Evaluation of a participatory ergonomics intervention in small commercial construction firms.

BACKGROUND: Work-related musculoskeletal disorders (WMSD) among construction workers remain high. Participatory ergonomics (PE) interventions that engage workers and employers in reducing work injury risks have shown mixed results. METHODS: Eight-six workers from seven contractors participated in a PE program. A logic model guided the process evaluation and summative evaluation of short-term and intermediate impacts and long-term outcomes from surveys and field records. RESULTS: Process measures showed good delivery of training, high worker engagement, and low contractor participation. Workers' knowledge improved and workers reported changes to work practices and tools used; contractor provision of appropriate equipment was low (33%). No changes were seen in symptoms or reported physical effort. CONCLUSIONS: The PE program produced many worker-identified ergonomic solutions, but lacked needed support from contractors. Future interventions should engage higher levels of the construction organizational system to improve contractor involvement for reducing WMSD. Am. J. Ind. Med. 59:465-475, 2016. © 2016 Wiley Periodicals, Inc.

Long-term symptomatic, functional, and work outcomes of carpal tunnel syndrome among construction workers.

BACKGROUND: The long-term outcomes of carpal tunnel syndrome (CTS) including symptoms, functional status, work disability, and economic impact are unknown. METHODS: We conducted a retrospective study of 234 active construction workers with medical claims for CTS and 249 workers without CTS claims; non-cases were matched on age, trade, and insurance eligibility. We conducted telephone interviews with cases and non-cases and collected administrative data on work hours. RESULTS: Compared to non-cases, CTS cases were more likely to report recurrent hand symptoms, decreased work productivity/quality, decreased performance of physical work demands, and greater functional limitations. Surgical cases showed larger improvements on multiple outcomes than non-surgical cases. Minimal differences in paid work hours were seen between cases and non-cases in the years preceding and following CTS claims. CONCLUSIONS: Persistent symptoms and functional impairments were present several years after CTS diagnosis. Long-term functional limitations shown by this and other studies indicate the need for improved prevention and treatment.

Functional Measures Developed for Clinical Populations Identified Impairment Among Active Workers with Upper Extremity Disorders.

PURPOSE: Few studies have explored measures of function across a range of health outcomes in a general working population. Using four upper extremity (UE) case definitions from the scientific literature, we described the performance of functional measures of work, activities of daily living, and overall health. METHODS: A sample of 573 workers completed several functional measures: modified recall versions of the QuickDASH, Levine Functional Status Scale (FSS), DASH Work module (DASH-W), and standard SF-8 physical component score. We determined case status based on four UE case definitions: (1) UE symptoms, (2) UE musculoskeletal disorders (MSD), (3) carpal tunnel syndrome (CTS), and (4) work limitations due to UE symptoms. We calculated effect sizes for each case definition to show the magnitude of the differences that were detected between cases and non-cases for each case definition on each functional measure. Sensitivity and specificity analyses showed how well each measure identified functional impairments across the UE case definitions. RESULTS: All measures discriminated between cases and non-cases for each case definition with the largest effect sizes for CTS and work limitations, particularly for the modified FSS and DASH-W measures. Specificity was high and sensitivity was low for outcomes of UE symptoms and UE MSD in all measures. Sensitivity was high for CTS and work limitations. CONCLUSIONS: Functional measures developed specifically for use in clinical, treatment-seeking populations may identify mild levels of impairment in relatively healthy, active working populations, but measures performed better among workers with CTS or those reporting limitations at work.

Responsiveness of a 1-Year Recall Modified DASH Work Module in Active Workers with Upper Extremity Musculoskeletal Symptoms.

OBJECTIVES: To evaluate the responsiveness to change of a modified version of the Work module of the Disabilities of the Arm, Shoulder, and Hand (DASH-W) in a prospective, longitudinal cohort study of active workers. METHODS: We compared change on a 1-year recall modified DASH-W to change on work ability, work productivity, and symptom severity, according to predetermined hypotheses following the Consensus-based standards for the selection of health measurement instruments (COSMIN). We evaluated concordance in the direction of change, and magnitude of change using Spearman rank correlations, effect sizes (ES), standardized response means (SRM), and area under the receiver operating characteristic curves (AUC). RESULTS: In a sample of 551 workers, change in 1-year recall modified DASH-W scores showed moderate correlations with changes in work ability, work productivity, and symptom severity (r = 0.47, 0.44, and 0.36, respectively). ES and SRM were moderate for 1-year recall modified DASH-W scores in workers whose work ability (ES = -0.58, SRM = -0.52) and work productivity improved (ES = -0.59, SRM = -0.56), and larger for workers whose work ability (ES = 1.24, SRM = 0.68) and work productivity worsened (ES = 1.02, SRM = 0.61). ES and SRM were small for 1-year recall modified DASH-W scores of workers whose symptom severity improved (-0.32 and -0.29, respectively). Responsiveness of the 1-year recall modified DASH-W was moderate for those whose symptom severity worsened (ES = 0.77, SRM = 0.50). AUC met responsiveness criteria for work ability and work productivity. CONCLUSIONS: The 1-year recall modified DASH-W is responsive to changes in work ability and work productivity in active workers with upper extremity symptoms.

