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1.  Work-related musculoskeletal disorders among health care professionals: A cross-sectional assessment of risk factors in a tertiary hospital, India 
Work-related musculoskeletal disorders (WMSDs) are responsible for morbidity in many working populations. Apart from lowering the quality of workers’ life and reducing the productivity, WMSDs are the most expensive form of work disability, attributing to about 40% of all costs toward the treatment of work-related injuries. WMSDs are considered to be multifactorials that are caused due to the interactions between various risk factors, which result in conditions that vary across different occupations. Although health care profession is known to be at a high risk for WMSDs, it is one of the least-studied occupations. Most of the previous studies on WMSDs among health care workers were limited to any one of the professional groups such as nurses, physical therapists, dentists, and others. Hence this study was aimed at looking into the WMSDs affecting five different health care professionals working in a tertiary care hospital. It compared the prevalence and distribution of WMSDs among the five groups, evaluated the multiple risk factors that contribute to the development of WMSDs, and identified the high-risk group.
Materials and Methods:
It was a cross-sectional study conducted among dentists, laboratory technicians, nurses, physicians, and physiotherapists of various clinical departments in a tertiary care hospital in Chennai, India, from January to June 2013. Face-to-face interviews as well as observational analysis of various tasks were employed. Different combinations of validated and standardized questionnaires were used for collecting different types of data.
A high proportion of health care professionals reported WMSDs at one or the other body region, lower back being the most commonly affected area. Working in the same position for long periods, working in awkward or cramped positions and handling an excessive number of patients or samples in one day were found to be the most commonly reported job risk factor that contributed to the development of WMSDs, in this study.
Among all the health care professionals assessed in this study, nurses were found to be at the highest risk, whereas physicians were at the lowest risk. A longitudinal study using quantitative analytical tools may give a more accurate estimate of WMSDs and job risk factors, which would pave way for making more precise recommendations to eliminate the risk factors and thereby prevent WMSDs.
PMCID: PMC4280781  PMID: 25568602
Health care professionals; risk factors; WMSDs
2.  Relationship between Occupational Stress and Work-related Musculoskeletal Disorders in Korean Male Firefighters 
A growing body of literature has documented that job stress is associated with the development of work-related musculoskeletal disorders (WMSDs). However, the association of WMSDs with job stress has not yet been fully studied in Korean male firefighters. The purpose of this study was to determine the status of WMSDs in almost all Korean male firefighters and to clarify the effect of job stress on the occurrence of WMSDs.
The study design was cross-sectional, and 21,466 firefighters were recruited. The study design included a structured questionnaire to assess general characteristics, the Korean Occupational Stress Scale (optional KOSS-26), Center for Epidemiologic Studies-Depression Scale (CES-D), and WMSDs. The chi-square test, and univariate and multivariate logistic regression analyses were used to look for a correlation between general characteristics and job stress, and the occurrence of WMSD.
Back pain is the most common WMSD. Among the job stress subgroup, physical environment, job demands, organizational system, occupational climate, lack of reward and job insecurity were related to the occurrence of WMSDs. However, insufficient job control and interpersonal conflict were not related to the occurrence of WMSDs.
Job stress was related to the occurrence of WMSDs in Korean male firefighters. To reduce the occurrence of WMSDs, a job stress management program may be required.
PMCID: PMC3923336  PMID: 24472292
Work-related musculoskeletal disorder; Firefighter; Job stress
3.  Common musculoskeletal problem experienced by fishing industry workers 
Work-related musculoskeletal disorders (WMSDs) are a common health problem throughout the world and a major cause of disability in the workplace. Awkward working posture is a main risk factor for developing WMSDs. Assessment of exposure level to WMSDs risks can be an appropriate base for planning and implementing interventional ergonomics program in the workplace. Fihing in India is a major industry in the coastal states employing over 14 million people. The job demand of fishermen make them vulnerable for various musculoskeletal problems This study was conducted among workers of fishing industry in Mumbai, India with the objective to determine WMSDs prevalence in fishing industry.
Materials and Methods:
In this cross-sectional study, 110 randomly selected workers from fishing industry, India, Mumbai, Anonymous questionnaire was used to study prevalence of WMSDs.visual analogue scale used to assess intensity of pain.
The results of NMQ revealed that WMSDs occurrence was high. The highest rates of WMSDs prevalence were reported in Low back(92.4%), Shoulder (64.8%) and Knee(31%) and Hand (25%).
This study showed that maximum of the fishermen have musculoskeletal problem with the most common joint involved is low back and then followed by shoulder, knee, and hand. Ergonomic risk factor involved were found to be repeated pulling and throwing of the net as well as repeated bending forward action to lift heavy load and transfer that heavy load.
PMCID: PMC4280776  PMID: 25568597
Fish industry; workers; musculoskeletal problems
4.  Musculoskeletal problems among workers of an Iranian communication company 
Work-related musculoskeletal disorders (WMSDs) are a common health problem throughout the world and a major cause of disability in the workplace. Awkward working posture is a main risk factor for developing WMSDs. Assessment of exposure level to WMSDs risks can be an appropriate base for planning and implementing interventional ergonomics program in the workplace. This study was conducted among workers of an Iranian communication company with the objectives of a) determination of WMSDs prevalence and b) assessment of exposure level to WMSDs risks.
