Association of Vibrotactile Biofeedback With Reduced Ergonomic Risk for Surgeons During Tonsillectomy.

Importance: Work-related musculoskeletal disorders are common among otolaryngologists and can be associated with decreased productivity, missed workdays, and reduced quality of life. Ergonomic risk for surgeons is elevated during common otolaryngology procedures; current ergonomic interventions lack the ability to provide real-time feedback. The ability to quantify and mitigate ergonomic risk during surgery may reduce work-related musculoskeletal disorders. Objective: To quantify the association of vibrotactile biofeedback with intraoperative ergonomic risk to surgeons during tonsillectomy. Design, Setting, and Participants: This cross-sectional study was conducted between June 2021 and October 2021 at a freestanding tertiary care children's hospital and included 11 attending pediatric otolaryngologists. Data analysis was conducted from August to October 2021. Interventions: Real-time quantification of ergonomic risk during tonsillectomy and the use of a vibrotactile biofeedback posture monitor. Main Outcomes and Measures: Association of vibrotactile biofeedback with objective measures of ergonomic risk. Assessment tools included the Rapid Upper Limb Assessment, craniovertebral angle, and time spent in an at-risk posture. Results: Eleven surgeons (mean [SD] age 42 [7] years; 2 women [18%]) performed 126 procedures with continuous posture monitoring in the presence (80 [63%]) and absence (46 [37%]) of vibrotactile biofeedback. No complications or delays associated with the device were reported. Intraoperative vibrotactile biofeedback was associated with improved Rapid Upper Limit Assessment neck, trunk, and leg scores by 0.15 (95% CI, 0.05-0.25), improved craniovertebral angle by 1.9 (95% CI, 0.32-3.40), and decreased overall time spent in an at-risk posture by 30% (95% CI, 22%-39%). Conclusions and Relevance: The results of this cross-sectional study suggest that use of a vibrotactile biofeedback device to quantify and mitigate ergonomic risk for surgeons is feasible and safe while performing surgery. Vibrotactile biofeedback was associated with reduced ergonomic risk during tonsillectomy and may have a role in improving surgical ergonomics and preventing work-related musculoskeletal disorders.

Ergonomic risk assessment during massage among physiotherapists: Introduction of generic postures notion.

BACKGROUND: Musculoskeletal disorders are prevalent among physiotherapists. They perform many repetitive tasks in awkward postures that require a high muscle load. This issue was often addressed through subjective analysis (questionnaire) but rarely using postural evaluation combined with an ergonomic assessment. OBJECTIVE: The aim of this article was to decompose draining lymphatic massage performed by physiotherapists in generic postures (GP) to quickly assess the musculoskeletal disorder risk. METHODS: Based on numeric video recorded in frontal and sagittal planes, 3360 postures were defined from 20-minutes lymphatic drainage massage performed by 7 physiotherapists over a period of 6 months. A hierarchical cluster analysis was applied to define the GP. RESULTS: Seven GP were identified, which were described by their average joint angles, variability and relative frequency. GP6, GP4 and GP2 had the highest frequencies (17.6%, 16.9% and 16.8% respectively). Trunk and neck were essentially flexed (neck: 17.0±10.0° for GP1; trunk: 20.4±8.7° for GP4). Shoulder flexion and abduction ranged from 15° (GP7) to 60° (GP4). Mean and variability of RULA score completed the analysis. The highest scores were computed for GP2 and GP3 (respectively 5.5±1.3 and 5.8±1.2, p < 0.05). GP4 had the lowest (4.0±1.1, p < 0.05). The results suggest that massages have to be monitored. Attention should be paid to the postures used to prevent the occurrence of MSDs. CONCLUSION: The massages could be described as a combination of generic posture for a rapid ergonomic assessment.

Applying a Human Factors Approach to Improve Patient Experience with Sacral Neuromodulation.

