Instrumentation for measuring dynamic spinal load moment exposures in the workplace.

Prior research has shown the load moment exposure to be one of the strongest predictors of low back disorder risk in manufacturing jobs. However, to extend these finding to the manual lifting and handling of materials in distribution centers, where the layout of the lifting task changes from one lift to the next and the lifts are highly dynamic, would be very challenging without an automated means of quantifying reach distances and item weights. The purpose of this paper is to describe the development and validation of automated instrumentation, the Moment Exposure Tracking System (METS), designed to capture the dynamic load moment exposures and spine postures used in distribution center jobs. This multiphase process started by obtaining baseline data describing the accuracy of existing manual methods for obtaining moment arms during the observation of dynamic lifting for the purposes of benchmarking the automated system. The process continued with the development and calibration of an ultrasonic system to track hand location and the development of load sensing handles that could be used to assess item weights. The final version of the system yielded an average absolute error in the load's moment arm of 4.1cm under the conditions of trunk flexion and load asymmetry. This compares well with the average absolute error of 10.9cm obtained using manual methods of measuring moment arms. With the item mass estimates being within half a kilogram, the instrumentation provides a reliable and valid means for assessing dynamic load moment exposures in dynamic distribution center lifting tasks.

Low back pain recurrence in occupational environments.

STUDY DESIGN: Prospective assessment of return to work after low back pain. OBJECTIVE: To determine which factors or combination of factors best predict recurrence of low back pain (defined 4 different ways) when returning to full-duty work. SUMMARY OF BACKGROUND DATA: Recurrent back pain is one of the more costly health problems facing industry today. Few systematic evaluations of the various factors suspected of exacerbating low back pain have been reported in the literature. METHODS: A total of 206 workers who reported low back pain were evaluated as they returned to full-duty work. Five types of assessments were performed including: 1) a low back kinematic functional assessments, 2) evaluation of job physical demands, 3) psychosocial assessment of the job environment, 4) self-reported impairment including perception of symptoms and psychological measures, and 5) personal (individual) factors. One year after return to full duty workers were interviewed to assess who had a recurrence of low back pain according to 4 different definitions of low back pain (symptom reports, medical visits, self-reported lost days, and employer-reported lost days due to back pain). Multiple logistic regression models were developed to assess the best combinations of predictors. RESULTS: The most liberal definition of recurrence, recurrent symptoms, had a significantly greater recurrence rate at 58% than all other outcome measures (P = 0.0001). The medical visit recurrence rate of 36% was significantly greater than the more conservative lost time measures (P = 0.0001). The recurrence rate for self-reported lost time was 15%, whereas the more conservative employer confirmed lost time measure was significantly lower at 10% (P = 0.0077). Multivariate predictive models associated with the various recurrence definitions yielded sensitivities varying between 78% and 80% and specificity between 73% and 80%. CONCLUSION: Recurrence is greatly dependent on how one defines recurrence with symptom reporting yielding 5.5 times as many recurrences compared with employer confirmed lost time. In general, more quantitative measures of worker musculoskeletal function yielded the best predictions of recurrence when predicting the more restrictive definitions of recurrence (employer confirmed lost time).