1. Copyright P.Buckle 2000 Robens Centre for Health Ergonomics University of Surrey Europe and work-related neck and upper limb musculoskeletal disorders Peter Buckle

2. Copyright P.Buckle 2000 Structure of the presentation Methods used to prepare review Nature, size & cost of the disorders Relationship between work and neck and upper limb disorders –Biological pathology, epidemiological evidence,workplace interventions Strategies for Prevention –risk assesment, existing practice, surveillance Action and Conclusions

3. Copyright P.Buckle 2000 Contemporary scientific literature Expert opinion Existing framework of Member state, European and International Directives, standards and guidance Existing Practice The needs and capacities of those who may use the ergonomic actions that are suggested Approaches Used

4. Copyright P.Buckle 2000 The Nature of the Disorders

5. Copyright P.Buckle 2000 Classification and Diagnosis of the Conditions With some conditions there is general agreement as to the nature of the disorder despite a lack of standardisation in agreed diagnostic criteria. In contrast, there are also predominantly symptom based conditions, where there is difficulty in identifying precisely the tissue(s) responsible.

6. Copyright P.Buckle 2000 Setting diagnostic criteria Different diagnostic criteria may be required dependent on the setting Sensitive criteria (low false negative rate) may be necessary in an occupational setting More highly specific criteria are required in secondary or tertiary care situations to avoid over-diagnosis

7. Copyright P.Buckle 2000 Consensus on Disorder Diagnosis Recognition of recent sources (e.g. Harrington et al, 1998; Coronel Institute, Amsterdam, Netherlands, 2000) Debate over the need for higher specificity of outcome versus the requirement to initiate common pathways for prevention with a generic approach

8. Copyright P.Buckle 2000 Size of the Problem

9. Copyright P.Buckle 2000 Guildford 155 million workers

10. Copyright P.Buckle 2000 WRULDS in the EU Size of the problem

11. Copyright P.Buckle 2000 European Survey of Working Conditions (European Foundation, 1997)

12. Copyright P.Buckle 2000 Pathogenesis Evidence of work causation and biological plausibility Biological plausibility National Academy of Science report 1998 Epidemiological basis National Institute of Occupational Health and Safety report 1997

13. Copyright P.Buckle 2000 Pathomechanisms Understanding varies across WRULDs Impressive knowledge (e.g. CTS) Knowledge base is derived from –biomechanics –mathematical modelling –direct measurement of tissue pathology Forms a coherent argument for biomechanically induced pathogenesis

14. Copyright P.Buckle 2000 Work-Relatedness Epidemiological evidence shows a strong positive relationship between WRULDs and work –Especially for high levels of exposure Psychosocial and work organisation factors are also important

15. Copyright P.Buckle 2000 Force Posture (static/dynamic) Vibration Combinations of factors DurationRepetition Intensity/Ampl. How much?How often?How long?

16. Copyright P.Buckle 2000 Psychological and Work Organisational Risk Factors Evidence for a relationship between psychosocial work factors and some neck and upper limb disorders Definitions for these factors required Guidance may include job decision latitude, job demands and social support

17. Copyright P.Buckle 2000  Posture  Force  Vibration (Buff./Vacuum s)  Diff. keeping up with work  Moving furniture  Repetitive work  Poor work environment Multifactorial problem

18. Copyright P.Buckle 2000 Is there evidence that workplace interventions would reduce the risks associated with these disorders?

19. Copyright P.Buckle 2000 Potential for intervention suitable evidence from both controlled and uncontrolled studies that work system interventions were effective for reducing the problem such interventions most likely to be successful amongst workers in high/risk exposure groups

20. Copyright P.Buckle 2000 Successful interventions Focus should be on work organisation interventions and work place interventions, not solely on worker interventions (i.e. training/work hardening) Also prudent to reduce discomfort and fatigue

21. Copyright P.Buckle 2000 Existing Directives, Standards and Guidance Framework for risk identification and prevention(89/391) Prevention of manual handling risks (90/269) Risks from DSE (90/270) Min. Standards w/places (89/654) Working time (93/104) Common CEN standards

22. Copyright P.Buckle 2000 Prevention Strategies Assessment of risk factors –postural, force applications, vibration, direct pressure, cold, psychosocial and work organisational factors –prudent to consider fatigue as a potential precursor of WRULDs –considered the ability of practitioners assessing risks

23. Copyright P.Buckle 2000 Main criteria for exposure assessment methods Cheap, easy to learn and quick to use Applicable to all Methods should not interfere with the work Method needs high validity, reliability and sensitivity Easy coding/analysis of data

24. Copyright P.Buckle 2000 Prevention Strategies Assessment of risk factors –postural, force applications, vibration, direct pressure, cold, psychosocial and work organisational factors –prudent to consider fatigue as a potential precursor of WRULDs –considered the ability of practitioners assessing risks Health and surveillance programmes A 3-zone model for action

25. Copyright P.Buckle 2000 3 Zone Model for Action

26. Copyright P.Buckle 2000 Conclusions Report download http://osha.eu.int WRULDs are a significant problem in the EU Biomechanical pathogenesis for some WRULDs Epidemiological evidence shows a strong positive relationship between (some) WRULDs and a number of work factors The potential benefits from work system interventions is supported by scientific knowledge … action is needed

27. Copyright P.Buckle 2000 The University of Surrey “Understanding the real world” Robens Centre for Health Ergonomics www.surrey.ac.uk