A randomized controlled trial investigating effects of an individualized pedometer driven walking program on chronic low back pain.

BACKGROUND: Walking is an easily prescribed physical activity for people with low back pain (LBP). However, the evidence for its effectiveness to improve pain and disability levels for people with chronic low back pain (CLBP) within a community setting has not been evaluated. This study evaluates the effectiveness of a clinician guided, pedometer-driven, walking intervention for increasing physical activity and improving clinical outcomes compared to education and advice. METHODS: Randomized controlled trial recruiting N = 174 adults with CLBP. Participants were randomly allocated into either a standardized care group (SG) or pedometer based walking group (WG) using minimization allocation with a 2:1 ratio to the WG. Prior to randomization all participants were given a standard package of education and advice regarding self-management and the benefits of staying active. Following randomization the WG undertook a physiotherapist guided pedometer-driven walking program for 12 weeks. This was individually tailored by weekly negotiation of daily step targets. Main outcome was the Oswestry Disability Index (ODI) recorded at baseline, 12 weeks, 6 and 12 months. Other outcomes included, numeric pain rating, International Physical Activity Questionnaire (IPAQ), Fear-Avoidance Beliefs Questionnaire (FABQ), Back Beliefs questionnaire (BBQ), Physical Activity Self-efficacy Scale, and EQ-5D-5L quality of life estimate. RESULTS: N = 138 (79%) participants completed all outcome measures at 12 weeks reducing to N = 96 (55%) at 12 months. Both observed and intention to treat analysis did not show any statistically significant difference in ODI change score between the WG and the SG at all post-intervention time points. There were also no significant between group differences for change scores in all secondary outcome measures. Post hoc sensitivity analyses revealed moderately disabled participants (baseline ODI ≥ 21.0) demonstrated a greater reduction in mean ODI scores at 12 months in the WG compared to SG, while WG participants with a daily baseline step count < 7500 steps demonstrated a greater reduction in mean ODI scores at 12 weeks. CONCLUSIONS: Overall, we found no significant difference in change of levels of (ODI) disability between the SG and WG following the walking intervention. However, ODI responses to a walking program for those with moderate levels of baseline disability and those with low baseline step count offer a potential future focus for continued research into the benefit of walking as a management strategy for chronic LBP. TRIAL REGISTRATION: United States National Institutes of Health Clinical Trails registry (http://ClinicalTrials.gov/) No. NCT02284958 (27/10/2014).

Potential exoskeleton uses for reducing low back muscular activity during farm tasks.

BACKGROUND: As the sustainability of the agricultural workforce has been threatened by the high prevalence of back pain, developing effective interventions to reduce its burden within farming will contribute to the long-term health and productivity of workers. Passive back-support exoskeletons are being explored as an intervention to reduce the physical demands on the back muscles, and consequently mitigate the risk of back pain, in many industrial sectors. METHODS: This study investigated whether exoskeleton use could reduce farmers' low back muscle load. Electromyography was used to evaluate exoskeleton use in field and laboratory settings. A total of 14 farmers (13 males and 1 female) with a mean age of 49 (SD = 12) years and 6 female nonfarmers (mean age 28, SD = 5 years) performed a standardized set of tasks that included symmetric and asymmetric lifting and sustained trunk flexion. Following the standardized tasks, 14 farmers also performed regular, real-world, farm tasks with and without use of the exoskeleton at their farms. RESULTS: Exoskeleton use decreased back muscular load during farming activities up to 65%, 56%, and 48% in static, median, and peak muscle activity, respectively. This indicates potential benefits of exoskeleton use to help farmers work under less muscular load. Paradoxically, exoskeleton use during standardized tasks increased muscle activity for some participants. CONCLUSIONS: This study demonstrates the potential effects of using passive exoskeletons in agriculture through observational and experimental research, and is among the first that explores the potential for using exoskeletons during actual work tasks in farm settings.

Stable prevalence of chronic back disorders across gender, age, residence, and physical activity in Canadian adults from 2007 to 2014.

