Midwives' thoughts about musculoskeletal disorders with an evaluation of working tasks.

The prevalence of musculoskeletal disorders is very high amongmidwives resulting in sickness absenteeism, functional limitation and staff shortages. There are several contributory risk factors having impact on the development of MSDs. This study aimed to (1) explore midwives' experiences and views about work-related MSDs and contributing risk factors, and (2) analyse working postures for musculoskeletal injury risks. A mixed method approach was used with interviews/focus group (n = 15/7) and observations (n = 22) of specific tasks (during birth and after birth) using the posture analysis observational method (Rapid Entire Body Assessment, REBA). The participants were midwives who had an active role in the United Kingdom (UK) National Health Services (NHS). It was found that MSDs were often attributed to the physical (working in awkward positions), organisational (longer shift hours, fewer staff, increased work load), psychosocial (defensive practice, higher demand) challenges of midwifery. All postures had very high to medium REBA risk levels with action categories indicating that action or further assessment is definitely necessary to reduce MSDs. This research provides a holistic approach by analysing risk factors and interactions in the work context to inform the development of risk management strategies. Midwifery working conditions have a big impact on developing musculoskeletal symptoms. Management of such symptoms will improve staff wellbeing, mother and baby safety, individuals' life trajectories and staff shortages.

Midwives are getting hurt: UK survey of the prevalence and risk factors for developing musculoskeletal symptoms.

OBJECTIVE: To investigate the prevalence, severity and impact of musculoskeletal disorders (MSDs) and to explore individual, work-related and psychosocial risk factors DESIGN: A cross sectional survey SETTING: A self-reported online questionnaire was used to collect data over seven months (May-December 2016). PARTICIPANTS: The survey was distributed to midwives across the United Kingdom through the Consultant Midwives Network and the Royal College of Midwives. MEASUREMENTS AND FINDINGS: Prevalence, severity and impact (12-month) of MSDs for nine body parts are presented. The associations between individual, occupational and psychosocial factors and symptoms are examined using Independent samples t-test or Chi-square statistical analyses, with Logistic regression analysis to understand the relative importance of variables. It was found that 92% of the participants reported MSDs, most commonly in the low back (71%), neck (45%) and shoulders (45%). Symptoms impacted on normal activities at work and/or leisure (50%), sick leave (30%) and jobs/duties (45%). Age and time practicing in midwifery were inversely associated with low back symptoms; reported less frequently with increasing age and experience. Longer working hours was a predictor for shoulder symptoms. Over commitment (intrinsic job stress) was associated with neck and more strongly with shoulder symptoms. Those caring for a dependent adult for more than 50 h a week were 4.54 times more likely to have neck discomfort. KEY CONCLUSIONS: This first survey of UK Midwives reveals a very high prevalence of low back, neck and shoulder symptoms, resulting in sickness absenteeism, reduction in normal activities and changing roles. Age, years in practice, body mass index, working hours, job satisfaction and job stress are contributory factors. IMPLICATIONS FOR PRACTICE: This study highlights the prevalence and impact of musculoskeletal symptoms and the potential harmful impacts on their working life and patient care. The findings will promote risk-awareness and national actions for risk management.

Plus size and obese workers: anthropometry estimates to promote inclusive design.

A significant proportion of the adult population globally is overweight, obese or classed as 'plus size'. This has led to variability in size and shape across the working population and exclusion in the workplace. A new dataset of the anthropometry of plus size people has been created. Length dimensions were similar to other data, but breadth, circumference, and depth measurements were substantially larger. The hip breadth and abdominal depth were important for predicting largeness in this population. These data help explain the high exclusion rates from design and the number of fit, reach, posture and clearance issues reported by participants with a high BMI: generally, the higher the BMI the greater prevalence of problems. It is hoped that a better understanding of the anthropometric characteristics of the plus size worker will inform the design of safe, productive work environments to promote inclusion for a wider range of people. Practitioner Summary: A new anthropometry dataset of plus size people has been created. The higher the BMI the greater the problems with design in the workplace for fit, reach, posture and clearance. To ensure inclusion and reduce stigma it is important to understand more about the size and shape of this population.

