0
Visualização
Acesso aberto Revisado por Pares
ARTIGO DE REVISÃO

Preventive factors against work-related musculoskeletal disorders: narrative review

Fatores de prevenção de distúrbios osteomusculares relacionados ao trabalho: revisão narrativa

Cleuma Oliveira Soares1; Bianca Furtado Pereira1; Marcella Veronnica Pereira Gomes1; Laís Passos Marcondes2; Fabiana de Campos Gomes3; João Simão de Melo-Neto1

DOI: 10.5327/Z1679443520190360

ABSTRACT

Musculoskeletal disorders (MSDs) are major causes of morbidity among workers. They comprise several signs and symptoms, as e.g. pain, paresthesia, fatigue and limited range of motion, which can be related to work tasks. Workplace-related factors include physical, psychological, social and biomechanical hazards. The main kinetic factors associated with MSDs include repetitive movements, exerting excessive force, awkward postures, compression and mechanical vibration. Accurate knowledge of epidemiological aspects, evaluation of ergonomic hazards and musculoskeletal symptoms, and workplace exercise may help reduce the occurrence of MSDs. The aim of the present review is to analyze the applicability of preventive strategies against MSDs among workers. We performed a narrative review based on a survey of databases PubMed and BIREME and included studies published in English, Spanish or Portuguese. We found that workplace exercise is beneficial for both employers and workers. Risk analysis of MSDs is essential for early identification of occupational hazards and to prevent health consequences and costs associated with absenteeism.

Keywords: work; disease prevention; exercise; musculoskeletal diseases; occupational health.

RESUMO

Os distúrbios osteomusculares (DOM) representam as principais causas de morbidade nos trabalhadores. Estes distúrbios podem ser entendidos como um conjunto de sinais e sintomas relacionados ao trabalho, tais como dor, parestesia, fadiga e limitação da amplitude de movimento. Estas disfunções são devidas a fatores biomecânicos, sociais, psicológicos e físicos no ambiente de trabalho. Os principais fatores cinéticos funcionais associados a essas lesões são: movimentos repetitivos, força excessiva, postura inadequada, compressão e vibração mecânica das articulações. Nesse contexto, o conhecimento das características epidemiológicas, das ferramentas para avaliação do risco ergonômico e da sintomatologia osteomuscular e a realização de ginástica laboral podem contribuir para reduzir a ocorrência dos DOM. Assim, a proposta da presente revisão é demonstrar a aplicabilidade de estratégias para a prevenção dos DOM nos trabalhadores. A revisão narrativa foi realizada a partir de um levantamento nas bases de dados PubMed e BIREME. Foram incluídos estudos publicados em inglês, espanhol ou português. A prática de exercício promove benefícios tanto para as organizações quanto para os trabalhadores. As ferramentas para análise de risco de DOM são importantes para a identificação precoce dos riscos no trabalho e assim evitar consequências negativas para a saúde e os custos gerados pelo afastamento dos trabalhadores.

Palavras-chave: trabalho; prevenção; exercício; doenças musculoesqueléticas; saúde do trabalhador.

MUSCULOSKELETAL DISORDERS

Musculoskeletal disorders (MSDs) are characterized by lesions in muscles, tendons, joints, ligaments, bone, nerves and the blood circulation system1 likely to cause functional imbalances. As per definition, MSDs include degenerative and inflammatory conditions which may affect a wide range of structures and result in acute or chronic pain, decreased mobility and impaired social participation. These disorders may further reduce the quality of life of workers2 and damage their physical and mental health.

Musculoskeletal pain may occur in any period of life—childhood, adolescence, adulthood or old age3,4—and persist long term. The main risk factors in childhood and adolescence are obesity, psychological problems, sitting too much, exhausting exercise and smoking. In adulthood, a sedentary lifestyle, overweight/obesity, psychological distress and long history of pain. All these factors contribute to the chronic pain associated with MSDs3.

Together with the increase of the life expectancy in developing countries, the incidence of sedentary lifestyles has grown, and consequently also that of MSDs5. These conditions may be triggered or aggravated when associated with comorbidities among individuals of advanced age and with bone fragility5,6. In the general population, a growing relationship has been noticed between work and development, exacerbation or worsening of work-related musculoskeletal disorders (WMSDs).

The frequency of adverse health outcomes in occupationally active populations has increased regardless of the type of labor activity7,8. These situation may influence the occurrence of WMSDs, as well as psychosocial problems, organizational behaviors, sociodemographic factors9 and underlying pathologies. WMSDs are one of the main problems in occupational health, resulting in high costs7,8, decreased productivity and poorer health-related quality of life10,11. While reducing workplace risk factors is difficult, ergonomic interventions and workplace exercise are essential to prevent injuries.

Indeed, ergonomic interventions and workplace exercise improve the quality of the work environment, help prevent or control musculoskeletal symptoms and provide the flexibility and adaptability needed to accomplish tasks7,12,13. This type of interventions may reduce the frequency of absenteeism, medical leave, exposure to risk factors and future injuries. In addition, workplace exercise programs may substantially improve the employees' perspective of their own work and quality of life and afford them a greater sense of wellbeing14, since regular physical activity can help prevent or reduce risk of several diseases5.

Prevention is favorable for workers, employers and society in general12. Within this context, identifying, correcting and avoiding work-related disorders is crucial, because the workplace affords conditions for adequate support and attention to occupational health15.

In the present review we discuss epidemiological and etiological aspects, the pathogenesis and clinical manifestations of WMSDs. We further address clinical evaluation, ergonomic interventions, workplace exercise and the applicability of primary prevention resources. Interventions likely to optimize and improve the quality of work environments enhance the functional quality of services and the health of employees, resulting in improved productivity and performance in daily life and at work.

 

EPIDEMIOLOGICAL ASPECTS

Musculoskeletal pain have gained worldwide attention inasmuch are seeking to understand and measure their burden to society15. The socioeconomic impact of WMSDs is significant in both developed and developing countries9, and identifying the main factors associated with their incidence and prevalence may help shape the primary prevention interventions.

Sociodemographic variables, such as ethnicity, sex, age and economic status, are directly related to the onset of WMSDs16. A high prevalence of these disorders has been identified among whites17. Women exhibit higher incidence and prevalence of MSDs16,18 than men in association with anthropometric differences. Older workers, as a function of their longer length in the job, are more susceptible to these conditions as a result of cumulative exposure19. These disorders are more frequent in countries with lower gross domestic product (GDP)16.

Low levels of education and of professional qualification are other factors to be taken into account20. Occupation directly influences WMSDs. For example, manual labor, traditional occupations, such as agriculture and fishing, or and jobs with high physical demands include repetitive and physically intensive tasks 9,20. Also conditions such as long working hours and pre-existing diseases, cultural factors and lack or scarcity of laws to support healthy and appropriate working conditions are aspects which should be considered21-23. In inadequate environments, workers are more susceptible to lesion24. Discomfort and pain; joint and soft injuries are Musculoskeletal complaints frequent in primary care25, that can lead the work withdrawal.

Chronic pain is more common among populations in developing than in developed countries. A meta-analysis found high frequency of WMSDs, unspecified chronic pain, lower back pain and chronic headache in low-income countries in Latin America, Africa and Asia. However, on comparison with the general population only the prevalence of low back and musculoskeletal pain was higher26.

Low back pain is the main complaint associated with work-related health problems22,27. This type of chronic pain causes financial losses, increases medical costs and impairs the personal life of workers21,22. Among workers, low back pain has been associated with heavy workloads, smoking, previous history of pain, and cultural and psychosocial factors, including poor mental health and multiple physical disorders28-31. Also neck and upper limb complaints are frequent among workers17,18. Cervicalgia occurs more often among females and workers who perform repetitive activities18. Work-related psychosocial and organizational factors were found to be associated with variables such as insecurity, work-life imbalance, hostile environment, non-standard work organization, multiple jobs and long working hours, all of which are potential risk factors for neck pain32. Neck pain is associated with higher-level occupations, working at the computer more than 6 hours/day, psychological fatigue and limited neck movement33.

