Jeppe Zielinski Nguyen Ajslev

Participatory intervention with objectively measured physical risk factors for musculoskeletal disorders in the construction industry: study protocol for a cluster randomized controlled trial

BackgroundThere is high prevalence of back pain and neck-shoulder pain among blue collar workers in Denmark. Excessive physical exposures such as heavy lifting or working with bended or twisted back are risk factors for back pain among workers in the construction industry. Technical evaluation of awkward postures and kinematics of upper/ lower extremities (accelerometry) during work combined with the level of muscular activity (EMG) and video recordings can improve quantification of physical exposure and thereby can facilitate designing preventive strategies. Participatory ergonomics potentially increase the success of interventions aimed at reducing excessive physical exposures. The objectives of this study are to; 1) determine which work-tasks in selected job-groups involve excessive physical load of the back and shoulders during a normal working day (measured with accelerometers, EMG and video recordings). And 2) investigate whether a participatory intervention can reduce the excessive physical workloads, drawing on measurements from phase 1.Methods/DesignA two-armed parallel-group, single-blind, cluster randomized controlled trial with allocation concealment will be conducted in the Danish construction industry. Approximately 20 construction gangs (≈80 subjects) will be recruited and randomized at the cluster level (gang). We will record in situ physical workload using technical measurements (EMG, accelerometers and video recordings) during a working day before and after the intervention. Based on these measurements a physical load matrix for each worker will be developed.The participatory intervention consist of three workshops: 1) One at baseline, involving presentation of video clips of the work-tasks with excessive physical load customized for each gang, followed by a participatory development of solutions on how to reduce excessive workloads, leading to development of an action plan on how to implement these solutions at the workplace. 2) A second workshop where the implemented solutions will be further developed and qualitatively evaluated during group discussions. 3) A final workshop at follow-up to enhance long-time organizational sustainability of the implemented solutions.DiscussionThe results will provide knowledge about the level of physical exposure of the back and shoulders during specific work tasks in the construction industry, and will provide information on options to implement participatory interventions aiming at reducing excessive physical workload.Trial registrationClinicalTrials.gov (NCT02498197), registered 29 June 2015.

Association between Occupational Lifting and Day-to-Day Change in Low-Back Pain Intensity Based on Company Records and Text Messages

Objective This study aimed to investigate the association between occupational lifting and day-to-day change in low-back pain (LBP) intensity. Methods Each day for three consecutive weeks, 95 full-time workers from 51 Danish supermarkets with frequent occupational lifting replied to daily text messages about LBP intensity (scale 0-10). Supervisors at the supermarkets provided information about daily working hours and load (number of different pallets handled) for each worker during the three weeks. Linear mixed models with repeated measures tested the association between variables controlled for LBP during the previous day and various confounders. Results Workers handled on average 1212 [standard deviation (SD) 861] kg and worked 8.5 (SD 1.8) hours per workday. LBP intensity was higher in the morning after work- compared with non-workdays [difference of 0.55, 95% confidence interval (95% CI) 0.39-0.71]. A cumulative effect of consecutive workdays existed, ie, pain intensity increased approximately 0.30 points per day for up to three days. For three consecutive work- compared with non-workdays, the difference was 0.92 (95% CI 0.50-1.34). Higher load resulted in higher pain intensity in the morning after workdays [0.16 (95% CI 0.02-0.31) per ton lifted], while no effect was found for number of daily working hours. Conclusion Among workers with frequent occupational lifting, workdays are associated, in a cumulative manner, with increased LBP intensity. Furthermore, an exposure-response association exists between workload and increased LBP intensity. However, the increase in pain intensity was small and future studies should assess whether long-term consequences exist.

Associations between Wage System and Risk Factors for Musculoskeletal Disorders among Construction Workers

Piece rate and performance based wage systems are common in the construction industry. Construction workers are known to have an increased risk of pain and musculoskeletal disorders (MSD). In this cross-sectional questionnaire study, we examined the association between wage system and (1) physical exertion, (2) time pressure, (3) pain, and (4) fatigue. The participants comprised 456 male Danish construction workers working on one of three different wage systems: group based performance wage, individually based performance wage, and time based wage system. The statistical analyses indicated differences between the wage systems in relation to physical exertion (ηp = 0.05) and time pressure (ηp = 0.03) but not to pain or fatigue. Workers on group based performance wage scored higher (i.e., worse) than workers on individual performance based wage and workers with an hourly/monthly wage. In conclusion, group performance based wage was associated with higher levels of physical exertion and time pressure. Accordingly, group performance based wage can be viewed as a factor that has the potential to complicate prevention of MSD among construction workers. Since performance based wage systems are common in many countries across the world, more attention should be paid to the health effects of these types of payment.

