Nicole Vézina

Disability Prevention: New Paradigm for the Management of Occupational Back Pain

Occupational back pain is a widespread self-limited but recurring disease that generates major societal costs and impairs workplace productivity. However, this societal impact is mostly accounted for by a small fraction of patients with back pain who have prolonged absence from work, i.e. prolonged disability.Evidence from research from the past 2 decades has progressively shown that most efforts to prevent or cure the disease have limited results, explaining the expanding number of disability cases from back pain. However, recent evidence has also shed light on the causes of disability that are not only due to the patients’s personal characteristics (physical and psychosocial), but also stem from the patients’s environment in the disability problem — the workplace, the compensation system and even the healthcare delivery system.In addition, successful intervention studies have used an approach to disability prevention through patient reassurance and interventions linked to the workplace, instead of using a medical model of back pain treatment. It is evident that the present disease treatment paradigm should be replaced by a disability prevention paradigm for patients with subacute or chronic back pain to avoid unnecessary evolution towards prolonged disability.We propose a disability prevention management model to encourage clinicians, employers, unions and insurers, as well as researchers in the field, to work within the perspective of the disability paradigm.

Workplace Interventions for Workers with Musculoskeletal Disabilities: A Descriptive Review of Content

Background: Despite the convergence of scientific data to the effect that interventions in the workplace promote a healthy return to work, the interventions carried out in the real work environment appear to be very heterogeneous and ill-defined. Objective: The goal of this review is to identify the different objectives pursued through the workplace interventions carried out in the context of a rehabilitation program, and to describe the activities involved. Methods: A descriptive review of the literature, including various research designs, was carried out. Results: This review reveals great heterogeneity in the content of interventions offered in the workplace to workers with musculoskeletal disabilities. The objectives of workplace interventions may range from gathering information in order to reproduce work demands in a clinical setting, to gradually exposing workers to the demands of the real work environment, or permanently reducing the demands of the work situation. A descriptive analysis of the literature also brings to light the diversity of actions carried out, human resources used, and workplace environments involved, while highlighting the few documented process outcome evaluations that have been done of workplace interventions. Conclusion: It is recommended that in future research in this area, efforts be made to better describe the components of the interventions, to develop process outcomes representing the multidimensional results obtained in the workplace, and to differentiate between temporary and permanent modifications made to the work situation.

When is light work heavy? Components of the physical workload of sewing machine operators working at piecework rates.

Epidemiologists have associated the job of sewing machine operators with a high incidence of musculoskeletal and other health problems, despite its classifications as light work according to energy expenditure criteria. An ergonomic analysis was undertaken in a trouser factory in order to describe components of the physical load of this work: force exerted, repetitions, time allocation and postures. Work activity of ten operators was observed and timed in situ, and forces were measured with a dynamometer. The time required to sew one seam is very short, 10-15 s per trouser leg. This short cycle is repeated more than 1500 times during the work day, involving quasi-continuous movements of the same parts of the body. The fact that movements are repeated so many times means that small details of the task assume a great importance. During the work day, a substantial force is exerted, only part of which can be measured with current technology. By these measurements, operators lift an average 406.1 kg of trousers per day and exert an average total force of 2858.4 kg with the upper limbs and 24 267.9 kg with the lower limbs. The work posture is static: seated with upper back curved and head bent over the sewing machine. Movements of the upper limbs involve abduction and adduction of the shoulders while exerting a force. For the same task, there is considerable variation in the dimensions of workstations. Interviews were conducted to determine the types of musculoskeletal complaints. The components of work activity could be treated to these complaints and to existing epidemiological data on musculoskeletal problems among sewing machine operators. This type of detailed examination can be applied by health and safety personnel to identify task components which could be changed to minimize the probability of musculoskeletal problems.

Margin of Manoeuvre Indicators in the Workplace During the Rehabilitation Process: A Qualitative Analysis

Introduction The task of evaluating workers’ capacity to return to their pre-injury employment or other jobs continues to pose a daily challenge for clinicians. In this study, a concept frequently used in the field of ergonomics, the margin of manoeuvre (MM), was applied during the rehabilitation process. The study identified the indicators of the MM taken into account during the return to work of workers with musculoskeletal disorders. Methods This study used a multiple-case design. A case was defined as a dyad comprising a worker admitted to a work rehabilitation program and the clinician who was managing the return-to-work process. The results were then validated with investigators and expert ergonomists, through group interviews. Content analyses were performed using the conceptual framework for the work activity model adapted from Vézina and the procedures recommended by Miles and Huberman. Results A total of 11 workers, five clinicians, two experts and two investigators participated in this study. The interview analysis process resulted in a more detailed definition of the MM and the identification of 50 indicators. The indicators were classified according to six dimensions: (1) work context; (2) employer’s requirements and expectations; (3) means and tools; (4) worker’s personal parameters; (5) work activity; and (6) impacts of the work situation. Conclusions The more specific indicators identified in this study will allow for more systematic observation of the MM. Subsequent studies will seek to link each indicator described in the model with a specific method of observation.

