J.H. van Dieen

Cumulative mechanical low-back load at work is a determinant of low-back pain

Objectives Reported associations of physical exposures during work (eg, lifting, trunk flexion or rotation) and low-back pain (LBP) are rather inconsistent. Mechanical back loads (eg, moments on the low back) as a result of exposure to abovementioned risk factors have been suggested to be important as such loads provide a more direct relationship with tissue failure and thus LBP. Since information on the effect of such load metrics with LBP is lacking yet, we aimed to assess this effect in a prospective study. Methods Of 1131 workers, categorised into 19 groups, LBP was prospectively assessed over 3 years. Video and hand force recordings of 4–5 workers per group (93 in total) were used to estimate mechanical low-back loads (peak load and three cumulative load metrics, ie, linear weighted load, squared weighted load and load weighted to the tenth power) during manual materials handling (MMH) tasks using a video analysis method. These data were combined with static mechanical load estimates based on structured observation of non-MMH tasks. Associations of mechanical loads and LBP were tested using generalised estimating equations. Results Significant effects on LBP were found for cumulative low-back moments (linear and squared weighted; both p<0.01 and ORs of 3.01 and 3.50, respectively) but not for peak and cumulative moments weighted to the tenth power. Conclusions Results of this first prospective study on the effect of mechanical low-back load on LBP support a LBP aetiology model of cumulative loads, potentially due to accumulation of microdamage or fatigue. Therefore, prevention of LBP should focus on reducing cumulative low-back loads, especially in highly exposed occupational groups, for example, by reducing handling of heavy loads and working in awkward body postures.

A benchmark test of accuracy and precision in estimating dynamical systems characteristics from a time series

Characteristics of dynamical systems are often estimated to describe physiological processes. For instance, Lyapunov exponents have been determined to assess the stability of the cardio-vascular system, respiration, and, more recently, human gait and posture. However, the systematic evaluation of the accuracy and precision of these estimates is problematic because the proper values of the characteristics are typically unknown. We fill this void with a set of standardized time series with well-defined dynamical characteristics that serve as a benchmark. Estimates ought to match these characteristics, at least to good approximation. We outline a procedure to employ this generic benchmark test and illustrate its capacity by examining methods for estimating the maximum Lyapunov exponent. In particular, we discuss algorithms by Wolf and co-workers and by Rosenstein and co-workers and evaluate their performances as a function of signal length and signal-to-noise ratio. In all scenarios, the precision of Rosensteins algorithm was found to be equal to or greater than Wolfs algorithm. The latter, however, appeared more accurate if reasonably large signal lengths are available and noise levels are sufficiently low. Due to its modularity, the presented benchmark test can be used to evaluate and tune any estimation method to perform optimally for arbitrary experimental data.

Effect of triceps surae and quadriceps muscle fatigue on the mechanics of landing in stepping down in ongoing gait

The aim of this study was to evaluate the effects of muscle fatigue of triceps surae and quadriceps muscles in stepping down in ongoing gait. We expected that the subjects would compensate for muscle fatigue to prevent potential loss of balance in stepping down. A total of 10 young participants walked over a walkway at a self-selected velocity to step down a height difference of 10-cm halfway. Five trials were performed before and after a muscle fatigue protocol. Participants performed two fatigue protocols: one for ankle muscle fatigue and another for knee muscle fatigue. Kinematics of and ground reaction forces on the leading leg were recorded. Fatigue did not cause a change in the frequency of heel or toe landing. Our results indicate that in stepping down fatigue effects are compensated by redistributing work to unfatigued muscle groups and by gait changes aimed at enhancing balance control, which was however only partially successful. Practitioner Summary: Problems with transitions between levels in gait are common causes of falls. Fatigue can affect the ability to dissipate energy gained during the step down. The main finding was that young adults recruited unfatigued muscle groups and adjusted their gait pattern to compensate the fatigue effects during landing.

The predictive validity of the RSI QuickScan questionnaire with respect to arm, shoulder and neck symptoms in computer workers

The aim of this study was to determine whether results from the RSI QuickScan questionnaire on risk factors for arm, shoulder and neck symptoms can predict future arm, neck and shoulder symptoms in a population of computer workers. For this prospective cohort study, with a follow-up of 24 months, 3383 workers who regularly worked with a computer were approached. Generalised estimating equations (GEE) with 6, 12, 18 and 24 months time lags were used to determine whether high exposure was related to symptoms at follow-up. The results showed that high scores on 9 out of 13 scales, including previous symptoms, were significantly related to arm, shoulder and neck symptoms at follow-up. These results provide support for the predictive validity of the RSI QuickScan questionnaire. Practitioner Summary: The results showed that high scores on 9 out of 13 scales, including previous symptoms, were significantly related to arm, shoulder and neck symptoms at follow-up. The RSI QuickScan questionnaire may be recommended as a tool in the identification of computer workers who should be targeted with interventions aimed at prevention of future symptoms.

Effect of bed height and use of hands on trunk angular velocity during the sit-to-stand transfer

The ability to rise from a chair or bed is critical to an individuals quality of life because it determines functional independence. This study was to investigate the effect of bed height and use of hands on trunk angular velocity and trunk angles during the sit-to-stand (STS) performance. Twenty-four older persons (median age 74 years) were equipped with a body-fixed gyroscopic sensor and stood up from a bed adjusted to different heights, with and without the use of hands at each height. Peak angular velocity and trunk range of motion decreased with increasing bed height (all p ≤ 0.038) and were lower using hands during STS transfer indicating less effort. In conclusion, gyroscopic sensor data of the STS transfer of older persons show differences as an effect of bed height and use of hands. These results provide the rationale for recommending a relatively high bed height for most of the older persons. Practitioner Summary: To minimise the effort during sit-to-stand transfer performance from bed, it is necessary to understand the effect of bed height and use of hands. It is concluded that a relatively high bed height and the use of hands is helpful for most of the older persons during sit-to-stand transfer.