Reducing Physical Risk Factors in Construction Work Through a Participatory Intervention: Protocol for a Mixed-Methods Process Evaluation.

Background Previous research has shown that reducing physical workload among workers in the construction industry is complicated. In order to address this issue, we developed a process evaluation in a formative mixed-methods design, drawing on existing knowledge of the potential barriers for implementation. Objective We present the design of a mixed-methods process evaluation of the organizational, social, and subjective practices that play roles in the intervention study, integrating technical measurements to detect excessive physical exertion measured with electromyography and accelerometers, video documentation of working tasks, and a 3-phased workshop program. Methods The evaluation is designed in an adapted process evaluation framework, addressing recruitment, reach, fidelity, satisfaction, intervention delivery, intervention received, and context of the intervention companies. Observational studies, interviews, and questionnaires among 80 construction workers organized in 20 work gangs, as well as health and safety staff, contribute to the creation of knowledge about these phenomena. Results At the time of publication, the process of participant recruitment is underway. Conclusions Intervention studies are challenging to conduct and evaluate in the construction industry, often because of narrow time frames and ever-changing contexts. The mixed-methods design presents opportunities for obtaining detailed knowledge of the practices intra-acting with the intervention, while offering the opportunity to customize parts of the intervention.

How do employees prioritise when they schedule their own shifts

We investigated how employees prioritised when they scheduled their own shifts and whether priorities depended on age, gender, educational level, cohabitation and health status. We used cross-sectional questionnaire data from the follow-up survey of an intervention study investigating the effect of self-scheduling (n = 317). Intervention group participants were asked about their priorities when scheduling their own shifts succeeded by 17 items covering family/private life, economy, job content, health and sleep. At least half of the participants reported that they were giving high priority to their family life, having consecutive time off, leisure-time activities, rest between shifts, sleep, regularity of their everyday life, health and that the work schedule balanced. Thus, employees consider both their own and the workplaces needs when they have the opportunity to schedule their own shifts. Age, gender, cohabitation and health status were all significantly associated with at least one of these priorities. Practitioner Summary: Intervention studies report limited health effects of self-scheduling. Therefore, we investigated to what extent employees prioritise their health and recuperation when scheduling their own shifts. We found that employees not only consider both their health and family but also the workplaces needs when they schedule their own shifts.

Trading health for money: agential struggles in the (re)configuration of subjectivity, the body and pain among construction workers

Construction work is physically demanding and often associated with bodily pain. This article presents a study of construction workers’ practices of using and relating to their bodies at work through an agential realist framework for analysing the (re)configuration of the workers’ embodied subjectivity. The analysis draws on interviews with 32 Danish construction workers as well as brief observations. The article shows how ‘trading health for money’ becomes a mode for maintaining positive social, occupational and masculine identity among construction workers. Furthermore, it shows how the agency of the body is overruled by the intra-acting agencies of productivity, collegiality, job security and masculine working-class identity. Finally, it shows an instability in this configuration of masculine working-class identity that leaves room for a focus on the body.

Regular use of pain medication due to musculoskeletal disorders in the general working population: Cross-sectional study among 10,000 workers

BACKGROUND We aimed to determine the association between work, health, and lifestyle with regular use of pain medication due to musculoskeletal disorders in the general working population. METHODS Currently employed wage earners (N = 10,024) replied to questions about health, work, and lifestyle. The odds for regularly using medication for musculoskeletal disorders were modeled using logistic regression controlled for various confounders. RESULTS Pain intensity increased the odds for using pain medication in a dose-response fashion. With seated work as reference, the odds for using pain medication were 1.26 (95%CI: 1.09-1.47) for workers engaged in standing or walking work that is not strenuous and 1.59 (95%CI: 1.39-1.82) for workers engaged in standing or walking work with lifting tasks or heavy and fast strenuous work. CONCLUSIONS Workers with higher levels of physical activity at work are more likely to use pain medication on a regular basis for musculoskeletal disorders, even when adjusting for pain intensity, lifestyle, and influence at work. Am. J. Ind. Med. 59:934-941, 2016.

