1. Department of Kinesiology - Biomechanics University of Waterloo, 2002 Effectiveness of a Participatory Ergonomics Intervention in Reducing Worker Pain Severity Through Physical and Psychosocial Exposure Pathways Andrew Laing

2. Department of Kinesiology - Biomechanics University of Waterloo, 2002 Why Ergonomics Research? Effectiveness debates Effectiveness debates Legislation and Policies Legislation and Policies Evidence based decisions Evidence based decisions What should should an ergonomist focus on? What should should an ergonomist focus on?

3. Department of Kinesiology - Biomechanics University of Waterloo, 2002 OUBPS Study Results

4. Department of Kinesiology - Biomechanics University of Waterloo, 2002 Participatory Ergonomics A process of ergonomic problem solving that incorporates input from each relevant workplace stakeholder group in identification of areas for improvement, solution development, and implementation of physical and work organizational changes in order to minimize risk of injury and maximize productivity. A process of ergonomic problem solving that incorporates input from each relevant workplace stakeholder group in identification of areas for improvement, solution development, and implementation of physical and work organizational changes in order to minimize risk of injury and maximize productivity.

5. Department of Kinesiology - Biomechanics University of Waterloo, 2002 Studies on Effectiveness N = 11 Inconsistent outcome variables Inconsistent outcome variables Weak study designs (Control Groups: N = 2) Weak study designs (Control Groups: N = 2) Need for: Need for:  high quality longitudinal studies  studies that describe and measure interventions  studies that measure worker health outcomes

6. Wells, Frazer, Norman, Laing, 2001

7. Intervention Outcome Pathway: 4: CHANGES IN PAIN / DISCOMFORT (questionnaires) 2a: Workplace physical interventions 2. PLANT LEVEL WORKPLACE INTERVENTIONS: 2b: Workplace psychosocial interventions 3b: Change in communication levels and/or psychosocial exposures (questionnaires) 3a1: Change in mechanical exposures (change specific evaluations) 3a2: Change in Perceived Effort (questionnaires) 1: MANAGEMENT/ WORKFORCE ATTITUDES TO CHANGING THE WORK ENVIRONMENT TO ADDRESS WMSDS UW Participative Ergonomics Process and Program Blueprint 3. PRIMARY HEALTH OUTCOMES

8. 4: CHANGES IN PAIN / DISCOMFORT (questionnaires) 2a: Workplace physical interventions 2. PLANT LEVEL WORKPLACE INTERVENTIONS: 2b: Workplace psychosocial interventions 3b: Change in communication levels and/or psychosocial exposures (questionnaires) 3a1: Change in mechanical exposures (change specific evaluations) 3a2: Change in Perceived Effort (questionnaires) 1: MANAGEMENT/ WORKFORCE ATTITUDES TO CHANGING THE WORK ENVIRONMENT TO ADDRESS WMSDS UW Participative Ergonomics Process and Program Blueprint 3. PRIMARY HEALTH OUTCOMES Intervention Outcome Pathway: Physical Change Pathway

9. 4: CHANGES IN PAIN / DISCOMFORT (questionnaires) 2a: Workplace physical interventions 2. PLANT LEVEL WORKPLACE INTERVENTIONS: 2b: Workplace psychosocial interventions 3b: Change in communication levels and/or psychosocial exposures (questionnaires) 3a1: Change in mechanical exposures (change specific evaluations) 3a2: Change in Perceived Effort (questionnaires) 1: MANAGEMENT/ WORKFORCE ATTITUDES TO CHANGING THE WORK ENVIRONMENT TO ADDRESS WMSDS UW Participative Ergonomics Process and Program Blueprint 3. PRIMARY HEALTH OUTCOMES Psychosocial Change Pathway Intervention Outcome Pathway:

10. 4: CHANGES IN PAIN / DISCOMFORT (questionnaires) 2a: Workplace physical interventions 2. PLANT LEVEL WORKPLACE INTERVENTIONS: 2b: Workplace psychosocial interventions 3b: Change in communication levels and/or psychosocial exposures (questionnaires) 3a1: Change in mechanical exposures (change specific evaluations) 3a2: Change in Perceived Effort (questionnaires) 1: MANAGEMENT/ WORKFORCE ATTITUDES TO CHANGING THE WORK ENVIRONMENT TO ADDRESS WMSDS UW Participative Ergonomics Process and Program Blueprint 3. PRIMARY HEALTH OUTCOMES Evaluation Framework

11. Department of Kinesiology - Biomechanics University of Waterloo, 2002 Objectives To evaluate: 1. 1. how the specific steps within the University of Waterloo Ergonomics Process and Program Blueprint may have influenced the effectiveness of the physical interventions implemented. 2. 2. the effectiveness of a participatory ergonomics process in reducing pain severity levels through interventions aimed at reducing worker physical demands and mechanical exposures. 3. 3. the effectiveness of a participatory ergonomics process in reducing pain severity levels through interventions aimed at enhancing workplace communication and reducing worker psychosocial risk factors.

