Estimating Pain and Disability in Virtual Patients with Low Back Pain: The Contribution of Nonverbal Behaviors

It is well recognized that chronic low back pain (cLBP) can be estimated from nonverbal pain behaviors. However, only a few studies examined how clinicians rely on those when estimating specific outcomes, such as pain intensity and pain disability. Therefore, the present study examines (1) if facial expressions and guarding behaviors (including speed of the movement and lifting strategy) contribute to the prediction of pain intensity and disability in patients with cLBP; and (2) if these pain behaviors have been given the same importance according to the outcome. Twenty-five experienced clinicians and thirty-one novice clinicians were asked to estimate low back pain intensity and disability from a realistic virtual character performing a lifting lowering task. The studied pain behaviors were manipulated across different conditions. Pain intensity and disability were judged higher when the character moved more slowly and displayed painful facial expression. Speed of the movement and facial expressions explained a greater portion of variance when related to pain intensity assessment than to pain disability assessment. Results also showed a significant interaction between the lifting strategy, the speed of the movement and facial expressions, but only when estimating the character’s pain-related intensity. Novice clinicians rated pain disability higher than experienced clinicians did. Although pain-related concepts, pain intensity and related disability are not estimated through the same pain behaviors by clinicians. Clinical experience does not contribute to clinical judgments through the use of nonverbal pain behaviors when estimating pain outcomes but contributes to pain disability rating overall.     

The economic evaluation of a Participatory Ergonomics programme to prevent low back and neck pain

This study was an economic evaluation conducted alongside a cluster randomised controlled trial with a follow-up of 12 months. The aim was to evaluate the cost-effectiveness and cost-benefit of the Stay@Work Participatory Ergonomics programme (PE) compared to a control group (no PE). In total, 37 departments (n=3047 workers) were randomised into either the intervention (PE) or control group (no PE). During a meeting, working groups followed the steps of PE, and composed and prioritized ergonomic measures aimed to prevent low back pain (LBP) and neck pain (NP). Working groups had to implement the ergonomic measures within three months in their department. Cost data included those directly related to LBP and NP. Cost-effectiveness analyses (CEA) and cost-benefit analyses (CBA) were performed. After 12 months, health care costs and costs of productivity losses were higher in the intervention group than in the control group (the mean total cost difference was $/euro$127; 95% CI $/euro$-164 - $/euro$418). From a societal perspective, the CEA showed that PE was not cost-effective compared to control for LBP and NP prevalence, work performance, and sick leave. The CBA from a company perspective showed a monetary loss of $/euro$78 per worker. The PE programme was neither cost-effective nor cost-beneficial on any of the effect measures.     

Multi dimensional system for evaluating preventive program for upper extremity disorders among computer operators

Typing is associated with musculoskeletal complaints (MSCs), caused by multiple risk factors. Although a wide variety of ergonomic intervention programs were conducted to reduce risk factors and MSC's, only few of them were found evidence based. This study aimed to test the efficacy of a workplace intervention in reducing MSC's among computer workers. 66 computer workers were assigned randomly to one of three intervention programs: ergonomic intervention including biofeedback, intervention without biofeedback and control group without intervention. The efficacy was tested by advanced assessment including; pain location and severity, posture at work, upper extremity 3D kinematics, muscle activity and psychosocial status. Working hypothesis; significant score differences will be found between the study groups which underwent ergonomic intervention and the control group on the following measures: pain complaints, upper extremity kinematics, muscle activity and psychosocial status. Significant differences were found between pre and post intervention and between research groups and the control group in pain, posture and motion. The ergonomic intervention with biofeedback had no unique contribution in comparison to other interventions. In conclusion; the proposed intervention program was found efficient for reducing pain among computer workers.     