Materials and Methods:
In this cross-sectional study, 85 randomly selected workers from assembly line and closed circuit TV (CCTV) participated. Nordic musculoskeletal questionnaire (NMQ) was used to study prevalence of WMSDs and rapid upper limb assessment (RULA) technique was applied to assess physical exposure to the risks.
The results of NMQ revealed that WMSDs occurred at an high rate. The highest rates of WMSDs prevalence were reported in shoulders (73%), knees (67.1%) and back (66.7%). RULA showed that the Grand Score of 88.1% of cases were high and very high (action levels 3 and 4). Significant association was found between risk level and musculoskeletal symptoms in lower back (P < 0.05).
Given the association between RULA score and the prevalence of the problems, reducing RULA score by designing ergonomic workstation may reduce the prevalence of WMSDs among the workers.
PMCID: PMC3168110  PMID: 21957370
Assembly workers; communication industry; rapid upper limb assessment technique; work-related musculoskeletal disorders
5.  Prevalence, characteristics, and impacts of work-related musculoskeletal disorders: a survey among physical therapists in the State of Kuwait 
Physical therapists working in the State of Kuwait are at risk of work-related musculoskeletal disorders (WMSDs). However, prevalence rates and risk factors are not well documented. The objective of this study was to determine the prevalence, characteristics, and impacts of WMSDs among physical therapists in the State of Kuwait.
A self-administered questionnaire was distributed to 350 physical therapists. The questionnaire gathered demographic data as well as information on occurrence of musculoskeletal complaints in the previous 12 months. Descriptive statistics, frequency, and Chi-square analyses were used.
The response rate to the questionnaire was 63% (222/350). Of the 212 responders included in the study, the one-year prevalence of WMSDs was 47.6%, with lower back complaints as the most common (32%). This was followed by neck (21%), upper back (19%), shoulder (13%), hand/wrist (11%), knee (11%), ankle/foot (6%), elbow (4%), and hip/thigh (3%) complaints. The frequency of WMSDs was not gender related (except lower back, neck, and shoulder complaints) nor was it related to age (except lower back complaints), working venues (except hand/wrist), working hours, area of specialty, or exercise. WMSDs' impact on work was minor.
WMSDs among physical therapists in Kuwait were common, with lower back and neck affected most. Lower back and neck WMSDs were related to the participant's demographics. Hand/wrist WMSDs were related to work settings. Further research is needed to investigate the effect of risk factors as physical load, psychosocial load, and general health status on prevalence musculoskeletal disorders.
PMCID: PMC2905326  PMID: 20540724
6.  Effect of working characteristics and taught ergonomics on the prevalence of musculoskeletal disorders amongst dental students 
Work-related musculoskeletal disorders are one of the main occupational health hazards affecting dental practitioners. This study was conducted to assess the prevalence of Work-related Musculoskeletal Disorder (WMSD) amongst dental students. Possible correlations with the working environment and ergonomics taught in Malaysian dental schools were also sought.
Five dental schools in Malaysia participated in this cross-sectional study. A validated self-administered questionnaire was used to establish the point prevalence of WMSD in the dental students based on various body regions. The questionnaire also collected data regarding the working environment, clinical practice and the taught ergonomics of the students during their training years.
Out of five hundred and sixty eight dental students who participated in the study, 410 were in their clinical years whilst 158 were students in their non- clinical years. Ninety three percent of the clinical year students reported symptoms of WMSD in one or more body regions. Female students reported a significantly higher numbers of symptoms compared to male students. The neck (82%) and lower back (64%) were reported to have the highest prevalence of WMSD. Discomfort in the neck region was found to be associated with self-reported frequency of bending of the neck. A majority of students (92%) reported minimum participation in workshops related to ergonomics in dentistry and 77% were unfamiliar with treatment and remedies available in the case of WMSD.
There was more WMSD seen in dental students who had started their clinical years. Neck and lower back are more injury prone areas and are at increased risk of developing musculoskeletal disorders. Theory and practice of ergonomics should be incorporated into the dental undergraduate curriculum.
PMCID: PMC3626888  PMID: 23547959
Dental students; Musculoskeletal diseases; Work characteristics; Work environment; Ergonomics
7.  Burden of Work-Related Knee Disorders in Washington State, 1999 to 2007 
To describe the burden of knee work-related musculoskeletal disorders (WMSDs).
Knee WMSDs were identified using Washington State Fund workers’ compensation data from 1999 to 2007 and analyzed by cost, industry, occupation, and claims incidence rates.
Knee WMSDs accounted for 7% of WMSD claims and 10% of WMSD costs. The rate of decline in claims incidence rates for knee WMSDs was similar to the rate of decline for all other WMSDs. Industries at highest risk for knee WMSDs included construction and building contractors. Occupations of concern included carpenters and truck drivers in men and nursing aides and housekeepers in women.