According to a study, independently from the intensity of tasks individual factors associated with WMSDs of the upper limbs among workers were: age (older), race (white), sex (female), previous symptoms and job tasks involving wrist bending or forceful gripping. Wrist bending was found to behave as independent predictor of functional impairment17. In another study, the most prevalent WMSDs of the upper limbs among workers in different occupational categories corresponded to nerve compression (radial and ulnar nerve entrapment). However, among shoe industry workers, the highest incidence was found to correspond to rotator cuff syndrome34. In regard to the elbow joint (medial or lateral) epicondylitis is the most prevalent disorder and affects mainly women. Job tasks allowing for higher physical mobility and less use of definite parts of the body might reduce the prevalence of elbow and hand pain18. Several measures to encourage coworker and supervisor support have been described as protective factors against WMSDs17.

 

PATHOPHYSIOLOGY

ETIOLOGY

The etiology of WMSDs is complex, as it involves kinetic, functional, psychosocial and ergonomic aspects of the work environment. Psychosocial conditions involving physical stress and mental health problems with exposure to an overload of fast-paced work may also be related to the etiology of WMSDs35-37. Ergonomic factors include awkward postures, continuous and excessive use of force, repetitive movements, working long hours without rest and poor working conditions35.

Staying in a same position for a long period of time has significant consequences for health, such as increase of musculoskeletal symptoms, discomfort in the workplace and exhaustion during the day38. Continuous and excessive use of strength, associated or not with repetitive movements, may cause tissue damage and thus reduce the tolerance to make the same effort again. Imbalance between job demands and workers' skills increases the risk of MSDs39.

The term workload alludes to a set of variables with impact on workers and which require regulation and constant adaptation to achieve the desired physical, psychological and cognitive outcomes40. The physical workload, associated with awkward postures8, repetitive movements and static postures (sitting or orthostatic)7 may cause or contribute to WMSDs.

Workers who sit long hours and use computers are predisposed to ergonomic risks and account for most cases of work-related neck and low back pain. Awkward upper limb postures are a risk factor for MSDs among office workers41. These WMSDs are directly related to the characteristics of the physical space, such as backrest adequacy, chair height and arm support. Readjusting the work equipment, including monitor, keyboard, mouse, chair and desk, is an important ergonomic intervention to reduce the rates of MSDs and improve the body posture, especially among workers who use computers daily42.

Keyboard-intensive tasks were found to be associated with less neutral wrist postures, larger wrist velocities and accelerations and larger forearm muscle activities43. In turn, mouse-intensive tasks were associated with less neutral shoulder postures and less variability in forearm muscle activity. Combined keyboard and mouse use tasks were associated with higher shoulder muscle activity, larger range of motion and larger velocities and accelerations of the upper arm43.

Height adjustable desks might help improve workstations and allow workers to perform their tasks either sitting or standing. Therefore, they shorten the time spent sitting and increase the time spent standing. Adjusting these desks is quick and easy44, while their use contributes to improve cardiometabolic parameters and is well accepted by workers given its easy handling45.

Workplace adjustments may minimize the impact of work tasks and shorten the workers' exposure to ergonomic hazards associated with WMSDs46.

PATHOGENESIS AND CLINICAL MANIFESTATIONS

Awkward postures at work may exacerbate pre-existing injuries24,47 or cause new ones. However, also adequate postures may trigger WMSDs. These disorders occur following the accumulation of microtraumas, which overload the musculoskeletal system, nerves and blood vessels1. Here we discuss several aspects of the pathogenesis and clinical manifestations of the body sites most frequently involved in WMSDs, namely the cervical and lumbar spine, and the upper limbs2.

Injuries in the lower back usually result from an abrupt response to sudden loading24. The paravertebral are considered intrinsic back muscles because they are primarily responsible for spine movements. In case of joint injury, the paravertebral muscles surrounding the affected joint contribute to cause pain48. Individuals who perform physically intensive activities involving heavy loads require greater activation of the spine flexor and extensor muscles to maintain the body stability24,49 which causes local hypertonicity. A poor posture may cause disc injury, as is, e.g. the case of office employees who spend most of the working day sitting50. This condition may cause microtrauma to the outer fibrous ring, resulting in disc protrusion and herniation.

Cervicalgia among workers might be due to the myofascial pain syndrome and muscle tension in the neck, eventually extending to the shoulders, a condition characterized by severe pain51. Cervical disk injury might also be caused by poor posture, especially among workers whose tasks demand bending the neck for a long period of time, which may cause microtrauma to the outer fibrous ring of the intervertebral discs.

Conditions such as tendinopathies, enthesitis and bursitis might occur in the upper limbs as a consequence of inappropriate joint movements, and are associated with the abovementioned etiological factors. The latter contribute to cause stress, microtrauma and lesions, which trigger inflammation and thus interfere with the biomechanics of the involved joint, resulting in several clinical manifestations52.

Tendinopathy is an inflammation of one or more tendons25, including rotator cuff injuries, i.e. one of the main complaints reported by workers and impairs their performance at work53. In turn, enthesitis is inflammation of the entheses and causes pain in the sites where muscles, tendons and ligaments attach to bones54. Bursitis is the inflammation of the bursa52.

When inflammation occurs in joints with considerable muscular recruitment and range of motion, it causes imbalance in the joint movement due to weakness and pain53 and may lead to arthritis and arthrosis.

The wrist is frequently affected in several peripheral neuropathies likely to cause disabling lesions, including ulnar tunnel syndrome55, hypothenar hammer syndrome56, De Quervain's tenosynovitis57 and carpal tunnel syndrome58.

The ulnar tunnel syndrome is associated with compression of the nerve that passes through Guyon's canal. Compression leads to sensory and motor deficits in the fifth finger, medial side of the fourth finger and the hypothenar region55,59.

Hypothenar hammer syndrome develops following ulnar artery damage in Guyon's canal56,60. It affects workers whose tasks involve pressure on the hypothenar eminence, which exposes the palm to repeated trauma, with consequent damage to the local vascularization61,62. Clinical manifestations range from pain to ischemia of the fingers63.

De Quervain's tenosynovitis is an inflammation of the sheath around the tendons of the thumb short extensor and long abductor muscles in the wrist, which causes constriction upon moving the wrist57. This condition is considered a work-related health problem and may be aggravated by ergonomic factors likely to intensify the symptoms of disease. However, there is insufficient evidence for a relationship with occupational factors64. Some clinical manifestations, such as pain and swelling of the radial styloid process, interfere with the movement of wrist65. Ulnar deviation might be limited as a function of pain; surgery might be indicated when symptoms are persistent66,67.

Carpal tunnel syndrome is a disorder with significant impact on the productivity of the affected workers58. It is due to the compression of the median nerve within an osteofibrous structure through which it passes together with the flexor tendons of the wrist67. Working postures which require sustained wrist flexion may induce tendon inflammation, with consequent compression of the median nerve58,68.

All these disorders might have acute or chronic nature, and cause pain or dysfunction due to overload to the musculoskeletal system, nerves and related vessels1. The symptoms of WMSDs are physical discomfort and pain, that can take the alters of the mental health and lifestyle2,69.

Some conditions, such as pre-existing osteoarthritis, obesity and diabetes, may intensify musculoskeletal and joint pain, and trigger a process of degeneration of appendicular and vertebral facet joints. However, there are divergences in regard to these association, therefore further studies are still needed70.

PREVENTIVE FACTORS

We analyzed the effectiveness of ergonomic resources and the benefits of workplace exercise mentioned in studies published in international journals and written in English, Portuguese or Spanish.

We first searched databases using keywords selected from the National Library of Medicine Medical Subject Headings (MeSH). Next we added four keywords corresponding to ergonomic tools not included in MeSH. The search strategies are described in Figure 1.

 


Figure 1. Search strategy. Belém (PA), 2018.

 

Two investigators independently searched published peer-reviewed research articles in the following databases: PubMed and Regional Library of Medicine (BIREME). During initial screening the investigators selected articles based on their titles and abstracts, and excluded studies which did not meet the inclusion criteria. Therefore, off-topic studies, articles published in languages other than English, Spanish or Portuguese, repeated records, review articles and studies published more than five years earlier were excluded. We chose to search a limited number of databases and set time limits to increase the quality of the records and obtain up-to-date sources. In the last step the studies were subjected to full-text analysis. Study protocols, pilot studies, care series and case reports were also excluded. Instances of disagreement were solved by discussion and consensus. The process of study selection is depicted in Figure 2.

