1. Coronel Institute Ergonomics in the construction sector Henk van der Molen, Judith Sluiter, Monique Frings-Dresen email: h.f.vandermolen@amc.nl j.sluiter@amc.uva.nl m.frings@amc.uva.nl Coronel Institute of Occupational Health, Academic Medical Center, Amsterdam, The Netherlands Arbouw, Health & Safety Institute in the Construction Industry, Amsterdam, The Netherlands

2. Coronel Institute Coronel Institute of Occupational Health Department of the Academic Medical Center (AMC) Samuel Coronel (Sr) (1827-1892): –one of the first to relate living conditions on health Coronel Institute: –Largest university-based center on occupational health in the Netherlands (± 80 colleagues) –Netherlands Center for Occupational Diseases –Research Center for Insurance Medicine –Out-patient Clinic People and Work

3. Coronel Institute Arbouw Knowledge & Service institute for Dutch industry sector Working circumstances & disability for work Board of employers & employee organisations Collectively financed Organisation: Research & Development Contract with Occupational Health & Safety services Facilitative towards sector, e.g. instruments

4. Coronel Institute What works!? (examples of studies)

5. Coronel Institute What works!? (1)_ Cochrane review Effectiveness of interventions to prevent occupational injuries among workers at construction sites Systematic literature review 7522 references N = 5 studies with time series Meta analysis (van der Molen et al 2007, Lehtola et al. accepted 2008 )

6. Coronel Institute No evidence that legislation alone is effective for reducing injuries Additional strategies necessary to increase compliance employers and workers to measures prescribed by legislation Multifaceted and continuing interventions seem effective for reducing injuries (like safety campaign and drug-free workplace program) Influencing safety culture and enforcement / feedback important elements of these interventions Implications on basis of systematic review

7. Coronel Institute What works!? (2) _ technical devices Effect of adjusting working height materials & mechanisation of transport on work demands Controlled field study; real time observations N = 10 bricklayers, 10 assistants

8. Coronel Institute Results with respect to day exposures: bricklayers: frequency trunk flexion > 60º: 79% (920 times) duration trunk flexion > 60º : 52% (42 minutes) assistants: frequency trunk flexion > 60º: 94% (474 times) duration trunk flexion > 60º: 92% (25 minutes) mmh objects > 4 kg: 86% (1326 times)

9. Coronel Institute What works!? (3)_lower weight Effect block weight on:  Compression force on low back? Conditions  6, 11, 14 (2 types) en 16 kg  N=9 blocklayers  Most demanding activities (based on field study) Measurements  Direct measurement  Biomechanical modelling (Faber et al. 2007 & Kuijer et al. 2007)

10. Coronel Institute

11. What works!? (4) _ paver’s trolley Effect of paver’s trolley on productivity, task demands, discomfort Controlled field study; observations and questionnaires N = 10 paviours (Kunst et al. 2007)

12. Coronel Institute RESULTS With paver's trolley Working on knees (rolling) : 141 min. Without paver's trolley Working on knees (crowling) : 146 min. No differences in: – productivity – energetic workload – local discomfort

13. Coronel Institute What works!? (5) _ergonomic measures Effect of use of ergonomic measures on musculoskeletal complaints Cohort study: 4.5 years Questionnaires: 2 times (pre-post) N= 1,114 carpenters, bricklayers and pavers (van der Molen, Sluiter & Frings-Dresen 2007; in press

14. Coronel Institute 6 ergonomic measures Mechanical transport Lifting aids Bricks on elevation Mechanical transport Mechanical paving Mechanical kerbs placing carpenters bricklayers pavers

15. Coronel Institute Results: primary prevention Over a 4.5 years period: 17.3% incidence of low back complaints Frequent use of ergonomic measures is associated with a non-significant 15% reduction of the risk on reported regularly or sustained low back complaints ´Number needed to treat´: 38 construction workers who are regularly using ergonomic measures to prevent 1 construction worker with low back complaints

16. Coronel Institute Low back complaints NRR (95% CI) Materials on elevation (31 cm)143 0,63 (0,44-0,92) More use of elevated tubs is related to reduced low back complaints over time Results: secondary prevention

17. Coronel Institute What works!? (5a)_Actor analysis Assocation between behavioural change and use of ergonomic measures Cross sectional study Structered interviews N=42; –Employers as behavior environmental agents –Workers as behavior individual agents

18. Coronel Institute Tresle knowunderstandwantdecideable EWEWEWEWEW A B C D E F G H I E = employers; W = workers; A-I: companies

19. Coronel Institute example Odds Ratio’s (95% CI) EmployersBricklayers Elevation of materials 2,4 (1,1 - 5,1) 7,2 (1,5 - 35,1) Results Overall: - Strength of associations between use of ergonomic measures and behavioral change phases differs between ergonomic measures actor groups of employers and workers - Significant positive associations between use of ergonomic measures and behavioral change phases

20. Coronel Institute -Wrist -Underarm -Elbow -Shoulder Design and development of new tools Awkard postures and high forces when working with traditional trowel of: What works!? (6)_Product development (Kuyt-Evers 2006)

21. Coronel Institute Position of handle determines load on body regions TRADITIONAL SMART ERGO Results

22. Coronel Institute Developing effective solutions is often a long and winding road…., Evaluate ergonomic measures before implementation on: Workload / Energy Complaints / Injuries Feasibility of measures for stakeholders Employer Worker but also at architects, manufacturers, et cetera Take home messages

23. Coronel Institute Exchange of knowledge (research) Fifth IEA symposium in Beijing 2009 Increase of peered reviewed articles Special issues about construction ergonomics –Scandinavian Journal of Work, Environment & Health 2005 –Applied Ergonomics 2005 –American Journal of Industrial Medicine (in preparation) Scientific committees –IEA –ICOH International projects (e.g. Cochrane review safety interventions)