Comparison of the work activity of two mechanics: A woman and a man

The average Canadian woman is smaller and lighter than her male counterpart. She is less able to handle heavy weights when tested in the laboratory, although such test results may not apply in the complex conditions of real industrial surroundings. Mechanic is the fourth most common occupation of Canadian men, and is considered a classic non-traditional job for women. We examined in detail a job in a machine shop employing 1200 men and three women. One woman and ten men were assigned to rebuilding diesel engines. The woman was typical of those entering non-traditional jobs in that she was smaller, lighter and less senior than the average worker, and her grip strength, average for a woman, was less than half that of her average co-worker. She and her teammate, a man 17 cm taller with three times her grip strength, were observed for 3 days. Tasks involving exertion of physical force took up less than 4% of the workday. The woman accomplished exactly the same tasks with a similar time allocation. There were few differences in work practices. However, the difference in height, weight and availability of appropriate tools and equipment forced the woman to exert her strength in uncomfortable positions more frequently than the man, which may account for the fact that she reported more pain and difficulty than her fellow workers. Making the height of the work surface adjustable and providing appropriate tools would benefit both larger and smaller workers.

Qualitative research using numbers: an approach developed in france and used to transform work in north america.

Qualitative research is often opposed to quantitative research. But numbers can play an important role in illustrating analyses in qualitative research. Their persuasive, concrete nature can help ensure the success of a workplace intervention, especially in the North American context, where numbers are treated very seriously. We describe a method of work analysis and transformation developed at the Conservatoire national des arts et métiers in Paris, where the meaning of the numbers used is critical. We think that the numbers used in work analysis have a different meaning from that in a “pure” quantitative study, where they are submitted to statistical procedures for hypothesis testing. Using examples from recent studies carried out in Québec and Canada in collaboration with unions or joint health and safety committees, we show that counting can be part of qualitative analysis, enrich our portrait of organizational and physical aspects of the work process, and help indicate pathways for workplace improvement.

Body maps: an indicator of physical pain for worker-oriented ergonomic interventions

Abstract Work-related musculoskeletal health damage causes pain and suffering, and can lead to disability. To prevent it, it is important to detect not only diagnosed musculoskeletal disorders but also early signs of impending damage. Workers have important information on workplace risks and health damage, and should be involved in the process of identifying damage. However, controversy surrounds the pain reports of workers and their claims for compensation. We have found that a body map is a useful tool for systematising and analysing workers pain reports.

Relationship between the margin of manoeuvre and the return to work after a long-term absence due to a musculoskeletal disorder: an exploratory study

Purpose. The application of the margin of manoeuvre (MM) concept in work rehabilitation is new. It allows for variations in both health status and work demands, and the interaction between the two, to be taken into account. The objective of this exploratory study was to document the relationship between the presence of an MM in the workplace and the return to work (RTW), after a long-term absence. Methods. This study used the data collected during an earlier study that sought to identify the dimensions and indicators of the MM. The data were analysed on three levels, and the convergences and divergences in the MM indicators and dimensions in relation to the RTW were grouped accordingly. Results. Eleven workers and five clinicians participated in this study. The results support the proposition that the presence of a sufficient MM in the workplace is associated with RTW of individuals at the end of a rehabilitation programme despite a long-term absence (n  ==  6), and conversely, that its absence would appear to be associated with a non-return to work (n  ==  4). Conclusions. A better understanding of this concept will help further the development of a tool to assist clinicians in their task of assessing a workers capacity to return to a given job.

Knowledge transfer between two geographically distant action research teams

Purpose – The objective of this study is to observe and document the transfer of a train the trainers program in knife sharpening and steeling. This knowledge transfer involved two groups of researchers: the experts and the learners. These groups are from geographically dispersed regions and evolve in distinct contexts by their language and culture.Design/methodology/approach – The paper favors the learning history (LH) technique, a methodology that enabled the different participants to share their experience through reiterate interviews.Findings – Based on the dynamic knowledge transfer capacity model, the absorptive capacity of the train the trainers process appears to have been mobilized. Although there were a number of hitches, people are confident that the project will be successful and that they will put what they have learned to good use in upcoming phases to transfer this program to other organizations.Research limitations/implications – The conclusions apply solely to a context of interprovincial...

Are work organization interventions effective in preventing or reducing work-related musculoskeletal disorders? A systematic review of the literature

Objectives We sought to determine whether interventions that target work organization or the psychosocial work environment are effective in preventing or reducing work-related musculoskeletal disorders (WMSD) compared to usual work. Methods We systematically reviewed the 2000-2015 English- and French-language scientific literature, including studies evaluating the effectiveness of an organizational or psychosocial work intervention on incidence, prevalence or intensity of work-related musculoskeletal pain or disorders in the neck, shoulders, upper limbs and/or back or of work absence due to such problems, among non-sick-listed workers. We excluded rehabilitation and individual-level behavioral interventions and studies with >50% attrition. We analyzed medium- and high-quality studies and synthesized the evidence using the Grading of Recommendations Assessment, Development & Evaluation (GRADE) approach. An analysis of key workplace intervention elements supplemented the interpretation of results. Results We identified 884 articles; 28 met selection criteria, yielding 2 high-quality, 10 medium-quality and 16 low-quality studies. There was moderate evidence that supplementary breaks, compared to conventional break schedules, are effective in reducing symptom intensity in various body regions. Evidence was low-to-very-low quality for other interventions, primarily due to risk of bias related to study design, high attrition rates, co-interventions, and insensitive indicators. Most interventions lacked key intervention elements, such as work activity analysis and ergonomist guidance during implementation, but the relation of these elements to intervention effectiveness or ineffectiveness remains to be demonstrated. Conclusions Targeting work-rest cycles may reduce WMSD. Better quality studies are needed to allow definitive conclusions to be drawn on the effectiveness of other work organizational or psychosocial interventions to prevent or reduce WMSD.