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Contents
Introduction
Work-related musculoskeletal disorders (MSD), such as low back pain,
tendinitis, hand-arm vibration syndrome and carpal tunnel syndrome,
account for a major component of the cost of work-related illness in the
United States. Recent estimates of the costs associated with
work-related musculoskeletal disorders range from $13 to $54 billion
annually. Regardless of the estimate used, the problem is large both in
health and economic terms. The enormous scope of the problem is
confirmed by statistics from the Annual Survey of Occupational Injuries
and Illnesses, conducted by the Bureau of Labor Statistics (BLS). For
those cases involving days away from work, BLS reports that in 1997
approximately one third of the total, or 603,096 cases, were the result
of overexertion or repetitive motion. Specifically:
- 297,317 of these injuries involved lifting; 75,896 were associated
with pushing or pulling tasks; and 60,588 were related to holding,
carrying, or turning objects.
- Approximately 63 percent of overexertion injuries affected the
back.
- The median time away from work due to overexertion injuries was six
days for lifting, seven days for pushing/pulling, and six days for
holding/carrying/turning.
- 75,188 injuries or illnesses occurred as a result of repetitive
motion, including typing or key entry, repetitive use of tools, and
repetitive placing, grasping, or moving of objects other than tools.
Sixty- eight percent of these affected the wrist, followed by 9 percent
affecting the shoulder, and 7 percent affecting the back.
- The median time away from work was 17 days as a result of injuries
or illnesses due to repetitive motion.
The National Institute for Occupational Safety and Health (NIOSH)
recognizes that addressing a problem of such magnitude requires
coordination and cooperation among its many external partners. This
philosophy underpins NIOSH's National Occupational Research Agenda
(NORA), a collaborative effort between NIOSH and its partners to guide
occupational safety and health research in the 21st century. As part of
the NORA process, a team of experts representing a broad range of
industry, labor, and government interests has been assembled to evaluate
the status and define future research needs in the area of work-related
MSD. (Team members are listed at the front of this document.) This team
has developed a National Occupational Research Agenda for MSD that
should serve as a blueprint for building a national research program by
identifying high priority research problems and influencing the
allocation of resources. Implementation of the agenda will be an ongoing
effort requiring an active exchange of information among all interested
partners.
During the past decade, approximately 4,000 articles that focused on
occupationally-related MSD were published. The findings from many of
these publications have been summarized in various literature reviews
(Anderson 1995; Buckle and Devereux 1999; Frank et al. 1995; Frank et
al. 1996a, 1996b; Katz et al. 1998; Krause et al. 1998; Moore 1992;
Rempel et al. 1998; Szabo 1998; Viikari- Juntura and Silverstein 1999;
NIOSH 1997; Ferguson and Marras 1997; NRC 1999). Based on a synthesis of
the findings from these publications, a simple conceptual framework of
factors that can contribute to MSD can be formulated (see Figure 1). In
this model, initial loads are applied to the musculoskeletal system
either by external forces or by internal forces resulting from dynamic
and gravitational effects on the mass of the body segments. These
applied loads create internal tissue responses in the muscles,
ligaments, and at the joint surfaces. Depending upon the magnitude of
the load and other individual, organizational, or social factors, one or
more outcomes may result. These may include adaptation effects (such as
increases in strength, fitness, or conditioning) or potentially harmful
outcomes (such as pain or other symptoms, and structural damage to
tendons, nerves, muscles, joints, or supporting tissues) that may result
in symptoms, impairment, or disability. Whether the exposure leads to an
MSD depends upon the physical demands of the job, the adaptation
response of the worker, and other individual physical and psychological
factors. These in turn may modulate the effects of the external
load.
Interventions designed to reduce risk of MSD can be implemented
anywhere along this pathway. Engineering interventions that reduce
intensity, frequency, and duration of exposure are often effective.
Figure 1. Conceptual model of factors that potentially contribute to musculoskeletal disorders.
To obtain maximum input from practitioners, academic and corporate
researchers, and organizations sponsoring research, the team adopted a
multi-phase approach for seeking input on the national research agenda.
The first phase involved sponsorship of three regional focus group
meetings where practitioners from a wide range of industry sectors were
asked a series of questions regarding research gaps, intervention
effectiveness, surveillance, and implementation needs. The three
meetings included representatives from light and heavy manufacturing,
warehouse and transportation, office environments, acute and long-term
health care, forest products, construction and maritime, agriculture,
and food processing. During the second phase, academicians and
researchers participated in a workgroup meeting using the findings from
the practitioner focus groups as the basis for further discussions.
Three practitioner focus groups were held in Chicago,
Seattle, and Washington, D.C., and a researcher workgroup
meeting was held in Houston. Overall, there were more than 150 focus
group attendees in the three meetings (in 16 groups) and over 50
researchers (in five workgroups) at the Houston meeting. The Chicago
focus group included representatives from agriculture, food processing,
light manufacturing, office work environment, warehouse and
transportation, health care, and heavy manufacturing. The Seattle focus
group included representatives from forest products/agriculture,
construction/maritime, health care, heavy manufacturing, office work
environment, and transportation/warehousing/light manufacturing. The
Washington D.C. focus group included representatives from two major
areas of the health care industry organized into three general health
care groups and one long-term health care group. The Chicago, Seattle,
and Washington D.C. focus groups attendees were asked to respond to
three basic questions:
-
Surveillance What methods do you
think need to be developed to improve your ability to identify
hazardous jobs (or working conditions) in your company or
industry?
-
Research Gaps What are the ergonomic
problems in your workplace for which there was insufficient research
to address the problems?
-
Intervention What methods have you
used that appear to be most effective or promising in reducing the
frequency and/or severity of MSD in your workplace and deserve further
research and development?
NORA Team MSD team members reviewed the transcripts and flip charts
from each of the three practitioner focus group meetings and summarized
them using a criteria-based extraction process. These assessments
resulted in the development of listings of research issues by industry
sector and a short summary statement reflecting the main topics of
discussion. The focus group summaries were further analyzed using a
manual search and extraction process by combining the results into a
single file and then extracting and organizing the material into four
listings of research issues by topic area: 1) Surveillance of
Musculoskeletal Disorders and Related Hazards, 2) Etiologic and Medical
Research, 3) Intervention Research, and 4) Improving the Research
Process. Each of the four sections were then edited to consolidate ideas
that were similar.
In addition, new ideas contributed by the academicians and
researchers at the Houston workgroup meeting were added to the listings.
The resulting four lists of research issues are provided in Appendix A.
These lists are designed to provide comprehensive inventories of the
issues only and do not provide any indications about what the NORA MSD
team believes about the priority or importance of individual research
issues. Some of the issues identified in the focus groups applied to
more than one industry, while others were primarily applicable to
specific industries. The selected industry-specific topics are listed in
Appendix B. The Houston workgroup was asked to identify research topics
where progress seemed most likely in the next five years. Those ideas
are listed in Appendix C.
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