Almost a year in: Virtual offices remained an ergonomic trouble spot.

BACKGROUND: Many individuals continued to work from home even after nearly 9 months since the COVID-19 pandemic started in spring of 2020. OBJECTIVE: To conduct a follow-up survey of the faculty and staff of a large Midwest university to determine whether there had been any changes to their home work environment and health outcomes since a prior survey conducted at the start of the pandemic in spring of 2020. METHODS: An electronic survey was sent out to all employees, staff, and administration (approximately 10,350 individuals) and was completed by 1,135 individuals. RESULTS: It was found that not much had changed after nearly 9 months of working at home. Faculty and staff continued to primarily use laptops without an external keyboard, monitor or mouse. Few participants reported using chairs with adjustable armrests. These conditions continued to result in high levels of body discomfort (49% neck and head, 45% low back, and 62% upper back and shoulders having moderate to severe pain). CONCLUSION: If workers are going to continue to work from home, companies will need to accommodate them with more than a laptop, and should include an external keyboard, monitor, and mouse.

The virtual office: A perspective from college students.

BACKGROUND: As the COVID-19 pandemic took root in the United States, most universities quickly transitioned to online and remained there through spring 2021. OBJECTIVE: The study objective was to identify the impact of the switch to online on student home offices and corresponding health outcomes. METHODS: An online survey was sent out to all student at a large Midwest university to assess the work practices and health outcomes. RESULTS: In total, 1074 responses were completed. The shift to online not only resulted in most students utilizing laptop computers without external monitors, keyboards, or mouse input devices, but also a major increase in the amount of time spent using technology (on average 31 to 40 hours per week). The amount of severe to extreme discomfort in the neck, shoulder, upper back, and lower back was alarming (above 41%). CONCLUSION: The home offices of students were often sub-optimal, indicating the need to educate university students.

Teachers feeling the burden of COVID-19: Impact on well-being, stress, and burnout.

BACKGROUND: Teachers have had to deal with many of the negative aspects of COVID-19 over the past year. The demands associated with the sudden requirement to teach remotely, and later having to manage hybrid (both in person and online) learning may be having adverse effects on the mental and physical health of teachers. OBJECTIVE: To determine whether COVID-19 continued to impact teacher stress, burnout, and well-being a year into the pandemic. METHODS: An online survey was sent out to 5300 teachers in public and private schools, and 703 completed the survey. RESULTS: Stress and burnout continue to be high for teachers, with 72% of teachers feeling very or extremely stressed, and 57% feel very or extremely burned out. Many teachers struggled to have a satisfactory work-family balance (37% never or almost never; 20% only has sometimes). CONCLUSION: School systems must start to deal with the mental and physical health of teachers before a large number of them leave the profession.

An assessment of ergonomic issues in the home offices of university employees sent home due to the COVID-19 pandemic.

BACKGROUND: As millions of workers have shifted to telework, special accommodations for workers with respect to ergonomics may be required to ensure the workforce remains healthy. METHODS: A survey about home office ergonomics and discomfort was sent to faculty, staff, and administrators by email and was completed by 843 individuals. RESULTS: Over 40%of the participants reported moderate to severe discomfort (severe low/middle back pain, moderate discomfort in eyes/neck/head, and discomfort in the upper back/shoulders). Laptops (always and often) were widely used (85%) with most using the laptop monitor (55%) of all respondents. Further, less than 45%of the seating conditions were reported as having adjustable arm rests. CONCLUSION: As teleworking in makeshift offices becomes more common, the risk of significant discomfort and potentially more serious musculoskeletal disorders may result from poor static postures. Companies may need to accommodate workers by allowing them to take home office chairs, external monitors, keyboards, and mice as laptops are insufficient, ergonomically.

Stopping the Slide: How Hospital Bed Design Can Minimize Active and Passive Patient Migration.