 


Figure 2. Flowchart depicting study selection for narrative review. Belém (PA), 2018.

 

We describe the main results relative to the application of the located resources to different populations is presented in the sequence in this narrative review narrative review.

CLINICAL EVALUATION

Adequate medical history taking is essential to achieve an accurate diagnosis. Physical examination including palpation of skeletal landmarks, posture analysis to investigate deformities71 and imaging tests further contribute to diagnostic accuracy71,72. Workplace risk and occupational health analysis with focus on the musculoskeletal system are fundamental to improve performance.

WORKPLACE RISK ANALYSIS

Risk analysis of WMSDs should consider both individual and environmental characteristics. In this regard, the main risk variables analyzed in the included studies were posture, daily working hours, task repetitiveness and environmental aspects such as tools and equipment35.

There are many ways to perform risk assessment in the present time, and the selected method should be based on the aims of the evaluation73. Ergonomic contribute to the analysis of the work environment and to the determination of the degree of risk to which workers are exposed during the performance of their job tasks. Among the many methods available to investigate WMSD risk we reviewed:

• Rapid Entire Body Assessment (REBA)

REBA is a systematic method for full-body postural evaluation74 and was used in studies conducted with different populations of workers: dentists75, construction laborers76, meat cutters77, workers at horse stables78, rubber factories79 and bicycle repair units80. These jobs demand postures associated with high risk for MSDs and thus require ergonomic evaluation and functional investigation.

Among dentists, risk was associated with repetitive actions and sustained muscle contraction75. Almost all of the tasks and postures among construction workers and meat cutters were found to increase the risk of WMSDs76,77. Ergonomic interventions are urgently needed in bicycle repair units to provide orientation on the use of tools, workstations and tasks80. For rubber factories, the REBA method provided predictors of MSDs in the neck, shoulders, elbows, upper back, lower back, hips, thighs, ankles and feet. This method further demonstrated that the manual tasks involved in the maintenance of horse stables represent severe ergonomic problems78.

The REBA method was also used to investigate the effectiveness of interventions. Thus Ratzon et al.81 could establish that the risk of WMSDs decreased among nurses following an ergonomic intervention program over a short follow-up period.

Quantifying risk through the REBA method allowed Yoon et al.82 to develop a job rotation model to prevent WMSDs based on tasks groups of high and low workload workstations. This type of model might be suggested and adapted also for other occupational groups to prevent injuries.

Lamarão et al.83 translated and cross-culturally adapted REBA for use in Brazil. However, they observe that some reformulations are still needed and that biomechanical risk should be interpreted cautiously.

In our view, further studies are still warranted including workers from different occupational groups.

• OVAKO Working Posture Analyzing System (OWAS)

OWAS is an evaluation tool for heavy lifting. It analyzes the body posture for the back, arms, legs and head according to weight or force requirements84,85. This scale has been applied to different categories of workers.

Based on OWAS, manual laborers were found to exhibit high frequency of MSDs due to job tasks repeated daily and which involve harmful postures86. In a semi-trailer assembly factory, Brandl et al.87 identified the most common working postures and found that 26% of them could have harmful effect on the musculoskeletal system. According to these authors87 ergonomic interventions centered on individual working postures may achieve better prevention outcomes than collective approaches.

Use of OWAS allowed demonstrating that almost all cooking work postures are associated with high risk of MSDs due to excessive repetitive movements. A similar result was found for construction workers76. In a truck assembly line, OWAS indicated that corrective measures were immediately necessary to prevent the occurrence of rotator cuff syndrome88.

Our analysis indicates that also other occupational groups should be investigated to verify the applicability of OWAS.

• Rapid Upper Limb Assessment (RULA)

RULA analyzes posture and force to estimate risk of damage to the upper limbs89. While this scale is one of the most widely used to investigate ergonomic risk in different occupational groups, further studies are still needed.

The RULA score was higher for computer office workers with musculoskeletal pain compared to those without this condition41,90. Ergonomic training may help reduce the risk of MSDs in this population of workers when outcomes are measured in terms of RULA scores91. Significant association was found between RULA scores and MSDs among dentists92,93. The RULA score indicated that workstations at a submersible pump manufacturing plant exhibited high level of risk94. For cooks, almost all body positions were found to pose high risk for MSDs in association with repetitive movements of the upper limbs95. A relationship between low back pain, RULA scores and educational level was found for pharmaceutical employees96.

In bicycle repair shops, the RULA scores pointed to immediate need for ergonomic intervention to provide technical guidance on the use of tools, workstations and execution of tasks80. In a study, RULA was used to guide an ergonomic intervention targeting assembly line workers at an electronic parts manufacturer. After RULA was applied, Daneshmandi et al.97 found reduction of the overload to the neck and trunk.

In clinical work environments, the RULA score was indicated to identify task difficulty and discomfort levels. However, this method is limited to steady postures98. In aircraft manufacturing, the condition with the highest adjustability created an environment with the lowest ergonomic risk, and consequently the best performance among workers in a simulated drilling task99. Ergonomic intervention may afford workers with neck and upper limb pain adaptations for the execution of their tasks, which may contribute to reduce the occurrence injuries100. RULA can also be used to test specific adjustments in the work environment to help reduce MSDs101.

• Strain Index (SI)

The Strain Index was devised to analyze posture and repetitive tasks of the upper limbs102, however, there is still scant research in this regard. SI scores were associated with lateral epicondylitis among workers103. In aircraft manufacturing, SI enabled adjusting tasks performed by workers subjected to a simulated drilling task to lower the risk of MSDs99. When applied to manufacturing workers, association was found between SI risk category and higher incidence of hand and arm symptoms104. While a revised version of SI (RSI) was recently developed105 the changes introduced need to be reevaluated.

TOOLS FOR FUTURE PERSPECTIVES

Several other tools are also described in the literature, however, more studies are still needed of their content and applicability, especially facing the current scenario. Such scales include:

• Novel Ergonomic Postural Assessment Method (NERPA), used for the postural analysis of the upper limbs106;

• European Assembly Worksheet (EAWS), which measures biomechanical loads to the upper limbs107;

• OCRA Index, which evaluates biomechanical stress to the hands, arms and shoulders during repetitive tasks107;

• National Institute for Occupational Safety and Health (NIOSH) Lifting Equation, which investigates the adequacy of physically demanding, two-handed manual lifting tasks108;

• Liberty Mutual Manual Materials Handling Tables, which serve to perform ergonomic assessments of lifting, lowering, pushing, pulling and carrying tasks so that they are tolerable to workers109,110;

• Key Indicator Methods (KIM), which consist in three different tools to analyze lifting, holding and carrying loads (KIM-LHC), pulling and pushing loads (KIM-PP) and health risk associated with manually handling in diverse work environments (KIM-MHO)73,111.

These assessment tools are able to detect risk and might support recommendations for interventions to avoid the occurrence of injuries. Therefore, they should be considered as a modality of primary prevention. Analysts may have resource to techniques such as photogrammetry, videogrammetry and anthropometry to perform these assessments. Also proper use of personal protective equipment, temperature, noise and lighting should be evaluated, because these factors may interfere with the execution of tasks and thus increase the risk of WMSDs.

EVALUATION OF THE OCCUPATIONAL HEALTH OF THE MUSCULOSKELETAL SYSTEM

Functions and dysfunctions of the musculoskeletal system have been investigated based on the electrical conductivity of muscles (electromyography), clinically evaluated in terms of presence of pain and restricted joint mobility, and associated with reported symptoms. The Nordic Musculoskeletal Questionnaire is one of the most widely used scales to evaluate reported musculoskeletal symptoms among workers112,113.

WORKPLACE EXERCISE

The main objective of workplace exercise is to contribute to improve performance along the working day and prevent WMSDs. Several exercise modalities may be implemented in the workplace as a function of the time of the day or purpose114. We briefly describe the main characteristics, applicability and benefits of the various available modalities.