Interdisciplinary team discussion on work environment issues related to low back disability: a multiple case study

From both a social and cost-benefit perspective, disability prevention and associated management strategies for assisting employees with back pain are only successful if they address critical return-to-work (RTW) determining factors present in the workplace, including ergonomic factors. Despite our current knowledge of the importance of an integrated team approach targeting these factors, questions remain regarding the conceptual framework adopted by contemporary rehabilitation teams as it relates to work-oriented interventions to accommodate employees back to work. The purpose of this study was to explore and describe the work environment issues discussed by an interdisciplinary team engaged in the work rehabilitation process of low back disability cases. A qualitative content analysis was conducted for 10 sample cases that underwent a rehabilitation program in Quebec (Canada). Drawing on the results of these analyses, a framework representing a synopsis of practitioners' involvement in the person-environment dynamic is presented and discussed. This study makes a unique contribution to the understanding of the 'real-life' content of an interdisciplinary activity in disability management, thus, helping rehabilitation practitioners to build knowledge on the practical application of a cross-disciplinary framework to address work environment issues during the RTW process of those patients sick-listed due to back pain.     

Exposure assessment in different occupational groups at a hospital using Quick Exposure Check (QEC) - a pilot study

In order to test the feasibility and sensitivity of the ergonomic exposure assessment tool Quick Exposure Check (QEC), a pilot-study was conducted. The aim was to test QEC in different occupational groups to compare the exposure in the most common work task with the exposure in the work task perceived as the most strenuous for the neck/shoulder region, and to test intra-observer reliability. One experienced ergonomist observed 23 workers. The mean observation time was 45 minutes, waiting time and time for complementary questions included. The exposure scores varied between the different occupational groups as well as between workers within the occupational groups. Eighteen workers rated their most common work task as also being the most strenuous for the neck/shoulder region. For the remaining five workers, the mean exposure score were higher both for the neck and shoulder/arm in the most common work task. Intra-observer reliability shows agreement in 86% of the exposure interactions in the neck and in 71% in the shoulder/arm. QEC seems to fulfill the expectations of being a quick, sensible and practical exposure assessment tool that covers physical risk factors in the neck, upper extremities and low back.     

Associations between psychosocial risk factors and musculoskeletal disorders: application to the IT profession in India

The exponential growth of the information technology (IT) industry in India has been accompanied with a substantial increase in the reporting of work-related musculoskeletal disorders (WMSDs). The purpose of the current study was to identify and assess the contributions of prevalent psychosocial factors on perceived WMSD outcomes among IT professionals from India. About 77 IT professionals from India completed a survey set consisting of 26 question items from the Job Content Questionnaire and 3 separate question items pertaining to WMSD outcomes (pain/discomfort and psychological stress scores). The findings suggest prevalence of existing pain (shoulder/neck and low back) in more than one-fourth of the respondents. Additionally two-thirds of the respondents had never had any ergonomics awareness training. Co-worker support and psychological work demands were found to be the strongest contributors of psychosocial risk factors towards pain/discomfort and psychological stress outcomes. Findings from this study highlight the influence of certain psychosocial traits of the Indian IT workplace on perceived WMSD outcomes. There is a need to develop and implement intervention strategies to address these factors that may help lower the risk of work-related musculoskeletal pain.     

Participatory ergonomic intervention for prevention of low back pain: assembly line redesign case

This paper gives an overview of a participatory ergonomic intervention aimed at reducing low back pain cases in the dispatch department of a catalogue and e-commerce retail company. Based on the findings of the ergonomic analysis and design committee, the company's own employees redesigned the assembly line's layout. As a result of these changes two job tasks that involved manual material handling of boxes, identified by the revised NIOSH equation as posing an increased risk for lifting-related low back pain, were totally eliminated, and the employees responsible for moving boxes from the end of the assembly line to pallets on the ground were given more control over their jobs, and these jobs were also enriched with a new, less heavy task. These results demonstrate that participatory ergonomic interventions are a viable and effective strategy to reduce the exposure to work-related physical and psychosocial risk factors for low back pain.     