Patient migration, or the amount of movement toward the foot of the bed, has been shown to significantly vary because of the mechanical design differences in hospital beds. Previously, the amount of migration was measured immediately following head-of-bed articulation in healthy subjects. This study not only evaluates how much migration occurs immediately after head-of-bed articulation but also measures additional migration during a standard 2-hour repositioning period in subjects with limited mobility.

Impact of Noise on Nurses in Pediatric Intensive Care Units.

BACKGROUND: Excessive exposure to noise places nurses at risk for safety events, near-misses, decreased job performance, and fatigue. Noise is particularly a concern in pediatric intensive care units, where highly skilled providers and vulnerable patients require a quiet environment to promote healing. OBJECTIVE: To measure noise levels and noise duration on specialty pediatric intensive care units to explore sources of noise and its effects on the health of registered nurses. METHODS: In a cross-sectional pilot study, levels and sources of noise in 3 different specialty pediatric intensive care units were assessed. Fifteen nurses were observed for 4-hour sessions during a 24-hour period. Sound pressure levels (noise) and heart rate were measured continuously, and stress ratings were recorded. Descriptive statistics were calculated for noise (level, source, location, and activity), heart rate, and stress. The Pearson correlation coefficient was calculated to analyze the relationship between heart rate and noise. RESULTS: Mean noise level was 71.9 (SD, 9.2) dBA. Mean heart rate was 85.2/min (SD, 15.8/min) and was significantly associated with noise, unit, within-unit location, nurse sources, and noise activities. The most frequent sources of noise were patients' rooms, care activities, and staff communications. CONCLUSIONS: Noise levels in pediatric intensive care units exceed recommended thresholds and require immediate attention through effective interventions. Although noise was not associated with stress, a significant correlation with increased heart rate indicates that noise may be associated with adverse health outcomes.

Prevalence of Musculoskeletal Disorders for Nurses in Hospitals, Long-Term Care Facilities, and Home Health Care: A Comprehensive Review.

OBJECTIVE: The aim of this study was to determine the prevalence of musculoskeletal pain and reported injuries for nurses and nursing aides. BACKGROUND: Nurses and nursing aides suffer from work-related pain and musculoskeletal disorders (MSDs). Although there have been a plethora of studies on MSDs, an overall understanding of the prevalence of MSDs and pain can lead to better prioritization of research needs with respect to the health care industry. METHOD: A total of 132 articles on prevalence of MSD pain and injuries were included in the review. All articles were published in peer-reviewed English-speaking journals and subjected to a quality review. RESULTS: Reported prevalence of MSD pain for nurses and nursing aides was highest in the low back, followed by shoulders and neck. However, the majority of the studies have been concentrated on 12-month pain in the low back and predominantly in hospitals. Few researchers have investigated pain in the upper and lower extremities (less than 27% of the studies). Even fewer researchers have evaluated reported injuries or even subjective lost-time injuries (less than 15% of the studies). CONCLUSION: MSD pain in the nursing profession has been widely investigated worldwide, with a major focus on low-back pain. Given new directions in health care, such as patients who live longer with more chronic diseases, bariatric patients, early mobility requirements, and those who want to be at home during sickness, higher prevalence levels may shift to different populations--home health care workers, long-term care workers, and physical therapists--as well as shift to different body regions, such as shoulders and upper extremities.

Role of Bed Design and Head-of-Bed Articulation on Patient Migration.

The ramifications of patient migration toward the foot of the bed in intensive care units are not well understood. Migration may cause shear and friction between the patient and the mattress, reduce elevation of the patient's torso, and require frequent repositioning of the patient. This study assesses how bed design impacts both the amount of migration that patients undergo during head section articulation to 30° and 45° and the extent of torso compression following the articulation.

Reduction of spinal loads through adjustable interventions at the origin and destination of palletizing tasks.

