PHYSICAL WORKLOAD AS A RISK FACTOR FOR SYMPTOMS IN THE NECK AND UPPER LIMBS : EXPOSURE ASSESSMENT AND ERGONOMIC INTERVENTION

The aims of this study were to investigate work related and individual factors as predictors of insident neck pain among video display unit (VDU) workers, to assess the effects of an ergonomic intervention and education on musculoskeletal symptoms, and to study the repeatability and validity of an expert assessment method of VDU workstation ergonomics. A method to assess the risk factors for upper limb disorders was developed, and its validity and repeatability were studied. The annual incidence of neck pain was 34.4%. A poor physical work environment and placement of the keyboard were work-related factors increasing the risk of neck pain. Among the individual factors, female sex was a strong predictor. The randomized intervention study included questionnaire survey, a diary of discomfort, and ergonomic rating of the workstations. The subjects (n=124) were allocated into three groups. The intensive and the education groups had less musculoskeletal discomfort than the control group at the 2-month followup. After the intervention, the level of ergonomics was distinctly higher in the intensive ergonomic group than in the education or control group. Two experts in ergonomics analyzed and rated the ergonomics of workstations before and after intervention. The validity of the assessment method was rated against the technical measurements, assessment of tidiness and space, and work chair ergonomics. The intraclass correlation coefficient between ratings of the two experts was 0.74. Changes in the location of the input devises and the screen, as well as the values of tidiness and space and work chair ergonomics showed a significant association with the ratings of both experts. The method to assess the loads imposed on the upper limbs was validated against the expert observations from the video, continuous recordings of myoelectric activity of forearm muscles, and wrist posture, measured with goniometers. Inter-observer repeatability and validity were good or moderate. Both intensive ergonomics approach and education in ergonomics have effects in reducing discomfort in VDU work. In attemps to improve the ergonomics of VDU workstation, the best result will be achieved with cooperative palaning in which both workers and pratitioners are actively invoved. The assessment methods for VDU work ergonomics and upper limb load studied here can be utilized in a repeatable manner.

[1]  Veikko Louhevaara,et al.  Ergonomic intervention on neck, shoulder and arm symptoms of newspaper employees in work with visual display units , 2003 .

[2]  L Punnett,et al.  Effects of an ergonomic training program on workers with video display units. , 1999, Scandinavian journal of work, environment & health.

[3]  L. Punnett,et al.  Physical capacity in relation to present and past physical load at work: a study of 484 men and women aged 41 to 58 years. , 1999, American journal of industrial medicine.

[4]  P. Buckle,et al.  Epidemiological study to investigate potential interaction between physical and psychosocial factors at work that may increase the risk of symptoms of musculoskeletal disorder of the neck and upper limb , 2002, Occupational and environmental medicine.

[5]  C Fransson-Hall,et al.  Characteristics of forearm-hand exposure in relation to symptoms among automobile assembly line workers. , 1996, American journal of industrial medicine.

[6]  Åsa Kilbom,et al.  Repetitive work of the upper extremity: Part II – The scientific basis (knowledge base) for the guide , 2000 .

[7]  A. Silman,et al.  Occupational risk factors for shoulder pain: a systematic review , 2000, Occupational and environmental medicine.

[8]  U Bergqvist,et al.  National Institute for Working Life Ergonomic Expert Committee Document No 1Visual Display Unit Work and Upper Extremity Musculoskeletal DisordersA Review of Epidemiological Findings , 1997 .

[9]  E. N. Corlett,et al.  Posture Targeting: A Technique for Recording Working Postures , 1979 .

[10]  A. Leclerc,et al.  One-year predictive factors for various aspects of neck disorders. , 1999, Spine.

[11]  Nell,et al.  Musculoskeletal Symptoms among Computer-assisted Design (CAD) Operators and Evaluation of a Self-assessment Questionnaire. , 1996, International journal of occupational and environmental health.

[12]  P M Bongers,et al.  Physical risk factors for neck pain. , 2000, Scandinavian journal of work, environment & health.

[13]  C. Monfort,et al.  Chronic neck and shoulder pain, age, and working conditions: longitudinal results from a large random sample in France , 2002, Occupational and environmental medicine.

