Ninica Howard

Rotator cuff syndrome: personal, work-related psychosocial and physical load factors.

Objective: To identify factors associated with rotator cuff syndrome (RCS) among active workers. Methods: Seven hundred thirty-three workers in 12 worksites participated in a cross-sectional study with individual structured physical and psychosocial health interviews, physical examinations, and exposure assessments of biomechanical factors. Work organization, including job content or structural constraints, was assessed at the departmental level. Multivariable logistic modeling was used. Results: Fifty-five subjects (7.5%) had RCS. Cases were more likely to report low job security (P < 0.04) and to have very high job structural constraints (P < 0.03). Age and body mass index were marginally significant. Upper arm flexion ≥ 45° ≥ 15% of time and either duty cycle of forceful exertions ≥9% time (odds ratio = 2.43, 95% CI = 1.04 to 5.68) or forceful pinch >0% [odds ratio = 2.66, 95% CI = 1.26 to 5.59] were significant risk factors. Conclusions: Long duration of shoulder flexion and forceful exertion (especially pinch) in a job are significant risk factors for RCS. Work organization may impact physical and psychosocial exposures and should be further explored.

Quantifying repetitive hand activity for epidemiological research on musculoskeletal disorders--part II: comparison of different methods of measuring force level and repetitiveness.

This paper focuses on comparisons between the different methods of assessing repetitive hand activities. Various methods were used to measure hand force and repetitiveness of hand activities on 733 subjects in the study described by Bao et al. (2006). Two definitions of repetitiveness were used in analysis of detailed time studies of repetitive hand activities and four parameters of the American Conference of Governmental Industrial Hygienists (ACGIH) hand activity level (HAL) and the Strain Index methods were estimated by ergonomists and used to quantify repetitiveness. Hand forces were measured or estimated using three different methods: 1) measured with a force gauge or mimicked on a force gauge (force matching); 2) estimated by ergonomists using rating scales; 3) self-reports by subjects. The jobs were also evaluated using the ACGIH HAL and Strain Index methods when different repetitiveness quantification methods were used. Results showed that different definitions of repetitive exertion might lead to measuring different physical exposure phenomena and produce very different results. There were poor correlations between the measures of repetitiveness estimated by the different methods. Correlations between force quantifications using different methods were also poor. This suggests that parameters measured by different methods might not be interchangeable. Both the ACGIH HAL and Strain Index methods identified more ‘hazardous’ jobs when repetitiveness was estimated by ergonomists than when it was calculated by detailed time studies of forceful hand exertions. The Strain Index method identified more ‘hazardous’ jobs than the ACGIH HAL method. Overall, the between-methods agreements were found to be moderate to substantial.

Two posture analysis approaches and their application in a modified Rapid Upper Limb Assessment evaluation

This paper presents two posture risk quantification methods: first, an event-based method where the most common and the worst postures are estimated in a task; second, a time-based method where posture distributions are calculated from random samples of observed postures in the task. A ‘click-on-screen’ posture data entry method was developed for the time-based posture analysis method to make the observation process easier and to reduce possible posture categorization bias. Both methods were used to quantify various work posture parameters among a study cohort of 733 subjects from a prospective epidemiological study of upper extremity musculoskeletal disorders. Composite posture indices using a modified Rapid Upper Limb Assessment (RULA) method were also computed using data obtained by the two posture analysis methods. Results showed that both methods were able to distinguish jobs with large differences in certain posture measures. However, they did not produce the same results and could not be used interchangeably. Risk evaluation criteria should be developed, either for specific posture parameters or as a composite index, with a well-defined postural analysis method, so that users can follow exact procedures and obtain comparable results. The event-based method is easy to use and may suit practitioners better, while the time-based method adds more information to the measurement and may suit users who want more detailed information about posture exposure.

Quantitative exposure-response relations between physical workload and prevalence of lateral epicondylitis in a working population.