TYPES

Time of the day

Preparatory

Workplace exercise can be undertaken at the beginning of the working day as a preventative measure. This type of workplace exercise is known as preparatory because its main purpose is to warm up the whole body before the job tasks begin115-119.

Compensatory exercise

Compensatory workplace exercise is also known as a short active breaks120 because it involves discontinuing job tasks to exercise. The aims of these breaks are to help release tension in the musculoskeletal system (muscles and joints) caused by task-related factors and to compensate for awkward postures. This type of exercise is essential to the physical and mental health of workers121,122.

Relaxation

Relaxation workplace exercise seeks to relieve fatigue and daily tension. This type of exercise should be performed at the end of working day122. It might also be combined to complementary therapies representing mind-body interventions, such as acupuncture, yoga, Pilates, progressive muscle relaxation and meditation123.

Purpose

Corrective or Postural

This modality seeks to rebalance the muscles by stretching and strengthening those recruited during the performance of job tasks114.

Compensatory exercise

This modality aims at providing postural rebalancing during work, preventing fatigue and reducing WMSDs. Postural rebalancing is needed especially when tasks require awkward static positions over a long period of time114.

Therapeutic

Therapeutic workplace exercise seeks to rehabilitate workers with WMSDs according to their individual complaints. This type of exercise should be performed in an appropriate location to contribute to readjust workers to their taks114. This modality is therefore not considered a form of primary prevention.

Management of MSDs to enable workers to return to work may include manual therapies, exercise and self-management education. Workers with injuries should develop the ability to manage their own state of health and quality of work life. Rehabilitation centered on return to work has paramount importance, since the affected individuals will have to work with the very equipment that initially caused the problems. Therefore self-management is fundamental for workers to perform their previous tasks safely124.

Work-oriented rehabilitation programs have been developed to reintegrate workers to the workplace125. Such programs are based on an evaluation of diagnosis, therapeutic interventions, strengthening goals and qualification to restart job tasks. These programs should be developed and run by a multidisciplinary staff125,126.

Maintenance or conservation

This type of workplace exercise consists in continuous programs to maintain the benefits achieved with therapeutic exercise. Physical conditioning and stretching resources may be used. Employers should provide appropriate locations for exercising at adequate intervals114.

Applicability

Workplace exercise should be performed daily or at least three times per week, duration depending on the selected type of exercise114:

Duration:

• Preparatory: 10 to 12 minutes;

• Compensatory exercise: 5 to 10 minutes;

• Relaxation: 10 to 12 minutes.

Purpose:

• Corrective or postural: 10 to 12 minutes;

• Compensatory exercise: 5 to 10 minutes;

• Therapeutic: 30 minutes;

• Maintenance or conservation: 45 to 90 minutes.

The weekly frequency and session duration depend on individual needs or those of groups of workers, therefore they vary accordingly. Time, rather than purpose, is the criterion most often considered in organizations114.

Table 1 describes the main methods used to design daily plans. Figure 3 demonstrates exercises which may be performed in the workplace. All exercises sould be performed under supervision. The movements of the exercise for postural control shoud be precisely executed and with the necessary ergonomic adjustments to reduce the chance of injury115,119. There are no specific protocols recommended. In addition, repeating a same routine might be demotivating, thereforeintroducing periodic changes is advised. Movements should be adjusted to the purpose of the exercise program. Figure 1 depicts some examples of movements which may be performed as part of workplace exercises.

 


Figure 3. Exercises which may be performed in the workplace. (A) Strengthening of the shoulder flexor muscles. (B) Stretching of the posterior neck muscles. (C) Stretching of the wrist flexor muscles. (D) Stretching of the lateral trunk muscles. Belém (PA), 2018.

 

 

 

BENEFITS

While there is no consensus on the best protocol or intervention to prevent MSDs14, workplace exercise programs are beneficial for both employers and workers127. Benefits for organizations include reduced absenteeism128, time-off requests, costs129 and sickness absence130, and improved subjective employability and work ability131. Benefits for workers are many. Exercising helps reduce muscle activity during tasks and increases the velocity of movements, accelerations during active neck movements115,132, aerobic capacity131 and fitness133. The rate of injuries was found to decrease among workers who exercise129, associated with reduced rates of MSDs128,134-137 and lower pain scores128,131,138-140. In addition, individuals who exercise report less fear of physical movement131.

 

FINAL CONSIDERATIONS

The prevalence of WMSDs is high in developed and developing countries and results in substantial costs and negative impact on the quality of life of workers. The workplace may be a crucial setting for early detection of these problems and rehabilitation of workers141. Workplace exercise programs have proven to be effective as primary prevention means142. Exercises should be well planned and appropriate for each particular group of workers. The work environment and the ability and physical profile of each individual worker should be taken into consideration. The frequency, intensity and type of exercises should be carefully established to ensure the corresponding benefits to workers and employers143.

 

REFERENCES

1. Jang TW, Koo JW, Know SC, Song J. Work-related musculoskeletal diseases and the workers compensation. J Korean Med Sci. 2014;29(Suppl.):S18-23. https://doi.org/10.3346/jkms.2014.29.S.S18

2. Punnett L, Wegman DH. Work-related musculoskeletal disorders: the epidemiologic evidence and the debate. J Electromyogr Kinesiol. 2004;14(1):13-23. https://doi.org/10.1016/j.jelekin.2003.09.015

3. Puroila A, Paananen M, Taimela S, Järvelin MR, Karppinen J. Lifestyle-factors in adolescence as predictors of number of musculoskeletal pain sites in adulthood: a 17-year follow-up study of a birth cohort. Pain Med. 2015;16(6):1177-85. https://doi.org/10.1111/pme.12697

4. Dick RB, Lowe BD, Lu Ml, Krieg EF. Further trends in work-related musculoskeletal disorders: A comparison of risk for simptons using quality of work life, data from the 2002, 2006 and 2010, general social survey. J Occup Environ Med. 2015;57(8):910-28. https://doi.org/10.1097/JOM.0000000000000501

5. Briggs AM, Cross MJ, Hoy DG, Sánchez-Riera L, Blyth FM, Woolf AD, et al. Musculoskeletal health conditions represent a global threat to healthy aging: a report for the 2015 world health organization world report on ageing and health. Gerontologist. 2016;56(Suppl. 2):S243-55. https://doi.org/10.1093/geront/gnw002

6. Chen X, Mao G, Leng SX. Frailty syndrome: an overview. Clin Interv Aging. 2014;9:433-41. https://doi.org/10.2147/CIA.S45300

7. Shuai J, Yue P, Li L, Liu F, Wang S. Assessing the effects of an educational program for the prevention of work-related musculoskeletal disorders among school teachers. BMC Public Health. 2014;14:1211. https://doi.org/10.1186/1471-2458-14-1211

8. Alghadir A, Anwer S. Prevalence of musculoskeletal pain in construction workers in Saudi Arabia. Scientific World J. 2015:1-5. http://dx.doi.org/10.1155/2015/529873

9. Dianat I, Kord M, Yahyazade P, Karimi MA, Stedmon AW. Association of individual and work-related risk factors with musculoskeletal symptoms among Iranian sewing machine operators. Appl Ergon. 2015;51:180-8. https://doi.org/10.1016/j.apergo.2015.04.017

10. Wang SY, Liu LC, Lu MC, Koo M. Comparisons of musculoskeletal disorders among ten different medical professions in Taiwan: a nationwide, population-based study. PLoS One. 2015;10(4):e0123750. https://doi.org/10.1371/journal.pone.0123750

11. McDonald M, DiBonaventura M, Ullman S. Musculoskeletal pain in the workforce: the effects of back, arthritis, and fibromyalgia pain on quality of life and work productivity. J Occup Environ Med. 2011;53(7):765-70. https://doi.org/10.1097/JOM.0b013e318222af81

12. Comper ML, Padula RS. The effectiveness of job rotation to prevent work-related musculoskeletal disorders: protocol of a cluster randomized clinical trial. BMC Musculoskelet Disord. 2014;15:170. https://dx.doi.org/10.1186%2F1471-2474-15-170

13. Macdonald W, Oakman J. Requirements for more effective prevention of work-related musculoskeletal disorders. BMC Musculoskeletal Disord. 2015;16:293. https://doi.org/10.1186/s12891-015-0750-8

14. Kuoppala J, Lamminpää A, Husman P. Work health promotion, job well-being, and sickness absences--a systematic review and meta-analysis. Occup Environ Med. 2008;50(11):1216-27. https://doi.org/10.1097/JOM.0b013e31818dbf92.