Back pack injuries in Indian school children: risk factors and clinical presentations

The use of backpack increased substantially among the school children. Studies have shown that carrying a backpack cause to develop different symptoms of musculoskeletal disorders among the carrier of the backpack. In India there are fewer studies available in literature which explains the musculoskeletal discomfort among the school children. This study aimed at to find out the prevalence of different musculoskeletal problems among the school children. In a retrospective study data were collected for twenty two students. The main diagnostic criteria were pressure mark (redness or swelling) over neck and shoulder corresponding to the straps of the backpack, stooping posture while carrying the back pack, pain or stiffness in the neck, upper back and shoulders predominantly while carrying the back pack and absence of these symptoms during school holidays. Results revealed that pain in the upper back (40%), neck (27%) and shoulder (20%) were most prevalent body regions followed by forearm and wrist pain (7%) and low back (6%). Results further revealed that all the students participated in this study have a pressure mark over shoulder. 54.55% of the children were diagnosed with myofascial pain and rest with thoracic outlet syndrome.     

BASE als Programm zur Pr?vention von (Rücken-)Beschwerden in der betrieblichen Gesundheitsf?rderung

Common occupational health problems, especially low back pain, are associated with physical demands of work, like lifting heavy weights. The study examined a multidimensional methodological approach (BASE) to reduce physical stresses in a logistic company in three stages: (1) theoretical background and implementation of the program, (2) evaluation of outcome-effects of a box lifting training (10 weeks) and (3) learning and lasting effects of workers?? knowledge and behaviour with regard to ergonomic box lifting. Video analysis and questionnaires were used for breakdown analysis. Stage (2) and (3) collected intervention effects with a controlled pre?\post test design (N?=?41 males; 37.8?±?10.8 y.). The breakdown analysis revealed low back pain (65?%) as a result of repeated manual lifting processes. Participants of the intervention showed a more ergonomic movement initiated by a more functional cognitive representation in long term memory. We suggest that especially this group of employees, with little motivation to participate in health promotion, benefit from the whole methodological approach of the BASE-program.     

A controlled case study of supervisor training to optimize response to injury in the food processing industry

The role of supervisors to aid injured workers, access health care, and provide reasonable accommodation may prevent prolonged disability among workers reporting musculoskeletal pain. Although supervisor training has been a common element of broad-based ergonomic interventions to prevent injuries, the impact of supervisor training alone to improve injury response has not been studied. In a controlled design, 11 supervisors in an intervention group and 12 supervisors in a delayed intervention control group from the same plant were provided a 4-hour training workshop. The workshop emphasized communication skills and ergonomic accommodation for workers reporting injuries or health concerns. Workers' compensation claims data in the 7 months before and after the workshop showed a 47% reduction in new claims and an 18% reduction in active lost-time claims versus 27% and 7%, respectively, in the control group. Improving the response of frontline supervisors to employees' work-related health and safety concerns may produce sustainable reductions in injury claims and disability costs.     

Yoga for stress reduction and injury prevention at work

At work employees face numerous psychological stressors that can undermine their work performance. These stressors, stemming from a variety of possible causes, have enormous health and financial impacts on employees as well as employers. Stress has been shown to be one of the factors leading to musculo-skeletal disorders (MSDs) such as: include back pain, carpal tunnel syndrome, shoulder or neck tension, eye strain, or headaches. Yoga is an ancient form of exercise that can reduce stress and relieve muscular tension or pain. Practicing yoga at the workplace teaches employees to use relaxation techniques to reduce stress and risks of injury on the job. Yoga at the workplace is a convenient and practical outlet that improves work performance by relieving tension and job stress.     

