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workers, building, architect

NORA Manufacturing Sector Strategic Goals

9277133 - Upper Limb Work-Related Musculoskeletal Disorders

Start Date: 10/1/2000
End Date: 9/30/2009

Principal Investigator (PI)
Name: Susan Burt
Phone: 513-841-4594
Organization: NIOSH
Sub-Unit: DSHEFS
Funded By: NIOSH

Primary Goal Addressed

Secondary Goal Addressed


Attributed to Manufacturing


Project Description

Short Summary

The purpose of the project is to quantify exposure-response relationships between physical job stressors and the prevalence and incidence of hand and arm musculoskeletal disorders, and to develop and test practical job assessment methods. Individual quantitative data on hand activity level, exertion and posture, as well as physical exams, nerve conduction testing and questionnaires have been collected prospectively over 5 years on 483 study subjects in manufacturing, healthcare and service jobs in 3 states. Ongoing collaboration and data pooling with 6 research organizations across the country who carried out similar coordinated studies will result in broad applicability and increased statistical power to resolve important questions about work-related hand and arm MSDs and focus preventive efforts. An anticipated outcome of this project is that occupational health professionals will be able to more easily and accurately identify risk for hand and arm MSDs by applying practical job assessment methods and develop interventions and design changes to make existing and future jobs safer. Another anticipated outcome is that company decision makers and policy makers will be able to make better informed decisions to prevent hand and arm MSDs.


The purpose of the project is to provide quantitative information on the varying risk for hand and arm MSDs associated with different levels of hand activity and exertion in the workplace, taking into account individual and organizational factors. A secondary goal is to evaluate job exposure assessment methods and to further validate a simple method of determining Hand Activity Level, and testing its application to multi-task jobs. A prospective epidemiological study is underway, with comprehensive exposure assessment and health assessment conducted at baseline, 1 year and 2 years, and the collection of more limited interim data. Worksites and jobs in the service and manufacturing industries were selected to represent the range of hand activity level and exertion. Data from this project will be combined with data from external cooperative agreement partners in order to broaden the applicability of findings and improve statistical power to quantify exposure-response relationships and to evaluate interactions between exposure variables, individual factors, and other variables that have been identified in the scientific literature as related to MSDs. NIOSH project staff and external partners collaborating on this study are recognized national and international experts representing a broad range of fields crucial to the scientific issues being addressed. Standardized exposure assessment used in the study includes quantitative analysis of videotaped job tasks to evaluate all relevant upper limb exposures for a wide range of job tasks, and provides sufficient detail for exposure-response analyses. Health assessment includes physical examinations, nerve conduction tests, and standardized questionnaires. This study will provide quantitative data on the relative risk for hand and arm musculoskeletal disorders represented by different levels of physical job demands, and an evaluation and recommendations for improvement of practical job assessment methods. The end result will be more effective job design changes or interventions in existing jobs to prevent work-related hand and arm musculoskeletal disorders.

FYO8 Accomplishments: (1) Wrote report for 5-year project review and wrote response to external peer review comments. (2) Trained and worked with new research fellow to complete additional data cleaning for multimedia video task analysis to eliminate duplicate coding and coded significant exertions that were missing for one study site. (3) Reviewed and provided comments to the Office of Extramural Programs on 2 final reports from cooperative agreements. (4) Collaborated with consortium partners in monthly conference calls to plan and prepare for data pooling. (5) Article published electronically on NIOSH research efforts in ergonomics.

FY09 Anticipated Accomplishments: (1) Complete exposure data reduction including posture and force data, and link exposure data to create simultaneously occurring combined exposure variables. (2) Share exposure summary variables and relevant methods with the Consortium. (3) Draft manuscript on Hand Activity Level and submit for review and publication and present findings at a scientific conference. (4) Complete health data reduction for carpal tunnel syndrome (CTS). (5) Identify prevalent and incident cases and share this information with the Consortium for pooling. (6) Complete exposure-response analysis for CTS, including individual and organizational covariates. (7) Draft manuscript on CTS and submit for review and publication and present findings at a scientific conference.


The objectives of this project are to: 1 )better define the exposure-response relationships between hand activity level and exertion and upper limb MSDs; 2) evaluate state of the art exposure assessment methods for the upper limb to facilitate practitioners' efforts to identify and prioritize jobs for redesign and intervention, and for assessing the effectiveness of interventions to reduce the physical demands of the job; and 3) better define, categorize and evaluate the severity of work-related MSDs of the upper limb.

Evaluation criteria include evidence from literature citation databases that this research is used by scienetists and practioners.

Mission Relevance

Work-related musculoskeletal disorders have been identified by many NORA sectors as a priority research area and also as a Healthy People 2010 objective. The social and economic benefits of a reduction in upper limb MSDs include a very large impact on work-related medical care costs and productivity losses. The costs of MSDs to American companies and workers have been estimated at $13 to $20 billion annually. Many of these disorders could be prevented by identifying hazardous jobs, and redesigning job tasks, tools and workstations to reduce the physical stressors. Quantifying the risk represented by workplace and individual factors will help to focus prevention efforts. This study will quantify the risk for MSDs such as carpal tunnel syndrome and hand-wrist tendonitis according to varying levels of repetitive, forceful work, with awkward postures, while taking into account organizational and individual factors. State of the art exposure assessment methods will be further validated in the study, providing valuable tools for occupational health practitioners to use in identifying and prioritizing jobs for redesign and intervention. This project aims to assist employers across many industries and hundreds of thousands of workers who are employed in jobs that require repetitive and forceful hand activity to reduce the incidence of hand and arm musculoskeletal disorders.

Healthcare and Social Assistance Sector - Strategic Goal 1: Reduce the incidence and severity of work-related accidents and injuries to workers in the health care and social assistance sectorIntermediate Goal 1.1: Reduce musculoskeletal disorders due to patient handling and working in awkward postures. Manufacturing Sector - Strategic Goal 2: Reduce adverse health outcomes by better understanding occupational risk and protective factors in and developing appropriate interventions for the manufacturing sector. Intermediate Goal 2: Musculoskeletal disorders. Musculoskeletal Disorders - Cross-Sector Program. Strategic Goal 1 (Exposure): Valid, reliable, comprehensive exposure assessment in multi-factorial environments. Intermediate Goal 1.1 (Biomechanical): Valid, reliable, comprehensive methods for measuring biomechanical exposures associated with MSDs. Strategic Goal 2 Causes): Definitive understanding of the multi-factorial relationships among exposures, risk factors, and MSDs. Intermediate Goal 2.1 (Biomechanical): Understanding of biomechanical exposures associated with the development of and recovery from MSDs. Exposure Assessment Emphasis area - Strategic Goal 2: Develop or improve specific methods and tools to assess worker exposures to critical occupational agents and stressors. Intermediate Goal 2.6: Develop and evaluate new or improved methods for assessing workplace exposure to physical, psychological, and other occupational stressors. Intermediate Goal 2.6.1: Completion of a new or improved method to measure an important physical, psychological, or other occupational health stressor such as noise, ergonomic factors, non-ionizing radiation or mixture of stressors.Intermediate Goal 2.6.2: Application of these methods to measure physical, psychological or other occupational health stressors.