OBJECTIVE: This article evaluates the effectiveness of two interventions: a self-leveling pallet carousel designed to position the loads vertically and horizontally at origin, and an adjustable cart designed to raise loads vertically at destination to reduce spine loads. BACKGROUND: Low back disorders among workers in manual material handling industries are very prevalent and have been linked to manual palletizing operations. Evidence into the effectiveness of ergonomic interventions is limited, with no research that investigates interventions with adjustable load location. METHOD: Thirteen males experienced in manual material handling participated in simulated order selecting tasks where spine loads were quantified for each intervention condition: carousel to traditional cart, pallet to traditional cart, pallet to adjustable cart, and carousel to adjustable cart. RESULTS: The results showed that combining both devices results in reduction in spine compression (61%), anterior-posterior shear (72%), and lateral shear (63%) compared to traditional palletizing conditions. Individually, the carousel was responsible for the greatest reductions, but the lowest values were typically achieved by combining the adjustable cart and carousel. CONCLUSION: The combination of the interventions (self-leveling carousel and adjustable cart) was most effective in reducing the spine loads when compared to the traditional pallet-cart condition. The individual interventions also reduced the loads compared to the traditional condition. APPLICATION: With de-palletizing/palletizing tasks being a major source of low back injuries, the combination of self-leveling carousel and adjustable cart has been found to be effective in reducing the peak spine loading as compared to traditional pallet on floor and nonadjustable flat cart conditions.

Postural variability: an effective way to reduce musculoskeletal discomfort in office work.

OBJECTIVE: This article investigates whether different interventions aimed at promoting postural change could increase body movement throughout the shift and reduce musculoskeletal discomfort. BACKGROUND: Many researchers have reported high levels of discomfort for workers that have relatively low-level demands but whose jobs are sedentary in nature. To date, few interventions have been found to be effective in reducing worker discomfort. METHODS: Thirty-seven call center operators were evaluated in four different workstation conditions: conventional workstation, sit-stand workstation, conventional workstation with reminder software, and sit-stand workstation with break reminder software-prompt to remind workers to take break The primary outcome variables consisted of productivity, measured by custom software; posture changes, measured by continuous video recording; and discomfort, measured by simple survey. Each condition was evaluated over a 2-week period. RESULTS: Significant reductions in short-term discomfort were reported in the shoulders, upper back, and lower back when utilizing reminder software, independent of workstation type. Although not significant, many productivity indices were found to increase by about 10%. CONCLUSIONS: Posture-altering workstation interventions, specifically sit-stand tables or reminder software with traditional tables, were effective in introducing posture variability. Further, postural variability appears to be linked to decreased short-term discomfort at the end of the day without a negative impact on productivity. APPLICATIONS: An intervention that can simply induce the worker to move throughout the day, such as a sit-stand table or simple software reminder about making a large posture change, can be effective in reducing discomfort in the worker, while not adversely impacting productivity.

Identifying risk factors of musculoskeletal disorders on Korean farms.

BACKGROUND: Farming is known to pose musculoskeletal disorder risk factors, although how risk factors differ between farmers in various countries is largely unknown. OBJECTIVE: To identify ergonomic risk factors through a qualitative assessment of common tasks performed by South Korean farmers. METHODS: A convenience sample of Korean farmers was videotaped performing typical jobs on farms that produced rice, fruits and vegetables, or raised animals. Ergonomists identified poor ergonomic risk factors that may lead to musculoskeletal disorders including poor postures of the shoulders, wrists, neck, low back, and knees. RESULTS: Severe flexion and lifting of heavy loads was common across farms. While many of the concerning risk factors identified were similar to those in other parts of the world, one was unique in this population - deep knee flexion while weeding, harvesting, and sorting. CONCLUSIONS: Given the Korean farm population is aging at an alarming rate and remains dominated by small farms, many of these potential risk factors may have a continued or increased role in the development of musculoskeletal disorders. While the current study provided the first observational assessment of ergonomic demands on Korean farms, more quantitative and rigorous investigations are needed to establish actual risk factors.