Effect of ergonomic and workstyle risk factors on work related musculoskeletal disorders among IT professionals in India

'Workstyle' can be described as a mechanism by which ergonomic and psychosocial risk factors interact to affect the development, exacerbation and/or maintenance of upper limb pain and functional limitations. Workstyle is associated with the increase in the work demand. In today's life use of computer in the workplace is very common and it causes to increase the work demand among the workers who are working with computer. As work demand increase, according to the characteristic of workstyle, risk of the development of musculoskeletal disorders also increased. This study aimed at to findout the association between ergonomics risk factors, workstyle and WRMSD. Two hundred IT professionals participated in this study. Result revealed that most prevalenet body regions were lower back (20%), Upper back (16%) and shoulder (14%). Study result says that there is a positive association between workstyle score with musculoskeletal pain (r=0.85). Also it revealed that posture and regional pain is associated (r=0.62), per day use of computer and musculoskeletal pain (r=0.46), micro breaks and pain (r=0.87) and productivity and the pain (r=0.95). This study further validates these observations and extends support for the assessment of working postures and workstyle behaviors during the design of WMSD treatment.     

Evaluating the effectiveness of ergonomics application

The effectiveness of ergonomics application is achieved in the course of this research by reviewing ergonomics literature, Internet searches and case studies of a number of work related musculoskeletal disorders (WMSD's) and other ergonomic related workplace incidence rate. The results of ergonomic intervention control measures such as engineering controls, administrative controls and personnel protective equipment were also studied. The findings in this paper may help to development model for analysing and solving ergonomic problems in the workplace. It concludes on the need for management to support ergonomics intervention programme for effective cost saving, litigation avoidance and better productivity.     

Participatory ergonomics among female cashiers from a department store

The objective of this paper was to control ergonomic risks among female cashiers working in a department store belonging to the retail market. This study was conducted between May and November 2010. Participatory ergonomics was applied through knowing and understanding how the company works, establishing the work team (Ergo group), training the team in ergonomics-related topics, and making decisions and interventions. The sample was composed of 71 participants--mostly female cashiers--, and all of them have a musculoskeletal compromise, declaring pain or discomfort mainly in the neck, lower back, right wrist and shoulders. Among others, following problems were found: postural overload, repetitive work, manual load handling, mental fatigue, environmental discomfort, variable work schedules, extended working days, and absence of breaks. In the intervention, the main implemented changes were the redesign of workstation, complete change of chairs and keyboards, and the implementation of a rotation system, as well breaks for compensatory exercises. After that, an evident improvement of found problems was observed, therefore it can be concluded that participatory ergonomics is an attractive methodology, appropriate and efficient for solving and controlling ergonomic risks and problems.     

Educating back-injured workers: What should we be teaching?

OBJECTIVE: The purpose of this study was to identify what information people with acute and chronic back pain, health care practitioners, employers and case managers felt should be included in an educational brochure for recently back-injured workers. STUDY DESIGN: Four focus groups were convened, each comprising several representatives from one of the four constituencies. Participants rated 32 information items regarding their inclusion in an educational brochure. Ratings were tabulated for ranking and for group comparisons. RESULTS: While consensus was strong for most information items, there were apparent differences between the groups for several items relating to work resumption, medical attention, and legal or compensation consultation. CONCLUSIONS: Perceived educational needs of back-injured workers may differ from those of their health care practitioners and from their employers or insurers. Future efforts to prevent back disability through education should include evaluation of the informational needs of injured workers.     

Work-related factors contributing to chronic disability in low back pain

Low back pain is a costly and incapacitating musculoskeletal disorder. Prospective studies documenting the capacity of work-related factors to predict chronicity are few in number, the methodology used is very diversified, and the results obtained diverge. The aim of the present study is to investigate the capacity of work-related objective (non-psychosocial) and psychosocial factors to predict chronic disability related to low back pain. A longitudinal prospective study with two measurement times was carried out. The sample (N = 258) consisted of workers with subacute low back pain who were on sick leave and receiving compensation from the CSST (Quebec Workers' Compensation Board). Of all the work-related variables measured, perceived stress and fears and beliefs about work were associated with return to work status at the six-month follow-up. The results obtained show the importance of considering fears and beliefs about work when identifying people in the subacute phase of low back pain who are at risk of developing chronic disability.     