Between 1999 and 2007, Washington State Fund knee WMSDs were widespread and associated with a large cost. Identification of specific occupational knee WMSD risk factors in high-risk industries is needed to guide prevention efforts.
PMCID: PMC3102793  PMID: 21508866
8.  Frequency and risk factors of musculoskeletal pain in nurses at a tertiary centre in Jeddah, Saudi Arabia: a cross sectional study 
BMC Research Notes  2014;7:61.
Musculoskeletal complaints are an important occupational problem; nevertheless, few studies have targeted nurses in Saudi Arabia. The aim of this study was to determine the frequency and risk factors of work-related musculoskeletal disorders (WMSDs) among nursing personnel at a tertiary centre in Jeddah.
A comparative cross-sectional study was performed in which full-time registered nurses from four different departments (n = 200) were selected for analysis between September 1, 2011 and February 29, 2012. Musculoskeletal symptoms over the past year were assessed using the Nordic Standardised Musculoskeletal Questionnaire. In addition to demographic questions, the researcher evaluated employment history, physical risk factors at work, and general health status.
In this study, approximately 85% of the nurses reported experiencing at least one musculoskeletal symptom. Musculoskeletal symptoms occurred most commonly in the lower back (65.7%), ankles and feet (41.5%), and shoulders (29%). Prolonged working hours and being underweight were significantly associated with the development of these symptoms (OR 3.66, 95% CI 1.24-10.79, P = 0.018, and OR 2.66, 95% CI 1.37-5.93, P = 0.004, respectively). Working in the surgical department was a greater risk factor for low back pain compared with working in other departments.
WMSDs are common among our nurses, and back pain is the most common symptom. As prolonged working hours and being underweight were factors that contributed most to WMSDs, decreasing shift durations or offering nutrition educational programmes may be suitable solutions. However, further studies are required to examine the best modality for decreasing the occurrence of WMSDs.
PMCID: PMC3905157  PMID: 24460669
Pain; Nurse; Musculoskeletal
9.  Prevalence of work-related musculoskeletal symptoms of the neck and upper extremity among dentists in China 
BMJ Open  2014;4(12):e006451.
Studies from western countries show that dentists are vulnerable to work-related musculoskeletal disorders (WMSDs) of the neck and upper extremities, but little is known about their epidemiology among members of this rapidly growing profession in China. This study aims to investigate the prevalence of WMSDs and identify potential risk factors associated with their occurrence in the dental profession in China.
Setting and participants
A cross-sectional survey was carried out in 52 different hospitals in a large metropolitan city in China. A total of 304 questionnaires were distributed to respondents identified via stratified random sampling and 272 dentists (121 females and 151 males) completed the survey. The response rate was 89.5%.
Visual analogue score was used to record neck and upper limb musculoskeletal symptoms on a body chart. Work-related risk factors, including physical and psychosocial factors, were accounted for in the regression analysis.
88% of the dentists reported at least one musculoskeletal disorder and 83.8% suffered from neck pain. In the multivariate analyses, working hours per day were associated with neck pain (OR=1.43; 95% CI 1.03 to 1.98). Inability to select the appropriate size of dental instrument was associated with shoulder (OR=2.07; 95% CI 1.00 to 4.32) and wrist/hand (OR=2.47; 95% CI 1.15 to 5.32) pain. As for psychosocial factors, high job demand was associated with symptoms in the shoulder (OR=1.09; 95% CI 1.00 to 1.18), elbow (OR=1.11; 95% CI 1.03 to 1.19) and wrist/hand (OR=1.09; 95% CI 1.02 to 1.17). Regular physical exercise was associated with decreased neck pain (OR=0.37; 95% CI 0.14 to 1.00).
The prevalence of WMSDs among Chinese dentists is high. Specifically, long working hours, inability to select the appropriate size of dental instrument and high job demand are the most significant risk factors.
PMCID: PMC4275663  PMID: 25526795
10.  Characteristics of Work-related Musculoskeletal Disorders in Korea and Their Work-relatedness Evaluation 
Journal of Korean Medical Science  2010;25(Suppl):S77-S86.
Work-related musculoskeletal disorders (WMSDs) can be compensated through the Industrial Accident Compensation Insurance Act. We looked at the characteristics of WMSDs in worker's compensation records and the epidemiological investigation reports from the Occupational Safety and Health Research Institute (OSHRI). Based on the records of compensation, the number of cases for WMSDs decreased from 4,532 in 2003 to 1,954 in 2007. However the proportion of WMSDs among the total approved occupational diseases increased from 49.6% in 2003 to 76.5% in 2007, and the total cost of WMSDs increased from 105.3 billion won in 2004 to 163.3 billion won in 2007. The approval rate of WMSDs by the OSHRI accounted for 65.6%. Ergonomic and clinical characteristics were associated with the approval rate; however, the degenerative changes had a minimal affect. This result was in discordance between OSHRI and the Korea Workers' Compensation & Welfare Service. We presumed that there were perceptional gaps in work-relatedness interpretation that resulted from the inequality of information in ergonomic analyses. We propose to introduce ergonomic analysis to unapproved WMSDs cases and discuss those results among experts that will be helpful to form a consensus among diverse groups.