Engineering movement into automotive seating: Does the driver feel more comfortable and refreshed?

The concept of introducing movement in automotive seating was investigated. Three seat conditions, a control (no movement) and two movement conditions (fore-aft and cushion-backrest) were compared. Movement was introduced at a fixed speed, slow, smooth and within a small range. Ten participants took part in a 60 min simulated drive for each condition - single blind, repeated measures, and balanced order. Discomfort ratings were collected for six body areas and overall discomfort, together with a wellbeing questionnaire. Driver posture and Seat Fidgets and Movements (SFMs) were captured. There was a trend for lower ratings of discomfort, overall and in the neck, shoulders, lower back, buttocks, and ankles with both seat movement conditions. Wellbeing ratings were also better with movement. Significant differences were found at minute 60 for buttock discomfort - less discomfort with seat movement. Overall discomfort and SFMs frequency increased with time driving. Generally, passive seat movement was well received.

Human Factors Evaluation of Surgeons' Working Positions for Gynecologic Minimal Access Surgery.

STUDY OBJECTIVE: To investigate work-related musculoskeletal disorders (WRMSD) in gynaecological minimal access surgery (MAS), including bariatric (plus size) patients DESIGN: Mixed methods (Canadian Task Force classification III). SETTING: Teaching hospital in the United Kingdom. MEASUREMENTS: Survey, observations (anthropometry, postural analysis), and interviews. RESULTS: Work-related musculoskeletal disorders (WRMSDs) were present in 63% of the survey respondents (n = 67). The pilot study (n = 11) identified contributory factors, including workplace layout, equipment design, and preference of port use (relative to patient size). Statistically significant differences for WRMSD-related posture risks were found within groups (average-size mannequin and plus-size mannequin) but not between patient size groups, suggesting that port preference may be driven by surgeon preference (and experience) rather than by patient size. CONCLUSION: Some of the challenges identified in this project need new engineering solutions to allow flexibility to support surgeon choice of operating approach (open, laparoscopic or robotic) with a workplace that supports adaptation to the task, the surgeon, and the patient.

An approach to vehicle design: In-depth audit to understand the needs of older drivers.

The population of older people continues to increase around the world, and this trend is expected to continue; the population of older drivers is increasing accordingly. January 2012 figures from the DVLA in the UK stated that there were more than 15 million drivers aged over 60; more than 1 million drivers were aged over 80. There is a need for specific research tools to understand and capture how all users interact with features in the vehicle cabin e.g. controls and tasks, including the specific needs of the increasingly older driving population. This paper describes an in-depth audit that was conducted to understand how design of the vehicle cabin impacts on comfort, posture, usability, health and wellbeing in older drivers. The sample involved 47 drivers (38% female, 62% male). The age distribution was: 50-64 (n = 12), 65-79 (n = 20), and those 80 and over (n = 15). The methodology included tools to capture user experience in the vehicle cabin and functional performance tests relevant to specific driving tasks. It is shown that drivers' physical capabilities reduce with age and that there are associated difficulties in setting up an optimal driving position such that some controls cannot be operated as intended, and many adapt their driving cabins. The cabin set-up process consistently began with setting up the seat and finished with operation of the seat belt.

Driving a better driving experience: a questionnaire survey of older compared with younger drivers.