Study of musculoskeletal risks of the office-based surgeries

Due to the cost and time benefits associated with patients and physicians, outpatient surgeries continue to become more and more popular over time. With the increase in the number of office-based surgical procedures, the prevalence of work-related musculoskeletal disorders (WMSDs) associated with office-based surgeries has been reported. The purpose of this pilot study is to ergonomically evaluate the risk of work-related musculoskeletal disorders of physicians/surgeons performing office-based surgery (OBS). Ergonomic assessment tools included Questionnaire, the BodyMap and the Rapid Upper Limb Assessment for measuring potential ergonomic concerns. The findings have shown that the ergonomic issues of greatest concerns were the discomforts in the neck, shoulders, arms/wrists, and back. Some additional comments were provided by the participants regarding the duration of discomfort or clarification on the frequency of their body discomfort. This study suggests that there is a considerable risk of musculoskeletal injuries of physicians/surgeons performing the OBS tasks. By properly using the ergonomic assessment techniques, valuable information on ergonomic OBS workplace design and selection could assist in the early interventions of WMSD prevention.     

Blueprint for ergonomics

Worker safety and health, and productivity and efficiency on the job can be greatly impacted by the application of ergonomics. This article outlines the decision making process for implementing ergonomic change in the workplace. Ergonomic principles, as well as risk factors for the upper extremity and low back are identified. Three ergonomic measurement methods are presented including the National Institute for Occupational Safety and Health (NIOSH) 1991 Revised Lifting Guidelines, Rodgers's Functional Job Analysis Technique, and the Moore and Garg Strain Index. Ergonomic solutions are discussed and additional factors to consider when designing ergonomic changes are identified.     

Workplace aesthetics: impact of environments upon employee health as compared to ergonomics

Associations between self-reported needs for aesthetic and ergonomic improvements were studied to analyse a possible impact of aesthetic needs on job performance as compared to ergonomic needs in 11 occupational groups. Employees at Swedish broadcasting company were invited to participate in a cross sectional study. 74% (n=1961/2641) fulfilled the inclusion criteria. Demographic data from company files and a pre-validated questionnaire were used. 'High rank' and 'low rank' aesthetic and ergonomic needs were compared. The perceived needs for aesthetic and ergonomic improvements showed significantly different distributions (p<0.001). Aesthetic needs were more frequently reported. No gender related differences were observed. Differences between occupational groups were shown (p=0.006, 0.003).'High rank' needs for aesthetic and ergonomic improvements were similarly associated to psychological demands, stress, pain and age. 16/24 factors showed significant differences between 'high and low rank' aesthetic needs, whereas 21/24 between ergonomic needs. Sick leave was stronger related to ergonomics. The study results show a relation between not only work place ergonomics but also work place aesthetics to health and well-being. Future work health promotion and prevention may benefit from the inclusion of workplace aesthetics.     

A cognitive-behavioral plus exercise intervention for older adults with chronic back pain: race/ethnicity effect?

This pilot study examined the feasibility and potential efficacy of a self-management program for seniors with chronic back pain and assessed for possible race/ethnicity differences in program impact. Sixty-nine seniors (24 African Americans, 25 Hispanics, and 20 non-Hispanic Whites) enrolled in the 8-wk community-based program. Efficacy outcomes included pain-related disability as measured by the Roland Morris Disability Questionnaire (RMDQ), pain intensity, pain self-efficacy, depressive symptoms, social activity, and functional status. Eighty percent of enrollees completed the program. Clinically important decreases in RMDQ scores were found for non-Hispanic White (adjusted change score = -3.53), African American (-3.89), and Hispanic (-8.45) participants. Improvements in all other outcomes were observed, but only for Hispanic participants. Results confirm that implementation of the protocol in urban senior centers is feasible, and the program shows potential efficacy. The race/ethnicity differences observed in the current study merit further investigation.