12. Department of Kinesiology - Biomechanics University of Waterloo, 2002 If the proper pre-requisites exist, a participatory ergonomics intervention will result in: Hypotheses: 1.Enhanced physical change projects 2.Decreased exposure to physical risk factors 3.Decreased worker perceived effort 4. Enhanced communication between workplace stakeholder parties 5. Increased worker perceived decision latitude 6. Increased worker perceived influence 7. Reduced pain severity reports Measurement Tool: Stakeholder Feedback Questionnaire QuestionnaireQuestionnaire Questionnaire Questionnaire Change Specific Evaluations

13. Department of Kinesiology - Biomechanics University of Waterloo, 2002 METHODS

14. Department of Kinesiology - Biomechanics University of Waterloo, 2002 Study Sites  Automotive Foam Manufacturer  Intervention (Whitby) / Control (Tilbury) Plants  Subjects performing identical work

15. Department of Kinesiology - Biomechanics University of Waterloo, 2002 Intervention Model

16. Department of Kinesiology - Biomechanics University of Waterloo, 2002 Team Composition Research Team n = 2 Management n = 5 Labour n = 4 Ergonomics Change Team

17. Department of Kinesiology - Biomechanics University of Waterloo, 2002 Input from stakeholder groups on the effectiveness of final changes compared to initial prototypes. Input from stakeholder groups on the effectiveness of final changes compared to initial prototypes. Evaluation Tools: Stakeholder Feedback

18. Department of Kinesiology - Biomechanics University of Waterloo, 2002 Evaluation Tools: Change Specific Evaluations   Evaluation of each change using:   EMG,   accelerometry,   biomechanical modeling,   worker ratings of preference   expert opinion of UW researchers   Peak, Task Level, Shift Long, Overall Exposure Changes Overall Time Weighted Changes = Shift-Long Time Weighted Changes * Compliance * # of Workers Affected At One Time / Total Workers in Department

19. Department of Kinesiology - Biomechanics University of Waterloo, 2002 Evaluation Tools: Questionnaires  Perceived Effort:  Borg CR-10 scale (Borg, 1990)  Communication Dynamics:  7 items, 5 point ordinal scale  Perceived Decision Latitude:  Karasek’s JCQ (1985) – 9 items, 5 point ordinal scale  Perceived Influence:  Greenberger (1981) – 11 items, 5 point ordinal scale  Reported pain severity  body-part specific, 5 point ordinal scale

20. Department of Kinesiology - Biomechanics University of Waterloo, 2002   Qualitative observation of elements implemented, and perceptions of commitment to the participatory process. Evaluation Tools: Qualitative Process Evaluation

21. Department of Kinesiology - Biomechanics University of Waterloo, 2002 Questionnaire Statistical Analyses:   Perceived effort, decision latitude, influence, reported pain severity   Between Plants: 2X2 ANOVAS (Pre/Post X Whitby/Tilbury).   Interaction effects were of primary interest   Communication Dynamics (only ‘Post’ responses)   Between Plants: Chi Square  Perceived effort, decision latitude, influence, reported pain severity  Between Plants: 2X2 ANOVAS (Pre/Post X Whitby/Tilbury).  Interaction effects were of primary interest  Communication Dynamics (only ‘Post’ responses)  Between Plants: Chi Square

22. Department of Kinesiology - Biomechanics University of Waterloo, 2002 Study Time Frame (Months) Team Formation & Training T=0 months Q’air #1 (Pre) T=1 month Change Projects / Change Specific Evaluations T=1-11 months Q’air #2 (Post) T=11 months 0 11

23. Department of Kinesiology - Biomechanics University of Waterloo, 2002 RESULTS

24. Department of Kinesiology - Biomechanics University of Waterloo, 2002 Results: Participatory Influence on Physical Change Projects  10 physical change projects implemented: Zytec bin platformsScoop knife handle wrap Rear seat back platformsSit-stand stool Pack 1 – 8/rowVelcro straightening tool Zytec bin build toolAir sock reposition Trimmer handle wrapAnti-fatigue matting  Based on worker input and feedback, the Blueprint participatory process enhanced the final changes implemented compared to the original prototypes