Quantification of patient migration in bed: catalyst to improve hospital bed design to reduce shear and friction forces and nurses' injuries.

OBJECTIVE: The study objective was to quantify the movement of hospital bed occupants relative to the bed in typical bed articulations. BACKGROUND: Movement of a patient in bed results in two common adverse events: (a) increase in shear and friction forces between the patient and bed, which are extrinsic pressure ulcer risk factors, and (b) musculoskeletal injuries to nurses, resulting from repositioning patients who have migrated down in bed. METHOD: The study involved 12 participants who lay supine in three hospital beds, which were articulated to common positions. Body movement relative to the bed was quantified with the use of motion capture. Cumulative movement, net displacement, and torso compression (shoulder to trochanter distance) were calculated for different bed types and bed movements. RESULTS: Bed design and bed movement had a significant effect on most of the dependent variables. Bed design (e.g., type) influenced cumulative movement by up to 115%, net displacement by up to 70%, and torso compression by about 20%. Bed movement (e.g., knee elevation) reduced cumulative migration by up to 35%. CONCLUSION: The quantification of patient migration provides a metric for evaluating the interaction between body and bed surfaces. Overall, the measures were sensitive to design changes in bed frames, bed articulations, and mattress inflation. APPLICATION: Documentation of the cumulative movement, net displacement, and torso compression provides hospital bed designers quantifiable measures for reducing migration and potentially shear and friction forces when designing bed frames, bed articulations, and mattresses. Optimization of these metrics may ultimately have an impact on patient and caregiver health.

Influence of weight loss on musculoskeletal pain: Potential short-term relevance.

OBJECTIVE: With the recent trend of increasing obesity in the United States, more immediate health outcomes such as reduced musculoskeletal pain may be more effective in encouraging compliance. The study objective was to investigate the relationship between weight loss and changes in musculoskeletal pain. PARTICIPANTS: Thirty-five females who recently enrolled into a weight loss program were enrolled into the study. METHODS: The impact of weight loss on musculoskeletal pain in the short-term was assessed by tracking pain and weight loss during bi-weekly visits to a weight loss clinic. During a 12-week prospective study, the pain ratings in 9 body regions measured during the bi-weekly weigh-ins at the clinic. RESULTS: A significant association was found between weight loss and reduction of pain in the elbow, upper back, lower back, and hip regions as well as overall pain. CONCLUSIONS: The significant trends between weight loss and corresponding reduction in pain provide support to weight-loss management providers that may have more immediate relevance - a quick impact on pain may encourage compliance with weight loss programs. While the trends for weight and pain are intriguing, future research will need to indentify the underlying mechanism for the reduced pain. One potential mechanism may be that a reduction of weight reduces the biomechanical stress on the load bearing joints, reducing pain responses.

Investigating reduced bag weight as an effective risk mediator for mason tenders.

Masonry workers face some of the highest physical demands in the construction industry where large bags of masonry material weighing 42.7 kg are commonly handled by mason tenders who mix the mortar, distribute mortar and bricks/blocks, and erect/dismantle scaffolding throughout the day. The objective of this study was to determine the effectiveness of using half-weight bags (21.4 kg) on reducing the biomechanical loading, physiological response, and perceived exertions. Ten male subjects performed asymmetric lifting tasks simulating unloading bags from a pallet. Muscle activity, trunk kinematics, heart rate, blood pressure and subjective rating data were collected. Spine loads were predicted from a well-validated EMG-assisted model. Bag weight, lift type, bag height at origin, and asymmetry at destination significantly impacted the spine loads. While there was a 50% reduction in bag weight, the peak loads for the half-weight bags were only 25% less than the more available full-weight bags (a reduction of about 320 N of shear and 1000 N of compression). Lifts allowing movement of the feet reduced the loads by about 22% in shear and 27% in compression compared to constrained postures. Interestingly, cumulative spine loads were greater for the lighter bags than the heavy bags ( approximately 40%). The subjective ratings of exertion and risk were significantly lower for the lighter bags. RELEVANCE TO INDUSTRY: The reduction in peak spine loading for the half-weight bags, particularly at the higher heights and when the feet were allowed to move could significantly reduce the injuries of masonry workers. However, there were trade-offs with cumulative loads that may minimize the reduced risk. Overall, given the limited amount of time lifting bags, the reduction of peak loads.