BACKGROUND Lateral epicondylitis is a common work-related musculoskeletal disorder. The objective of this study was to identify risk factors associated with lateral epicondylitis among active workers. METHODS Seven-hundred thirty-three workers in 12 Washington worksites participated in structured interviews, physical examinations, and individual exposure assessments of biomechanical and psychosocial factors. Multivariable logistic modeling was used. RESULTS Thirty-eight subjects (5.2%) had lateral epicondylitis. Age (36-50 years-old), being female, and low social support at work were significant risk factors. Frequency of forceful exertion (> or =5 vs. < 1 times/min (OR 5.17, 95%CI 1.78-15.02), and > or =1 to <5 vs. <1 (OR 4.47, 95%CI 1.57-13.71)) and forearm supination at > or =45 degrees for > or =5% of the time with high lifting force (OR = 2.98, 95% CI 1.18-7.55) were significant physical load factors. CONCLUSIONS Frequency of forceful exertion or a combination of forearm supination and forceful lifting were significant physical factors and should be considered for prevention strategies.

Interrater Reliability of Posture Observations

Objective: The aims of this research were (a) to study the interrater reliability of a posture observation method, (b) to test the impact of different posture categorization systems on interrater reliability, and (c) to provide guidelines for improving interrater reliability. Background: Estimation of posture through observation is challenging. Previous studies have shown varying degrees of validity and reliability, providing little information about conditions necessary to achieve acceptable reliability. Method: Seven raters estimated posture angles from video recordings. Different measures of interrater reliability, including percentage agreement, precision, expression as interrater standard deviation, and intraclass correlation coefficients (ICC), were computed. Results: Some posture parameters, such as the upper arm flexion and extension, had ICCs ≥ 0.50. Most posture parameters had a precision around the 10° range. The predefined categorization and 30° posture categorization strategies showed substantially better agreement among the raters than did the 10° strategy. Conclusions: Different interrater reliability measures described different aspects of agreement for the posture observation tool. The level of agreement differed substantially between the agreement measures used. Observation of large body parts generally resulted in better reliability. Wider width angle intervals resulted in better percentage agreement compared with narrower intervals. For most postures, 30°angle intervals are appropriate. Training aimed at using a properly designed data entry system, and clear posture definitions with relevant examples, including definitions of the neutral positions of the various body parts, will help improve interrater reliability. Application: The results provide ergonomics practitioners with information about the interrater reliability of a postural observation method and guidelines for improving interrater reliability for video-recorded field data.

Reliability and validity assessment of the hand activity level threshold limit value and strain index using expert ratings of mono-task jobs.

This study evaluated two subjective assessment methods for physical work-related musculoskeletal disorder (WMSD) risk factors. A total of 567 participants from 12 companies in the manufacturing and health care industries were evaluated using the hand activity level (HAL) threshold limit value (TLV) and the Strain Index. Inter-rater reliability comparisons were performed on 125 selected cyclic tasks, with one novice and three experienced raters. Predictive validity was assessed by evaluation of relationships between measured exposure parameters and diagnosed WMSDs of the hand/wrist and elbow. HAL hand repetition ratings had a Spearman r value of 0.65 and a kappa value of 0.44 between raters. Subjective force (0–10 scale) estimates had a Spearman r = 0.28 and were not significantly different between raters (p > .05). The rating comparison for the four subjective components of the Strain Index had Spearman r correlations of 0.37–0.62 and kappa values of 0.25–0.44. The Strain Index and HAL TLV agreed on exposure categorization 56% of the time. Logistic regression showed, after adjustment for age, gender, and body mass index, that higher peak hand force estimates (odds ratio [OR] 1.14, confidence interval (CI) 1.02–1.27), most common force estimates (OR 1.14, CI 1.02–1.28), hand/wrist posture rating (OR 1.71, CI 1.15–2.56), and Strain Index scores ≥ 7 (OR 1.82, CI 1.04–3.18) were associated with distal upper extremity disorders in the dominant hand. HAL repetition ratings ≥ 4 (OR 2.81, CI 1.40–5.62) and hand/wrist posture ratings (OR 1.59, CI 1.01–2.49) were associated with disorders in the nondominant hand. These findings show moderate to good inter-rater agreement and significant relationships to health outcomes for the identified measures.

