Does occupational health surveillance lead to risk reduction for workers exposed to hand-intensive work?

This mixed method study aimed to describe what risk-reducing actions were proposed by ergonomists after the execution of a guided process for occupational health surveillance for workers exposed to hand-intensive work in ten companies. Another aim was to describe the exposed workers' proposals for risk-reducing actions, including their perceptions of potential changes in the self-assessed exposure levels and work-related pain. Several actions, targeting organizational, technical, and/or individual measures were proposed. Proposals from the ergonomists more often targeted the personal measures, whereas the workers' proposals targeted technology or organizational changes. Six companies implemented at least one of the action proposals. These action proposals were not related to evaluation metrics, nor were they evaluated. This study indicates that both ergonomists and companies need guidance on how to improve to work in a participatory process for the implementation and evaluation of risk-reducing actions, e.g., by how to better include workers' experiences.

Reliability and Validity of Six Selected Observational Methods for Risk Assessment of Hand Intensive and Repetitive Work.

Risk assessments of hand-intensive and repetitive work are commonly done using observational methods, and it is important that the methods are reliable and valid. However, comparisons of the reliability and validity of methods are hampered by differences in studies, e.g., regarding the background and competence of the observers, the complexity of the observed work tasks and the statistical methodology. The purpose of the present study was to evaluate six risk assessment methods, concerning inter- and intra-observer reliability and concurrent validity, using the same methodological design and statistical parameters in the analyses. Twelve experienced ergonomists were recruited to perform risk assessments of ten video-recorded work tasks twice, and consensus assessments for the concurrent validity were carried out by three experts. All methods' total-risk linearly weighted kappa values for inter-observer reliability (when all tasks were set to the same duration) were lower than 0.5 (0.15-0.45). Moreover, the concurrent validity values were in the same range with regards to total-risk linearly weighted kappa (0.31-0.54). Although these levels are often considered as being fair to substantial, they denote agreements lower than 50% when the expected agreement by chance has been compensated for. Hence, the risk of misclassification is substantial. The intra-observer reliability was only somewhat higher (0.16-0.58). Regarding the methods ART (Assessment of repetitive tasks of the upper limbs) and HARM (Hand Arm Risk Assessment Method), it is worth noting that the work task duration has a high impact in the risk level calculation, which needs to be taken into account in studies of reliability. This study indicates that when experienced ergonomists use systematic methods, the reliability is low. As seen in other studies, especially assessments of hand/wrist postures were difficult to rate. In light of these results, complementing observational risk assessments with technical methods should be considered, especially when evaluating the effects of ergonomic interventions.

Ergonomists' experiences of executing occupational health surveillance for workers exposed to hand-intensive work: a qualitative exploration.

BACKGROUND: In order to reduce work-related upper limb disorders, the Swedish Work Environment Authority introduced an occupational health surveillance targeting hand-intensive work. A process model, aimed at supporting the employers as well as the occupational health service provider (i.e., ergonomist) in the work process with the occupational health surveillance, was developed. The objective of this qualitative study was to explore ergonomists' experiences of the execution of occupational health surveillance for hand-intensive work when following the novel process model as well as factors influencing the execution. METHODS: Semi-structured individual interviews were conducted with ten ergonomists on one occasion regarding their experience of following the work process. Qualitative content analysis with an inductive approach was used for analyzing the data. RESULTS: The ergonomists' experiences were summarized in one theme "A joint roadmap supporting a participatory process" and two categories "Clear structure provided by the components" and "The process influenced by collaboration and context". The ergonomists valued being guided by the systematics of the model, which provided structure and clarity in their work. Factors affecting the execution were related to communication deficiencies and uncertainties regarding expectations between different roles and functions (e.g., ergonomists and contact person, lack of information to workers). Additional factors, for instance, companies' routines and the ergonomist's intra-organizational support, such as access to IT-resources, could also affect the process. CONCLUSIONS: The findings reveal that this process model facilitates the ergonomists' work and cooperation with a client company. However, the process model needs to be developed and accompanied by a guideline with information related to the process, including e.g., description of a start-up meeting and of the roles/functions of the involved parties.

Exploring ergonomists' experiences after participation in a theoretical and practical research project on observational risk assessment tools.

Objective. The aim of this qualitative study was to explore how ergonomists experienced an e-learning concept as a tool for knowledge translation; furthermore, to explore what, if any, impact the knowledge translation had regarding the ergonomists' work with risk assessments. Methods. Twelve Swedish ergonomists employed in the occupational health service (OHS) participated in a research project, which included an e-learning program in risk assessment training. Focus group interviews and individual interviews were used for data collection. Results. The ergonomists appreciated the e-learning concept, e.g., its flexibility enabled them to decide when and where to practice. The concept was considered feasible within the context of the OHS. The ergonomists experienced an increased knowledge of different observation-based risk assessment tools, which expanded their professional toolboxes. Additionally, they began to reflect more regarding the reliability of risk assessment tools and how to enhance quality in risk assessment assignments. Conclusion. This study showed that e-learning may comprise an efficient knowledge translation for improved risk assessments in the OHS. The program contributed to changes in ergonomists' risk assessment procedures, e.g., in the selection of tools, increasing the number of observers, employing a participatory approach and more often actively involving stakeholders during the risk assessment process.