25. Results: Mechanical Exposures Overall Changes Including Compliance and Job Rotation

26. Department of Kinesiology - Biomechanics University of Waterloo, 2002 Results: Mechanical Exposures

27. Department of Kinesiology - Biomechanics University of Waterloo, 2002 Results: Mechanical Exposures

28. Department of Kinesiology - Biomechanics University of Waterloo, 2002 Results: Mechanical Exposures n When evaluated at the task level, the physical ergonomic changes implemented were successful in reducing physical demands. However, overall calculations (including compliance and job rotation schemes) showed only 2 changes with substantial cumulative impacts. However, overall calculations (including compliance and job rotation schemes) showed only 2 changes with substantial cumulative impacts.

29. Department of Kinesiology - Biomechanics University of Waterloo, 2002 Results: Questionnaires Population Information Pre-Post Matched Subjects for Questionnaires Same Dept Pre-Post Matches Total Population Whitby Foam 4458.7 Tilbury Foam 3960.9 Total8359.7 75 64 167 Response Rate (%)

30. Department of Kinesiology - Biomechanics University of Waterloo, 2002 Results: Perceived Effort Intervention Control

31. Department of Kinesiology - Biomechanics University of Waterloo, 2002 Results: Perceived Effort 4 body parts x 3 departments

32. Department of Kinesiology - Biomechanics University of Waterloo, 2002 Results: Perceived Effort 4 body parts x 3 departments

33. Department of Kinesiology - Biomechanics University of Waterloo, 2002 Results: Perceived Effort No systematic changes in perceived effort at jobs where interventions were implemented. No systematic changes in perceived effort at jobs where interventions were implemented.

34. Department of Kinesiology - Biomechanics University of Waterloo, 2002 10 Psychosocial Elements introduced: User TrialsOne Minute Surveys ECT Newsletter Suggestion Box Bulletin Board Logo Contest Shift Meetings Corporate Newspaper ECT Meetings Steering Committee Meetings Results: Psychosocial Interventions

35. Department of Kinesiology - Biomechanics University of Waterloo, 2002 Results: Communication Dynamics Since completing the last ergonomics project questionnaire (June 2001): 1. Overall communication between labour and management has been enhanced. 2. Communication between you and your fellow workers has been enhanced. 3. Communication about general ergonomic issues has been enhanced. 4. Communication about specific ergonomic improvement projects has been enhanced. 5. Your opinion regarding specific ergonomic projects has been directly asked more often. 6. You have been encouraged to express your opinions about ergonomic issues more often. 7. You have expressed your opinions regarding ergonomic issues more often. Since completing the last ergonomics project questionnaire (June 2001): 1. Overall communication between labour and management has been enhanced. 2. Communication between you and your fellow workers has been enhanced. 3. Communication about general ergonomic issues has been enhanced. 4. Communication about specific ergonomic improvement projects has been enhanced. 5. Your opinion regarding specific ergonomic projects has been directly asked more often. 6. You have been encouraged to express your opinions about ergonomic issues more often. 7. You have expressed your opinions regarding ergonomic issues more often. Since completing the last ergonomics project questionnaire (June 2001): 1. Overall communication between labour and management has been enhanced. 2. Communication between you and your fellow workers has been enhanced. 3. Communication about general ergonomic issues has been enhanced. 4. Communication about specific ergonomic improvement projects has been enhanced. 5. Your opinion regarding specific ergonomic projects has been directly asked more often. 6. You have been encouraged to express your opinions about ergonomic issues more often. 7. You have expressed your opinions regarding ergonomic issues more often.

36. Department of Kinesiology - Biomechanics University of Waterloo, 2002 Results: Communication Dynamics

37. Department of Kinesiology - Biomechanics University of Waterloo, 2002 Results: Qualitative Observations of Psychosocial Interventions 10 Psychosocial Elements introduced: User TrialsOne Minute Surveys ECT Newsletter Suggestion Box Bulletin Board Logo Contest Shift Meetings Corporate Newspaper ECT Meetings Steering Committee Meetings Lack of Commitment to Participatory Process Observed 10 Psychosocial Elements introduced: User TrialsOne Minute Surveys ECT Newsletter Suggestion Box Bulletin Board Logo Contest Shift Meetings Corporate Newspaper ECT Meetings Steering Committee Meetings