15. Wynne-Jones G, Artus M, Bishop A, Lawton SA, Lewis M, Jowett S, et al. Effectiveness and costs of a vocational advice service to improve work outcomes in patients with musculoskeletal pain in primary care: a cluster randomised trial (SWAP trial ISRCTN 52269669). Pain. 2018;159(1):128-38. https://doi.org/10.1097/j.pain.0000000000001075

16. European Musculoskeletal Conditions Surveillance and Information Network. Musculoskeletal Health in Europe: Report v5.0. European Musculoskeletal Conditions Surveillance and Information Network; 2012.

17. Gardner BT, Dale AM, VanDillen L, Franzblau A, Evanoff BA. Predictors of upper extremity symptoms and functional impairment among workers employed for 6 months in a new job. Am J Ind Med. 2008;51(12):932-40. https://doi.org/10.1002/ajim.20625

18. Nordander C, Ohlsson K, Akesson I, Arvidsson I, Balogh I, Hansson GA, et al. Risk of musculoskeletal disorders among females and males in repetitive/constrained work. Ergonomics. 2009;52(10):1226-39. https://doi.org/10.1080/00140130903056071

19. Petit A, Bodin J, Delarue A, D'Escatha A, Fouquet N, Roquelaure Y. Risk factors for episodic neck pain in workers: a 5-year prospective study of a general working population. Int Arch Occup Environ Health. 2018;91(3):251-61. https://doi.org/10.1007/s00420-017-1272-5

20. Farioli A, Mattioli S, Quaglieri A, Curti S, Violante FS, Coggon D. Musculoskeletal pain in Europe: the role of personal, occupational, and social risk factors. Scand J Work Environ Health. 2014;40(1):36-46. https://doi.org/10.5271/sjweh.3381

21. Matsudaira K, Konishi H, Miyoshi K, Isomura T, Takeshita K, Hara N, et al. Potential risk factors for new onset of back pain disability in Japanese workers: findings from the Japan epidemiological research of occupation-related back pain study. Spine. 2012;37(15):1324-33. https://doi.org/10.1097/BRS.0b013e3182498382

22. Kawaguchi M, Matsudaira K, Sawada T, Koga T, Ishizuka A, Isomura T, et al. Assessment of potential risk factors for new onset disabling low back pain in Japanese workers: findings from the cupid (cultural and psychosocial influences on disability) study. BMC Musculoskelet Disord. 2017;18(1):334. https://doi.org/10.1186/s12891-017-1686-y

23. Hossain MD, Aftab A, Al Imam MH, Mahmud I, Chowdhury IA, Kabir RI, et al. Prevalence of work related musculoskeletal disorders (WMSDs) and ergonomic risk assessment among readymade garment workers of Bangladesh: A cross sectional study. PLoS One. 2018;13(7):1-18. https://doi.org/10.1371/journal.pone.0200122

24. Madinei S, Motabar H, Ning X. The influence of external load configuration on trunk biomechanics and Spinal loading during sudden loading. Ergonomics. 2018;61(10):1364-1373. https://doi.org/10.1080/00140139.2018.1489068

25. Hubbard MJ, Hildebrand BA, Battafarano MM, Battafarano DF. Common soft tissue musculoskeletal pain disorders. Prim Care. 2018;45(2):289-303. https://doi.org/10.1016/j.pop.2018.02.006

26. Jackson T, Thomas S, Stabile V, Shotwell M, Han X, McQueen K. A systematic review and meta-analysis of the global burden of chronic pain without clear etiology in low- and middle-income countries: trends in heterogeneous data and a proposal for new assessment methods. Anesth Analg. 2016;123(3):739-48. https://doi.org/10.1213/ANE.0000000000001389

27. Jin K, Sorock GS, Courtney T, Liang Y, Yao Z, Matz S, et al. Risk factors for work-related low back pain in the people's Republic of China. Int J Occup Environ Health. 2000;6(1):26-33. https://doi.org/10.1179/oeh.2000.6.1.26

28. Sakthiswary R, Singh R. Has the median nerve involvement in rheumatoid arthritis been overemphasized? Rev Bras Reumatol Engl Ed. 2017;57(2):122-8. https://doi.org/10.1016/j.rbre.2016.09.001

29. Shiri R, Falah-Hassani K, Heliövaara M, Solovieva S, Amiri S, Lallukka T, et al. Risk factors for low back pain: A population-based longitudinal study. Arthritis Care Res (Hoboken). 2019;71(2):290-9. https://doi.org/10.1002/acr.23710

30. Vargas-Prada S, Serra C, Martínez JM, Ntani G, Delclos GL, Palmer KT, et al. Psychological and culturally-influenced risk factors for the incidence and persistence of low back pain and associated disability in Spanish workers: findings from the cupid study. Occup Eviron Med. 2013;70(1):57-62. https://doi.org/10.1136/oemed-2011-100637

31. Jensen JN, Holtermann A, Clausen T, Mortensen OS, Carneiro IG, Andersen LL. The greatest risk for low-back pain among newly educated female health care workers; body weight or physical work load? BMC Musculoskelet Disord. 2012;13:87. https://doi.org/10.1186/1471-2474-13-87

32. Yang H, Hitchcock E, Haldeman S, Swanson N, Lu ML, Choi B, et al. Work-related psychosocial and organizational factors for neck pain in workers in the United States. Am J Ind Med. 2016;59(7):549-60. https://dx.doi.org/10.1002%2Fajim.22602

33. Chen X, O'Leary S, Johnston V. Modifiable individual and work-related factors associated with neck pain in 740 office workers: a cross-sectional study. Braz J Phys Ther. 2018;22(4):318-27. https://doi.org/10.1016/j.bjpt.2018.03.003

34. Costa JT, Baptista JS, Vaz M. Incidence and prevalence of upper-limb work related musculoskeletal disorders: a systematic review. Work. 2015;51(4):635-44. https://doi.org/10.3233/WOR-152032

35. Bugajska J, Zolnierczyk-Zreda D, Jedryka-Góral A, Gasik R, Hildt-Ciupinska K, Malinska M, et al. Psychological factors at work and musculoskeletal disorders: a one year prospective study. Rheumatol Int. 2013;33(12):2975-83. https://dx.doi.org/10.1007%2Fs00296-013-2843-8

36. Vargas-Prada S, Coggon D. Psychological and psychosocial determinants of musculoskeletal pain and associated disability. Best Pract Clin Rheumatol. 2015;29(3):374-90. https://doi.org/10.1016/j.berh.2015.03.003

37. Freimann T, Pääsuke M, Merisalu E. Work-related psychosocial factors and mental health problems associated with musculoskeletal pain in nurses: a cross-sectional study. Pain Res Manag. 2016:2016:9361016. https://doi.org/10.1155/2016/9361016

38. Daneshmandj H, Choobineh A, Ghaem H, Karimj M. Adverse effects of prolonged sitting behavior on the general health of office workers. J Lifestyle Med. 2017;7(2):69-75. https://dx.doi.org/10.15280%2Fjlm.2017.7.2.69

39. Lunde LK, Koch M, Knardahl S, Wærsted M, Mathiassen SE, Forsman M, et al. Musculoskeletal health and work ability in physically demanding occupations: study protocol for prospective field study on construction and health care workers. BMC Public Health. 2014;14:1075. https://doi.org/10.1186/1471-2458-14-1075

40. Silva NR. Fatores determinantes da carga de trabalho em uma unidade básica de saúde. Ciênc Saúde Coletiva. 2011;16(8):3393-402. http://dx.doi.org/10.1590/S1413-81232011000900006

41. Rodrigues MS, Leite RDV, Lelis CM, Chaves TC. Differences in ergonomic and workstation factors between computer office workers with and without reported musculoskeletal pain. Work. 2017;57(4):563-72. https://doi.org/10.3233/WOR-172582

