This paper examines the prevalence, costs, and prevention of work-related musculoskeletal disorders (MSDs) through ergonomic interventions. Drawing on epidemiological data showing that MSDs account for 29–35% of occupational injuries and cost billions annually, the paper evaluates specific assessment tools such as the Hand Activity Level (HAL), Job Strain Index (JSI), Rapid Upper Limb Assessment (RULA), and Quick Exposure Check (QEC). The author argues that effective interventions require both physical ergonomic controls and attention to psychosocial, organizational, and cultural factors. The paper concludes that combined intervention approaches, supported by participatory engagement and a just-culture organizational approach, offer the most promising outcomes for reducing MSDs and improving worker health and productivity.
It is often argued that ergonomic interventions in the workplace can help to reduce the incidence of musculoskeletal disorder (MSD). According to the United States Bureau of Labor Statistics (BLS, 2010), musculoskeletal disorders (MSDs) can be described as a variety of conditions that affect the muscles, joints, and bones. Some of these conditions include carpal tunnel syndrome, back pain, strains, sprains, soreness, hernia, and connective tissue disorders, to name a few. These injuries or illnesses can occur from overexertion, bad posture, bending, climbing, twisting, crawling, or repetitive motions.
The aforementioned conditions have the potential to seriously impact people's lives if not managed properly. The American Federation of Labor and Congress of Industrial Organizations (AFL-CIO) 2012 report states that MSDs accounted for 29–35% of all occupational injuries and illnesses involving days away from work in the private sector from 1992–2010. In 2000, the percentage of MSDs was highest at 35% during the period 1992–2010 (AFL-CIO, 2012). The report also states that in 2010, the percent of MSD cases increased from 29.4% in 2008 and 2009 to 30.5%.
According to BLS (2011), nursing aides, orderlies, hand laborers, janitors, truck drivers, and registered nurses had MSD cases greater than 10,000. Of the aforementioned occupations, nursing aides and orderlies had the highest MSD incidence rate of 249 cases per 10,000 full-time employees and the highest case count of 27,020 in 2010. This is concerning because if this increase continues over time, the financial impact would be significant.
The cost of work-related MSDs varies depending on the assessment technique used, the definition of MSDs, and the specific policies, procedures, and regulations employed by different regions. Treatment for MSDs can be very expensive. Treatment and compensation can cost industries, organizations, and insurance companies millions every year. Silverstein and Adams (2007) indicated that for the period 1997 through 2005, Washington State alone incurred direct costs for work-related MSDs of $6.8 billion. Dunning et al. (2010) obtained workers' compensation claims data from the Ohio Bureau of Workers' Compensation and noted that from 1999 to 2004, there were 572,508 eligible claims for MSDs, costing approximately $2,937 million—an average of $5,130 per claim. These figures are alarming, as they represent only two states. Therefore, the cost per country or region per year would be well into the billions, which, if not managed properly, can destabilize the economic state of businesses.
In order to mitigate or eliminate some of the risk factors associated with MSDs, ergonomic interventions must be put in place. Ergonomic interventions are policies and procedures used to better manage the risk factors associated with MSDs. Once ergonomic interventions are put in place and used effectively, they may not entirely eliminate the risk factors associated with MSDs; however, they will significantly reduce them. This will in turn be beneficial for both employer and employee.
There has been increasing concern about MSDs, their effects on employees, and how businesses and industries are affected by these effects. Due to these increasing concerns, numerous research studies have been conducted over the years to better understand the effects of MSDs and how these effects can be eliminated or reduced.
Due to the severe impact MSDs can have on employees, industries, and organizations, legislations, regulations, and standards have been developed and put in place to help control, reduce, and in some cases eliminate the risk factors associated with MSDs. Different countries or regions utilize different regulations, legislations, and standards depending on the anthropometry of the country or region. There are also different agencies and authorities that develop ergonomic intervention tools that can be used for the different risk factors associated with MSDs.
Risk to the hands and wrists takes into account repetition and duration. The American Conference of Governmental Industrial Hygienists (2002) recommends the Hand Activity Level (HAL) threshold limit values method to assist with managing these risks. While this tool takes workers' perspectives into account, it is more appropriate for assessing workstations with short cycles and is also time-consuming to complete. The Job Strain Index (JSI), on the other hand, assesses the same risk. Although this tool may have similar limitations as HAL, it has many strong points. It provides a basis for discussing workstation strengths and weaknesses with employees and is a useful source of information for understanding root causes of the most severe risk factors and tasks that are most difficult for employees. As such, it should be used instead of HAL. Both tools should not be used jointly, as they use different definitions for repetitive exertion, which, if different physical exposures are measured, will provide different results.
Depending on the task, some ergonomic intervention tools can be used solely, while others may require a combination of intervention tools in order to manage risk properly. According to McAtamney and Corlett (1993), Rapid Upper Limb Assessment (RULA) can be used to manage postural risk factors on the whole body; however, there are limitations within this tool, as it does not provide sub-scores for different regions of the body and workers' perceptions are not taken into account. Although RULA may prove useful as part of an ergonomic assessment, its level of reliability warrants caution for sole use. Therefore, this intervention tool should be paired with another tool like the Quick Exposure Check (QEC), which is able to eliminate the limitations of RULA. This combination will be better able to manage risk; however, the QEC can be used alone, as it is applicable to a number of working activities because it does not focus mainly on physical factors in the workplace but also evaluates psychosocial factors.
As stated by Moray (2000), "Issues relating to organizational culture, training needs, work organization and legal regulatory rules should also be addressed when making workplace interventions." Therefore, industries and organizations, when developing or choosing ergonomic intervention tools, should not focus solely on the physical aspect of the task. Instead, they should also take into account psychosocial, physiological, and organizational culture aspects. This is necessary because the development of work-related musculoskeletal disorders (WMSDs) is associated with a range of workplace, individual, and psychosocial risk factors. If employees are not in the correct frame of mind regarding their thoughts, behavior, and physical fitness, then having the right ergonomic intervention tools still will not be as effective in reducing risk factors.
Despite the physical demands imposed by task performance, researchers over the years noted that work or time pressure, lack of social support, and poor job satisfaction are all psychosocial factors that can contribute to WMSDs (Bernard et al., 1994; Lee et al., 1989; Toomingas et al., 1997; Hoogendoorn et al., 2000; Woods, 2005).
Culture plays a significant role in the implementation of ergonomic intervention tools. Therefore, it is necessary that employers use participatory intervention tools so that employees feel part of the process. It is also important that the industry and organization develop or adopt a just-culture approach. This can be done by providing training for all management personnel in mentoring and coaching skills, embedding organizational beliefs, values, and assumptions through changes in leader behavior and focus, and by implementing reward and recognition systems. By doing this, the implementation of the ergonomic intervention tool is more likely to be successful.
"Results of properly implemented ergonomic controls"
Since MSDs is one of the leading causes of workplace disabilities, lower production rates, and poor quality of living, it should be a major concern. The severity of the injuries, illnesses, and losses associated with MSDs should be motivation for industries to explore ergonomic interventions and reduce exposures causing MSDs.
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