PMCID: PMC3023344  PMID: 21258595
Musculoskeletal Diseases; Workplace; Low Back Pain; Upper Extremity; Risk Factors
11.  Work-Related Musculoskeletal Disorders of the Hand and Wrist: Epidemiology, Pathophysiology, and Sensorimotor Changes 
The purpose of this commentary is to present recent epidemiological findings regarding work-related musculoskeletal disorders (WMSDs) of the hand and wrist, and to summarize experimental evidence of underlying tissue pathophysiology and sensorimotor changes in WMSDs. Sixty-five percent of the 333 800 newly reported cases of occupational illness in 2001 were attributed to repeated trauma. WMSDs of the hand and wrist are associated with the longest absences from work and are, therefore, associated with greater lost productivity and wages than those of other anatomical regions. Selected epidemiological studies of hand/wrist WMSDs published since 1998 are reviewed and summarized. Results from selected animal studies concerning underlying tissue pathophysiology in response to repetitive movement or tissue loading are reviewed and summarized. To the extent possible, corroborating evidence in human studies for various tissue pathomechanisms suggested in animal models is presented. Repetitive, hand-intensive movements, alone or in combination with other physical, nonphysical, and nonoccupational risk factors, contribute to the development of hand/wrist WMSDs. Possible pathophysiological mechanisms of tissue injury include inflammation followed by repair and/or fibrotic scarring, peripheral nerve injury, and central nervous system reorganization. Clinicians should consider all of these pathomechanisms when examining and treating patients with hand/wrist WMSDs.
PMCID: PMC1557630  PMID: 15552707
carpal tunnel syndrome; hand/wrist tendinitis; inflammation; neuroplasticity; repetitive-motion injury
12.  Impact on the Quality of Life of an Educational Program for the Prevention of Work-Related Musculoskeletal Disorders: a randomized controlled trial 
BMC Public Health  2011;11:60.
Work-related musculoskeletal disorders (WMSD) are a major cause for concern in public health and the main causes of sick leave. Treatments for WMSD have given disappointing results; prevention is the best strategy, but results of preventive measures have not been consistent. To the best of our knowledge there are few studies in literature that evaluated the impact of a specific program aimed at preventing WMSD on the quality of life of employed persons.
One hundred and one clerical and production workers in a steel trading company were enrolled in an open-label randomized controlled clinical trial (parallel groups) to compare the efficacy of an educational program for primary prevention of WMSD with control intervention. The primary outcome was a change in the physical functioning domain of the quality of life (QL) measured by Medical Outcomes Study Short Form 36 Health Survey (SF-36). The intervention group underwent six consecutive weekly sessions concerning specific orientations for the prevention of WMSD, while the control group received general health education in an identical schedule. The SF-36 and theses Work Limitation Questionnaire (WLQ) were evaluated at weeks zero, five and 26.
Baseline characteristics of the interventions groups were comparable, and both groups comprised predominantly young healthy individuals. No significant differences in the variation of the SF-36 and WLQ between the groups were observed at weeks five and 26. However, both groups demonstrated improvement in some aspects of SF-36, suggesting that both educational interventions have beneficial impacts on QL.
A specific educational program aimed at the preventing of WMSD was comparable with general health orientation for the improvement of QL and work capacity in a sample of healthy workers during a six month period.
Trial Registration NCT00874718
Trial Registration
PMCID: PMC3037313  PMID: 21276217
13.  Work-organisational and personal factors associated with upper body musculoskeletal disorders among sewing machine operators 
To assess the contribution of work-organisational and personal factors to the prevalence of work-related musculoskeletal disorders (WMSDs) among garment workers in Los Angeles.
This is a cross-sectional study of self-reported musculoskeletal symptoms among 520 sewing machine operators from 13 garment industry sewing shops. Detailed information on work-organisational factors, personal factors, and musculoskeletal symptoms were obtained in face-to-face interviews. The outcome of interest, upper body WMSD, was defined as a worker experiencing moderate or severe musculoskeletal pain. Unconditional logistic regression models were adopted to assess the association between both work-organisational factors and personal factors and the prevalence of musculoskeletal pain.
The prevalence of moderate or severe musculoskeletal pain in the neck/shoulder region was 24% and for distal upper extremity it was 16%. Elevated prevalence of upper body pain was associated with age less than 30 years, female gender, Hispanic ethnicity, being single, having a diagnosis of a MSD or a systemic illness, working more than 10 years as a sewing machine operator, using a single sewing machine, work in large shops, higher work–rest ratios, high physical exertion, high physical isometric loads, high job demand, and low job satisfaction.