OBJECTIVES: To apply a human factors approach, the study of interactions between humans and complex systems, to investigate patient preparedness, satisfaction, and perceived usability with sacral neuromodulation (SNM) and develop interventions aimed at improving patient experience. MATERIALS AND METHODS: Ten patients with overactive bladder undergoing staged SNM were observed, and data including pre-operative preparedness, satisfaction, perceived usability and barriers impacting patient experience were collected. Interventions were developed and an additional ten patients were observed. All patients were English-speaking and at least 18 years of age. RESULTS: Pre-intervention patients had difficulty understanding the risks of the procedure, did not know what to expect post-operatively and were unsatisfied with pre-operative materials. Interventions included: A pre-procedure educational video and informational sheet, detailed discharge instructions; and a nursing inservice. Pre-operative preparedness (Stage I: U = 100, z = 3.785, P = .000; Stage II: U = 80, z = 2.864, P = .003), post-operative satisfaction (Stage I: U = 100, z = 3.788, P = .000; Stage II: U = 77.5, z = 2.665, P = .006.) and perceptions of usability (Stage I: U = 77.00, z = 2.056, P = .043.; Stage II: U = 80.50, z = 2.308, P = .019) increased significantly after the intervention. CONCLUSION: Our observations highlight the value of implementing a human factors approach to identify and mitigate barriers impacting patient experiences with SNM. Through the implementation of systems-level interventions (ie, interventions that impact the non-clinical aspects of surgery such as patient and/or staff education), significant improvements can be made.

The Rise of Shop Floor Ergonomics: A Personal Perspective.

OCCUPATIONAL APPLICATIONS Based on a 45-year career as a practitioner in industrial ergonomics, I offer in this paper a personal memoir on how ergonomics came to the shop floor in North America, involving ordinary workers in an early effort to prevent what was at the time an unknown problem - work-related Musculoskeletal Disorders. The actions included the beginning of a low-tech, practical improvement process that is still effective today. In total, the experience can provide encouragement to everybody to be confident in their ability when trying new endeavors and to remember that small initial steps can eventually lead to major change.

Development of an Ambulatory Biofeedback App to Enhance Emotional Awareness in Patients with Borderline Personality Disorder: Multicycle Usability Testing Study.

BACKGROUND: Patients with borderline personality disorder experience great difficulties in regulating their emotions. They often are unable to effectively detect their emotional arousal and struggle to timely apply learned techniques for emotion regulation. Although the use of continuous wearable biofeedback has been repeatedly suggested as an option to improve patients' emotional awareness, this type of app is not yet available for clinical use. Therefore, we developed an ambulatory biofeedback app named Sense-IT that can be integrated in mental health care. OBJECTIVE: The aim of the study was to develop an ambulatory biofeedback app for mental health care that helps with learning to better recognize changes in personal emotional arousal and increases emotional awareness. METHODS: Using several methods in a tailored User Centred Design (UCD) framework, we tested the app's usability and user experience (UX) via a cyclic developmental process with multiple user groups (patients, therapists, and UCD experts; 3-5 per group, per cycle). RESULTS: The process resulted in a stable prototype of the app that meets most of the identified user requirements. The app was valued as useful and usable by involved patients, therapists, and UCD experts. On the Subjective Usability Scale (SUS), the patients rated the app as "Good" (average score of 78.8), whereas the therapists rated the app as "OK" (average score of 59.4). The UCD experts judged the app's overall usability as between "OK" and "acceptable" (average score of 0.87 on a cognitive walkthrough). As most critical usability problems were identified and addressed in the first cycle of the prototyping process, subsequent cycles were mainly about implementing new or extending existing functions, and other adjustments to improve UX. CONCLUSIONS: mHealth development within a clinical mental health setting is challenging, yet feasible and welcomed by targeted users. This paper shows how new mHealth interventions for mental health care can be met with enthusiasm and openness by user groups that are known to be reluctant to embrace technological innovations. The use of the UCD framework, involving multiple user groups, proved to be of added value during design and realization as evidenced by the complementary requirements and perspectives. Future directions on studying clinical effectiveness of the app, appliance of the app in other fields, and the implications of integration of the app for daily practice in mental health are discussed.

RGB-D ergonomic assessment system of adopted working postures.