[14]  W M Keyserling Postural analysis of the trunk and shoulders in simulated real time. , 1986, Ergonomics.

[15]  P M Bongers,et al.  Psychosocial risk factors for neck pain: a systematic review. , 2001, American journal of industrial medicine.

[16]  S E Mathiassen,et al.  Assessment of physical work load in epidemiologic studies: concepts, issues and operational considerations. , 1994, Ergonomics.

[17]  F. Biering-Sørensen,et al.  [Musculoskeletal disorders]. , 2004, Ugeskrift for laeger.

[18]  Å. Kilbom,et al.  Assessment of physical exposure in relation to work-related musculoskeletal disorders--what information can be obtained from systematic observations? , 1994, Scandinavian journal of work, environment & health.

[19]  O. Svensson,et al.  The influence of the viewing angle on neck-load during work with video display units. , 2001, Journal of rehabilitation medicine.

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

[21]  R. Letz,et al.  Clinical diagnostic tests for carpal tunnel syndrome. , 2000, The Journal of hand surgery.

[22]  P. Fanger,et al.  Perception of draught in ventilated spaces. , 1986, Ergonomics.

[23]  D. Kleinbaum,et al.  A prospective study of computer users: I. Study design and incidence of musculoskeletal symptoms and disorders. , 2002, American journal of industrial medicine.

[24]  L Punnett,et al.  Ergonomic stressors and upper extremity disorders in vehicle manufacturing: cross sectional exposure-response trends. , 1998, Occupational and environmental medicine.

[25]  C. Cooper,et al.  The prevalence of sensorineural symptoms attributable to hand-transmitted vibration in Great Britain: a national postal survey. , 2000, American journal of industrial medicine.

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

[27]  Bryan Buchholz,et al.  Practical Operation of a Biaxial Goniometer at the Wrist Joint , 1997, Hum. Factors.

[28]  R W Marklin,et al.  Effect of setup configurations of split computer keyboards on wrist angle. , 2001, Physical therapy.

[29]  S. Knardahl,et al.  Job characteristics as predictors of neck pain. A 4-year prospective study. , 1999, Journal of occupational and environmental medicine.

[30]  A Aarås,et al.  Postural load during VDU work: a comparison between various work postures. , 1997, Ergonomics.

[31]  E. Viikari-Juntura,et al.  Physical exercise and musculoskeletal pain among forest industry workers , 2001, Scandinavian journal of medicine & science in sports.

[32]  Pentti K. Seppälä,et al.  Experience of Stress, Musculoskeletal Discomfort, and Eyestrain in Computer-Based Office Work: A Study in Municipal Workplaces , 2001, Int. J. Hum. Comput. Interact..

[33]  E Dowler,et al.  Effects of Neutral Posture on Muscle Tension During Computer Use , 2001, International journal of occupational safety and ergonomics : JOSE.

[34]  E P Takala,et al.  Validation of Portable Ergonomic Observation (PEO) method using optoelectronic and video recordings. , 1997, Applied ergonomics.

[35]  M. B. Villanueva,et al.  Adjustments of posture and viewing parameters of the eye to changes in the screen height of the visual display terminal. , 1996, Ergonomics.

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

[37]  Todd P. Stitik,et al.  Work Related Musculoskeletal Disorders (WMSDs): A Reference Book for Prevention , 1996 .

[38]  P. Buckle,et al.  Fortnightly review: work factors and upper limb disorders , 1997, BMJ.

[39]  Prospects Liubolong Improving quality. , 1990, The Psychiatric clinics of North America.

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

[41]  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.

[42]  E Viikari-Juntura,et al.  Incidence of tenosynovitis or peritendinitis and epicondylitis in a meat-processing factory. , 1991, Scandinavian journal of work, environment & health.

[43]  R. Burgess-Limerick,et al.  The prevalence of neck and upper extremity musculoskeletal symptoms in computer mouse users , 2000 .

[44]  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.

[45]  B. Jonsson,et al.  Standardised Nordic questionnaires for the analysis of musculoskeletal symptoms. , 1987, Applied ergonomics.

[46]  Marino Menozzi,et al.  Training in ergonomics at VDU workplaces , 1999 .

