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Work-Related Musculoskeletal Disorders (WMSDs) Prevention

Boy with ice pack on shoulderOnce a company has conducted assessment and planning for work-related musculoskeletal disorders (WMSDs)Are musculoskeletal disorders (injuries or disorders of the muscles, nerves, tendons, joints, cartilage, and spinal discs) in which the work environment and performance of work contribute significantly to the condition; and/or the condition is made worse or persists longer due to work conditions. prevention programs, and developed the specific tasks of implementation for these programs, it is time to develop the evaluation plan. This evaluation plan should be in place before any program implementation has begun.

Metrics for worker productivity, health care costs, heath outcomes, and organizational change allow measurement of the beginning (baseline), middle (process), and results (outcome) of workplace health programs. It is not necessary to use all these metrics for evaluating programs. Some information may be difficult or costly to collect, or may not fit the operational structure of a company. These lists are only suggested approaches that may be useful in designing an evaluation plan.

These measures are designed for employee group assessment. They are not intended for examining an individual’s progress over time, which would raise concerns of employee confidentiality. For employer purposes, individual-level measures should be collected anonymously and only reported (typically by a third party administrator) in the aggregate, because the company’s major concerns are overall changes in productivity, health care costs, and employee satisfaction.

In general, data from the previous 12 months will provide sufficient baseline information and can be used in establishing the program goals and objectives in the planning phase, and in assessing progress toward goals in the evaluation phase. Ongoing measurements every 6 to 12 months after programs begin are usually appropriate measurement intervals, but measurement timing should be adapted to the expectations of the specific program. 

Musculoskeletal disorders (MSD) are injuries or disorders of the muscles, nerves, tendons, joints, cartilage, and spinal discs. Work-related musculoskeletal disorders (WMSDs)Are musculoskeletal disorders (injuries or disorders of the muscles, nerves, tendons, joints, cartilage, and spinal discs) in which the work environment and performance of work contribute significantly to the condition; and/or the condition is made worse or persists longer due to work conditions. are conditions in which:

  1. The work environment and performance of work contribute significantly to the condition; and/or
  2. The condition is made worse or persists longer due to work conditions1

In 1997, the Centers for Disease Control and Prevention's (CDC) National Institute for Occupational Safety and Health (NIOSH) released a review of evidence for work-related musculoskeletal disorders. Examples of work conditions that may lead to WMSDs include routine lifting of heavy objects, daily exposure to whole body vibration, routine overhead work, work with the neck in chronic flexion position, or performing repetitive forceful tasks. This report identified positive evidence for relationships between work conditions and MSDs of the neck, shoulder, elbow, hand and wrist, and back.1

The Bureau of Labor Statistics of the Department of Labor defines MSDs as musculoskeletal system and connective tissue diseases and disorders when the event or exposure leading to the case is bodily reaction (e.g., bending, climbing, crawling, reaching, twisting), overexertion, or repetitive motion. MSDs do not include disorders caused by slips, trips, falls, or similar incidents. Examples of MSDs include:

  • Sprains, strains, and tears
  • Back pain
  • Carpal tunnel syndrome
  • Hernia2

Musculoskeletal disorders are associated with high costs to employers such as absenteeism, lost productivity, and increased health care, disability, and worker’s compensation costs. MSD cases are more severe than the average nonfatal injury or illness (e.g., hearing loss, occupational skin diseases such as dermatitis, eczema, or rash).

