Economic evaluations of ergonomic interventions preventing work-related musculoskeletal disorders: a systematic review of organizational-level interventions.

BACKGROUND: Work-related musculoskeletal disorders (WMSD) represent a major public health problem and economic burden to employers, workers and health insurance systems. This systematic review had two objectives: (1) to analyze the cost-benefit results of organizational-level ergonomic workplace-based interventions aimed at preventing WMSD, (2) to explore factors related to the implementation process of these interventions (obstacles and facilitating factors) in order to identify whether economic results may be due to a successful or unsuccessful implementation. METHODS: Systematic review. Studies were searched in eight electronic databases and in reference lists of included studies. Companion papers were identified through backward and forward citation tracking. A quality assessment tool was developed following guidelines available in the literature. An integration of quantitative economic results and qualitative implementation data was conducted following an explanatory sequential design. RESULTS: Out of 189 records, nine studies met selection criteria and were included in our review. Out of nine included studies, grouped into four types of interventions, seven yielded positive economic results, one produced a negative result and one mixed results (negative cost-effectiveness and positive net benefit). However, the level of evidence was limited for the four types of interventions given the quality and the limited number of studies identified. Our review shows that among the nine included studies, negative and mixed economic results were observed when the dose delivered and received by participants was low, when the support from top and/or middle management was limited either due to limited participation of supervisors in training sessions or a lack of financial resources and when adequacy of intervention to workers' needs was low. In studies where economic results were positive, implementation data showed strong support from supervisors and a high rate of employee participation. CONCLUSION: Studies investigating the determinants of financial outcomes of prevention related to implementation process are very seldom. We recommend that in future research economic evaluation should include information on the implementation process in order to permit the interpretation of economic results and enhance the generalizability of results. This is also necessary for knowledge transfer and utilization of research results for prevention-oriented decision-making in occupational health and safety.

Implementation process evaluation of an ergonomic train the trainer program: How to learn from mechanisms and the temporal structure of processes?

In implementation process evaluation, the analysis of the temporal structure of processes is key for understanding the successive interactions between the flow of practitioners' actions and evolving workplace reactions and context. However, capturing the temporal structure of processes in data analysis is a methodological challenge, and available literature to overcome this challenge is scarce, especially for workplace ergonomic interventions. The aim of this paper was to perform an implementation process evaluation of an ergonomic train the trainer program taking into account the temporal structure of processes. We provided a method for qualitative data analysis based on a three-stage strategy: 1) producing the timeline of the implemented intervention, 2) identifying influential factors, 3) identifying determinant mechanisms (sequence of influential factors that intervened in the implementation process). This method allowed us to identify six determinant mechanisms positioned on the timeline of the intervention. Obstacles and levers were identified as a sequence of interrelated causes and consequences rather than isolated factors. We recommended success strategies for practitioners, while also shedding light on how organizations can better be prepared to undertake the intervention and their required actions to attain targeted intervention objectives.

Integrative prevention and coordinated action toward primary, secondary and tertiary prevention in workplaces: A scoping review.

BACKGROUND: Integrated approaches are valued in several occupational health strategic programmatic orientations. A better understanding of the use of integrative prevention in coordinating measures is needed to develop its use in workplaces. OBJECTIVE: Identify workplace integrative prevention approaches and definitions of prevention (primary, secondary and tertiary) in the literature. METHODS: A scoping review was conducted following Arksey and O'Malley (2005). The literature search was carried out in three databases without date restrictions. In order to be retained, the articles needed to address at least two levels of prevention using an integrative approach in a workplace setting. A qualitative analysis was conducted. RESULTS: The review yielded 16 published articles between 1995 and 2017. The articles addressed mental health, musculoskeletal disorder prevention and comprehensive approaches. Integrative prevention approaches are diverse and are not always named as such. Prevention definitions are not homogenous. CONCLUSIONS: This review identified some of the integrative prevention characteristics aimed at coordinated action for prevention in the workplace and to clarify measures taken at different levels of prevention. Further studies are needed to elaborate on the implementation of integrative prevention in the workplace.

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.

The Organization of Working Time: Developing an Understanding and Action Plan to Promote Workers' Health in a Seasonal Work Context: L'organisation temporelle du travail: la comprendre pour développer des actions favorisant la santé des travailleuses en contexte de travail saisonnier.