A questionnaire survey of drivers (n = 903) was conducted covering musculoskeletal symptoms, the vehicle seat, access to specific vehicle features, ingress/egress, driving performance and driving behaviours. Significantly, more discomfort was reported by older drivers (aged 65+) in the hips/thighs/buttocks and knees. Older drivers reported more difficulty parallel parking (p ≤ 0.01), driving on a foggy day (p ≤ 0.01), and turning their head and body to reverse (p ≤ 0.001). They also reported that their reactions were slower than they used to be (p ≤ 0.01). Dissatisfaction was found by all drivers with adjusting the headrest (height and distance), seat belt height and opening/closing the boot. There is a growing population of older people globally, and the number of older drivers is showing a parallel increase. Clearly, efforts are needed to ensure car design of the future is more inclusive of older drivers. Practitioner Summary: This paper describes a questionnaire survey of drivers on their driving experience - the vehicle seat, access to specific vehicle features, ingress/egress, driving performance and driving behaviours. Comparisons are made by age and gender. Issues with driving and vehicle design particularly for older drivers in the UK are identified.

Reducing work-related Musculoskeletal Disorders (MSDs) through design: Views of ergonomics and design practitioners.

BACKGROUND: Work-related Musculoskeletal Disorders (MSDs) affect the well-being of workers. Unfortunately, user requirements for design to reduce workplace risk factors for MSDs are not always effectively communicated to designers creating a mismatch between the user requirements and what is ultimately produced. OBJECTIVE: To understand the views of practitioners of design and ergonomics regarding tools for participatory design and features they would like to see in such tools. METHODS: An online questionnaire survey was conducted with a cohort of practitioners of ergonomics and design (n = 32). In-depth interviews were then conducted with a subset of these practitioners (n = 8). To facilitate discussion, a prototype integrated design tool was developed and demonstrated to practitioners using a verbalized walkthrough approach. RESULTS: According to the results of the questionnaire survey, the majority (70%) believed an integrated approach to participatory design would help reduce work-related MSDs and suggested ways to achieve this, for example, through sharing design information. The interviews showed the majority (n = 7) valued being provided with guidance on design activities and ways to manage and present information. CONCLUSION: It is believed that an integrated approach to design in order to help reduce work-related MSDs is highly important and a provision to evaluate design solutions would be desirable for practitioners of design and ergonomics.

Driving performance and driver discomfort in an elevated and standard driving position during a driving simulation.

The primary purposes of a vehicle driver's seat, is to allow them to complete the driving task comfortably and safely. Within each class of vehicle (e.g. passenger, commercial, industrial, agricultural), there is an expected driving position to which a vehicle cabin is designed. This paper reports a study that compares two driving positions, in relation to Light Commercial Vehicles (LCVs), in terms of driver performance and driver discomfort. In the 'elevated' driving position, the seat is higher than usually used in road vehicles; this is compared to a standard driving position replicating the layout for a commercially available vehicle. It is shown that for a sample of 12 drivers, the elevated position did not, in general, show more discomfort than the standard position over a 60 min driving simulation, although discomfort increased with duration. There were no adverse effects shown for emergency stop reaction time or for driver headway for the elevated posture compared to the standard posture. The only body part that showed greater discomfort for the elevated posture compared to the standard posture was the right ankle. A second experiment confirmed that for 12 subjects, a higher pedal stiffness eliminated the ankle discomfort problem.

Design and evaluation: end users, user datasets and personas.

Understanding the needs and aspirations of a suitable range of users during the product design process is an extremely difficult task. Methods such as ethnographic studies can be used to gain a better understanding of users needs, but they are inherently time consuming and expensive. The time pressures that are evident in the work performed by design consultancies often make these techniques impractical. This paper contains a discussion about the use of 'personas', a method used by designers to overcome these issues. Personas are descriptive models of archetypal users derived from user research. The discussion focuses on two case studies, the first of which examines the use of personas in the car design process. The second examines the use of personas in the field of 'inclusive design', as demonstrated by the HADRIAN system. These case studies exemplify the benefits 'data rich' personas contribute as opposed to 'assumption based' personas.

An evaluation of personalised insoles developed using additive manufacturing.