  • Musculoskeletal disorders account for nearly 70 million physician office visits in the United States annually, and an estimated 130 million total health care encounters including outpatient, hospital, and emergency room visits3
  • The Institute of Medicine estimates of the economic burden of WMSDs, as measured by compensation costs, lost wages, and lost productivity, are between $45 and $54 billion annually3
  • The Bureau of Labor Statistics reported 26,794 Carpal tunnel syndrome cases involving days away from work in 20014
  • In 2001, the Bureau of Labor Statistics reported 372,683 back injury cases involving days away from work5
  • In 2003, the total cost for arthritis conditions was $128 billion—$81 billion in direct costs and $47 billion in indirect costs6
  • Persons who are limited in their work by arthritis are said to have Arthritis-attributable work limitations (AAWL).  AAWL affects one in 20 working-age adults (aged 18-64) in the United States and one in three working-age adults with self-reported, doctor-diagnosed arthritis7
Developing and Implementing Workplace Controls

Engineering controls, administrative controls and use of personal protective equipment

  • The preferred approach to prevent and control WMSDs is to design the job to take account of the capabilities and limitations of the workforce using engineering controls such as changing workstation layout, which might include using height-adjustable workbenches or locating tools and materials within short reaching distances
  • Administrative control strategies are policies and practices that reduce WMSD risk but they do not eliminate workplace hazards such as changes in job rules and procedures such as scheduling more breaks to allow for rest and recovery. Although engineering controls are preferred, administrative controls can be helpful as temporary measures until engineering controls can be implemented or when engineering controls are not technically feasible
  • Use of personal protective equipment (PPE)
Ergonomics

Ergonomics Is the science of designing the job and the workplace to suit the capabilities of the workers. Simply stated, ergonomics means "fitting the task to the worker." The aim of ergonomics is the evaluation and design of facilities, workstations, jobs, training methods, and equipment to match the capabilities of users and workers, and thereby reduce stress and eliminate injuries and disorders associated with the overuse of muscles, bad posture, and repeated tasks. is the science of fitting workplace conditions and job demands to the capability of the working population.1 The goal of ergonomics is to reduce stress and eliminate injuries and disorders associated with the overuse of muscles, bad posture, and repeated tasks. A workplace ergonomics program can aim to prevent or control injuries and illnesses by eliminating or reducing worker exposure to WMSD risk factors using engineering and administrative controls. PPE is also used in some instances but it is the least effective workplace control to address ergonomic hazards. Risk factors include awkward postures, repetition, material handling, force, mechanical compression, vibration, temperature extremes, glare, inadequate lighting, and duration of exposure.8 For example, employees who spend many hours at a workstation, may develop ergonomic-related problems resulting in musculoskeletal disorders (MSDs).

Of particular interest in evaluation of programs to prevent WMSDs is the Centers for Disease Control and Prevention's (CDC) National Institute for Occupational Safety and Health (NIOSH) Elements of Ergonomics Programs primer with seven steps to address WMSDs.9 Each step lends itself to an evaluation measure.

  1. Look for signs of a potential WMSD in the workplace, such as frequent worker reports of aches and pains or tasks requiring repetitive forceful exertions (health care costs, health outcomes) and act to reduce them
  2. Show management commitment by addressing possible problems and encouraging worker involvements in problem-solving activities (organizational change)
  3. Offer training to expand management and worker ability to evaluate potential WMSDs (health outcomes, organizational change)
  4. Gather data to identify jobs or work conditions that are most problematic, using sources such as injury and illness logs, medical records, and job analyses (health outcomes)
  5. Identify effective controls for tasks that pose a risk of WMSD and evaluate these approaches once they have been instituted to see if they have reduced or eliminated the problem (organizational change)
  6. Establish health care management to emphasize the importance of early detection and treatment of WMSDs for preventing impairment and disability (health outcomes)
  7. Minimize risk factors for WMSDs when planning new work processes and operations (organizational change)

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Worker productivity measures for WMSD prevention10-16

Healthier employees are less likely to call in sick. Companies can sometimes assess sick day use to determine whether health programs are increasing worker productivity.