Ensuring a healthier working environment is of utmost importance for companies and global health organizations. In manufacturing plants, the ergonomic assessment of adopted working postures is indispensable to avoid risk factors of work-related musculoskeletal disorders. This process receives high research interest and requires extracting plausible postural information as a preliminary step. This paper presents a semi-automated end-to-end ergonomic assessment system of adopted working postures. The proposed system analyzes the human posture holistically, does not rely on any attached markers, uses low cost depth technologies and leverages the state-of-the-art deep learning techniques. In particular, we train a deep convolutional neural network to analyze the articulated posture and predict body joint angles from a single depth image. The proposed method relies on learning from synthetic training images to allow simulating several physical tasks, different body shapes and rendering parameters and obtaining a highly generalizable model. The corresponding ground truth joint angles have been generated using a novel inverse kinematics modeling stage. We validated the proposed system in real environments and achieved a joint angle mean absolute error (MAE) of 3.19±1.57∘ and a rapid upper limb assessment (RULA) grand score prediction accuracy of 89% with Kappa index of 0.71 which means substantial agreement with reference scores. This work facilities evaluating several ergonomic assessment metrics as it provides direct access to necessary postural information overcoming the need for computationally expensive post-processing operations.

ACD3 as a framework for design of ergonomic workplaces.

BACKGROUND: Workplace Ergonomics and Human Factors (E/HF) remains as relevant and important as ever to respond to contemporary workplace design challenges. Therefore, E/HF expertise must be involved in early and appropriate phases of the workplace design process, in order to leverage user needs and requirements to constrain the proposed design solution. In this process, design decisions are made. OBJECTIVE: The aim of this article is to describe the use of a systems-theoretical framework as a guide in collaborative workplace design, focussing on planning and documenting which decisions and activities should involve E/HF expertise. METHODS: As this is a conceptual paper, its method is to synthesise a framework from a combination of design process methodology-, general systems theory- and sociotechnical systems literature. RESULTS: The framework organises the design decisions to be made into hierarchical abstraction levels and cross-cuts them into five perspectives from which the design problem can be viewed holistically. CONCLUSIONS: The ACD3 framework is intended as an enabler of many types of design, including the design of work systems. It provides a framework that allows all stakeholders to converge around design decisions that ensure that the work system is optimised to human characteristics and the activity to be performed.

Effect of a posture correction-based intervention on musculoskeletal symptoms and fatigue among control room operators.

This study was conducted to examine the effect of a posture correction-based intervention (with a biofeedback device) on the occurrence of musculoskeletal symptoms (MSS) and fatigue among control room operators in a petrochemical plant in Iran. A total of 188 office workers (91 in the case group and 97 in the control group) participated at baseline as well as at 6- and 12-month follow-up. A questionnaire survey (including the Nordic Musculoskeletal Questionnaire and Multidimensional Fatigue Inventory) and direct observations of working postures by using the Rapid Upper Limb Assessment (RULA) method were used. The occurrence of MSS in the shoulders, upper back, neck, and low back areas, as well as the mental and physical dimensions of fatigue were found to be the most common problems. The results showed considerable improvements in working postures (in the neck, trunk, and RULA grand scores) and the occurrence of MSS (particularly in the neck, shoulders, and upper back and low back areas) and fatigue (in particular the mental and physical aspects) after the intervention. The overall mean RULA grand score for the case group was significantly decreased after the intervention (mean scores of 5.1, 4.4, and 4.6 at pre-intervention, post-intervention 1, and post-intervention 2, respectively). A total of 81 operators (89.0%) reported some kind of MSS at baseline, which were reduced to 75 operators (82.4%) and 77 operators (84.6%) at post-interventions 1 and 2, respectively. Significant differences were also found between the pre- and post-intervention scores for the physical fatigue (mean of 12.19, 10.16, and 9.99 at pre-intervention, post-intervention 1, and post-intervention 2, respectively) and mental fatigue (mean of 14.03, 12.05, and 12.16 at pre-intervention, post-intervention 1, and post-intervention 2, respectively) dimensions. The findings confirm the effectiveness of this low-cost, simple, and easy-to-use ergonomic intervention.

Workplace-Based Rehabilitation of Upper Limb Conditions: A Systematic Review.