[47]  T. Läubli,et al.  Motor-unit activity in the trapezius muscle during rest, while inputting data, and during fast finger tapping , 2000, European Journal of Applied Physiology.

[48]  R. H. Westgaard,et al.  Ergonomic intervention research for improved musculoskeletal health: A critical review , 1997 .

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

[50]  D Colombini,et al.  An observational method for classifying exposure to repetitive movements of the upper limbs. , 1998, Ergonomics.

[51]  C S Pan,et al.  The impact of keyboard design on comfort and productivity in a text-entry task. , 1997, Applied ergonomics.

[52]  P. Croft,et al.  Effects of manual work on recovery from lateral epicondylitis. , 2002, Scandinavian journal of work, environment & health.

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

[54]  E. Takala Static muscular load, an increasing hazard in modern information technology. , 2002, Scandinavian journal of work, environment & health.

[55]  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.

[56]  Lindsay C. Mitchell Assessment at Work? , 1986, Scottish Educational Review.

[57]  M Hagberg,et al.  Computer mouse position as a determinant of posture, muscular load and perceived exertion. , 1998, Scandinavian journal of work, environment & health.

[58]  I Kuorinka,et al.  Prevalence of epicondylitis and elbow pain in the meat-processing industry. , 1991, Scandinavian journal of work, environment & health.

[59]  L Karlqvist,et al.  Variation in upper limb posture and movement during word processing with and without mouse use. , 1994, Ergonomics.

[60]  J P Psihogios,et al.  A field evaluation of monitor placement effects in VDT users. , 2001, Applied ergonomics.

[61]  P. Chappell,et al.  Hand and arm injuries associated with repetitive manual work in industry: a review of disorders, risk factors and preventive measures. , 1999, Ergonomics.

[62]  D. Rempel,et al.  Effect of Four Computer Keyboards in Computer Users with Upper Extremity Musculoskeletal Disorders , 1999, American journal of industrial medicine.

[63]  Jörgen Winkel,et al.  Validity of self-reported exposures to work postures and manual materials handling , 1993 .

[64]  Arne Aarås,et al.  Workload When Using a Mouse as an Input Device , 1997, Int. J. Hum. Comput. Interact..

[65]  J P Bonde,et al.  Physical exposure assessment in monotonous repetitive work--the PRIM study. , 2001, Scandinavian journal of work, environment & health.

[66]  Gunnar Horgen,et al.  Work With the Visual Display Unit: Health Consequences , 2000, Int. J. Hum. Comput. Interact..

[67]  Sarah Burch,et al.  Evaluating Health Interventions for Older People , 1999 .

[68]  D Rempel,et al.  Risk factors for musculoskeletal disorders among computer users. , 1999, Occupational medicine.

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

[70]  Anker Helms Jørgensen,et al.  Effect of mental and physical demands on muscular activity during the use of a computer mouse and a keyboard. , 2002, Scandinavian journal of work, environment & health.

[71]  S. Moon,et al.  Beyond Biomechanics: Psychosocial Aspects of Musculoskeletal Disorders In Office Work , 1996 .

[72]  J P Psihogios,et al.  The effects of video display terminal height on the operator: a comparison of the 15 degree and 40 degree recommendations. , 1998, Applied ergonomics.

[73]  P. Bongers,et al.  Duration of computer use and mouse use in relation to musculoskeletal disorders of neck or upper limb , 2002 .

[74]  A Aarås,et al.  Musculoskeletal, visual and psychosocial stress in VDU operators before and after multidisciplinary ergonomic interventions. A 6 years prospective study--Part II. , 2001, Applied ergonomics.

[75]  D Mergler,et al.  Combining quantitative and qualitative approaches in occupational health for a better understanding of the impact of work-related disorders. , 1999, Scandinavian journal of work, environment & health.

[76]  M Hagberg,et al.  Differences between work methods and gender in computer mouse use. , 2000, Scandinavian journal of work, environment & health.

[77]  M. B. Villanueva,et al.  Sitting posture and neck and shoulder muscle activities at different screen height settings of the visual display terminal. , 1997, Industrial health.

[78]  A. Leclerc,et al.  Upper-limb disorders in repetitive work. , 2001, Scandinavian journal of work, environment & health.

[79]  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.