Baseline

Process

  • Re-assess the average number of sick days per employee at the first follow-up evaluation
    • If employee education programs are successful such as ergonomics awareness, these measures may increase in the short term as screening and detection rates for WMSDs increase
  • Periodic repeats of baseline measures

Outcome

  • Assess changes in the average number of sick days per employee in repeated follow-up evaluations
  • Assess changes in costs from baseline (e.g., absenteeism)
  • Assess changes in time employees spend during working hours participating in WMSD related worksite prevention programs

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Health care costs measures for WMSD prevention10-12

In contrast with the worker productivity costs described above (e.g., absenteeism), health care costs are measures of the direct medical expenses of providing employee health care and preventive health programs.

Baseline

  • Determine costs and use for health care, such as benefits, disability, health care costs, counseling, and treatment (e.g., medications) for WMSD related illness and disability
    • It is difficult to attribute the effects of WMSDs directly to the costs of health care because it may be unclear if the work environment and performance of work contributed significantly to the condition; and/or the condition was made worse or persisted longer due to work conditions. However, tracking this information over time gives the program evaluator an indication of the WMSD prevention program’s impact
    • Note: For assessing the burden of arthritis using health care claims data, the CDC Arthritis Program recommends using the case definition and ICD-9 codes of the National Arthritis Data Workgroup labeled “arthritis and other rheumatic conditions”
  • Measure the number of worker reports of aches, pains and WMSDs in occupational clinics and other settings
  • Determine health care use and costs of employee participants before and after a WMSD prevention program such as training or changes in shift schedules

Process

  • Periodic repeats of baseline measures

Outcome

  • Assess changes in health care use and costs from baseline
  • Assess changes in worker reports of aches, pains and WMSDs in occupational clinics and other settings
  • Compare health care use and costs of employee participants before and after a WMSD prevention program such as training or changes in shift patterns

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Health outcomes measures for WMSD prevention10-12

The effectiveness of WMSD prevention programs often depends on the intensity of program effort and the use of multiple interventions. For most health conditions, a rule of thumb is that the more programs implemented together as a package or campaign, the more successful the interventions will be.

Baseline

Process

  • Periodic repeats of baseline measures
  • Analyze data on potential WMSDs risk environments and implement worksite risk reduction programs (see organizational change)

Outcome

  • Assess changes in percentage of employees reporting WMSDs
    • Assess changes in percentage of employees with work exposures that increase the risk of WMSDs (e.g., repetitive motions, awkward postures)
    • Assess reductions in WMSD reports after reducing environment risks and compare with baseline
  • Determine changes in levels of diagnostic and treatment procedures related to WMSD from health care and pharmaceutical claims data
    • Note that these data can be dramatically skewed by a few costly cases (e.g., newly diagnosed rheumatoid arthritis is generally far more costly to treat than many cases of osteoarthritis or gout)
  • Assess changes in employee knowledge, attitudes, and beliefs about WMSDs
    • Measure changes in employees’ knowledge of workplace ergonomics
    • Assess changes in employee awareness of existing workplace ergonomic and WMSD programs, policies and benefits
    • Assess changes in management attitudes regarding the importance of early detection and treatment of WMSDs for preventing impairment and disability

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Organizational change measures for WMSD prevention10-12

Prevention of WMSDs requires ongoing support from employers. New programs can be added over time and evaluated periodically for their effectiveness. For best results, recognition of the benefits of preventing WMSDs should become an inherent part of organizational change and corporate culture.

Measuring organization change is an assessment of company-initiated programs and policies that affect most employees regardless of their health status. These efforts need to be integrated for greatest effectiveness and will require time for full implementation. Regular measures of employee attitudes and program development are key in determining whether new programs are effective or require further adaptation to prevent continuing investment in ineffective efforts.