BACKGROUND: Chronic back disorders (CBD) are a global health problem and the leading cause of years lived with disability. The present study aims to examine overall and specific trends in CBD in the Canadian population aged 18 to 65 years. METHODS: Data from the Canadian Community Health Survey (CCHS), a cross-sectional study, from 2007 to 2014 (8 cycles) were used to calculate CBD prevalence across gender, age, geographical area (urban/rural and ten provinces and northern territories), and physical activity levels. CBD was defined in the CCHS as having back problems, excluding fibromyalgia and arthritis, which have lasted or are expected to last six months or more and that have been diagnosed by a health professional. Prevalence of CBD using survey weights and associated 95% confidence intervals (95% CI) were calculated yearly using balanced repeated replications technique. Trend tests were calculated using joinpoint regressions; ArcGIS software was used for mapping. RESULTS: Age-standardized CBD prevalence in 2007 and 2014 were 18.9% (95% CI = 18.4;19.5) and 17.8% (95% CI = 17.2,18.4), respectively. CBD prevalence was consistently higher in women, older age groups, rural dwellers, and people classified as inactive. Crude and age-standardized CBD prevalence decreased faster in people classified as physically active compared to those who were inactive (p < 0.006). Although CBD slightly decreased over time, no statistically significant trends were found overall or by gender, area of residence, province or level of physical activity. The prevalence of CBD remained consistently high in the province of Nova Scotia, and consistently low in the province of Quebec over the eight CCHS cycles. CONCLUSION: Despite prevention efforts, such as the Canadian back pain mass media campaign, CBD prevalence has remained stable between 2007 and 2014. Tailored prevention and management of CBD should consider gender, age, and geographical differences. Further longitudinal studies could elucidate the temporal relationship between potentially modifiable risk factors such as physical activity and CBD.

Self-reported use of family physician, chiropractor and physiotherapy services among adult Canadians with chronic back disorders: an observational study.

BACKGROUND: Chronic back disorders (CBD) are prevalent, costly, and among the most common reasons for seeking primary care; however, little is known regarding the comparative use of family physician, chiropractic, and physiotherapy services among people with CBD in Canada. Elucidating these differences may identify potential gaps in access to care and inform the development of strategies to improve access. The research objectives were to investigate patterns of health care use and to profile factors associated with self-reported use of family physicians, chiropractors, and physiotherapists among adult Canadians with CBD. METHODS: The combined 2009 and 2010 Canadian Community Health Surveys conducted by Statistics Canada were used to investigate self-reported health care use among adults with CBD. This complex survey employs population weights and bootstrapping to be representative of the Canadian population. Following descriptive analyses, we used multiple logistic regression to profile self-reported health care use while statistically controlling for possible confounding effects. RESULTS: The majority of adult respondents with CBD sought care only with a family physician (53.8%), with 20.9% and 16.2% seeking care with combined family physician/chiropractor or family physician/physiotherapist, respectively. Few respondents sought care only with a chiropractor (2.5%) or physiotherapist (1.0%). After adjustment, differential patterns of utilization (p < 0.05) were evident between provider groups with respect to age, gender, socioeconomic status, rural/urban residence, functional limitations, and presence of co-morbidities. CONCLUSIONS: This research highlights potential inequities in access to physiotherapists and chiropractors in relation to family physicians among adult Canadians with CBD, particularly among lower socioeconomic status and rural/remote populations.

Musculoskeletal discomfort among Canadian bovine practitioners: Prevalence, impact on work, and perception of physically demanding tasks.

Musculoskeletal discomfort (MSD) is prevalent in large animal veterinarians but little research has been conducted on prevalence of MSD and its impact among Canadian bovine veterinarians. This 2017 survey targeted practicing and retired members of the Western Canadian Association of Bovine Practitioners, and adapted the Nordic Musculoskeletal Questionnaire to quantify MSD prevalence. Open-ended questions were used to determine the impact of MSD on work and to determine what were perceived to be the most physically demanding tasks. The survey response rate was 51.4% (133/259). Prevalence of MSD was high, with 12-month and lifetime rates of 89.5% and 96.9%, respectively. Obstetrical procedures, rectal examinations, and bull semen collections were reported as the 3 most physically strenuous tasks. The high MSD prevalence rates observed in the shoulder, neck, and lower back call for research on direct ergonomic assessments and work practice interventions for bovine veterinarians.

