Working group on Ergonomics
Chair: Dr Thomas Waters US
Cochair: Mr Robert Mounier-Vehier EU
Scribe: Dr Bertil Remaeus EU
The Ergonomics workgroup discussed four subtopics:
- Definition of Musculoskeletal Disorders- size of the problem and trends
- Legislation; Standards/Regulations and guidelines, including issues of compliance and enforcement
- Interventions: What type of interventions are the most effective?
- Scientific and policy challenges. What are the biggest challenges that we face in the next five years?
In the working group the climate was very positive with lots of questions asked, and with a very intense discussion taking place in order to increase the level of understanding of each others measures taken, whether they are in the field of legislation, data collection and analysis, interventions or any other area.
SUBTOPIC 1: Definition of MSD.
Presentations on this subtopic was made by;
Mr Robert Mounier-Vehier,EU Gov.
Dr Thomas Waters, US Gov.
The EU-view approached the definition by stating that Ergonomics means "adapt work to the worker." In this framework the MSD needs to be discussed more in detail. MSD cover a broad range of health problems. There are two main groups
- back pain and illness/injuries, including work related upper limb disorders, commonly known as "repetitive strain injuries"
- lower limbs can also be affected
The main risk factors for MSD are
Physical aspects of work
poor posture
loads
highly repetitive movements
forceful hand applications
direct mechanical pressure on body tissues
vibration (localized and whole body)
Work environment and work organization
pace of work
repetitive work
time patterns
payment systems
monotonous work
cold work environments
how workers perceive the work organization
psychosocial work factors
The size of the problem.
In EU 7 % of the workers say that their work involves short, repetitive tasks, 31 % have no choice over their pace of work, 54 % are exposed to high speed work and 57 % say that the work involves repetitive hand or arm movements.
As an average 30 %, meaning 44 million workers, suffer from backache, and 17 % of the workers suffer from muscular pains in arms or legs.
Trend
Recognizing MSD risks means that there is clear evidence that MSD are strongly work related and that the causes have been found to be related to the design of work systems.
It is also agreed that manual workers both skilled and unskilled are most at risk. Further the upper limb disorders affect women workers more than men largely because of the type of work they do. For example 35 % of EU-female workers do permanent repetitive work compared to 31 % of EU-male workers. It is also a fact that older workers in Europe report more MSD-problems. For example the EU average for reports of backache is 30 %, for 15 - 24 year old it is 25 %, while those + 55 shows 35 %. Many older workers will have spent more time working in MSD-risky situations. Workers in precarious employment such as fixed-duration or employment agency contracts face also an increased risk..
As a summary;
In Europe MSD"s are one of the first causes of occupational diseases
More than 600 million days are lost due to work related ill-health each year in Europe
Prevention of MSD is not easy, but prevention of these work related disorders is good business for all.
The US-presentation focused on
- what is an MSD?
- What is the trend of MSD's in the US?
MSD's exactly what are they?
NIOSH broadly defines MSD's as any condition that involves the nerves, tendons, muscles and supporting structures of the body.
The magnitudes of MSD's were described. In 1994 there were 705 800 cases involving days away from work in the US. There were 525 000 injuries due to overexertion in lifting, pushing, pulling or carrying. There were 92 500 injuries or illnesses due to repetitive motion, including typing or key entry, repetitive use of tools, and repetitive placing, grasping or moving of objects. Concerning the trends, it was reported that in 1997/98 the number of MSD-cases had decreased to 507 520.
If you look at Workers Compensation the number of non-traumatic soft Tissue MSD's were 486 per 10 000 FTEs in 1990 while the figures in 1997 were 379. Comparing other claims the rate was 1 131 in 1990 and 782 in 1997.
The decrease is greater for non-ms claims. Within the ms-claims the decrease is greatest for neck/back disorders.
Sciatica, Rotator cuff and epicondylitis showed no significant decline.
Is there an explanation for trend in the US?
- Rising costs in the 1980's focused more attention on disability case management and efforts to get workers back to work.
- Response to increase in WC
- Increase in prevention
- More non lost time cases
- Reduction in the generosity of WC
- Underreporting
What does scientific research tell us?
The NIOSH's review of scientific studies concluded that high levels of exposure, especially in combination with exposure to more than one physical factor, provides strong evidence of work relatedness.
The National Academy of Science found that "compelling evidence from numerous studies that as the amount of biomechanical stress is reduced, prevalence of MSD's is reduced".
Conclusions - since 1997
- Newer studies reinforce NIOSH and NAS conclusions
- Newer studies often examined combined exposures
- More studies now include personal factors and psychosocial factors
- More studies use direct exposure measures
Proposed Topics For Further Consideration
Sources of injury and illness data need to be identified at the time of presentation in order to allow us to compare the data.
Definitions are important when evaluating the effectiveness of various reporting and data collection systems, e.g., surveys versus workers compensation (regulatory or insurance) methods because the link between definitions and compensation is critical.
Underreporting of injuries and illnesses was identified as a problem area that needs further attention.