42. Esmaeilzadeh S, Ozcan E, Capan N. Effects of ergonomic intervention on work-related upper extremity musculoskeletal disorders among computer workers: a randomized controlled trial. Int Arch Occup Environ Health. 2014;87(1):73-83. https://doi.org/10.1007/s00420-012-0838-5

43. Dennerlein JT, Johnson PW. Different computer tasks affect the exposure of the upper extremity to biomechanical risk factors. Ergonomics. 2006;49(1):45-61. https://doi.org/10.1080/00140130500321845

44. Radas A, Mackey M, Leaver A, Bouvier AL, Chau JY, Debra S, et al. Evaluation of ergonomic and education interventions to reduce occupational sitting in office-based university workers: study protocol for a randomized controlled trial. Trials. 2013;14:330. https://doi.org/10.1186/1745-6215-14-330

45. Graves LEF, Murphy RC, Shepherd SO, Cabot J, Hopkins ND. Evaluation of sit-stand workstations in an office setting: a randomised controlled trial. BMC Public Health. 2015;15:1145. https://doi.org/10.1186/s12889-015-2469-8

46. Coenen P, Willenberg L, Parry S, Shi JW, Romero L, Blackwood DM, et al. Associations of occupational standing with musculoskeletal symptoms: a systematic review with meta-analysis. Br J Sports Med. 2018;52(3):176-83. https://doi.org/10.1136/bjsports-2016-096795

47. Barkallah E, Freulard J, Otis MJ, Ngomo S, Ayena JC, Desrosiers C. Wearable devices for classification of inadequate posture at work using neural networks. Sensors (Basel). 2017;17(9). https://doi.org/10.3390/s17092003

48. Bierry G, Kremer S, Kellner F, Abu Eid M, Bogorin A, Dietemann JL. Disorders of paravertebral lumbar muscles: from pathology to cross-sectional imaging. Skeletal Radiol. 2008;37(11):967-77. https://doi.org/10.1007/s00256-008-0494-8

49. Shahvarpour A, Shirazi-Adl A, Larivière C, Bazrgari B. Trunk active response and spinal forces in sudden forward loading: analysis of the role of perturbation load and pre-perturbation conditions by a kinematics-driven model. J Biomech. 2015;48(1):44-52. https://doi.org/10.1016/j.jbiomech.2014.11.006

50. Dreischarf M, Shirazi-Adl A, Arjmand N, Rohlmann A, Schmidt H. Estimation of loads on human lumbar spine: A review of in vivo and computational model studies. J Biomech. 2016;49(6):833-45. https://doi.org/10.1016/j.jbiomech.2015.12.038

51. Almeida MCV, Cezar-Vaz MR, Soares JFS, Silva MRS. The prevalence of musculoskeletal diseases among casual dock workers. Rev Latino-Am de Enfermagem. 2012;20(2):243-50. http://dx.doi.org/10.1590/S0104-11692012000200005

52. Reilly D, Kamineni S. Olecranon bursitis. J Shoulder Elbow Surg. 2016;25(1):158-67. https://doi.org/10.1016/j.jse.2015.08.032

53. Alonso LR, Moriana GC, Rejano JJJ, Tarrida PL, Fernández CR. Relationship between chronic pathologies of the supraspinatus tendon and the long head of the biceps tendon: systematic review. BMC Musculoskelet Disord. 2014;15:377. https://doi.org/10.1186/1471-2474-15-377

54. Watad A, Cuthbert RJ, Amital H, McGonagle D. Enthesitis: much more than focal insertion point inflammation. Curr Rheumatol Rep. 2018;20(7):41. https://doi.org/10.1007/s11926-018-0751-3

55. Lewanska M, Skorupa JW. Is ulnar nerve entrapment at wrist frequent among patients with carpal tunnel syndrome occupationally exposed to monotype wrist movements? Int J Occup Med Environ Health. 2017;30(6):861-74. https://doi.org/10.13075/ijomeh.1896.00970

56. Zhang F, Weerakkody Y, Tosenovsky P. Hypothenar hammer syndrome in an office worker. J Med Imaging Radiat Oncol. 2017;61(6):774-6. https://doi.org/10.1111/1754-9485.12651

57. Goel R, Abzug JM. De Quervain's tenosynovitis: a review of the rehabilitative options. Hand (N Y). 2015;10(1):1-5. https://doi.org/10.1007/s11552-014-9649-3

58. Ginanneschi F, Mondelli M, Cioncoloni D, Rossi A. Impact of carpal tunnel syndrome on ulnar nerve at wrist: systematic review. J Electromyogr Kinesiol. 2018;40:32-8. https://doi.org/10.1016/j.jelekin.2018.03.004

59. Coraci D, Loreti C, Piccinini G, Doneddu PE, Biscotti S, Padua L. Ulnar neuropathy at wrist: entrapment at a very "congested" site. Neurol Sci. 2018;39(8):1325-31. https://doi.org/10.1007/s10072-018-3446-7

60. Swanson KE, Bartholomew JR, Paulson R. Hypothenar hammer syndrome: a case and brief review. Vasc Med. 2012;17(2):108-15. https://doi.org/10.1177/1358863X11425878

61. Maroukis BL, Ogawa T, Rehim SA, Chung KC. Guyon canal: the evolution of clinical anatomy. J Hand Surg Am. 2015;40(3):560-5. https://doi.org/10.1016/j.jhsa.2014.09.026

62. Athlani L, Almeida YK, Maschino H, Dap F, Dautel G. Hypothenar hammer syndrome: A case of a late complication after surgery. Hand Surg Rehabil. 2018;37(5): 316-9. https://doi.org/10.1016/j.hansur.2018.07.001

63. Cigna E, Spagnoli AM, Tarallo M, De Santo L, Monacelli G, Scuderi N. Therapeutic management of hypothenar hammer syndrome causing ulnar nerve entrapment. Plast Surg Int. 2010;2010:343820. https://doi.org/10.1155/2010/343820

64. Stahl S, Vida D, Meisner C, Lotter O, Rothenberger J, Schaller HE, et al. Systematic review and meta-analysis on the work-related cause of De Quervain tenosynovitis: a critical appraisal of its recognition as an occupational disease. Plast Reconstr Surg. 2013;132(6):1479-91. https://doi.org/10.1097/01.prs.0000434409.32594.1b

65. Danda RS, Kamath J, Jayasheelan N, Kumar P. Role of guided ultrasound in the treatment of De Quervain tenosynovitis by local steroid infiltration. J Hand Microsurg. 2016;8(1):34-7. https://doi.org/10.1055/s-0036-1581123

66. Bakhach J, Chaya B, Papazian N. Omega "W" pulley plasty for surgical management of De Quervain's disease. J Hand Surg Asian Pac Vol. 2018;23(2):170-5. https://doi.org/10.1142/S2424835518500169

67. Abrisham SJ, Karbasi MH, Zare J, Behnamfar Z, Tafti AD, Shishesaz B. De qeurvian tenosynovitis: clinical outcomes of surgical treatment with longitudinal and transverse incision. Oman Med J. 2011 Mar;26(2):91-3. https://doi.org/10.5001/omj.2011.23.

68. Srikanteswara PK, Cheluvaiah JD, Agadi JB, Nagaraj K. The relationship between nerve conduction study and clinical grading of carpal tunnel syndrome. J Clin Diagn Res. 2016;10(7):13-8. https://dx.doi.org/10.7860%2FJCDR%2F2016%2F20607.8097

69. Neves RF, Araújo SPA, Magalhães LV, Lima MAG. Workplace physical activity in Brazil from 2006 to 2016: scoping review. Rev Bras Com Trab. 2018;16(1):82-96.

70. Goode AP, Carey TS, Jordan JM. Low back pain and lumbar spine osteoarthritis: how are they related? Curr Rheumatol Rep. 2013;15(2):305. https://dx.doi.org/10.1007%2Fs11926-012-0305-z

71. Patrick N, Emanski E, Knaub MA. Acute and chronic low back pain. Med Clin North Am. 2016;100(1):169-81. https://doi.org/10.1016/j.mcna.2015.08.015

72. Golob AL, Wipf JE. Low back pain. Med Clin North Am. 2014;98(3):405-28. https://doi.org/10.1016/j.mcna.2014.01.003

73. Berlin C, Adams C. Production Ergonomics. Designing work systems to support optimal human performance. London: Ubiquity Press; 2017.