Baseline

  • Determine workplace barriers to using WMSD prevention programs and ergonomics controls to reduce the risk of WMSDs
  • Assess current workplace WMSD prevention programs
    • List current WMSD prevention program options for employees including those directed toward employee behavior, such as information on protecting the back when lifting heavy loads, and those directed toward the workplace environment, such as altering the positions of equipment to reduce muscle and joint strain through worksite and identify number of employees (i.e., participation) using each option. Examples:
      • Number of WMSD prevention programs (e.g., current training programs on hazards awareness, safe work practices) and participation in these programs. Participation can be enhanced by assessing the needs of workers, including workers in the planning process, designing training objectives to provide workers with the most critical information they need to know and actions that can take; and making safety and health training a part of basic job training
      • Number of current WMSD prevention policies (e.g., current management approaches to recognizing possible problems and involving workers in problem-solving activities; administrative controls)
      • Number of environmental strategies to reduce the risk of WMSD (e.g., effective controls for tasks that pose a risk of WMSD and evaluate the current approaches to control these settings)
      • Number of partnerships with community resources for preventing WMSD
    • Determine costs of current company WMSD prevention programs such as:
      • Staffing, equipment, and space
      • Employee time to participate in programs during work hours (e.g., training)
      • Costs of implementation of administrative or engineering controls
    • Conduct survey of employee satisfaction with current workplace supported WMSD prevention programs (this measure is also useful as a baseline for assessing worker productivity)
  • Determine new interventions to minimize risk factors for WMSDs when initiating new work processes and operations such as implementation of engineering or administrative controls

Process

  • Reassess barriers to using WMSD prevention programs and ergonomics controls to reduce the risk of WMSDs
  • Document steps taken and progress toward implementing each intervention selected
    • List numeric goals in each form of intervention within a designated time period (e.g., 12 months from startup):
      • Employee reach (e.g., number of training opportunities offered)
      • Employee participation (e.g., such as number of people trained)
    • Describe timeline for implementation of each planned intervention (e.g., length of time and timing of tasks to develop, initiate, and conduct a training program for workers and managers to evaluate workplace WMSDs)
    • Create a baseline budget for new interventions including classes, instructors, classroom space, materials, etc
    • Identify opportunities for new partnerships with community groups for preventing WMSD
  • Reassess employee satisfaction regarding workplace supported WMSD prevention programs

Outcome

  • Measure reductions in the number and type of barriers to using WMSD prevention programs and ergonomics controls to reduce the risk of WMSDs
  • Assess changes in workplace WMSDs prevention programs, including employee education and workplace adaptation. Include progress in achieving goals and in implementation of each intervention
    • Measure changes in the number of WMSD prevention programs for employees through the worksite and changes in employee participation using each option between baseline and time of reassessment. Examples:
      • Numbers of new WMSD prevention programs (e.g., training) offered to employees and participation in these programs
      • Number of new WMSD prevention policies (e.g., active involvement of workers in problem-solving activities; administrative controls) developed and implemented compared with baseline
      • Number of new environmental strategies (e.g., implementation of effective controls) developed and implemented compared with baseline
      • Number of new partnerships formed with community groups to enhance access and opportunity for employees to reduce WMSDs
    • Assess changes in program costs from baseline
      • Increases in staffing or equipment needs due to new program offerings
      • Changes in employee participation time during work hours (e.g., training)
      • Changes in costs of implementing administrative or engineering controls
    • Assess changes in survey responses for employee satisfaction following implementation of workplace supported prevention programs and compare with baseline

Depending on goal success, evaluate the need to adjust workplace programs.

Tools and Resources

WMSD Baseline Measures

The assessment tools described in the assessment module include specific questions related to WMSDs.

  Health-related Programs

  • Q10; Q11; Q12; Q13; Q14; Q15; Q16; Q17; Q18; Q19; Q20c,g,j; Q22; Q23; Q24a,b,c,d,f,g,h,i,j,k,l,m; Q26; Q27; Optional Questions A, B, C, I, J, M, N, OO

  Health-related Policies

  • 28c,e

  Health Benefits

  • Q29; Q30; Q32; Q36; Q37; Optional Questions T, V, Z, AA

  Environmental Support

  • Q39; Q40; Q41; Q42; Q46; Q47; Optional Questions CC, GG, HH, II, JJ, KK, LL

Additional Tools

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