Work-organisational and personal factors were associated with increased prevalence of moderate or severe upper body musculoskeletal pain among garment workers. Owners of sewing companies may be able to reduce or prevent WMSDs among employees by adopting rotations between different types of workstations thus increasing task variety; by either shortening work periods or increasing rest periods to reduce the work–rest ratio; and by improving the work-organisation to control psychosocial stressors. The findings may guide prevention efforts in the garment sector and have important public health implications for this workforce of largely immigrant labourers.
PMCID: PMC2095384  PMID: 17522131
work organisation; musculoskeletal disorder; ergonomic; psychosocial; sewing machine
14.  Work-Related Musculoskeletal Disorders at Two Textile Factories in Edirne, Turkey 
Balkan medical journal  2013;30(1):23-27.
“Work-related musculoskeletal disorders” (WMSDs) is a term used to describe a painful or disabling injury to the muscles, tendons or nerves caused or aggravated by work. WMSDs are preventable or at least can be delayed. The aim of this study to determine the work related musculo-skeletal disorders and risk levels of the these factory workers.
Study Design:
Cross sectional study.
Material and Methods:
This is a cross-sectional study conducted at two textile factories in Edirne, Turkey and it involved 381 workers. The questionnaire used for data collection consisted of two parts. The first part described some socio-demographic features, working conditions and health problems of workers in the previous four weeks. In the second part, a Rapid Upper Limb Assessment (RULA) Employer Assessment worksheet was used.
In the assessment of the upper limbs of the workers, the arm/wrist score (AWS) is 5.9±1.7 (3–11); neck, trunk, legs score (NTLS) is 5.3±2.5 (3–11); and total score (TS) is 5.5±1.3 (3–7). The ages of the workers are significantly associated with higher RULA scores (r=0.207, p=0.000). AWS, NTLS and TS of the women workers were found to be statistically significantly lower than for the men.
Musculoskeletal disorders are a common problem among textile workers. Employers can prevent WMSD hazards by properly designing the jobs or workstations and selecting the appropriate tools or equipment.
PMCID: PMC4116035  PMID: 25207064
Work-related musculoskeletal disorders; ergonomics; upper limb
15.  Work-related Musculoskeletal Disorders in Korea and Japan: A Comparative Description 
Work related Musculoskeletal disorders (WMSD) is one of the most important problem in occupational health system of Korea and Japan, where the OHS system developed in similar socio-cultural environment. This study compared WMSD in Korea and Japan to review similarities and differences in their historical background, and development of prevention policies.
Scientific articles, government reports, and related official and non-official statistics on WMSD since the 1960s in Japan and Korea were reviewed.
The historical background and basic structure of the compensation system in Korea and Japan largely overlapped. The issuing of WMSD in both countries appeared as upper limb disorder (ULD), named occupational cervicobrachial diseases (OCD) in Japan, and neck-shoulder-arm syndrome (NSA) 30 years later in Korea, following the change from an industrial structure to automated office work. Both countries developed manuals for diagnosis, guidelines for workplace management, and prevention policies. At present, compensation cases per covered insurers for WMSD are higher in Korea than in Japan, due to the social welfare system and cultural environment. Prevention policies in Korea are enforced more strongly with punitive measures than in Japan. In contrast, the Japanese system requires autonomous effort toward risk control and management, focusing on specific risky processes.
WMSD in Korea and Japan have a similar history of identification and compensation structure, yet different compensation proportions per covered insurer and prevention policies. Follow-up study with international cooperation is necessary to improve both systems.
PMCID: PMC4096546  PMID: 25024844
Musculoskeletal disorders; Work-related; Korea; Japan; Comparative review
16.  Work-related Musculoskeletal Disorders in Korea Provoked by Workers’ Collective Compensation Claims against Work Intensification 
This article presents the process of workers’ problems with work related musculoskeletal disorders (WMSDs), the introduction of risk assessments (RA) for their prevention, and the consequences of this process in Korea. In 1997, economic crisis caused a rapid increase of massive layoffs, worker dispatch system introduction, job insecurity, and use of irregular workers resulting in work intensification. Work intensification increased WMSDs, which created massive workers’ compensation collective claims. Workers argued for the reduction of work intensity. The RAs introduced as a consequence of the workers’ struggle is unique in the world. Whereas these RAs were expected to play a pivotal role in WMSDs prevention, they dis not due to workers’ lack of engagement after the compensation struggle. In fact, changes in the compensation judgment system and criteria have resulted in lower compensation approval rates leading to lower workers’ compensation claims. The Korean experience provides insight into WMSDs causes in a globalized world. In such a the globalized world, work intensification as the result of work flexibility could be an international trend.
PMCID: PMC4118076  PMID: 25089205
Musculoskeletal; Neoliberalism; Risk assessment; Compensation; Work intensification; Struggle; Campaign; Globalization
17.  Effectiveness of an Ergonomics Training Program on Decreasing Work-Related Musculoskeletal Disorders Risk among Video Display Terminals Users  
Health Promotion Perspectives  2012;2(1):89-95.
