To demonstrate the effectiveness of a workplace program for primary, secondary and tertiary prevention of work-related musculoskeletal disorders (WMSD) of the neck and upper extremity. 1. To document the nature and timing of the interventions undertaken by the workplace parties (labor and management) as part of their commitment to a multipronged "RSI Program" in an office workplace. 2. To measure changes in awareness of WMSD prevalence, knowledge of WMSD risk factors and management attitudes towards WMSD. 3. To measure changes in exposure to physical and psychological risk factors for WMSD and WMSD symptoms among employees undergoing reorganization and a relative control group to assess the impact of an ergonomically informed reorganization process. 4. To assess whether the RSI Program resulted in a workforce wide reduction in self-reported exposures to physical and psychological risk factors for WMSD with a concomitant reduction in the self-reported period prevalence and severity of WMSD-related symptoms and their associated disability. 5. To implement and evaluate an enhanced workplace WMSD surveillance system. 6. To model changes in rates of health care utilization and associated costs for WMSD and determine whether the RSI Program resulted in reductions in these measures. Importance to occupational safety & health: Evaluation of workplace ergonomic interventions and longitudinal studies of the impact of work re-organization efforts on musculoskeletal health are sorely needed to inform workplace parties and policy makers. A prospective, longitudinal study using mixed methods. Qualitative research based on document review, worksite participation, and interviews was matched with quantitative research using surveys, clinical questionnaires, administrative data bases and intensive exposure assessment methods. Analyses of change used a variety of approaches including trend descriptions, trajectory analyses and path analyses. The workplace parties built on earlier research to develop an innovative Ergonomic Policy. Special RSI/WMSD training sessions were held in all departments, with 58% of 2001 survey (Q4) respondents remembering these sessions and another 11 % indicating that they received training on RSI/WMSD as part of their orientation. 90% of Q4 respondents felt that The Toronto Star RSI Program had completely to moderately "ensured that all employees are informed about RSI". Compared to our earlier PI 1996 survey, significantly greater endorsement of relevant responses as to potential causes of RSI/WMSD were observed e.g., workstation, tools, breaks, keyboarding, workload, exercise and posture, at the same time that "lack of training" was mentioned less frequently. Further, 74% agreed or strongly agreed (vs. 64% in 1996) that Toronto Star management were supportive in dealing with RSI though proportions indicating that their immediate supervisor was aware and concerned about RSI and the proportion of respondents who disagreed that "I can take breaks when I want to" remained unchanged. Among a small group of predominantly advertising employees undergoing direct measures, we observed reductions in extreme mouse positions (horizontal and vertical), fewer monitors to the side with less head rotation, and fewer extreme head tilts, the last despite monitor heights being generally higher. Increases in keyboard time and post-reorganization mousing time were positively associated with changes in employee pain among those undergoing reorganization into teams. Informal observations suggested that employees' jobs had changed little except for increased use of computers through introduction of new software. The RSI Program was associated with some positive changes in self-reported exposures to physical and psychological WMSD risk factors. The proportion reporting equipment inside a preferred location increased between PI in 1996 and Q4 from 56% to 72% for the keyboard as did levels of social support at work. Time sitting >2 hours continuously increased by 9% of PI to 33% ofQ4 respondents. Among a cohort that participated in PI and Q4 26% got better, 54% stayed the same, and 21 % had increased pain. In path analyses on the cohort, RSI training and job task changes were both associated with significant (p<0.1) increases in decision latitude and reductions in disability, after taking account of demographic confounders (gender and age). Over five years, 1000 Ergonomic Reports/Workstation Assessments were completed by over 40 trained assessors, proactively reaching 881 employees as part of an active hazard and symptom surveillance program. The surveillance system met a number of the important criteria for such systems, including utility through a wide range of improvements directly made or planned. Substantial aggregate increases in physiotherapy services promoted by the RSI Program, MSK-related drug utilization and use of NSAIDs occurred through the intervention period. Overall health care costs increased due to a combination of meeting previously unmet needs for physiotherapy and escalating costs associated with changing drug availability and prescribing patterns. At the same time, workers' compensation claim related absence (to 0 new lost time claims in 2001). Workplace parties, informed by research findings, were able to bring about improvement in a number of physical and psychosocial risk factors, though intense competitive pressures brought about aggravation of some others. Reduction in severity of WMSD and control of WMSD-related compensable absence were both important achievements.
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The Institute for Work and Health, Toronto, Ontario, Canada