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Copyright P.Buckle 2000
Robens Centre for Health ErgonomicsUniversity of Surrey
Europe and work-related neck and upper limb musculoskeletal disorders
Peter Buckle
Copyright P.Buckle 2000
Structure of the presentation
• Methods used to prepare review• Nature, size & cost of the disorders • Relationship between work and neck and upper
limb disorders– Biological pathology, epidemiological
evidence,workplace interventions• Strategies for Prevention
– risk assesment, existing practice, surveillance• Action and Conclusions
Copyright P.Buckle 2000
• Contemporary scientific literature• Expert opinion• Existing framework of Member state,
European and International Directives, standards and guidance
• Existing Practice• The needs and capacities of those who may
use the ergonomic actions that are suggested
Approaches Used
Copyright P.Buckle 2000
The Nature of the Disorders
Copyright P.Buckle 2000
Classification and Diagnosis of the Conditions
• With some conditions there is general agreement as to the nature of the disorder despite a lack of standardisation in agreed diagnostic criteria.
• In contrast, there are also predominantly symptom based conditions, where there is difficulty in identifying precisely the tissue(s) responsible.
Copyright P.Buckle 2000
Setting diagnostic criteria
• Different diagnostic criteria may be required dependent on the setting
• Sensitive criteria (low false negative rate) may be necessary in an occupational setting
• More highly specific criteria are required in secondary or tertiary care situations to avoid over-diagnosis
Copyright P.Buckle 2000
Consensus on Disorder Diagnosis
• Recognition of recent sources (e.g. Harrington et al, 1998; Coronel Institute, Amsterdam, Netherlands, 2000)
• Debate over the need for higher specificity of outcome versus the requirement to initiate common pathways for prevention with a generic approach
Copyright P.Buckle 2000
Size of the Problem
Copyright P.Buckle 2000
Guildford
155 million workers
Copyright P.Buckle 2000
WRULDS in the EUSize of the problem
COUNTRY STUDY/ ORGANISATION
PREVALENCE OUTCOME DEFINITION
TheNetherlands
Belgium
TNO Work &Employment
Amsterdam 1999 Blatter & Bongers 1999
Blatter et al., 1999
30.5%
39.7%
Great Britain
SWI The Health & Safety
Executive J ones et al. 1998
17%
Self-reported Symptoms ofthe neck andupper limbsin the last 12months
Copyright P.Buckle 2000
Percentage of self-reported muscular pain in the arms or legs
0
5
10
15
20
25
30
35
40
Per
cen
tag
e o
f re
spo
nd
ents
European Survey of Working Conditions (European Foundation, 1997)
Copyright P.Buckle 2000
Pathogenesis
Evidence of work causation and biological plausibility
• Biological plausibility• National Academy of Science report 1998
• Epidemiological basis• National Institute of Occupational Health and Safety report 1997
Copyright P.Buckle 2000
Pathomechanisms• Understanding varies across WRULDs
• Impressive knowledge (e.g. CTS)
• Knowledge base is derived from– biomechanics– mathematical modelling– direct measurement of tissue pathology
• Forms a coherent argument for biomechanically induced pathogenesis
Copyright P.Buckle 2000
Work-Relatedness• Epidemiological evidence shows a
strong positive relationship between WRULDs and work
– Especially for high levels of exposure
• Psychosocial and work organisation factors are also important
Copyright P.Buckle 2000
Force Posture (static/dynamic)VibrationCombinations of factors
DurationRepetitionIntensity/Ampl.How much? How often? How long?
Copyright P.Buckle 2000
Psychological and Work Organisational Risk Factors
• Evidence for a relationship between psychosocial work factors and some neck and upper limb disorders
• Definitions for these factors required
• Guidance may include job decision latitude, job demands and social support
Copyright P.Buckle 2000
Posture
Force
Vibration (Buff./Vacuums)
Diff. keeping up with work
Moving furniture
Repetitive work
Poor work environment
Multifactorial problem
Copyright P.Buckle 2000
Is there evidence that workplace interventions would reduce the risks associated with these
disorders?
Copyright P.Buckle 2000
Potential for intervention
• suitable evidence from both controlled and uncontrolled studies that work system interventions were effective for reducing the problem
• such interventions most likely to be successful amongst workers in high/risk exposure groups
Copyright P.Buckle 2000
Successful interventions• Focus should be on work organisation
interventions and work place interventions, not solely on worker interventions (i.e. training/work hardening)
• Also prudent to reduce discomfort and fatigue
Copyright P.Buckle 2000
Existing Directives, Standards and Guidance
• Framework for risk identification and prevention(89/391)
• Prevention of manual handling risks (90/269)
• Risks from DSE (90/270)• Min. Standards w/places
(89/654)• Working time (93/104)• Common CEN standards
Copyright P.Buckle 2000
Prevention Strategies• Assessment of risk factors
– postural, force applications, vibration, direct pressure, cold, psychosocial and work organisational factors
– prudent to consider fatigue as a potential precursor of WRULDs
– considered the ability of practitioners assessing risks
Copyright P.Buckle 2000
Main criteria for exposure assessment methods
• Cheap, easy to learn and quick to use
• Applicable to all
• Methods should not interfere with the work
• Method needs high validity, reliability and
sensitivity
• Easy coding/analysis of data
Copyright P.Buckle 2000
Prevention Strategies• Assessment of risk factors
– postural, force applications, vibration, direct pressure, cold, psychosocial and work organisational factors
– prudent to consider fatigue as a potential precursor of WRULDs
– considered the ability of practitioners assessing risks
• Health and surveillance programmes• A 3-zone model for action
Copyright P.Buckle 2000
3 Zone Model for Action
1 High Risk This zone identifies those at highest risk for thedevelopment of upper limb disorders and whereaction is almost certainly required.
2 Medium risk Work factors require close attention and remedialactions may be necessary.
3 Low Risk Areas of least concern, although some actionmay be prudent. Assessment may provide usefulinformation to inform workplace interventionselsewhere. Routine assessment and surveillanceshould be extended to this group.
Copyright P.Buckle 2000
Conclusions Report download http://osha.eu.int
• WRULDs are a significant problem in the EU• Biomechanical pathogenesis for some WRULDs• Epidemiological evidence shows a strong
positive relationship between (some) WRULDs and a number of work factors
• The potential benefits from work system interventions is supported by scientific knowledge …action is needed
Copyright P.Buckle 2000
The University of Surrey “Understanding the real world”
Robens Centre for Health Ergonomics
www.surrey.ac.uk
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