Costs by industry and diagnosis among musculoskeletal claims in a state workers compensation system: 1999-2004.

BACKGROUND: Musculoskeletal disorders (MSDs) are a tremendous burden on industry in the United States. However, there is limited understanding of the unique issues relating to specific industry sectors, specifically the frequency and costs of different MSDs. METHODS: Claim data from 1999 to 2004 from the Ohio Bureau of Workers' Compensation were analyzed as a function of industry sector (NAICS industry-sector categories) and anatomical region (ICD-9 codes). RESULTS: Almost 50% of the claims were lumbar spine (26.9%) or hand/wrist (21.7%). The majority of claims were from manufacturing (25.1%) and service (32.8%) industries. The industries with the highest average costs per claim were transportation, warehouse, and utilities and construction. Across industries, the highest costs per claim were consistently for the lumbar spine, shoulder, and cervical spine body regions. CONCLUSION: This study provides insight into the severity (i.e., medical and indemnity costs) of MSDs across multiple industries, providing data for prioritizing of resources for research and interventions.

Investigation of select ergonomic interventions for farm youth. Part 1: shovels.

There is some evidence that performing farm chores may place youth at risk of musculoskeletal injuries. However, actual investigations of interventions for farm youth have been sparse. The objective of the current study was to investigate two different types of interventions (add-on handles) for shovels, potentially reducing the risk of injury in farm youth. A lumbar motion monitor was used to capture trunk posture and motion while the youth performed a simulated shoveling task--removal of material from an animal stall. Ratings of perceived exertion and comfort of use were also assessed. The results indicate add-on handles decreased sagittal flexion but increased twisting as compared to regular shovels. Perceived ratings were worse for shovels with add-on handles. Overall, there appears to be a trade-off between sagittal and nonsagittal motion and appears to have minimal impact on risk of low back injury. However, further research is necessary to determine the complete ramifications of this trade-off with respect to the biomechanical load within the low back and on other joints.

Investigation of select ergonomic interventions for farm youth. Part 2: wheelbarrows.

Previous research has provided evidence that farm youth performing farm chores may be at risk of developing a low back musculoskeletal injury. In order to reduce these risks, effective interventions for reducing the stressors that cause the injuries are needed. The objective of the current study was to investigate alternative wheelbarrow styles as an intervention for youth working to transfer material on the farm with respect to trunk motion and perceived exertion. A lumbar motion monitor was used to capture three-dimensional trunk kinematics while several wheelbarrow tasks (e.g., pushing, pushing over bump, and dumping) were performed by youth. Ratings of perceived exertion and comfort of use were also assessed. Results indicated a reduction in the sagittal trunk flexion and velocity was achieved by adding a push bar to the handles, in combination with three-wheels, or utilizing adjustable handles. However, these alterations had little impact in the predicted low back disorder risk levels. Additionally, the youths' perceptions of risk and exertion levels were greater for these alternative wheelbarrows than for the regular wheelbarrow. Therefore, the mismatch between perception and kinematic response will probably affect usage of the alternative wheelbarrows. While the results indicate that alternative wheelbarrow designs can reduce the awkward postures and motions during wheelbarrow tasks, further research into the effectiveness of these interventions, including spine loading and long long-term use, is necessary.

Impact of order and load knowledge on trunk kinematics during repeated lifting tasks.