Company Representatives' Experiences of Occupational Health Surveillance for Workers Exposed to Hand-Intensive Work: A Qualitative Study.

Exposure assessment seldom precedes the medical health checks in occupational health surveillance. In order to emphasize the interconnection between exposure assessment and medical health checks, a process model was developed. The process model aimed to guide employers and Occupational Health Service providers through the execution of occupational health surveillance. The objective of this qualitative study is to explore company representatives' experiences of the process model, in terms of feasibility and values, and to identify factors that facilitate or impede the process. Thirty-three company representatives from ten companies were interviewed. Interviews were analyzed using content analysis. The company representatives experienced that the model contributed to increased risk awareness and understanding of the exposure effects on workers' health. They valued the exposure assessments performed by an ergonomics expert, which led to the discovery of previously unidentified risks. The feasibility was facilitated by: a joint start-up meeting in which the process was planned, clear communication between the involved parties, and clarity regarding the process ownership. The findings reveal that a guiding process model is valuable for the execution of occupational health surveillance. However, the model should not only define the components included; a practical guide concerning how the process can be executed is also needed.

Study Protocol for a Qualitative Research Project Exploring an Occupational Health Surveillance Model for Workers Exposed to Hand-Intensive Work.

The objective of this study protocol is to describe the development of a process model for occupational health surveillance for workers exposed to hand-intensive work (the HIW-model), and to describe the studies that will explore the model. The studies are designed to: (1) explore stakeholders' experiences of the model, and (2) explore if, and how, the model affects actions for reduction of exposure to hand-intensive work. The study protocol presents a research project that is described as two studies. The first study will explore company representatives' and ergonomists' experiences of the execution of the HIW-model and its various components concerning feasibility and values. Semi-structured interviews will constitute the data source. The second study will explore whether the execution of the HIW-model leads to work environmental changes, such as actions for reduction of exposure to hand-intensive work, and whether these potential actions are based on the ergonomist's feedback of the exposure assessment and the medical health checks. A mixed method approach will be applied, in which the data sources will be comprised of semi-structured interviews, questionnaires, and documents. The project is expected to generate knowledge regarding the values of the HIW-model. The project is anticipated to shed light on factors that facilitate or impede execution of the model from the different stakeholders' perspectives; the employer's as having the legal responsibility for the work environment, and the occupational health service consultants', being the work environment experts supporting the employers.

Factors influencing ergonomists' use of observation-based risk-assessment tools.

BACKGROUND: Several observation-based risk-assessment tools have been developed in recent decades. Studies reporting their use often focus only on the user, the ergonomist. The influence of context and the attributes of the tools may also affect the use but are factors that are seldom considered. OBJECTIVE: The aim of the present study was to explore the process of risk-assessment assignments and to identify factors influencing the use of research-based observation-based risk-assessment tools among Swedish ergonomists, with a background as reg. physiotherapists, employed in Occupational Health Services (OHS). METHODS: A web-based questionnaire (n = 70) was combined with semi-structured interviews (n = 12). RESULTS: There was limited use of several observation-based risk-assessment tools. Furthermore, the results showed that ergonomics risk-assessment assignments are most commonly initiated reactively and that interventions were seldom evaluated. Factors that influence use are related both to the ergonomist and to the attributes of the tools as well as to contextual factors assigned to authorities, and internal organisations both within occupational health service companies and client companies. CONCLUSION: There was a lack of systematic approaches in ergonomics risks assessment and low use and knowledge of risk-assessment tools. This indicates that there is a need to support OHS companies in implementing systematic tools in their practice.

Inter- and intra- observer reliability of risk assessment of repetitive work without an explicit method.

A common way to conduct practical risk assessments is to observe a job and report the observed long term risks for musculoskeletal disorders. The aim of this study was to evaluate the inter- and intra-observer reliability of ergonomists' risk assessments without the support of an explicit risk assessment method. Twenty-one experienced ergonomists assessed the risk level (low, moderate, high risk) of eight upper body regions, as well as the global risk of 10 video recorded work tasks. Intra-observer reliability was assessed by having nine of the ergonomists repeat the procedure at least three weeks after the first assessment. The ergonomists made their risk assessment based on his/her experience and knowledge. The statistical parameters of reliability included agreement in %, kappa, linearly weighted kappa, intraclass correlation and Kendall's coefficient of concordance. The average inter-observer agreement of the global risk was 53% and the corresponding weighted kappa (Kw) was 0.32, indicating fair reliability. The intra-observer agreement was 61% and 0.41 (Kw). This study indicates that risk assessments of the upper body, without the use of an explicit observational method, have non-acceptable reliability. It is therefore recommended to use systematic risk assessment methods to a higher degree.