Purpose The objective of this systematic review was to identify, collate and analyse the current available evidence on the effectiveness of workplace-based rehabilitative interventions in workers with upper limb conditions on work performance, pain, absenteeism, productivity and other outcomes. Methods We searched Medline, Cochrane Library, Scopus, Web of Science, Academic Search Premier, Africa-Wide Information, CINAHL, OTSeeker and PEDro with search terms in four broad areas: upper limb, intervention, workplace and clinical trial (no date limits). Studies including neck pain only or musculoskeletal pain in other areas were not included. Results Initial search located 1071 articles, of which 80 were full text reviewed. Twenty-eight articles were included, reporting on various outcomes relating to a total of seventeen studies. Nine studies were of high methodological quality, seven of medium quality, and one of low quality. Studies were sorted into intervention categories: Ergonomic controls (n = 3), ergonomic training and workstation adjustments (n = 4), exercise and resistance training (n = 6), clinic-based versus workplace-based work hardening (n = 1), nurse case manager training (n = 1), physiotherapy versus Feldenkrais (n = 1), and ambulant myofeedback training (n = 1). The largest body of evidence supported workplace exercise programs, with positive effects for ergonomic training and workstation adjustments, and mixed effects for ergonomic controls. Ambulant myofeedback training had no effect. The remaining three categories had positive effects in the single study on each intervention. Conclusion While there is substantial evidence for workplace exercise programs, other workplace-based interventions require further high quality research. Systematic review registration PROSPERO CRD42017059708.

Many model thinking in systems ergonomics: a case study in road safety.

In complexity science, the many models thinking philosophy argues for a multi-method approach to complex problems. This article investigates whether the use of multiple systems ergonomics methods to examine the same problem is useful, or whether using different approaches creates incompatible analyses. Five systems ergonomics analyses of road trauma are examined and their key insights extracted. The extent to which these insights are compatible with one another and can be integrated when attempting to reduce road trauma is assessed. The findings indicate that applying several systems ergonomics methods to the same problem is useful, as multiple insights are developed and deficiencies in one approach are countered by the others. Importantly, the case study demonstrates that the insights gained are compatible and support the development of holistic systems thinking-based interventions. In conclusion it is recommended that a many systems ergonomics model thinking approach be adopted by ergonomists working in complex problem spaces. Practitioner Summary: Many model thinking uses multiple methods to understand complex problems. We explore whether this is beneficial in systems ergonomics. Five models of road trauma, developed using five systems ergonomics methods, are examined. The findings demonstrate that a many model systems ergonomics approach produces a diverse but complimentary set of insights.

Effectiveness of a multifactorial ergonomic intervention and exercise conditioning kinesiology program for subsequent work related musculoskeletal disorder prevention.

BACKGROUND: Health care workers are known to be at high risk for occupational musculoskeletal disorders and injuries. Many different intervention strategies have been implemented in order to reduce the risk of injury to health care workers, however not many have been proven to be effective. A continuing care establishment in Ottawa, Canada, implemented a multidimensional kinesiology intervention program for injured employees. OBJECTIVE: To evaluate the effectiveness of the kinesiology intervention program on reducing subsequent rates for the nursing personnel and analyze the impact of age, position (RN, RPN, PCA) and sex on subsequent injuries. METHODS: The number of recorded work related musculoskeletal disorders (WRMSD) for each patient care worker was counted from 2007-2011. The control group included injured employees that were not referred to the kinesiologists, or who chose not to participate in the program. The intervention group included injured employees that were referred to the kinesiology service and followed their treatment program. RESULTS: The intervention group showed a statistically significant reduction of subsequent acute cases when compared to the control group. Nevertheless there was no significant impact regarding age, position or sex on subsequent acute cases. CONCLUSION: The kinesiology intervention program within the health care facility was effective at reducing subsequent WRMSD rates within the nursing personnel.

A participatory systems approach to design for safer integrated medicine management.

It is recognised that whole systems approaches are required in the design and development of complex health care services. Application of a systems approach benefits from the involvement of key stakeholders. However, participation in the context of community based health care is particularly challenging due to busy and geographically distributed stakeholders. This study used action research to investigate what processes and methods were needed to successfully employ a participatory systems approach. Three participatory workshops planned and facilitated by method experts were held with 30 representative stakeholders. Various methods were used with them and evaluated through an audit of workshop outputs and a qualitative questionnaire. Findings on the method application and participation are presented and methodological challenges are discussed with reference to further research. Practitioner Summary: This study provides practical insights on how to apply a participatory systems approach to complex health care service design. Various template-based methods for systems thinking and risk-based thinking were efficiently and effectively applied with stakeholders.