Background: According to the findings of several studies conducted on work-related musculoskeletal disorders (WMSDs) among the video display terminals (VDTs) users, Prevention of these disorders among this population is a challenge for many workplaces today. Ergonomically Improving of VDT workstations may be an effective and applicable way to decrease the risk of WMSDs. This study evaluated the effect of an ergonomics-training program on the risk of WMSDs among VDT users.
Methods: This study was conducted among a large group of computer users in SAPCO industrial company, Tehran, Iran (84 persons with 29.85±11.2 years of age and with 6.98±2.54 years of experience). An active ergonomics-training program was designed and implemented during 14 days to empower the VDT users and involve them in improving their workstations. The direct observational RULA (Rapid Upper Limb Assessment) method was used in pre and post-intervention stages to evaluate the risk of WMSDs among participants.
Results: The RULA final scores showed that 18.8 % of VDT users were at action level 2, 63.5% at action level 3 and 17.6% at action level 4 before any intervention. In addition, 8.2% of users were at action level 1, 44.7% at action level 2, 42.4% at action level 3 and 4.7% at action level 4 at the post-intervention stage. The results of Wilcoxon statistical test indicated that RULA scores ere decreased significantly after interventions (P < 0.05) and consequently, decreased risk of WMSDs.
Conclusion: Active ergonomics training programs can be used effectively to improve the VDT workstations and decrease the risk of musculoskeletal disorders among VDT users.
PMCID: PMC3963647  PMID: 24688922
VDT workstation; Ergonomics; Training; RULA; Musculoskeletal disorders
18.  Pathophysiological Tissue Changes Associated With Repetitive Movement: A Review of the Evidence 
Physical therapy  2002;82(2):173-187.
Work-related musculoskeletal disorders (WMSDs) represent approximately one third of workers’ compensation costs in US private industry, yet estimates of acceptable exposure levels for forceful and repetitive tasks are imprecise, in part, due to lack of measures of tissue injury in humans. In this review, the authors discuss the scope of upper-extremity WMSDs, the relationship between repetition rate and forcefulness of reaching tasks and WMSDs, cellular responses to injury in vivo and in vitro, and animal injury models of repetitive, forceful tasks. The authors describe a model using albino rats and present evidence related to tissue injury and inflammation due to a highly repetitive reaching task. A conceptual schematic for WMSD development and suggestions for further research are presented. Animal models can enhance our ability to predict risk and to manage WMSDs in humans because such models permit the direct observation of exposed tissues as well as motor behavior.
PMCID: PMC1550512  PMID: 11856068
Animal models; Grip force; Inflammation; Motor behavior; Motor control; Neuroplasticity; Pathophysiology; Repetitive motion; Tissue injury; Work-related musculoskeletal disorders
19.  Computer work and self-reported variables on anthropometrics, computer usage, work ability, productivity, pain, and physical activity 
Computer users often report musculoskeletal complaints and pain in the upper extremities and the neck-shoulder region. However, recent epidemiological studies do not report a relationship between the extent of computer use and work-related musculoskeletal disorders (WMSD).
The aim of this study was to conduct an explorative analysis on short and long-term pain complaints and work-related variables in a cohort of Danish computer users.
A structured web-based questionnaire including questions related to musculoskeletal pain, anthropometrics, work-related variables, work ability, productivity, health-related parameters, lifestyle variables as well as physical activity during leisure time was designed. Six hundred and ninety office workers completed the questionnaire responding to an announcement posted in a union magazine. The questionnaire outcomes, i.e., pain intensity, duration and locations as well as anthropometrics, work-related variables, work ability, productivity, and level of physical activity, were stratified by gender and correlations were obtained.
Women reported higher pain intensity, longer pain duration as well as more locations with pain than men (P < 0.05). In parallel, women scored poorer work ability and ability to fulfil the requirements on productivity than men (P < 0.05). Strong positive correlations were found between pain intensity and pain duration for the forearm, elbow, neck and shoulder (P < 0.001). Moderate negative correlations were seen between pain intensity and work ability/productivity (P < 0.001).
The present results provide new key information on pain characteristics in office workers. The differences in pain characteristics, i.e., higher intensity, longer duration and more pain locations as well as poorer work ability reported by women workers relate to their higher risk of contracting WMSD. Overall, this investigation confirmed the complex interplay between anthropometrics, work ability, productivity, and pain perception among computer users.
PMCID: PMC3751662  PMID: 23915209
Computer use; Musculoskeletal complaints; Arm-shoulder pain; Gender; Sex
20.  Musculoskeletal disorder risk factors among nursing professionals in low resource settings: a cross-sectional study in Uganda 
BMC Nursing  2014;13:7.
Musculoskeletal disorders (MSD) constitute one of the main occupational hazards among health care workers. However, few epidemiological studies on work related MSD among nursing professionals have been carried out in Africa. The purpose of this study was to assess the work related musculoskeletal disorders and associated risk factors among nursing professionals in Uganda.