Inconfort musculo-squelettique parmi les praticiens bovins canadiens : prévalence, impact sur le travail et perception des tâches exigeantes sur le plan physique. L'inconfort musculo-squelettique (IMS) est prévalent chez les vétérinaires pour grands animaux mais peu de recherches ont été réalisées sur la prévalence de l'IMS et son impact parmi les vétérinaires bovins canadiens. Cette enquête de 2017 a ciblé les membres praticiens et retraités de la Western Canadian Association of Bovine Practitioners et a adapté le questionnaire nordique sur la santé musculo-squelettique pour quantifier la prévalence de l'IMS. Des questions à réponse libre ont été utilisées pour déterminer l'impact de l'IMS sur le travail et déterminer ce qui était perçu comme les tâches les plus exigeantes physiquement. Le taux de réponse a été de 51,4 % (133/259). La prévalence de l'IMS était élevée, avec des taux de 12 mois et d'une vie de 89,5 % et de 96,9 %, respectivement. Les interventions obstétriques, les examens rectaux et le prélèvement de sperme chez les taureaux étaient signalés comme les tâches les plus difficiles sur le plan physique. Des taux élevés de prévalence de l'IMS ont été observés dans les épaules, le cou et le bas du dos et nécessitent de la recherche sur les évaluations ergonomiques directes et des interventions pour les pratiques de travail des vétérinaires bovins.(Traduit par Isabelle Vallières).

Whole-body vibration exposure of occupational horseback riding in agriculture: A ranching example.

BACKGROUND: Horse riding is common in many occupations; however, there is currently no research evaluating exposure to whole-body vibration and mechanical shock on horseback. METHODS: Whole-body vibration was measured on a cattle rancher during two 30 min horseback rides using a tri-axial accelerometer mounted on a western saddle. Vibration was summarized into standardized metrics, including the 8 hr equivalent root-mean-squared acceleration (A[8]) and the daily 4th power vibration dose value (VDV). The resulting exposures were compared to the exposure limit and action values provided by European Union Directive 2002/44/EC. RESULTS: The highest vibration for both rides was in the vertical axis, with average A(8) and VDV of 0.56 m/s2 and 26.24 m/s1.75 , respectively. The A(8) value indicated moderate risk while the VDV suggested high risk of harmful health effects. CONCLUSIONS: Exposure to whole-body vibration and mechanical shock during occupational horseback riding may pose deleterious health risks and increased susceptibility to low back pain. Am. J. Ind. Med. 60:215-220, 2017. © 2017 Wiley Periodicals, Inc.

Trends of ATV use and associated injury on Saskatchewan farms.

PURPOSE: All-terrain vehicles (ATV's) are a hazardous source of injury in many contexts and geographical regions, but to date have not been investigated in Saskatchewan. METHODS: Baseline surveys from the Saskatchewan Farm Injury Project were examined at two time points in terms of: (1) rates and correlated characteristics of reported ATV use; and (2) qualitative content analysis of injury events involving ATVs. The sample of eligible farmers was 2,972 in 2007 and 1,702 in 2013. FINDINGS: Self-reported ATV use increased on Saskatchewan farms over the five-year period, both in terms of the number of individuals using ATV's on the farm and the days per year of operation. ATV use is significantly more common on farms with livestock, among male farmers, and among younger farmers. Farmers with low back pain were also more likely to report ATV use. Qualitative content analysis of farmers' reported "most serious injury" on the farm revealed themes related to: (1) tasks undertaken with ATV's at the time of the incident (e.g., stock work and personal transport); (2) contributing factors (vehicle, environmental and driver); and (3) safety reflections. CONCLUSION: The apparent trends of increasing ATV use on Saskatchewan farms and serious nature of the injury incidents reported indicate that this is an issue worthy of further investigation.

Whole body vibration exposure patterns in Canadian prairie farmers.

Whole body vibration is a significant physical risk factor associated with low back pain. This study assessed farmers' exposure to whole body vibration on the Canadian prairies according to ISO 2631-1. Eighty-seven vibration measurements were collected with a triaxial accelerometer embedded in a rubber seat pad at the operator-seat interface of agricultural machinery, including tractors, combines, pickup trucks, grain trucks, sprayers, swathers, all-terrain vehicles, and skid steers. Whole body vibration was highest in the vertical axis, with a mean (range) frequency-weighted root mean squared acceleration of 0.43 m/s2 (0.19-1.06 m/s2). Mean crest factors exceeded 9 in all 3 axes, indicating high mechanical shock content. The vertical axis vibration dose value was 7.55 m/s1.75 (2.18-37.59 m/s1.75), with 41.4% of measurements within or above the health guidance caution zone. These high exposures in addition to an ageing agricultural workforce may increase health risks even further, particularly for the low back. Practitioner Summary: Agricultural workers are frequently exposed to whole body vibration while operating farm equipment, presenting a substantial risk to musculoskeletal health including the low back. Assessing vibration exposure is critical in promoting a safe occupational environment, and may inform interventions to reduce farmer's exposure to vibration.