A review and exploration of sociotechnical ergonomics.

A holistic review of ergonomic history shows that science remains important for general occupational health and safety (OSH), the broad society, culture, politics and the design of everyday things. Science provides an unconventional and multifaceted viewpoint exploring ergonomics from a social, corporate and OSH perspective. Ergonomic solutions from this mindset may redefine the science, and it will change with companies that change within this socially hyper-connected world. Authentic corporate social responsibility will counter 'misleadership' by not approaching ergonomics with an afterthought. The review concludes that ergonomics will be stronger with social respect and ergonomic thinking based on the optimisation of anthropometric data, digital human models, computer-aided tools, self-empowerment, job enrichment, work enlargement, physiology, industrial psychology, cybernetic ergonomics, operations design, ergonomic-friendly process technologies, ergonomic empowerment, behaviour-based safety, outcome-based employee wellness and fatigue risk management solutions, to mention a few.

Ergonomía cognitiva. Resultados de un taller de capacitación / Cognitive ergonomics. Results of a training workshop

Introducción: Es una necesidad de capacitar a los profesionales y técnicos interesados en el campo de la salud y seguridad en el trabajo y en los desafíos de un nuevo paradigma sistémico y holístico. Desarrollo: Se realizó un ejercicio práctico (taller), donde a partir de modelo de Análisis del trabajo, se estudiaron siete puestos de trabajo. Mediante los instrumentos ofrecidos en los intercambios teóricos, los pasantes hicieron el estudio de puesto utilizando el Método de Helsinki (modificado por Almirall et al. 2004) y de los efectos aplicando la ESE, PSF y EER. Resultados y comentarios: El modelo de Análisis del trabajo y el desarrollo de la Ergonomía cognitiva fueron desarrollados por los pasantes, y fueron expuestos en el ejercicio final, el cual, a pesar de constituir un ejercicio docente, llamó la atención sobre dos de los puestos estudiados, y caracterizó los demás, tanto en las condiciones imperantes como en los efectos(AU)

Radiation safety and ergonomics in the electrophysiology laboratory: update on recent advances.

PURPOSE OF REVIEW: Risks associated with exposure to ionizing radiation in patients undergoing electrophysiology procedures and interventional cardiac electrophysiologists performing these procedures are a serious concern. Strategies to reduce radiation exposure are of obvious importance. In addition, interventional cardiac electrophysiologists have to perform procedures wearing heavy lead protection for prolonged periods, making them prone to cervical and lumbar spinal injuries. RECENT FINDINGS: Recently developed technologies, such as low-exposure radiographic imaging, novel radiographic imaging protection systems, nonfluoroscopic mapping systems using image integration, and remote catheter manipulation systems have been successful in reducing ionizing radiation exposure in the electrophysiology laboratory. The efficacy and safety of these technologies are being evaluated in clinical trials. In addition, economic analyses are being performed to evaluate these novel systems. The use of nonweight-bearing radiation protection devices and ergonomic design of the electrophysiology laboratory aim to reduce the incidence of occupational injuries in interventional cardiac electrophysiologists. SUMMARY: There is need for ongoing development and evaluation of new technologies to minimize exposure to ionizing radiation during electrophysiologic procedures. In addition, ergonomic planning of the electrophysiology laboratory and training of interventional cardiac electrophysiologists are crucial to occupational injury prevention.

Human factors engineering approaches to patient identification armband design.

The task of patient identification is performed many times each day by nurses and other members of the care team. Armbands are used for both direct verification and barcode scanning during patient identification. Armbands and information layout are critical to reducing patient identification errors and dangerous workarounds. We report the effort at two large, integrated healthcare systems that employed human factors engineering approaches to the information layout design of new patient identification armbands. The different methods used illustrate potential pathways to obtain standardized armbands across healthcare systems that incorporate human factors principles. By extension, how the designs have been adopted provides examples of how to incorporate human factors engineering into key clinical processes.