74. Hignett S, McAtamney L. Rapid entire body assessment (REBA). Appl Ergon. 2000;31(2):201-5. https://doi.org/10.1016/s0003-6870(99)00039-3

75. Batham C, Yasobant S. A risk assessment study on work-related musculoskeletal disorders among dentists in Bhopal, India. Indian J Dent Res. 2016;27(3):236-41. https://doi.org/10.4103/0970-9290.186243

76. Chatterjee A, Sahu S. A physiological exploration on operational stance and occupational musculoskeletal problem manifestations amongst construction labourers of West Bengal, India. J Back Musculoskelet Rehabil. 2018;31(4):775-83. https://doi.org/10.3233/BMR-170935

77. Mukhopadhyay P, Khan A. The evaluation of ergonomic risk factors among meat cutters working in Jabalpur, India. Int J Occup Environ Health. 2015;21(3):192-8. https://doi.org/10.1179/2049396714Y.0000000064

78. Löfqvist L, Osvalder AL, Bligård LO, Pinzke S. An analytical ergonomic risk evaluation of body postures during daily cleaning tasks in horse stables. Work. 2015;51(4):667-82. https://doi.org/10.3233/WOR-152022

79. Samaei SE, Tirgar A, Khanjani N, Mostafaee M, Bagheri Hosseinabadi M. Effect of personal risk factors on the prevalence rate of musculoskeletal disorders among workers of an Iranian rubber factory. Work. 2017;57(4):547-53. https://doi.org/10.3233/WOR-172586

80. Mukhopadhyay P, Jhodkar D, Kumar P. Ergonomic risk factors in bicycle repairing units at Jabalpur. Work. 2015;51(2):245-54. https://doi.org/10.3233/WOR-141852

81. Ratzon NZ, Bar-Niv NA, Froom P. The effect of a structured personalized ergonomic intervention program for hospital nurses with reported musculoskeletal pain: An assigned randomized control trial. Work. 2016;54(2):367-77. https://doi.org/10.3233/WOR-162340

82. Yoon SY, Ko J, Jung MC. A model for developing job rotation schedules that eliminate sequential high workloads and minimize between-worker variability in cumulative daily workloads: Application to automotive assembly lines. Appl Ergon. 2016;55:8-15. https://doi.org/10.1016/j.apergo.2016.01.011

83. Lamarão AM, Costa LC, Comper ML, Padula RS. Translation, cross-cultural adaptation to Brazilian- Portuguese and reliability analysis of the instrument Rapid Entire Body Assessment-REBA. Braz J Phys Ther. 2014;18(3):211-7. http://dx.doi.org/10.1590/bjpt-rbf.2014.0035

84. Karhu O, Kansi P, Kuorinka I. Correcting working postures in industry: a practical method for analysis. Appl Ergon. 1977;8(4):199-201. https://doi.org/10.1016/0003-6870(77)90164-8

85. Scott GB, Lambe NR. Working practices in a perchery system, using the OVAKO working posture analysing system (owas). Appl Ergon. 1996;27(4):281-4. https://doi.org/10.1016/0003-6870(96)00009-9

86. Sarkar K, Dev S, Das T, Chakrabarty S, Gangopadhyay S. Examination of postures and frequency of musculoskeletal disorders among manual workers in Calcutta, India. Int J Occup Environ Health. 2016;22(2):151-8. https://doi.org/10.1080/10773525.2016.1189682

87. Brandl C, Mertens A, Schlick CM. Ergonomic analysis of working postures using OWAS in semi-trailer assembly, applying an individual sampling strategy. Int J Occup Saf Ergon. 2017;23(1):110-7. https://doi.org/10.1080/10803548.2016.1191224

88. Marques GM, Silva-Junior JS. Síndrome do manguito rotador em trabalhadores de linha de montagem de caminhões. Cad Saúde Coletiva. 2015;23(3):323-9. http://dx.doi.org/10.1590/1414-462X201500030077

89. McAtamney L, Nigel Corlett E. RULA: a survey method for investigation of work-related upper limb disorders. Appl Ergon. 1993;24(2):91-9. https://doi.org/10.1016/0003-6870(93)90080-s

90. Kaliniene G, Ustinaviciene R, Skemiene L, Vaiciulis V, Vasilavicius P. Associations between musculoskeletal pain and work-related factors among public service sector computer workers in Kaunas County, Lithuania. BMC Musculoskelet Disord. 2016;17(1):420. https://doi.org/10.1186/s12891-016-1281-7

91. Ekinci Y, Atasavun Uysal S, Kabak, VY, Duger T. Does ergonomics training have an effect on body posture during computer usage? J Back Musculoskelet Rehabil. 2019;32(2):191-5. https://doi.org/10.3233/BMR-181196

92. Golchha V, Sharma P, Wadhwa J, Yadav D, Paul R. Ergonomic risk factors and their association with musculoskeletal disorders among Indian dentist: a preliminary study using Rapid Upper Limb Assessment. Indian J Dent Res. 2014;25(6):767-71. https://doi.org/10.4103/0970-9290.152202

93. Tirgar A, Javanshir K, Talebian A, Amini F, Parhiz A. Musculoskeletal disorders among a group of Iranian general dental practitioners. J Back Musculoskelet Rehabil. 2015;28(4):755-9. https://doi.org/10.3233/BMR-140579

94. Binoosh SA, Mohan GM, Ashok P, Dhana Sekaran K. Virtual postural assessment of an assembly work in a small scale submersible pump manufacturing industry. Work. 2017;58(4):567-78. https://doi.org/10.3233/WOR-172635

95. Xu YW, Cheng AS. An onsite ergonomics assessment for risk of work-related musculoskeletal disorders among cooks in a Chinese restaurant. Work. 2014;48(4):539-45. https://doi.org/10.3233/WOR-131805

96. Labbafinejad Y, Imanizade Z, Danesh H. Ergonomic Risk Factors and Their Association with Lower Back and Neck Pain Among Pharmaceutical Employees in Iran. Workplace Health Saf. 2016;64(12):586-95. https://doi.org/10.1177/2165079916655807

97. Daneshmandi H, Kee D, Kamalinia M, Oliaei M, Mohammadi H. An ergonomic intervention to relieve musculoskeletal symptoms of assembly line workers at an electronic parts manufacturer in Iran. Work. 2018;61(4):515-21. https://doi.org/10.3233/WOR-182822

98. Shafti A, Lazpita BU, Elhage O, Wurdemann HA, Althoefer K. Analysis of comfort and ergonomics for clinical work environments. Conf Proc IEEE Eng Med Biol Soc. 2016;2016:1894-7. https://doi.org/10.1109/EMBC.2016.7591091

99. Alabdulkarim S, Nussbaum MA, Rashedi E, Kim S, Agnew M, Gardner R. Impact of task design on task performance and injury risk: case study of a simulated drilling task. Ergonomics. 2017;60(6):851-66. https://doi.org/10.1080/00140139.2016.1217354

100. Dropkin J, Kim H, Punnett L, Wegman DH, Warren N, Buchholz B. Effect of an office ergonomic randomised controlled trial among workers with neck and upper extremity pain. Occup Environ Med. 2015;72(1):6-14. https://doi.org/10.1136/oemed-2014-102160

101. Sayyahi Z, Mirzaei R, Mirkazemi R. Improving body posture while fueling with a newly designed pump nozzle. Int J Occup Saf Ergon. 2016;22(3):327-32. http://dx.doi.org/10.1080/10803548.2016.1159391

102. Moore JS, Garg A. The strain index: a proposed method to analyze jobs for risk of distal upper extremity disorders. Am Ind Hyg Assoc J. 1995;56(5):443-58. https://doi.org/10.1080/15428119591016863