Full-Shift Trunk and Upper Arm Postures and Movements Among Aircraft Baggage Handlers.

OBJECTIVES: The present study assessed full-shift trunk and upper arm postural exposure amplitudes, frequencies, and durations among Swedish airport baggage handlers and aimed to determine whether exposures differ between workers at the ramp (loading and unloading aircraft) and baggage sorting areas. METHODS: Trunk and upper arm postures were measured using inclinometers during three full work shifts on each of 27 male baggage handlers working at a large Swedish airport. Sixteen of the baggage handlers worked on the ramp and 11 in the sorting area. Variables summarizing postures and movements were calculated, and mean values and variance components between subjects and within subject (between days) were estimated using restricted maximum likelihood algorithms in a one-way random effect model. RESULTS: In total, data from 79 full shifts (651h) were collected with a mean recording time of 495min per shift (range 319-632). On average, baggage handlers worked with the right and left arm elevated >60° for 6.4% and 6.3% of the total workday, respectively. The 90th percentile trunk forward projection (FP) was 34.1°, and the 50th percentile trunk movement velocity was 8° s(-1). For most trunk (FP) and upper arm exposure variables, between-subject variability was considerable, suggesting that the flight baggage handlers were not a homogeneously exposed group. A notable between-days variability pointed to the contents of the job differing on different days. Peak exposures (>90°) were higher for ramp workers than for sorting area workers (trunk 0.6% ramp versus 0.3% sorting; right arm 1.3% ramp versus 0.7% sorting). CONCLUSIONS: Trunk and upper arm postures and movements among flight baggage handlers measured by inclinometry were similar to those found in other jobs comprising manual material handling, known to be associated with increased risks for musculoskeletal disorders. The results showed that full-shift trunk (FP) and, to some extent, peak arm exposures were higher for ramp workers compared with sorting workers.

Farmers, mechanized work, and links to obesity.

OBJECTIVE: In a contemporary sample of Saskatchewan farm people, to relate the degree of mechanized and also non-mechanized farm work to the occurrence of being overweight or obese. Secondarily to determine the prevalence of being overweight or obese, and to compare these prevalence levels with those reported for general populations. METHOD: Cross-sectional analyses of baseline survey data provided for 2849 individuals (2619 adults) from 1216 Saskatchewan farms in 2013. Age/sex-standardized prevalence levels of overweight and obesity were compared between the farm cohort and general populations. Durations of specific types of work were described by metabolic equivalent scoring. Multi-level binomial regression was used to study relations between mechanized and also non-mechanized farm work with overweight and obesity. RESULTS: Overall, 65.1% of the adult farm cohort was overweight (39.6%) or obese (25.5%), with prevalence levels that exceeded estimated norms for Canada but not the province of Saskatchewan. Increases in risks for obesity were related to higher amounts of mechanized but not non-mechanized farm work. CONCLUSION: While the mechanization of farm work has obvious benefits in terms of productivity, its potential effects on risks for overweight and obesity must be recognized.

Walking away from back pain: one step at a time - a community-based randomised controlled trial.

BACKGROUND: Low back pain is highly prevalent and a significant public health burden in Western society. Feasibility studies suggest personalised pedometer-driven walking is an acceptable and effective motivating tool in the management of chronic low back pain (CLBP ≥ 12 weeks). The proposed study will investigate pedometer-driven walking as a low cost, easily accessible, and sustainable means of physical activity to improve disability and clinical outcomes for people with CLBP in Saskatchewan, Canada. METHODS/DESIGN: A fully-powered single-blinded randomised controlled trial will compare back care advice and education with back care advice and education followed by a 12-week pedometer-driven walking programme in adults with CLBP. Adults with self-reported CLBP will be recruited from the community and screened for elibility. Two-hundred participants will be randomly allocated to one of two intervention groups. All participants will receive a single back care advice and education session with a physiotherapist. Participants in the walking group will also receive a physiotherapist-facilitated pedometer based walking programme. The physiotherapist will facilitate the participant to monitor and progress the walking programme, by phone, on a weekly basis over 10 weeks following two face-to-face sessions. Outcome measures of self-reported disability, physical activity, participants' low back pain beliefs/perceptions, quality of life and direct/indirect cost estimates will be gathered at baseline, three months, six months, and 12 months by a different physiotherapist blinded to group allocation. Following intervention, focus groups will be used to explore participants' thoughts and experiences of pedometer-driven walking as a management tool for CLBP. DISCUSSION: This paper describes the design of a community-based RCT to determine the effectiveness of a pedometer-driven walking programme in the management of CLBP. TRIAL REGISTRATION: United States National Institutes of Health Clinical Trails registry (http://ClinicalTrials.gov/) No. NCT02284958 . Registered on 27(th) October 2014).