38. Department of Kinesiology - Biomechanics University of Waterloo, 2002 10 Psychosocial Elements introduced: User TrialsOne Minute Surveys ECT Newsletter Suggestion Box Bulletin Board Logo Contest Shift Meetings Corporate Newspaper ECT Meetings Steering Committee Meetings Lack of Commitment to Participatory Process Observed Results: Qualitative Observations of Psychosocial Interventions

39. Department of Kinesiology - Biomechanics University of Waterloo, 2002 Results: Decision Latitude Intervention Control

40. Department of Kinesiology - Biomechanics University of Waterloo, 2002 Results: Influence Control Intervention

41. Department of Kinesiology - Biomechanics University of Waterloo, 2002 Results: Pain Severity - Components Intervention Control

42. Department of Kinesiology - Biomechanics University of Waterloo, 2002 Results: Pain Severity – Plant Wide Intervention Control

43. Discussion: Physical Change Pathway Distribution of WMSD symptoms Psychosocial Time delay 4: CHANGES IN PAIN / DISCOMFORT (questionnaires) 2a: Workplace physical interventions 2. PLANT LEVEL WORKPLACE INTERVENTIONS: 2b: Workplace psychosocial interventions 3b: Change in communication levels and/or psychosocial exposures (questionnaires) Compliance # of workers affected Ergonomic change quality # of changes implemented Extent to which changes used Quality of communications Amount of feedback acted on 3a1: Change in mechanical exposures (change specific evaluations) 3a2: Change in Perceived Effort (questionnaires) 1: MANAGEMENT/ WORKFORCE ATTITUDES TO CHANGING THE WORK ENVIRONMENT TO ADDRESS WMSDS UW Participative Ergonomics Process and Program Blueprint 3. PRIMARY HEALTH OUTCOMES

44. Discussion: Physical Change Pathway Distribution of WMSD symptoms Psychosocial Time delay 4: CHANGES IN PAIN / DISCOMFORT (questionnaires) 2a: Workplace physical interventions 2. PLANT LEVEL WORKPLACE INTERVENTIONS: 2b: Workplace psychosocial interventions 3b: Change in communication levels and/or psychosocial exposures (questionnaires) Compliance # of workers affected Ergonomic change quality # of changes implemented Extent to which changes used Quality of communications Amount of feedback acted on 3a1: Change in mechanical exposures (change specific evaluations) 3a2: Change in Perceived Effort (questionnaires) 1: MANAGEMENT/ WORKFORCE ATTITUDES TO CHANGING THE WORK ENVIRONMENT TO ADDRESS WMSDS UW Participative Ergonomics Process and Program Blueprint 3. PRIMARY HEALTH OUTCOMES 10 physical change projects

45. Discussion: Physical Change Pathway Distribution of WMSD symptoms Psychosocial Time delay 4: CHANGES IN PAIN / DISCOMFORT (questionnaires) 2a: Workplace physical interventions 2. PLANT LEVEL WORKPLACE INTERVENTIONS: 2b: Workplace psychosocial interventions 3b: Change in communication levels and/or psychosocial exposures (questionnaires) Compliance # of workers affected Ergonomic change quality # of changes implemented Extent to which changes used Quality of communications Amount of feedback acted on 3a1: Change in mechanical exposures (change specific evaluations) 3a2: Change in Perceived Effort (questionnaires) 1: MANAGEMENT/ WORKFORCE ATTITUDES TO CHANGING THE WORK ENVIRONMENT TO ADDRESS WMSDS UW Participative Ergonomics Process and Program Blueprint 3. PRIMARY HEALTH OUTCOMES Only 2 with substantial overall impacts 10 physical change projects

46. Discussion: Physical Change Pathway Distribution of WMSD symptoms Psychosocial Time delay 4: CHANGES IN PAIN / DISCOMFORT (questionnaires) 2a: Workplace physical interventions 2. PLANT LEVEL WORKPLACE INTERVENTIONS: 2b: Workplace psychosocial interventions 3b: Change in communication levels and/or psychosocial exposures (questionnaires) Compliance # of workers affected Ergonomic change quality # of changes implemented Extent to which changes used Quality of communications Amount of feedback acted on 3a1: Change in mechanical exposures (change specific evaluations) 3a2: Change in Perceived Effort (questionnaires) 1: MANAGEMENT/ WORKFORCE ATTITUDES TO CHANGING THE WORK ENVIRONMENT TO ADDRESS WMSDS UW Participative Ergonomics Process and Program Blueprint 3. PRIMARY HEALTH OUTCOMES Only 2 with substantial overall impacts Only 1 position with sig. decreased perceived effort 10 physical change projects