The aim of the study was to evaluate the short and medium term use of personalised insoles, produced by combining additive manufacturing (AM) with three-dimensional (3-D) foot scanning and computer aided design (CAD) systems. For that, 38 runners (19 pairings) were recruited. The experimental conditions were: personalised and control. The personalised condition consisted of trainers fitted with personalised glove fit insoles manufactured using AM and using foot scans to match the plantar geometry of the feet. The control condition consisted of the same trainers fitted with insoles also manufactured using AM but using scans of the original insole shape. Participants were allocated to one of the experimental conditions and wore the trainers for 3 months. Over this period they attended three laboratory sessions (at months 0, 1.5 and 3) and completed an Activity Diary after each training session. The footwear was evaluated in terms of discomfort and biomechanics. Lower discomfort ratings were found in the heel area (P ≤ 0.05) and for overall fit (P ≤ 0.05), with the personalised insole. However, discomfort was reported under the arch region for both conditions. With regard to the biomechanical data, differences between conditions were detected for ankle dorsiflexion at footstrike (P ≤ 0.05), maximum ankle eversion (P ≤ 0.05) and peak mean pressure under the heel (P ≤ 0.01): the personalised condition had lower values which may reduce injury risk. The personalisation of the geometry of insoles through advances in AM together with 3-D scanning and CAD technologies can provide benefits and has potential.

Participatory ergonomics: co-developing interventions to reduce the risk of musculoskeletal symptoms in business drivers.

The participatory process within four case study organisations with a target population of high mileage business drivers is described. The aim was to work with drivers and their managers to co-develop intervention activities to raise awareness of musculoskeletal health in drivers, including use of the car as a mobile office and manual handling from the car. Train-the-trainer sessions were delivered in each organisation, along with the co-production of training materials. The effectiveness of these activities were evaluated using three sources of data: post-intervention questionnaires, interviews with organisation 'champions' and observations from the research team's diaries. The approach raised management awareness of the risks to drivers and was successful in affecting change, and as such, participatory research should consider the early stages of a project as part of any intervention activities. The research team also reflect on conducting applied longitudinal research in the field. PRACTITIONER SUMMARY: Raising awareness of the risks of musculoskeletal disorders in drivers who work from their vehicle is important. This paper reflects on research in the field and provides guidance on the participatory process and evaluating intervention activities. The participatory process was successful in affecting change at management level.

The specification of personalised insoles using additive manufacturing.

Research has been conducted to explore a process that delivers insoles for personalised footwear for the high street using additive manufacturing (AM) and to evaluate the use of such insoles in terms of discomfort. Therefore, the footwear personalisation process was first identified: (1) foot capture; (2) anthropometric measurements; (3) insole design; and (4) additive manufacturing. In order to explore and evaluate this process, recreational runners were recruited. They had both feet scanned and 15 anthropometric measurements taken. Personalised insoles were designed from the scans and manufactured using AM. Participants were fitted with footwear under two experimental conditions: personalised and control, which were compared in terms of discomfort. The mean ratings for discomfort variables were generally low for both conditions and no significant differences were detected between conditions. In general, the personalisation process showed promise in terms of the scan data, although the foot capture position may not be considered 'gold standard'. Polyamide, the material used for the insoles, demonstrated positive attributes: visual inspection revealed no signs of breaking. The footwear personalisation process described and explored in this study shows potential and can be considered a good starting point for designer and researchers.

Stakeholder perspectives on managing the occupational health of UK business drivers: a qualitative approach.