Exploring the link between occupationally relevant whole body vibration and headache and neck pain: is elevated muscle tension an intermediary factor?

Whole body vibration (WBV) is linked to short- and longer-term adverse health outcomes, including cognitive impairment, stress and memory loss, loss of balance, reduced proprioception, visual and vestibular disturbances, gastrointestinal problems, and musculoskeletal disorders. Epidemiological evidence supports the link between WBV and headache and head discomfort, but few experimental studies have examined this relationship, particularly with increased muscle tension, as an intermediary. This study aimed to investigate the relationship between muscle tension and vibration intensity, between perceived neck pain and headache/head discomfort and vibration intensity, and between muscle tension and reported neck pain and headache symptoms from simulated WBV based on field measurements of all-terrain vehicle operation on farm terrain. We observed significantly higher electromyography amplitude in the High condition (equivalent to EU Directive's Exposure Limit Value) compared to both Low (equivalent to EU Directive's Exposure Action Value) and Control (quiet sitting) conditions at the left upper trapezius muscle but there were no significant time effects. Neck pain and headache/head discomfort significantly increased after both Low (91% increase from baseline) and High (154% increase from baseline) vibration conditions but there were no significant differences between conditions. Based on simple regression modeling, the relationship between muscle activity and neck pain or headache was very weak (R2 = 0-0.093). Given the possibility of multiple factors contributing to headache symptoms, future research should not only consider the role of muscle tension but also sensory conflict, excessive noise, biodynamic responses, and a combination of these factors.

"Navigating chaos": Urban, Rural, and Remote Patient Experiences in Accessing Healthcare with Indigenous and Non-Indigenous Perspectives of Living with Chronic Low Back Pain.

Background: Healthcare access for chronic low back pain is complex and should consider not only the health system, but patient care seeking experiences as well. People who live in rural and remote communities and/or identify as being Indigenous may often encounter additional barriers to accessing care for chronic low back pain; thus, these contexts must be considered to fully understand barriers and facilitators. Aims: The aim of this study was to understand care-seeking experiences of people living with chronic back pain in Saskatchewan and determine unique experiences facing urban, rural, remote, and/or Indigenous peoples. Methods: Thirty-three participants with chronic low back pain completed a preliminary survey followed by individual semistructured interviews. Participants were categorized as urban, rural, or remote including Indigenous status. A qualitative interpretive research approach with inductive thematic analysis was employed. Results: Three overarching themes were identified with the following subthemes: (1) healthcare access challenges: challenges to accessing care, challenges within the health system, and challenges leading to self-directed management/coping strategies; (2) healthcare access facilitators: funded care, participant education and knowledge, patient-provider communication, and care closer to home; and (3) participant recommendations for improved care provision: coordination of care, integrative and holistic care, and patient-centered care and support. Rural and remote participants highlighted travel as a main barrier. Indigenous participant experiences emphasized communication with healthcare providers and past experiences influencing desire to access care. Conclusion: Participants identified a range of challenges and facilitators as well as recommendations for improving access to care for chronic low back pain, with unique barriers for rural, remote, and Indigenous participants.