This was a cross-sectional study of MSD among 880 nursing professionals from five selected hospitals in Uganda. Data was collected using a questionnaire adapted from the Dutch Musculoskeletal and Nordic Musculoskeletal questionnaires. Descriptive (mean, standard deviation and percentages) and inferential (Chi square test and logistic regression analysis) statistics were used to analyse data. Alpha level was set at p < 0.05.
A total of 741 completed questionnaires were analysed (response rate 85.4%). The average age of the respondents was 35.4 (SD 10.7) years and a majority were female (85.7%). The average working hours per week was 43.7 (SD 18.9 hours). The 12-month period-prevalence of MSD at anybody site was 80.8%. The most common site of MSD was the lower back (61.9%). Significant risk factors for reported MSD included often working in a slightly bent posture (adjOR 2.25, 95% CI 1.20-4.26), often working in a slightly twisted posture for long (adjOR 1.97, 95% CI 1.03-3.77), mental exhaustion (adjOR 2.05, 95% CI 1.17-3.5), being absent from the work station for more than 6 months due to illness or an accident (adjO|R, 4.35, 95% CI 1.44-13.08) and feeling rested after a break (adjOR 2.09, 95% CI 1.16-3.76).
Musculoskeletal disorders affect more than 80% of nursing professionals in Uganda with the most commonly, affected site being the lower back. Significant risk factors for MSD include; being absent from the work station for more than 6 months due to illness or an accident, working in awkward postures, pushing/pulling of heavy loads and mental exhaustion. There is a need for greater advocacy, better working conditions and adoption of strategies to reduce occupational injuries.
PMCID: PMC3940025  PMID: 24565421
Musculoskeletal disorders; Risk factors; Uganda
21.  Prioritizing industries for occupational injury prevention and research in the Services Sector in Washington State, 2002–2010 
The Services Sector, as defined by the National Occupational Research Agenda (NORA), is comprised of a diverse industry mix and its workers face a variety of occupational exposures and hazards. The objective of this study was to identify high-risk industry groups within the Services Sector for prevention targeting.
Compensable Washington State workers’ compensation claims from the Services Sector from 2002 through 2010 were analyzed. A “prevention index” (PI), the average of the rank orders of claim count and claim incidence rate, was used to rank 87 Services Sector industry groups by seven injury types: Work- Related Musculoskeletal Disorders (WMSDs), Fall to Lower Level, Fall on Same Level, Struck By/Against, Caught In/Under/Between, Motor Vehicle, and Overexertion. In the PI rankings, industry groups with high injury burdens appear higher ranked than industry groups with low counts or low rates of injury, indicating a need for prioritizing injury prevention efforts in these groups.
In the Services Sector, these 7 injury types account for 84% of compensable claims in WA. The industry groups highest ranked by PI across the injury types included: Services to Buildings and Dwellings; Executive, Legislative, and Other General Government Support; and Waste Collection. WMSDs had the highest compensable claims rates.
Services is a large sector of the economy, and the substantial number, rate, and cost of occupational injuries within this sector should be addressed. Several Services Sector industry groups are at high risk for a variety of occupational injuries. Using a PI to rank industry groups based on their injury risk provides information with which to guide prevention efforts.
PMCID: PMC4229604  PMID: 25395986
Surveillance; NORA sector; Workers’ compensation; Traumatic injury; Work related musculoskeletal disorder; Falls; Motor vehicle; Occupational health; Safety
22.  Manual handling activities and risk of low back pain in nurses. 
OBJECTIVE--To investigate the risk factors for low back pain in hospital nurses, with particular emphasis on the role of specific nursing activities. METHODS--A cross sectional survey of 2405 nurses employed by a group of teaching hospitals was carried out. Self administered questionnaires were used to collect information about occupational activities, non-occupational risk factors for back symptoms, and history of low back pain. RESULTS--The overall response rate was 69%. Among 1616 women, the lifetime prevalence of back pain was 60% and the one year period prevalence 45%. 10% had been absent from work because of back pain for a cumulative period exceeding four weeks. Rates in men were generally similar to those in women. In women back pain during the previous 12 months was weakly associated with height, and was significantly more common in those who reported frequent non-musculoskeletal symptoms such as headache and low mood. After adjustment for height and non-musculoskeletal symptoms, significant associations were found with frequency of manually moving patients around on the bed, manually transferring patients between bed and chair, and manually lifting patients from the floor. In contrast, no clear increase in risk was found in relation to transfer of patients with canvas and poles, manually lifting patients in and out of the bath, or lifting patients with mechanical aids. Confirmation of these findings is now being sought in a prospective study of the same population. CONCLUSIONS--This study confirms that low back pain is highly prevalent among nurses and is associated with a high level of sickness absence. People who often report non-musculoskeletal symptoms were significantly more likely to report low back pain. Specific manual handling tasks were associated with an increased risk of back pain; however, no such association was found with mechanised patient transfers.
PMCID: PMC1128180  PMID: 7735387
23.  Relationship between Psychosocial Risk Factors and Work-Related Musculoskeletal Disorders among Public Hospital Nurses in Malaysia 
This study examined the relationships between psychosocial work factors and risk of WRMSDs among public hospital nurses in the Klang Valley, Malaysia.