[80]  Keir Fraser,et al.  The influence of computer monitor height on head and neck posture 1 Requests for reprints should be , 1999 .

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

[82]  Lena Karlqvist,et al.  Assessment of physical work load at visual display unit workstations : ergonomic applications and gender aspects , 1997 .

[83]  Corbett McDonald,et al.  Epidemiology of Work Related Diseases , 1999 .

[84]  Richard W. Marklin,et al.  Effect of Computer Keyboard Slope and Height on Wrist Extension Angle , 2001, Hum. Factors.

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

[86]  V Louhevaara,et al.  Effects of Ergorest® Arm Supports on Muscle Strain and Wrist Positions During the Use of the Mouse and Keyboard in Work With Visual Display Units: A Work Site Intervention , 2001, International journal of occupational safety and ergonomics : JOSE.

[87]  R. Shell,et al.  Ergonomic risk assessment: preliminary guidelines for analysis of repetition, force and posture. , 1993, Journal of human ergology.

[88]  J B Malchaire,et al.  Prevalence of musculoskeletal disorders at the wrist as a function of angles, forces, repetitiveness and movement velocities. , 1996, Scandinavian journal of work, environment & health.

[89]  M Fogleman,et al.  Computer mouse use and cumulative trauma disorders of the upper extremities. , 1995, Ergonomics.

[90]  W Jones,et al.  Computer users' postures and associations with workstation characteristics. , 2000, AIHAJ : a journal for the science of occupational and environmental health and safety.

[91]  Michelle Fleury,et al.  Visual Context and the Control of Movements through Video Display , 2001, Hum. Factors.

[92]  M. Hagberg,et al.  Hand-arm symptoms related to impact and nonimpact hand-held power tools , 1997, International archives of occupational and environmental health.

[93]  Sigurd Mikkelsen,et al.  Physical, psychosocial, and individual risk factors for neck/shoulder pain with pressure tenderness in the muscles among workers performing monotonous, repetitive work. , 2002, Spine.

[94]  L Karlqvist,et al.  Influence of laptop computer design and working position on physical exposure variables. , 2002, Clinical biomechanics.

[95]  Suebsak Nanthavanij,et al.  The effect of ergonomic intervention on discomfort in computer users with tension neck syndrome , 2000 .

[96]  P Sainio,et al.  Shoulder joint impairment among Finns aged 30 years or over: prevalence, risk factors and co-morbidity. , 1999, Rheumatology.

[97]  H. Christensen,et al.  The influence of experimental muscle pain on motor unit activity during low-level contraction , 2000, European Journal of Applied Physiology.

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

[99]  W M Keyserling,et al.  A checklist for evaluating ergonomic risk factors associated with upper extremity cumulative trauma disorders. , 1993, Ergonomics.

[100]  Laura Punnett,et al.  Ergonomic Job Analysis: A Structured Approach for Identifying Risk Factors Associated with Overexertion Injuries and Disorders , 1991 .

[101]  W M Keyserling A computer-aided system to evaluate postural stress in the workplace. , 1986, American Industrial Hygiene Association journal.

[102]  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.

[103]  A Zecevic,et al.  An evaluation of the ergonomics of three computer keyboards , 2000, Ergonomics.

[104]  W M Keyserling,et al.  Median sensory distal amplitude and latency: comparisons between nonexposed managerial/professional employees and industrial workers. , 1993, American journal of industrial medicine.

[105]  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.

[106]  C Fransson-Hall,et al.  A portable ergonomic observation method (PEO) for computerized on-line recording of postures and manual handling. , 1995, Applied ergonomics.

[107]  O Karhu,et al.  Correcting working postures in industry: A practical method for analysis. , 1977, Applied ergonomics.

[108]  Arne Aarås,et al.  Can a More Neutral Position of the Forearm When Operating a Computer Mouse Reduce the Pain Level for Visual Display Unit Operators? A Prospective Epidemiological Intervention Study: Part II , 1999, Int. J. Hum. Comput. Interact..

[109]  Gavriel Salvendy,et al.  Handbook of human factors. , 1987 .

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

[111]  D Rempel,et al.  Workplace use of an adjustable keyboard: adjustment preferences and effect on wrist posture. , 1999, American Industrial Hygiene Association journal.

[112]  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.