Contexte: L'accès aux soins de santé pour la lombalgie chronique est complexe et devrait tenir compte non seulement du système de santé, mais aussi des expériences de recherche de soins des patients. Les personnes vivant dans des communautés rurales et éloignées et/ou qui s'identifient comme autochtones font souvent face à des obstacles supplémentaires pour accéder aux soins pour la lombalgie chronique; il faut donc tenir compte de ces contextes pour bien comprendre les obstacles et les facilitateurs.Objectifs: L'objectif de cette étude était de comprendre les expériences de recherche de soins des personnes vivant avec une lombalgie chronique en Saskatchewan et de déterminer les expériences uniques d'accès aux soins auxquelles sont confrontées les personnes vivant en milieu urbain, rural, éloigné et/ou ayant un statut d'autochtone.Méthodes: Trente-trois participants souffrant de lombalgie chronique ont répondu à un questionnaire préliminaire suivi d'entretiens individuels semi-structurés. Les participants ont été catégorisés comme vivant en milieu urbain, rural, éloigné, incluant ceux ayant un statut d'autochtone. Une approche de recherche qualitative interprétative avec une analyse thématique inductive a été utilisée.Résultats: Trois thèmes principaux ont été répertoriés avec les sous-thèmes suivants : (1) difficultés d'accès aux soins de santé : difficultés pour accéder aux soins, difficultés au sein du système de santé et difficultés conduisant à des stratégies de gestion et d'adaptation autonomes; (2) facilitateurs de l'accès aux soins de santé : financement des soins, éducation et connaissances des participants, communication entre le patient et le prestataire de soins et proximité des soins par rapport au domicile et (3) recommandations des participants pour l'amélioration de la prestation des soins : la coordination des soins, les soins intégrés et holistiques, les soins et le soutien centrés sur le patient. Les participants des régions rurales et éloignées ont souligné que les déplacements constituaient un obstacle majeur. Les expériences des participants autochtones ont mis l'accent sur la communication avec les prestataires de soins de santé et les expériences passées qui influencent le désir d'accéder aux soins.Conclusion: Les participants ont répertorié un ensemble de difficultés, de facilitateurs et de recommandations pour améliorer l'accès aux soins pour les lombalgies chroniques, qui présente des obstacles uniques pour les participants vivant en milieu rural et éloigné et les participants autochtones.

Data processing costs for three posture assessment methods.

BACKGROUND: Data processing contributes a non-trivial proportion to total research costs, but documentation of these costs is rare. This paper employed a priori cost tracking for three posture assessment methods (self-report, observation of video, and inclinometry), developed a model describing the fixed and variable cost components, and simulated additional study scenarios to demonstrate the utility of the model. METHODS: Trunk and shoulder postures of aircraft baggage handlers were assessed for 80 working days using all three methods. A model was developed to estimate data processing phase costs, including fixed and variable components related to study planning and administration, custom software development, training of analysts, and processing time. RESULTS: Observation of video was the most costly data processing method with total cost of € 30,630, and was 1.2-fold more costly than inclinometry (€ 26,255), and 2.5-fold more costly than self-reported data (€ 12,491). Simulated scenarios showed altering design strategy could substantially impact processing costs. This was shown for both fixed parameters, such as software development and training costs, and variable parameters, such as the number of work-shift files processed, as well as the sampling frequency for video observation. When data collection and data processing costs were combined, the cost difference between video and inclinometer methods was reduced to 7%; simulated data showed this difference could be diminished and, even, reversed at larger study sample sizes. Self-report remained substantially less costly under all design strategies, but produced alternate exposure metrics. CONCLUSIONS: These findings build on the previously published data collection phase cost model by reporting costs for post-collection data processing of the same data set. Together, these models permit empirically based study planning and identification of cost-efficient study designs.

Anthropometry-corrected exposure modeling as a method to improve trunk posture assessment with a single inclinometer.

Measuring trunk posture in the workplace commonly involves subjective observation or self-report methods or the use of costly and time-consuming motion analysis systems (current gold standard). This work compared trunk inclination measurements using a simple data-logging inclinometer with trunk flexion measurements using a motion analysis system, and evaluated adding measures of subject anthropometry to exposure prediction models to improve the agreement between the two methods. Simulated lifting tasks (n=36) were performed by eight participants, and trunk postures were simultaneously measured with each method. There were significant differences between the two methods, with the inclinometer initially explaining 47% of the variance in the motion analysis measurements. However, adding one key anthropometric parameter (lower arm length) to the inclinometer-based trunk flexion prediction model reduced the differences between the two systems and accounted for 79% of the motion analysis method's variance. Although caution must be applied when generalizing lower-arm length as a correction factor, the overall strategy of anthropometric modeling is a novel contribution. In this lifting-based study, by accounting for subject anthropometry, a single, simple data-logging inclinometer shows promise for trunk posture measurement and may have utility in larger-scale field studies where similar types of tasks are performed.

Addressing Exoskeleton Implementation Challenges: Case Studies of Non-Acceptance in Agriculture.

