonomics.

[191]  A Burdorf,et al.  Occupational risk factors for low back pain among sedentary workers. , 1993, Journal of occupational medicine. : official publication of the Industrial Medical Association.

[192]  Bengt-O. Wikström,et al.  Effects from twisted postures and whole-body vibration during driving , 1993 .

[193]  H. Heneweer,et al.  Physical activity and low back pain: a systematic review of recent literature , 2011, European Spine Journal.

[194]  Willem van Mechelen,et al.  High physical and psychosocial load at work and sickness absence due to neck pain. , 2002, Scandinavian journal of work, environment & health.