Copyright P.Buckle 2000 Robens Centre for Health Ergonomics University 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 EU Size of the problem
Copyright P.Buckle 2000 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) Vibration Combinations of factors DurationRepetition Intensity/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./Vacuum s) 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 Zone Model for Action
Copyright P.Buckle 2000 Conclusions Report download 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