OBJECTIVE: To determine if lifting random unknown weights is more detrimental than lifting sequences of unknown weights and to investigate whether load knowledge impacts the effect of lifting random box weights. BACKGROUND: Much research has investigated lifting under known load conditions, but few studies have investigated unknown loads, especially when presented in random order. There has been some documentation of alteration in trunk mechanics when there is an overestimation of the unknown load. METHOD: Ten men and 10 women performed three lifting tasks: random unknown, random known, and same weight. A lumbar motion monitor was used to collect kinematic data, and Borg's Rating of Perceived Exertion (RPE) and a task risk rating were also assessed. RESULTS: Both presentation order and load knowledge impacted trunk kinematics during repeated lifting tasks. However, these differences were relatively low in magnitude. Furthermore, kinematic response and perceived risk and exertion for these conditions varied between genders. CONCLUSION: Lifting random unknown loads appears to alter kinematic responses, particularly for men. Women attempt to modify the effect of random unknown loads by changing the lifting style through alterations in upper limb motions (e.g., drag box toward them prior to lifting). However, a need remains for a more comprehensive biomechanical investigation (e.g., spine loading) into the effects of random unknown loads because many of the effect sizes were small. APPLICATION: Small kinematic adaptations resulting from tasks involving unknown and random loads may be mediated by the use of visual cues, order of presentation, or a change in lifting style.

Understanding the ergonomic risk for musculoskeletal disorders in the United States agricultural sector.

INTRODUCTION: Farming is a very large industry in the United States. Understanding the risks for injuries and more specifically musculoskeletal disorders in this industry poses a challenge for health officials. METHODS: A review was conducted of the existing peer-reviewed publications prior to December 2006 about injuries and musculoskeletal disorders for farmers and farm workers. The aim was to review existing knowledge concerning: (1) the prevalence, types, and causes of farm-related injuries, paying particular attention to musculoskeletal disorders and the special populations within the agricultural sector, and (2) interventions that have been developed to reduce risk factors associated with farm-related injuries. RESULTS: Farmers and farm workers experience high rates of low back, shoulder, and upper extremity disorders. Musculoskeletal disorders may disproportionately affect farm youth and migrant workers due to the types of farm tasks performed. There is an urgent need for improved and validated interventions to reduce exposures and to improve the health of farmers and farm workers. DISCUSSION: Future farm-related musculoskeletal disorder research should emphasize: (1) better identification of exposures for special populations, (2) development of interventions for diverse farm populations, and (3) identification of additional exposures for musculoskeletal disorders. Inadequate understanding of musculoskeletal disorders in farming impedes efforts to prevent this common and important type of occupational injuries on farms.

Preliminary evidence of the short-term effectiveness of alternative treatments for low back pain.

In recent years, there has been increased popularity for use of alternative treatment modalities for low back pain with limited investigation into whether they are effective in returning the worker to normal functionality. The objective of this study was to investigate the short-term impact on the restoration of the functional ability of common treatment modalities including physical therapy, acupuncture, chiropractic treatment, and massage therapy. A within subjects design was used that compared a baseline assessment to three follow-up assessments: immediately following treatment, two days and seven days post treatment. Individuals suffering from low back pain were recruited from local clinics that specialize in one of the four treatment modalities. Twenty-four individuals who were suffering from low back pain and had started one of the treatment modalities were recruited into the study. Three-dimensional motions (ROM, velocity, and acceleration) during a standardized functional capacity protocol were measured prior to and during three follow-up periods. The results show the effectiveness of the treatments was dependent upon time and were predominantly in the non-sagittal motion planes (velocities and accelerations). Individual subjective pain levels also indicate all the treatment modalities were effective after the 1-week follow-up. Findings suggest those modalities primarily focused on the back musculature (acupuncture, massage, physical therapy) were more effective with respect to functional capacity restoration. The current results provide a quantitative evaluation, based upon trunk dynamics, of the effectiveness of these four treatment modalities.