47. Discussion: Physical Change Pathway Distribution of WMSD symptoms Psychosocial Time delay 4: CHANGES IN PAIN / DISCOMFORT (questionnaires) 2a: Workplace physical interventions 2. PLANT LEVEL WORKPLACE INTERVENTIONS: 2b: Workplace psychosocial interventions 3b: Change in communication levels and/or psychosocial exposures (questionnaires) Compliance # of workers affected Ergonomic change quality # of changes implemented Extent to which changes used Quality of communications Amount of feedback acted on 3a1: Change in mechanical exposures (change specific evaluations) 3a2: Change in Perceived Effort (questionnaires) 1: MANAGEMENT/ WORKFORCE ATTITUDES TO CHANGING THE WORK ENVIRONMENT TO ADDRESS WMSDS UW Participative Ergonomics Process and Program Blueprint 3. PRIMARY HEALTH OUTCOMES Only 2 with substantial overall impacts Only 1 position with sig. decreased perceived effort 1 sig. decrease – leg pain in Components department 10 physical change projects

48. Department of Kinesiology - Biomechanics University of Waterloo, 2002 Discussion: Psychosocial Change Pathway Distribution of WMSD symptoms Psychosocial Time delay 4: CHANGES IN PAIN / DISCOMFORT (questionnaires) 2a: Workplace physical interventions 2. PLANT LEVEL WORKPLACE INTERVENTIONS: 2b: Workplace psychosocial interventions 3b: Change in communication levels and/or psychosocial exposures (questionnaires) Compliance # of workers affected Ergonomic change quality # of changes implemented Extent to which changes used Quality of communications Amount of feedback acted on 3a1: Change in mechanical exposures (change specific evaluations) 3a2: Change in Perceived Effort (questionnaires) 1: MANAGEMENT/ WORKFORCE ATTITUDES TO CHANGING THE WORK ENVIRONMENT TO ADDRESS WMSDS UW Participative Ergonomics Process and Program Blueprint 3. PRIMARY HEALTH OUTCOMES

49. Discussion: Psychosocial Change Pathway Distribution of WMSD symptoms Psychosocial Time delay 4: CHANGES IN PAIN / DISCOMFORT (questionnaires) 2a: Workplace physical interventions 2. PLANT LEVEL WORKPLACE INTERVENTIONS: 2b: Workplace psychosocial interventions 3b: Change in communication levels and/or psychosocial exposures (questionnaires) Compliance # of workers affected Ergonomic change quality # of changes implemented Extent to which changes used Quality of communications Amount of feedback acted on 3a1: Change in mechanical exposures (change specific evaluations) 3a2: Change in Perceived Effort (questionnaires) 1: MANAGEMENT/ WORKFORCE ATTITUDES TO CHANGING THE WORK ENVIRONMENT TO ADDRESS WMSDS UW Participative Ergonomics Process and Program Blueprint 3. PRIMARY HEALTH OUTCOMES 10 Psychosocial projects

50. Discussion: Psychosocial Change Pathway Distribution of WMSD symptoms Psychosocial Time delay 4: CHANGES IN PAIN / DISCOMFORT (questionnaires) 2a: Workplace physical interventions 2. PLANT LEVEL WORKPLACE INTERVENTIONS: 2b: Workplace psychosocial interventions 3b: Change in communication levels and/or psychosocial exposures (questionnaires) Compliance # of workers affected Ergonomic change quality # of changes implemented Extent to which changes used Quality of communications Amount of feedback acted on 3a1: Change in mechanical exposures (change specific evaluations) 3a2: Change in Perceived Effort (questionnaires) 1: MANAGEMENT/ WORKFORCE ATTITUDES TO CHANGING THE WORK ENVIRONMENT TO ADDRESS WMSDS UW Participative Ergonomics Process and Program Blueprint 3. PRIMARY HEALTH OUTCOMES 10 Psychosocial projects Ergo communication sig. increased