Despite the health problems associated with irregular schedules and long working hours, few studies have focused on the temporal dimension of work in seasonal working contexts. Through the monitoring of sixteen seasonal workers in the crab-processing industry over a two-year period, this study aimed to better understand their working reality and to provide a detailed picture of the temporal dimension of seasonal work as experienced by these workers. Observations of the work activity, interviews, and analysis of official documents were carried out. The findings reveal that the organization of working time and working conditions are very restrictive. These constraints are linked not only to the work environment and management but also to various public policies and ministerial directives. Methodological elements essential for the study of the organization of working time have been identified and could contribute to a better understanding of temporal constraints experienced by seasonal workers. Résumé Malgré les problèmes de santé associés aux horaires non standards et aux longues heures de travail, peu d'études se sont attardées à dégager un portrait de la dimension temporelle du travail en contexte de travail saisonnier. Par le suivi de 16 travailleuses saisonnières de l'industrie de la transformation du crabe pendant deux années, cette étude visait à mieux comprendre leur réalité de travail et à dresser un portrait détaillé de la dimension temporelle du travail saisonnier tel que vécu par ces travailleuses. Des observations du travail, des entretiens et l'analyse de documents ont été réalisés. Les résultats révèlent une organisation temporelle et des conditions de travail fort contraignantes pour ces travailleuses liées, entre autres, à l'environnement et à la gestion du travail, mais également à diverses politiques publiques et consignes ministérielles. Des éléments méthodologiques essentiels pour l'étude des temps de travail ont également été identifiés et contribueront à mieux cerner les contraintes temporelles des situations de travail vécues par les travailleuses saisonnières.

Reproducibility and validity of workers' self-reports of physical work demands.

The objective of this paper is to provide a systematic review of the reproducibility and validity of self-report questions concerning physical work demands. After a bibliographic search of Medline and Ergonomic Abstracts for 1980-2003, 15 articles meeting the eligibility criteria were reviewed for methodological quality; 82 formulations of questions on physical work demands were evaluated for reproducibility and 83 for validity. Questions evaluated for both reproducibility and validity that performed well in both sets of studies included those on duration or presence of sitting and standing posture, the presence of walking, kneeling or squatting postures, duration or frequency of hands above shoulders, manual handling of more than or less than 10 kg, general level of physical effort, presence and duration of whole-body vibration, and duration of the use of visual display terminals. Suggestions for improving the design of reproducibility and validity studies and directions for future research in physical workload measurement are proposed.

Safe and healthy integration into semiskilled jobs: does gender matter?

Women report fewer injuries than men when they are young, but report a higher proportion of professional diseases later in life (35 years +). Understanding early work conditions that lead to postponed health outcomes is necessary if we are to prevent women's injury as well as men's. Introduction to work and safe integration programs are often put forward to prevent injuries among youth. This paper aims to illustrate some differences in the job introduction / integration process for men and women and to discuss some gender-based Occupational Health and Safety (OHS) implications. Data come from two waves of interviews with 31 students enrolled in vocational training for a semiskilled trade. Results demonstrated differences between men and women: trades chosen, OHS complaints, supervising patterns, integration to work, etc. Women often choose customer service jobs, have less formal supervision and are often left to themselves when learning to do their job. Men declared more accidents while women reported more musculoskeletal symptoms. Findings from this research suggest young women's OHS issues should not be trivialized and that specific youth prevention programs for sectors where women are more present, such as customer service, should be developed.

Understanding knowledge transfer in an ergonomics intervention at a poultry processing plant.

This case study reviews the knowledge transfer (KT) process of implementing a knife sharpening and steeling program into a poultry processing plant via a participatory ergonomics intervention. This ergonomics intervention required stakeholder participation at the company level to move a 'train-the-trainer' program, developed in Québec, Canada, into action on the plant's deboning line. Communications and exchanges with key stakeholders, as well as changes in steeling and production behaviours were recorded. The intervention was assumed to be at least partially successful because positive changes in work operations occurred. Ergonomic-related changes such as those documented have been cited in the academic literature as beneficial to worker health. However, several components cited in literature that are associated with a successful participatory ergonomics intervention were not attained during the project. A Dynamic Knowledge Transfer Model was used to identify KT issues that impacted on the success of train-the-trainer program. A debriefing analysis reveals that a failure to consider key participatory ergonomics factors necessary for success were related to capacity deficits in the knowledge dissemination strategy.

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 worker's capacity to return to a given job.

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.

Training the next generation of researchers in work disability prevention: the Canadian Work Disability Prevention CIHR Strategic Training Program.

INTRODUCTION: There is a need to create, disseminate, and implement new knowledge in the work disability prevention (WDP) field. Training programs attracting high-quality applicants and taking into account the complexity of this emerging field are urgently needed. METHODS: An advanced training program, funded by the Canadian Institutes of Health Research (CIHR), was developed by 24 mentors affiliated with nine different universities. The main objective of this program is to develop transdisciplinary knowledge, skills, and attitudes regarding WDP. This program has been developed for PhD students or post-doctoral fellows already registered full-time in a Canadian or recognized foreign university whose main interest is WDP, regardless of the health problem. RESULTS: Since its implementation, the program received two successive cohorts of 10 students. They were registered in 13 universities in five countries and trained in nine different disciplines. CONCLUSIONS AND SIGNIFICANCES: Appropriate WDP research may save major societal costs attributable to prolonged work disability. The proposed training program will contribute to developing tomorrow's research workforce.