Application of the Strain Index in multiple task jobs

Six different methods to calculate the Strain Index (SI) scores for jobs with multiple forces/tasks were developed. Exposure data of 733 subjects from 12 different worksites were used to calculate these SI scores. Results show that using different SI computation methods could result in different SI scores, hence different risk level classifications. However, some simpler methods generated SI scores were comparable to the more complicated composite SI method. Despite differences in the scores between the six different SI computation methods, Spearman rank-order correlation coefficients of 0.61-0.97 were found between the methods. With some confidence, ergonomic practitioners may use simpler methods, depending on their specificity requirement in job evaluations and available resources. Some SI computation methods may tend to over-estimate job risk levels, while others may tend to under-estimate job risk levels, due to different ways used in obtaining the various SI parameters and computations.

Self-Reported Musculoskeletal Symptoms and Observed Risk Factors in Bareroot Tree Nurseries

A cross-sectional study of jobs at four bareroot reforestation tree nurseries in Washington and Oregon investigated the prevalence of musculoskeletal symptoms and potential work-related musculoskeletal disorders (WMSDs), and analyzed their association with physical and psychosocial risk factors of the jobs. Questionnaires were used to assess symptoms and psychosocial factors. Direct observational work sampling was utilized to estimate physical risk factors. The response rate for the questionnaires was 41% (203 subjects), of which 72% reported recurring symptoms in the past year. The most common body region was the wrist/hand (42%). Pain was the most commonly reported symptom. Forty-one percent of the subjects had at least one potential WMSD, the hand region having the greatest number of cases (n = 51). The average age of those with and without potential WMSDs did not significantly differ; however, tenure at the nursery (p < 0.03) did. Being female (OR = 7.37; 95% CI = 2.75, 19.7,) high job satisfaction (OR = 0.32; 95% CI = 0.15, 0.72), and having a second job (OR = 3.76; 95% CI = 1.12, 12.57) were significantly associated with potential WMSDs. No significant difference in WMSD prevalence was found between the field and packing shed areas of the nurseries (p = 0.88). Pinch gripping was observed 24% of the time in the shed and 8% of the time in the field. Torso flexion was observed more often in the field than the shed (38% vs. 18% of the time). This study found that both physical and psychosocial factors associated with WMSDs are present in bareroot trees nurseries.

Baseline Exposure Assessment Results from a Prospective Study of Upper Extremity Musculoskeletal Disorders

This prospective study is following a cohort of up to 1000 workers for three years to determine the relationship between risk factors and confounders and the development of clinically diagnosed upper extremity musculoskeletal disorders (UEMSDs). Results from 535 workers at baseline in manufacturing and service industries showed that 28.8% of jobs had an average RULA grand score of 5–7 for the right side of the body, and 24.1% for the left. The average and median Strain Index scores for the right side were 19.8 (±42.5) and 5.1, and for the left side were 16.4 (±41.0) and 3.4. HAL TLV analysis showed that 65.7% of subjects were below the Action Limit for the right side and 71.6% for the left, while 18.7% were over the TLV for the right side and 15.2% for the left. These data in combination with more detailed measurements will be used in prospective analysis to quantify the relationship between risk factors and UEMSD outcomes.

Predicting work-related incidence of lateral and medial epicondylitis using the strain index.

BACKGROUND The Strain Index (SI) has been developed to evaluate the risk for developing a distal upper extremity disorder. The objective of this study is to determine if the SI predicts incidence cases of work-related lateral, medial, or any epicondylities (LEPI, MEPI, and EPI). METHODS Six hundred seven workers were followed for up to 3.5 years, 70 developed EPI on the dominant side (44 LEPI, 13 MEPI, and 13 both). Survival analyses were conducted adjusting for demographic, psychosocial, and work organizational factors, with the SI as time-dependent variable. RESULTS High exposure (SI > 5), older age, and self-perceived poor general health were associated with incidence of LEPI and EPI, but not MEPI. There was a significant relationship between higher scores of SI and LEPI, hazard ratio (HR) 2.00 (95% CI 1.04-3.87) for SI 5.1-12, HR 2.12 (95% CI 1.11-4.05) for SI > 12. CONCLUSIONS The SI can effectively identify jobs with increased risk of developing incidence of LEPI.