51. Discussion: Psychosocial Change Pathway Distribution of WMSD symptoms Psychosocial Time delay 4: CHANGES IN PAIN / DISCOMFORT (questionnaires) 2a: Workplace physical interventions 2. PLANT LEVEL WORKPLACE INTERVENTIONS: 2b: Workplace psychosocial interventions 3b: Change in communication levels and/or psychosocial exposures (questionnaires) Compliance # of workers affected Ergonomic change quality # of changes implemented Extent to which changes used Quality of communications Amount of feedback acted on 3a1: Change in mechanical exposures (change specific evaluations) 3a2: Change in Perceived Effort (questionnaires) 1: MANAGEMENT/ WORKFORCE ATTITUDES TO CHANGING THE WORK ENVIRONMENT TO ADDRESS WMSDS UW Participative Ergonomics Process and Program Blueprint 3. PRIMARY HEALTH OUTCOMES 10 Psychosocial projects Ergo communication sig. increased Unchanged perceived decision latitude and influence

52. Discussion: Psychosocial Change Pathway Distribution of WMSD symptoms Psychosocial Time delay 4: CHANGES IN PAIN / DISCOMFORT (questionnaires) 2a: Workplace physical interventions 2. PLANT LEVEL WORKPLACE INTERVENTIONS: 2b: Workplace psychosocial interventions 3b: Change in communication levels and/or psychosocial exposures (questionnaires) Compliance # of workers affected Ergonomic change quality # of changes implemented Extent to which changes used Quality of communications Amount of feedback acted on 3a1: Change in mechanical exposures (change specific evaluations) 3a2: Change in Perceived Effort (questionnaires) 1: MANAGEMENT/ WORKFORCE ATTITUDES TO CHANGING THE WORK ENVIRONMENT TO ADDRESS WMSDS UW Participative Ergonomics Process and Program Blueprint 3. PRIMARY HEALTH OUTCOMES 10 Psychosocial projects Ergo communication sig. increased Unchanged perceived decision latitude and influence Plantwide pain levels did not change

53. Department of Kinesiology - Biomechanics University of Waterloo, 2002 Potential Confounders: Differential Study Site Experiences  Line speed changes  New plant managers  Contract negotiations

54. Department of Kinesiology - Biomechanics University of Waterloo, 2002 Conclusions:  The Blueprint participatory model enhanced the quality and impact of each of the final physical change projects.  The Intervention Outcome Pathway model was helpful in interpreting the results, and in performing diagnostic evaluations of the different elements involved in the ergonomic intervention.

55. Department of Kinesiology - Biomechanics University of Waterloo, 2002 Conclusions:  Peak and task-level cumulative exposures were decreased by each of the 10 change projects.  However, when shift long job demands and job rotation schedules were considered, the cumulative impacts were sufficient to reduce overall mechanical exposures for only two changes.  Perceived Effort did not systematically change  This might, in part, explain the decreased pain severity values in only one department.

56. Department of Kinesiology - Biomechanics University of Waterloo, 2002 Conclusions:  The participatory ergonomics intervention resulted in enhanced communication dynamics regarding ergonomic issues.  Lack of commitment lead to lack of significant change in perceived Decision Latitude and Influence.  This, in part, explains the lack of changes in plant-wide Pain Severity levels.

57. Department of Kinesiology - Biomechanics University of Waterloo, 2002 Recommendations:  Additional research should be performed to determine: the mechanical exposure changes necessary to reduce pain severity levels, the mechanical exposure changes necessary to reduce pain severity levels, the intensity of psychosocial interventions necessary to alter perceived decision latitude and influence levels, and the intensity of psychosocial interventions necessary to alter perceived decision latitude and influence levels, and the magnitude of psychosocial risk factor changes necessary to influence pain severity levels, the magnitude of psychosocial risk factor changes necessary to influence pain severity levels, The success of the participatory process in other worksites. The success of the participatory process in other worksites.

58. Department of Kinesiology - Biomechanics University of Waterloo, 2002 Recommendations:  The Ergonomics Change Team evaluated in this study should: be encouraged to commit to the participatory change process, and be encouraged to commit to the participatory change process, and continue to implement physical and psychosocial ergonomic changes in hopes that additional interventions will involve enough cumulative benefits to influence primary indicators of health. continue to implement physical and psychosocial ergonomic changes in hopes that additional interventions will involve enough cumulative benefits to influence primary indicators of health.

59. Department of Kinesiology - Biomechanics University of Waterloo, 2002 Recommendations:  To enhance chances of improved indicators of health, a corporate ergonomist should be involved to direct the team’s efforts.

60. Department of Kinesiology - Biomechanics University of Waterloo, 2002 THANK YOU “You can buy people’s time, you can buy their physical presence at a given place, you can even buy a measured number of their skilled muscular motions per hour. But you cannot buy loyalty, you cannot buy the devotion of hearts, minds, or souls. You must earn them.” - in Saari, 1989