Contradictory individualized self-blaming: a cross-sectional study of associations between expectations to managers, coworkers, one-self and risk factors for musculoskeletal disorders among construction workers

BackgroundWithin work sociology, several studies have addressed construction workers’ practices of masculinity, class, economy, safety risks and production. However, few studies have investigated room for agency in relation to bodily pain or musculoskeletal disorders and even fewer have made a quantitative approach. Accordingly, by means of a questionnaire, we examined the association between construction workers’ room for agency and physical exertion, bodily and mental fatigue, and lower back pain.MethodsA total of 481 Danish construction workers who responded to a multifaceted questionnaire were included. Drawing on previous studies and a Foucauldian inspired concept of agency, agency was quantified through specially crafted questions and examined in relation to established measures on physical exertion, physical and mental fatigue and pain in the lower back. Associations were tested using analyses of variance (general linear models) and controlled for age, gender, job group, lifestyle and depression.ResultsWhen asked about options for agency reducing the burden of work, few workers believed themselves to be prime agents of such practices. When asking about their view on performing alternative agency implying caring for the body, 39–49% expected negative reactions from management, and 20–33% expected negative reactions from colleagues. In contrast, only 13–18% of the participants stated that they would give a negative reception to such alternative practices.Using the expected reception outcomes (positive, neutral, negative) to alternative practices as predictors, the statistical regression analyses showed that negative expectations to management were associated with higher levels of physical exertion 0.62 (95% CI = 0.14–1.09) (scale 0-11), bodily fatigue 0.63 (95% CI = 0.22–1.04), mental fatigue 0.60 (95% CI = 0.07–1.12), and low back pain 0.79 (95% CI = 0.13–1.46) (scales 0-10).ConclusionIn our study, construction workers answered questions about work and MSD. The answers indicated a contradiction between perceived responsibility and room for agency.Based on the study, a number of target areas could fruitfully be addressed in aiming to reduce MSD among construction workers. To change workers’ expectances to the reception of lowering work pace if needed to take care of the body, their expectances to the reception of sickness absence as a result of pain, of discussing physical exertion in work and of demanding appropriate technical assistive devices are such examples. Our results emphasize that management plays an important role in this.

Effects of a participatory ergonomics intervention with wearable technical measurements of physical workload in the construction industry: A cluster randomized controlled trial (Preprint)

Background Construction work frequently involves heavy physical work, and a reduction of the physical workload should have high priority. Technological development has made it possible to obtain field measurements with surface electromyography (sEMG), kinematics measured with inertial measurement units (IMUs), and video recordings. However, no studies have used these methods simultaneously to detect situations with excessive physical workload (events) during a working day. Thus, knowledge about these specific events may combat work-related risk factors. Participatory ergonomics (PE) has shown promising results, but whether it can be used as a tool to reduce the physical workload during construction work remains unknown. Objective This cluster randomized controlled trial investigated whether a PE intervention with technical measurements consisting of IMUs, sEMG, heart rate monitoring, and video recordings of physical workload could reduce the number of events with excessive physical workload during a working day. Furthermore, other outcomes were obtained from questionnaires. Methods A total of 80 male full-time construction workers (aged 19 to 67 years) were randomized at the cluster level (gang) to a PE intervention consisting of 3 workshops (7 gangs and 32 workers) or to a control group (8 gangs and 48 workers). The physical workload was recorded by technical measurements, that is, IMUs, sEMG, heart rate monitoring, and video recordings during a full working day at baseline and 3 and 6 months’ follow-up. On the basis of the technical measurements, a custom-made computer program detected the situations (events) where the construction workers were exposed to excessive physical workload and used in the intervention. Differences in the number of events from baseline to follow-up between intervention and control were evaluated using linear mixed models (intention-to-treat), with individual nested in cluster as a random factor. Furthermore, questionnaires were filled out on test days. Results The results of the primary outcome showed no change in the number of events with excessive physical workload. However, compared with the control group, the other outcomes showed decreased general fatigue after a typical working day (P=.001) and increased influence on own work (P=.04). Conclusions This PE intervention with technical measurements did not reduce the number of events with excessive physical workload during construction work. However, the intervention led to decreased general fatigue and increased influence on own work. Trial Registration ClinicalTrials.gov NCT02498197; https://clinicaltrials.gov/ct2/show/NCT02498197 (Archived by WebCite at http://www.webcitation.org/74SZ3DIWS)