We conducted a cross-sectional study among 660 public hospital nurses. A self-administered questionnaire was used to collect data on the occurrence of WRMSDs according to body regions, socio-demographic profiles, occupational information and psychosocial risk factors. 468 questionnaires were returned (response rate of 71%), and 376 questionnaires qualified for subsequent analysis. Univariate analyses were applied to test for mean and categorical differences across the WRMSDs; multiple logistic regression was applied to predict WRMSDs based on the Job Strain Model’s psychosocial risk factors.
Over two thirds of the sample of nurses experienced discomfort or pain in at least one site of the musculoskeletal system within the last year. The neck was the most prevalent site (48.94%), followed by the feet (47.20%), the upper back (40.69%) and the lower back (35.28%). More than 50% of the nurses complained of having discomfort in region one (neck, shoulders and upperback) and region four (hips, knees, ankles, and feet). The results also revealed that psychological job demands, job strain and iso-strain ratio demonstrated statistically significant mean differences (p < 0.05) between nurses with and without WRMSDs. According to univariate logistic regression, all psychosocial risk factors illustrated significant association with the occurrence of WRMSDs in various regions of the body (OR: 1.52–2.14). Multiple logistic regression showed all psychosocial risk factors were significantly associated with WRMSDs across body regions (OR: 1.03–1.19) except for region 1 (neck, shoulders and upper back) and region 4 (hips, knees, ankles, and feet). All demographic variables except for years of employment were statistically and significantly associated with WRMSDs (p < 0.05).
The findings indicated the high prevalence of WRMSDs in many body regions, and the risks of developing WRMSDs according to the various body regions were associated with important psychosocial risk factors based on the job strain model. These findings have implications for the management of WRMSDs among public hospital nurses in the Klang Valley, Malaysia.
PMCID: PMC4387780  PMID: 25852937
Work-related musculoskeletal disorders (WRMSDs); Psychosocial risk factors; Job strain model; Public hospital nurses
24.  Back disorders and lumbar load in nursing staff in geriatric care: a comparison of home-based care and nursing homes 
Back pain is one of the most frequent complaints in the nursing profession. Thus, the 12-month prevalence of pain in the lumbar spine in nursing staff is as high as 76%. Only a few representative studies have assessed the prevalence rates of back pain and its risk factors among nursing staff in nursing homes in comparison to staff in home-based care facilities. The present study accordingly investigates the prevalence in the lumbar and cervical spine and determines the physical workload to lifting and caring in geriatric care.
1390 health care workers in nursing homes and home care participated in this cross sectional survey. The nursing staff members were examined by occupational physicians according to the principals of the multistep diagnosis of musculoskeletal disorders. Occupational exposure to daily care activities with patient transfers was measured by a standardised questionnaire. The lumbar load was calculated with the Mainz-Dortmund dose model. Information on ergonomic conditions were recorded from the management of the nursing homes. Comparisons of all outcome variables were made between both care settings.
Complete documentation, including the findings from the occupational physicians and the questionnaire, was available for 41%. Staff in nursing homes had more often positive orthopaedic findings than staff in home care. At the same time the values calculated for lumbar load were found to be significant higher in staff in nursing homes than in home-based care: 45% vs. 6% were above the reference value. Nursing homes were well equipped with technical lifting aids, though their provision with assistive advices is unsatisfactory. Situation in home care seems worse, especially as the staff often has to get by without assistance.
Future interventions should focus on counteracting work-related lumbar load among staff in nursing homes. Equipment and training in handling of assistive devices should be improved especially for staff working in home care.
PMCID: PMC2801493  PMID: 20003284
25.  Musculoskeletal disorders among staff in South Korea’s largest nursing home 
Although musculoskeletal disorders (MSD) represent a significant occupational issue for most nursing home staff, few epidemiological studies have been conducted in Korea.
We investigated the prevalence of, and risk factors for, MSD within South Korea’s largest nursing home using a previously validated, self-reporting questionnaire.
From a total of 130 registered employees, 91 (70.0%) successfully completed questionnaires were obtained. The majority were female (80.2%, n=73), with an age range of 27 to 62 years and an average age of 47.0 years (SD 8.0). MSD occurred in varying amounts and was classified into distinct categories depending on body site. The most commonly affected region was the shoulder (reported by 35.2%), followed by the arm (22.0%), knee (20.9%) and lower back (19.8%). Three statistically significant risk factors were consistently identified among all 4 MSD sites: manually handling patients (OR 5.1 to 20.8), changing a patient’s clothes (OR 6.7 to 30.1) and working as a nursing aide (OR 3.7 to 74.3).
Overall, the present results suggest that employment within a South Korean nursing home incurs certain hazards depending on job description and daily work tasks. The MSD prevalence differed from other occupations within South Korea and previous nursing home studies.
PMCID: PMC2723262  PMID: 21432112
musculoskeletal disorders; nursing home; Korea; low back pain; self-reported

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