Musculoskeletal disorders are one of the leading causes of work related ill health and sickness absence. Those who drive as part of their job may be at particular risk, with evidence suggesting that prolonged exposure to driving is associated with increased absence from work due to low back pain. Business drivers often work away from a traditional office environment. Such mobile working may pose greater risks to occupational health due to increased ergonomic risks, for example working from the car, longer working hours and a lack of concern amongst drivers about health and safety. It has been suggested that occupational health practices have not adapted to meet the needs of peripatetic workers. The current study explored how occupational health services are delivered to business drivers. Semi-structured interviews were carried out with a sample of 31 stakeholders in 4 organisations. Respondents included, health and safety professionals, occupational health nurses, fleet managers and high mileage business drivers. The interviews were transcribed and analysed using 'Template Analysis'. The data revealed that, within these organisations, the provision of occupational health services was often fragmented and drivers and other key stakeholders were often unaware of the existing systems within their organisations. The peripatetic nature of business drivers meant that they were difficult for occupational health teams to reach. The paper concludes by presenting recommendations for occupational health professionals and researchers engaged with improving the health of peripatetic workers, namely that occupational health policies should be integrated in company strategy and widely disseminated to drivers and those with responsibility for managing their occupational health provision.

Musculoskeletal symptoms in pharmaceutical sales representatives.

BACKGROUND: Musculoskeletal disorders (MSDs) are a leading cause of work-related ill health. Existing literature indicates that pharmaceutical sales representatives (PSRs) report a high prevalence of MSDs, possibly exacerbated by the nature of work (prolonged driving and manual handling). In addition, they experience difficulty in accessing occupational health services. AIMS: To assess the prevalence of musculoskeletal symptoms and associated risk factors among PSRs in order to assist their occupational health management through raising risk awareness. METHODS: A self-completed questionnaire distributed to 205 PSRs within a UK pharmaceutical company was used to assess the prevalence of musculoskeletal symptoms, psychosocial factors, work tasks undertaken and company car use. To assist understanding of work tasks and organizational factors, semi-structured interviews were undertaken with a sample of 12 key personnel. RESULTS: The questionnaire response rate was 68%. PSRs reported high mileage and 100% reported working from the car in a typical day. Forty-seven per cent reported both manual handling for > or = 4 h/day and 'often' or 'sometimes' working from the car. Fifty-seven per cent reported low back symptoms in the last 12 months. Interview data revealed issues relating to car choice, storage in the boot and working from the car, which should be considered when developing priorities for preventive management of MSDs. CONCLUSIONS: Musculoskeletal symptoms appear to be a problem for PSRs, with risk factors reported as prolonged driving, sitting in the car, working from the car and manual handling. Interventions to facilitate their occupational health management should focus on raising awareness of the risks of prolonged driving and working from the car.

The HADRIAN approach to accessible transport.

This paper describes research carried out at Loughborough University in the UK into the areas of 'design for all' and accessible transport. The research addresses two common needs for designers and ergonomists working towards developing more inclusive products and environments, namely data on users that is accessible, valid, and applicable and a means of utilising the data to assess the accessibility of designs during the early stages of development. HADRIAN is a computer-based inclusive design tool that has been developed to support designers in their efforts to develop products that meet the needs of a broader range of users. Currently HADRIAN is being expanded to support transport design. This includes data on an individual's ability to undertake a variety of transport-related tasks, such as vehicle ingress/egress, coping with uneven surfaces, steps, street furniture and complex pedestrian environments. The subsequent use of this data will be supported either through a task analysis system that will allow a designer to evaluate a design for a part of the transport infrastructure (ticket barrier, train carriage etc.), or alternatively allow the designer or an end user to evaluate a whole journey. The 'journey planner' feature of the HADRIAN tool will compare an individual's physical, cognitive and emotional abilities with the demands placed upon that individual by the mode(s) of transport available and the route options selected. It is envisaged that these developments will prove extremely useful to users, designers, planners and all those involved with transport use and implementation.

Interface pressure data and the prediction of driver discomfort in road trials.

An objective measure that will predict discomfort reliably, and which can be used at an early stage in the development of a vehicle and its seating, would have the potential to reduce the prevalence of musculoskeletal problems associated with driving. This paper reports on an extended road trial study to further investigate the potential value of pressure distribution data in the prediction of reported discomfort. Road trial data were collected from three cars and then interface pressure data were recorded for each of the three seats. Clear differences were identified between the cars with respect to reports of discomfort. However, no clear relationship was found between interface pressure data and reported discomfort.