Explore the possibility of developing common definitions of hazards and health outcomes within and between US and EU.
SUBTOPIC 2 - LEGISLATION: Standards and guidelines, including issues of compliance and enforcement.
Presentations on this subtopic were made by:
Mrs Raili Perimaki-Dietrich, EU Labor
Dr Graciela Perez US Gov
Dr Bertil Remaeus EU Gov
Dr Thomas Waters US Gov
There were presentations of activities on the federal level in US, primarily the OSHA standard on ergonomics and a description of the activities producing it. The relation between a federal standard and national standards were shown. It was also shown that compared to the work with some other standards (i.e. confined spaces) the 9 years used to promulgate this standard was not extremely long. Given that only 30% of the US-companies had ergonomic programs, an effective enforceable standard is needed. There was also a discussion about the mandatory status of the OSHA-regulations, also noting that mining, maritime work, construction and agriculture are not covered by the regulations.
On the EU-level, regulation (directives) related to ergonomics were described which member states have to comply with as National law. There was a discussion about the need to evaluate whether the directives sufficiently cover MSDs. Examples of national regulation implementing the EU-directives were given, also highlighting methods of control of compliance.
On the US level, different standards and other voluntary guidelines were described. Methods presented included the ACGIH TLV for upper extremity MSD's, the ANSI Z 365 standard (proposed), the NIOSH lifting equation, as well as he California Ergonomics Standard
In the presentation the ACGIH Ergonomics TLV proposal was presented showing the TLV and the action limit, as well as the HAL rating scale ranging from 0 to 10. It was mentioned that the ACGIH proposed TLV could be a useful tool and first step. That is is based on a relationship demonstrated in many studies and that input from users will be important over time. It was also demonstrated a studie concerning low back pain prevalence by the NIOSH lifting equation, showing a good correlation between the lifting index and LBP prevalence.
Proposed Topics For Further Consideration
Describe the relationship between the various existing Standards/regulations within each group (US and EU)
Evaluate core elements of the different regulations for effectiveness and for different governmental levels (i.e., EU/US, Member States/ States).
Subtopic 3: Interventions: What type of interventions are most effective?
Presentations on this subtopic were made by:
Ms Theoni Koukoulaki, EU Labor
Mr Ira Janowitz, US Gov /Academia
Examples from a French pastry industry where the participatory approach was done, initiated by the safety and health committee. The example highlighted both organizational and technical changes in the work process, and illustrated the benefit of workers participation. On the same theme, participatory improvements, were shown in a number of examples from California, originating partly from ideas of the workers, both in agriculture and in electricity supply.
Proposed Topics For Further Consideration
Develop and define criteria for evaluating the effectiveness of interventions directed at prevention.
Explore development of threshold limit values for compliance (mandatory and voluntary).
Develop criteria/methodology to determine best practices.
Develop information about best practices and effective methods of exchanging and disseminating.
Subtopic 4: Scientific and policy challenges. What are the biggest challenges that we face in the next five years?
Presentations on this subtopic were made by:
Dr Patrick Levy EU Industry
Dr Marilyn Fingerhut US Gov
Research areas were presented from an EU perspective. These included: Epidemiology, Clinical aspects, Physiopathology, Risk Assessment methods and prevention approach.
There is a need to estimate the size of the problem and to establish epidemiological evidence of relation to work. The role of health surveillance was discussed. The need of risk assessment tools was approached, noting that there is no tool applicable in all the activities sectors. There are though some pragmatic and simple tools developed like the Swedish "green-yellow-red". Guidelines are developed as well as validation of questionnaires and performance indicators. It was stressed the need of feed-back of experience from interventions in the workplace.
Areas highlighted include:
- The potential benefits of workplace interventions amongst workers in high risk/high exposure groups
- The effects of multi-factoral interventions in the workplace
- The role of multiple ergonomics redesign
- The importance of "participative approach"
Finally the need of evaluation of the direct and indirect costs of CTD were touched upon, and specially
- The importance of assessment of the indirect costs
- The need of relatively simple and low-cost ergonomics solutions: reduction in exposure to work risk factors for upper limb MSD's
- The return on investment, CBA.
The US described a national effort to develop a process for identifying and prioritizing research in Occupational Safety and Health. The National Occupational Research Agenda (NORA) was a framework chaired by NIOSH that provided a method of increasing resources available to national research. NORA aimed at joining resources on a national level by getting different stakeholders to get together in some prioritized areas to support it more efficiently. The number of cooperating groups as well as the number of grants available had increased. The program contained 21 areas, of which two were directly of interest talking about the prevention of MSD's. A discussion followed about the value of this approach establishing a closer cooperation between EU and US.
Proposed Topics For Further Consideration
Share information on the results of current research efforts.
Explore collaborative efforts to conduct cross-continent scientific studies, such as international health and hazard surveillance, prevention outcomes, and intervention methods.
Develop processes for increasing tripartite cooperation for the future. One suggestion was to form a tripartite workgroup that meets on a regular basis via the web or videoconference to continue the dialogue and develop action items.