OBJECTIVES: The objective of this study was to detect success and failure factors for the implementation of passive exoskeletons in agriculture. Exoskeletons have been shown to reduce musculoskeletal loads during lab-based manual tasks, but long-term implementation experiences in agriculture are lacking. METHODS: We analyzed four intervention studies in agriculture focusing on methodological and contextual reasons why the trials were successful or unsuccessful. The study context, attempted intervention, and data collection of each field trial is compared. In the absence of long-term studies investigating the implementation and effectiveness of exoskeletons in agriculture, a set of multi-week pilot trials were initiated among German market vegetable farms and French vineyards from 2019 to 2022. Participant ratings, farm characteristics (e.g. employment duration and payment scheme) and intervention implementation characteristics (e.g. participation in implementation or language barriers) were analyzed using a mixed-methods approach to identify success and failure factors. RESULTS: The comparison of the studies showed that despite the organizational issues, there were several practical issues that limit the success of exoskeleton use in agriculture. We observed that participant rejection of the intervention is a major barrier to successfully conducting long-term field trials in agriculture. Factors like pain, discomfort, heat stress, or a lack of perceived benefits have been identified as failure factors but also the implementation process itself. CONCLUSION: In addition to careful targeting of trial sites and inclusion of participatory elements in the implementation plan, successful implementation of exoskeletons in agriculture requires fundamental human factors development of the exoskeletons themselves. This will require better matching the physical needs of the workers, the production needs of the tasks, and compatibility with the environment.

The effect of selected rest break activities on reaction time, balance, and perceived discomfort after one hour of simulated occupational whole-body vibration exposure in healthy adults.

MATERIALS & METHODS: Eleven healthy adults participated in four 1-hour sessions of ecologically valid WBV exposure followed by one of four 5-minute activities: sitting, walking, 2 min of gaze stabilization exercise (GSE) coupled with 3 min of trunk mobility exercise (GSE + MOBIL), or 2 min of GSE coupled with a 3-minute walk (GSE + WALK). Baseline and post-activity measurements (rating of perceived discomfort, balance and postural sway measurements, 5-minute psychomotor vigilance task test) were submitted to a paired t-test to determine the effect of WBV exposure and activities on physical, cognitive, and sensorimotor systems and to a repeated measures ANOVA to determine any differences across activities. RESULTS: We observed degradation of the slowest 10% reaction speed outcomes between baseline and post-activity after walking (7.3%, p < 0.05) and sitting (8.6%, p < 0.05) but not after GSE + MOBIL or GSE + WALK activities. Slowest 10% reaction speed after GSE + MOBIL activity was faster than all other activities. The rating of perceived discomfort was higher after SIT and WALK activities. There were no notable differences in balance outcomes. CONCLUSION: When compared to sitting for 5 min, an activity including GSE and an active component, such as walking or trunk mobility exercises, resulted in maintenance of reaction time after WBV exposure. If confirmed in occupational environments, GSE may provide a simple, rapid, effective, and inexpensive means to protect against decrements in reaction time after WBV exposure.

A 5-minute intervention activity after 1 hour of occupational whole-body vibration (WBV) exposure may provide protection against detriments in reaction time.Intervention activities that include a gaze stabilization exercise component maintained the slowest reaction speeds after 1 hour of WBV exposure, whereas sitting and walking activities resulted in a further slowing of the slowest reaction speeds.It may be possible for machinery operators to incorporate gaze stabilization activities in occupational environments, either in or out-of-cab, but further evaluation for feasibility and practicality of in-field adoption is required.

Healthcare Access Challenges and Facilitators for Back Pain Across the Rural-Urban Continuum in Saskatchewan, Canada: Cross-Sectional Results From a Provincial-Wide Telephone Survey.