Self-reported physical work exposures and incident carpal tunnel syndrome.

BACKGROUND: To prospectively evaluate associations between self-reported physical work exposures and incident carpal tunnel syndrome (CTS). METHODS: Newly employed workers (n = 1,107) underwent repeated nerve conduction studies (NCS), and periodic surveys on hand symptoms and physical work exposures including average daily duration of wrist bending, forearm rotation, finger pinching, using vibrating tools, finger/thumb pressing, forceful gripping, and lifting >2 pounds. Multiple logistic regression models examined relationships between peak, most recent, and time-weighted average exposures and incident CTS, adjusting for age, gender, and body mass index. RESULTS: 710 subjects (64.1%) completed follow-up NCS; 31 incident cases of CTS occurred over 3-year follow-up. All models describing lifting or forceful gripping exposures predicted future CTS. Vibrating tool use was predictive in some models. CONCLUSIONS: Self-reported exposures showed consistent risks across different exposure models in this prospective study. Workers' self-reported job demands can provide useful information for targeting work interventions.

Reliability of job-title based physical work exposures for the upper extremity: comparison to self-reported and observed exposure estimates.

OBJECTIVES: To evaluate the agreement between job-title based estimates for upper extremity physical work exposures and exposure estimates from work observation and worker self-report. METHODS: Self-reported exposure questionnaires were completed by 972 workers, and exposure estimates based on worksite observation were completed for a subset of 396 workers. Job-title based estimates were obtained from O*NET, an American database of job demands. Agreement between self-reported, observed and job-title based physical work exposures was assessed using Spearman correlations and intraclass correlation coefficients. RESULTS: Job-title based exposure estimates from O*NET, self-reported and observer-rated exposures showed moderate to good levels of agreement for some upper extremity exposures, including lifting, forceful grip, use of vibrating tools and wrist bending. CONCLUSIONS: Job-title based physical work exposure variables may provide useful surrogate measures of upper extremity exposure data in the absence of other individual level data such as observed or self-reported exposure. Further validation of these data is necessary to determine the utility of the O*NET databases in future epidemiological studies.

Researcher perspectives on competencies of return-to-work coordinators.

PURPOSE: Return-to-work (RTW) coordination programs are successful in reducing long-term work disability, but research reports have not adequately described the role and competencies of the RTW coordinator. This study was conducted to clarify the impact of RTW coordinators, and competencies (knowledge, skills, and attitudes) required to achieve optimal RTW outcomes in injured workers. METHODS: Studies involving RTW coordination for injured workers were identified through literature review. Semi-structured interviews were conducted with 12 principal investigators to obtain detailed information about the RTW coordinator role and competencies not included in published articles. Interview results were synthesized into principal conceptual groups by affinity mapping. RESULTS: All investigators strongly endorsed the role of RTW coordinator as key to the program's success. Affinity mapping identified 10 groups of essential competencies: (1) individual traits/qualities, (2) relevant knowledge base, (3) RTW focus and attitude, (4) organizational/administrative skills, (5) assessment skills, (6) communication skills, (7) interpersonal relationship skills, (8) conflict resolution skills, (9) problem-solving skills, and (10) RTW facilitation skills. Specific consensus competencies were identified within each affinity group. Most investigators endorsed similar competencies, although there was some variation by setting or scope of RTW intervention. CONCLUSIONS: RTW coordinators are essential contributors in RTW facilitation programs. This study identified specific competencies required to achieve success. More emphasis on mentorship and observation will be required to develop and evaluate necessary skills in this area.

Predictors of upper extremity symptoms and functional impairment among workers employed for 6 months in a new job.

BACKGROUND: We sought to identify personal and work-related predictors of upper extremity symptoms and related functional impairment among 1,108 workers employed for 6 months in a new job. METHODS: We collected data at baseline and 6-month follow-up using self-administered questionnaires. Multivariate logistic regression models were created for each outcome variable. Predictors included personal risk factors, physical work exposures and psychosocial factors. RESULTS: Independent predictors for upper extremity symptoms at 6-month follow-up were age, Caucasian race, female gender, baseline history of UE symptoms, and job tasks involving wrist bending or forceful gripping. Independent predictors for functional impairment were baseline history and severity of UE symptoms, wrist bending, and social support. CONCLUSIONS: Both personal and work-related factors were independent predictors of upper extremity symptoms and functional impairment in this working population. We found different risk factors for symptoms than for functional impairment related to symptoms.