Background: Chronic back pain is a common musculoskeletal disorder, disproportionately affecting rural and Indigenous people. Saskatchewan has a relatively high proportion of rural and Indigenous residents; therefore, understanding barriers and facilitators to accessing healthcare are needed to improve healthcare service delivery. Methods: A provincial-wide telephone survey explored experiences and perceived healthcare access barriers and facilitators among 384 Saskatchewan residents who experienced chronic low back pain. Chi-squared tests were performed to determine if people who lived in urban versus rural areas differed in the proportion who had accessed services from various healthcare practitioners. T-test and Mann-Whitney U analyses were conducted to determine differences between urban and rural, and Indigenous and non-Indigenous respondents. Results: Of 384 residents surveyed, 234 (60.9%) reported living in a rural location; 21 (5.5%) identified as Indigenous. Wait times (47%), cost (40%), travel (39%), and not knowing how to seek help (37%) were the most common barriers for Saskatchewan residents seeking care, with travel being the only barrier that was significantly different between rural and urban respondents (P ⩽ .001). Not knowing where to go to access care or what would help their low back pain (P = .03), lack of cultural sensitivity (P = .007), and comfort discussing problems with health care professionals (P = .26) were greater barriers for Indigenous than non-Indigenous participants. Top facilitators (>50% of respondents) included publicly funded healthcare, locally accessible healthcare services, and having supportive healthcare providers who facilitate referral to appropriate care, with urban respondents considering the latter 2 as greater facilitators than rural respondents. Telehealth or virtual care (P = .013) and having healthcare options nearby in their community (P = .045) were greater facilitators among Indigenous participants compared to non-Indigenous respondents. Conclusions: Rural, urban, Indigenous, and non-Indigenous people report overlapping and unique barriers and facilitators to accessing care for chronic low back pain. Understanding perceived access experiences will assist in developing more effective care models for specific communities or regions.

Data collection costs in industrial environments for three occupational posture exposure assessment methods.

BACKGROUND: Documentation of posture measurement costs is rare and cost models that do exist are generally naïve. This paper provides a comprehensive cost model for biomechanical exposure assessment in occupational studies, documents the monetary costs of three exposure assessment methods for different stakeholders in data collection, and uses simulations to evaluate the relative importance of cost components. METHODS: Trunk and shoulder posture variables were assessed for 27 aircraft baggage handlers for 3 full shifts each using three methods typical to ergonomic studies: self-report via questionnaire, observation via video film, and full-shift inclinometer registration. The cost model accounted for expenses related to meetings to plan the study, administration, recruitment, equipment, training of data collectors, travel, and onsite data collection. Sensitivity analyses were conducted using simulated study parameters and cost components to investigate the impact on total study cost. RESULTS: Inclinometry was the most expensive method (with a total study cost of € 66,657), followed by observation (€ 55,369) and then self report (€ 36,865). The majority of costs (90%) were borne by researchers. Study design parameters such as sample size, measurement scheduling and spacing, concurrent measurements, location and travel, and equipment acquisition were shown to have wide-ranging impacts on costs. CONCLUSIONS: This study provided a general cost modeling approach that can facilitate decision making and planning of data collection in future studies, as well as investigation into cost efficiency and cost efficient study design. Empirical cost data from a large field study demonstrated the usefulness of the proposed models.

Higher unemployment and higher work-related traumatic fatality: trends and associations from the Canadian province of Saskatchewan, 2007-2018.

OBJECTIVE: Although Saskatchewan appears to have the greatest burden of work-related fatality (WRF) in Canada, it is unclear how WRF rates have varied over time. We investigated the WRF rate in Saskatchewan over the past decade and modeled potential risk factors for WRF, including economic indicators. METHODS: In this cross-sectional, population-based study, Saskatchewan workplace traumatic fatalities grouped by year, season, and worker characteristics (eg, age, industry) were used in addition to Statistics Canada labor force survey total employment, total labor force, and the number of unemployed workers by year and season. WRF rates were calculated as fatalities per total number of employed workers. A Poisson generalized additive model was employed to examine the association between WRF rates and personal characteristics, and economic indicators. RESULTS: The rate remained fairly stable between 2013-2014 and 2015-2017 but sharply increased from 2017 to 2018. On average, the highest rate was observed among workers aged ≥60 years (0.70 ± 0.21 per 100 000). Men had a more than 13-fold greater risk of WRF than women [relative risk (RR)13.7, 95% confidence interval (CI) 10.48-17.9), with the highest RR of WRF observed in the construction industry (RR 9.2, 95% CI 6.1-13.8). The risk of mortality increased non-linearly with increasing unemployment rate, with instability as the unemployment rate reaches the highest modeled values. CONCLUSION: Workplace fatality in the province has fluctuated over the past decade, with differential impact observed among industry groups. Furthermore, an increase in the unemployment rate was followed by an increase in mortality risk. Prioritizing and encouraging prevention strategies during periods of economic recessions could help address the incidence of fatalities at work.