Observed use of voluntary controls to reduce physical exposures among sheet metal workers of the mechanical trade.

INTRODUCTION: Little is known about the transfer into the workplace of interventions designed to reduce the physical demands of sheet metal workers. METHODS: We reviewed videos from a case series of 15 sheet metal worksite assessments performed in 2007-2009 to score postures and physical loads, and to observe the use of recommended interventions to reduce physical exposures in sheet metal activities made by a NIOSH stakeholder meeting in 2002. RESULTS: Workers showed consistent use of material handling devices, but we observed few uses of recommended interventions to reduce exposures during overhead work. Workers spent large proportions of time in awkward shoulder elevation and low back rotation postures. CONCLUSIONS: In addition to the development of new technologies and system designs, increased adoption of existing tools and practices could reduce time spent in awkward postures and other risks for musculoskeletal disorders in sheet metal work.

Postoffer Pre-Placement Screening for Carpal Tunnel Syndrome in Newly Hired Manufacturing Workers.

OBJECTIVE: We determined the predictive validity of a postoffer pre-placement (POPP) screen using nerve conduction velocity studies (NCV) to identify future cases of carpal tunnel syndrome (CTS). METHODS: A cohort of 1648 newly hired manufacturing production workers underwent baseline NCS, and were followed for 5 years. RESULTS: There was no association between abnormal POPP NCV results and incident CTS. Varying NCV diagnostic cut-offs did not improve predictive validity. Workers in jobs with high hand/wrist exposure showed greater risk of CTS than those in low exposed jobs (relative risk 2.82; 95% confidence interval 1.52 to 5.22). CONCLUSIONS: POPP screening seems ineffective as a preventive strategy for CTS.

Comparison of Employer Productivity Metrics to Lost Productivity Estimated by Commonly Used Questionnaires.

OBJECTIVE: The aim of the study was to assess construct and discriminant validity of four health-related work productivity loss questionnaires in relation to employer productivity metrics, and to describe variation in economic estimates of productivity loss provided by the questionnaires in healthy workers. METHODS: Fifty-eight billing office workers completed surveys including health information and four productivity loss questionnaires. Employer productivity metrics and work hours were also obtained. RESULTS: Productivity loss questionnaires were weakly to moderately correlated with employer productivity metrics. Workers with more health complaints reported greater health-related productivity loss than healthier workers, but showed no loss on employer productivity metrics. Economic estimates of productivity loss showed wide variation among questionnaires, yet no loss of actual productivity. CONCLUSIONS: Additional studies are needed comparing questionnaires with objective measures in larger samples and other industries, to improve measurement methods for health-related productivity loss.

Natural history of upper extremity musculoskeletal symptoms and resulting work limitations over 3 years in a newly hired working population.

OBJECTIVE: To describe the proportions of workers with upper extremity (UE) symptoms and work limitations because of symptoms in a newly hired working population over a 3-year study period and to describe transitions between various outcome states. METHODS: A total of 827 subjects completed repeat self-reported questionnaires including demographics, medical and work history, symptoms, and work status. Outcomes of interest were UE symptoms and work limitations because of symptoms. RESULTS: Up to 72% of workers reported symptoms at least once during the study, with 12% reporting persistent symptoms and 27% reporting fluctuating symptoms; 31% reported work limitations at least once, with 3% reporting consistent work limitations and 8% reporting fluctuating limitations. CONCLUSIONS: UE symptoms and work limitations are common among workers and dynamic in their course. A better understanding of the natural course of symptoms is necessary for targeted interventions.

The effectiveness of post-offer pre-placement nerve conduction screening for carpal tunnel syndrome.

OBJECTIVE: We evaluated post-offer pre-placement (POPP) nerve conduction studies (NCS) for carpal tunnel syndrome (CTS), testing diagnostic yield and cost-effectiveness. METHODS: A total of 1027 newly hired workers underwent baseline NCS and were followed for an average of 3.7 years for diagnosed CTS. Measures of diagnostic yield included sensitivity, specificity, and positive predictive value (PPV). Cost-effectiveness of POPP screening was evaluated using a range of inputs. RESULTS: Abnormal NCS was strongly associated with future CTS with univariate hazard ratios ranging from 2.95 to 11.25, depending on test parameters used. Nevertheless, PPV was poor, 6.4% to 18.5%. Cost-effectiveness of POPP varied with CTS case costs, screening costs, and NCS thresholds. CONCLUSIONS: Although abnormal NCS at hire increases risk of future CTS, the PPV is low, and POPP screening is not cost-effective to employers in most scenarios tested.