103. Garg A, Kapellusch JM, Hegmann KT, Thiese MS, Merryweather AS, Wang YC, et al. The strain index and TLV for HAL: risk of lateral epicondylitis in a prospective cohort. Am J Ind Med. 2014;57(3):286-302. https://doi.org/10.1002/ajim.22279

104. Gerr F, Fethke NB, Merlino L, Anton D, Rosecrance J, Jones MP, et al. A prospective study of musculoskeletal outcomes among manufacturing workers: I. Effects of physical risk factors. Hum Factors. 2014;56(1):112-30. https://doi.org/10.1177/0018720813491114

105. Garg A, Moore JS, Kapellusch JM. The Revised Strain Index: an improved upper extremity exposure assessment model. Ergonomics. 2017;60(7):912-22. https://doi.org/10.1080/00140139.2016.1237678

106. Sanchez-Lite A, Garcia M, Domingo R, Santiago MA. Novel ergonomic postural assessment method (NERPA) using product-process computer aided engineering for ergonomic workplace design. PLoS One. 2013;8(8):e72703. https://doi.org/10.1371/journal.pone.0072703

107. Lavatelli I, Schaub K, Caragnano G. Correlations in between EAWS and OCRA index concerning the repetitive loads of the upper limbs in automobile manufacturing industries. Work. 2012;41(Supl. 1):4436-44. https://doi.org/10.3233/WOR-2012-0743-4436

108. Waters TR, Putz-Anderson V, Garg A, Fine LJ. Revised NIOSH equation for the design and evaluation of manual lifting tasks. Ergonomics. 1993;36(7):749-76. https://doi.org/10.1080/00140139308967940

109. Snook SH. The design of manual handling tasks. Ergonomics. 1978;21(12):963-85. https://doi.org/10.1080/00140137808931804

110. Snook SH, Ciriello VM. The design of manual handling tasks: revised tables of maximum acceptable weights and forces. Ergonomics. 1991;34(9):1197-213. https://doi.org/10.1080/00140139108964855

111. Klussmann A, Steinberg U, Liebers F, Gebhardt H, Rieger MA. The key indicator method for manual handling operations (KIM-MHO) - evaluation of a new method for the assessment of working conditions within a cross-sectional study. BMC Musculoskelet Disord. 2010;11:272. https://doi.org/10.1186/1471-2474-11-272

112. Kuorinka I, Jonsson B, Kilbom A, Vinterberg H, Biering-Sorensen F, Andersson G, et al. Standardised Nordic questionnaires for the analysis of musculoskeletal symptoms. Appl Ergon. 1987;18(3):233-7. https://doi.org/10.1016/0003-6870(87)90010-x

113. Pinheiro FA, Troccoli BT, Carvalho CV. Validação do Questionário Nórdico de Sintomas Osteomusculares como medida de morbidade. Rev Saúde Pública. 2002;36(3):307-12. http://dx.doi.org/10.1590/S0034-89102002000300008

114. Maciel R, Albuquerque A, Melzer A, Leônidas S. Quem se beneficia dos programas de ginástica laboral? Cad Psicologia Social Trabalho. 2005;8:71-86. https://doi.org/10.11606/issn.1981-0490.v8i0p71-86

115. Tsang SMH, So BCL, Lau RWL, Dai J, Szeto GPY. Effects of combining ergonomic interventions and motor control exercises on muscle activity and kinematics in people with work-related neck-shoulder pain. Eur J Appl Physiol. 2018;118(4):751-65. https://doi.org/10.1007/s00421-018-3802-6

116. Park HK, Jung MK, Park E, Lee CY, Jee YS, Eun D, et al. The effect of warm-ups with stretching on the isokinetic moments of collegiate men. J Exerc Rehabil. 2018;14(1):78-82. https://doi.org/10.12965/jer.1835210.605

117. Sihawong R, Janwantanakul P, Sitthipornvorakul E, Pensri P. Exercise therapy for office workers with nonspecific neck pain: a systematic review. J Manipulative Physiol Ther. 2011;34(1):62-71. https://doi.org/10.1016/j.jmpt.2010.11.005

118. Tunwattanapong P, Kongkasuwan R, Kuptniratsaikul V. The effectiveness of a neck and shoulder stretching exercise program among office workers with neck pain: a randomized controlled trial. Clin Rehabil. 2016;30(1):64-72. https://doi.org/10.1177/0269215515575747

119. Shariat A, Cleland JA, Danaee M, Kargarfard M, Sangelaji B, Tamrin SBM. Effects of stretching exercise training and ergonomic modifications on musculoskeletal discomforts of office workers: a randomized controlled trial. Braz J Phys Ther. 2018;22(2):144-53. https://doi.org/10.1016/j.bjpt.2017.09.003

120. Serra MVGB, Pimenta LC, Quemelo PRV. Efeitos da ginástica laboral na saúde do trabalhador: uma revisão da literatura. Rev Pesquisa Fisioter. 2014;4(3):197-205. http://dx.doi.org/10.17267/2238-2704rpf.v4i3.436

121. Freitas-Swerts FC, Robazzi ML. The effects of compensatory workplace exercises to reduce work-related stress and musculoskeletal pain. Rev Latino-Am Enfermagem. 2014;22(4):629-36. http://dx.doi.org/10.1590/0104-1169.3222.2461

122. Bernardes JM. Ginástica laboral e prática de atividades físicas de lazer: uma revisão bibliográfica. Rev Educação Física. 2011;2(1):71-81.

123. Gok Metin Z, Ejem D, Dionne-Odom JN, Turkman Y, Salvador C, Pamboukian S, et al. Mind-body interventions for individuals with heart failure: a systematic review of randomized trials. J Card Fail. 2018;24(3):186-201. https://doi.org/10.1016/j.cardfail.2017.09.008

124. Johnston V, Jull G, Sheppard DM, Ellis N. Applying principles of self-management to facilitate workers to return to or remain at work with a chronic musculoskeletal condition. Man Ther. 2013;18(4):274-80. https://doi.org/10.1016/j.math.2013.04.001

125. Streibelt M, Buschmann-Steinhage R. A profile of requirements for the performance of work related medical rehabilitation from the perspective of the statutory pension insurance. Rehabilitation. 2011;50(3):160-7. https://doi.org/10.1055/s-0031-1275721

126. Streibelt M, Bethge M. Effects of intensified work-related multidisciplinary rehabilitation on occupational participation: a randomized-controlled trial in patients with chronic musculoskeletal disorders. Int J Rehabil Res. 2014;37(1):61-6. https://doi.org/10.1097/MRR.0000000000000031

127. Voit S. Work-site health and fitness programs: Impact on the employee and employer. Work. 2001;16(3):273-86.

128. Harari D, Casarotto RA. Effectiveness of a multifaceted intervention to manage musculoskeletal disorders in workers of a medium-sized company. Int J Occup Saf Ergon. 2019:1-11. https://doi.org/10.1080/10803548.2019.1575052

129. Aje OO, Smith-Campbell B, Bett C. Preventing Musculoskeletal Disorders in Factory Workers: Evaluating a New Eight Minute Stretching Program. Workplace Health Saf. 2018;66(7):343-7. https://doi.org/10.1177/2165079917743520

130. Storm V, Paech J, Ziegelmann JP, Lippke S. Physical exercise, sickness absence and subjective employability: An 8-year longitudinal observational study among musculoskeletal patients. J Rehabil Med. 2016;48(6):541-6. https://doi.org/10.2340/16501977-2103

131. Andersen LN, Juul-Kristensen B, Roessler KK, Herborg LG, Sørensen TL, Søgaard K. Efficacy of 'Tailored Physical Activity' on reducing sickness absence among health care workers: A 3-month randomised controlled trial. Man Ther. 2015;20(5):666-71. https://doi.org/10.1016/j.math.2015.04.017

132. Louw S, Makwela S, Manas L, Meyer L, Terblanche D, Brink Y. Effectiveness of exercise in office workers with neck pain: A systematic review and meta-analysis. S Afr J Physiother. 2017;73(1):392. https://doi.org/10.4102/sajp.v73i1.392

133. Schulze C, Becker M, Finze S, Holtherm C, Hinder J, Lison A. An Evaluation of the Significance of Work-Related Influence Factors on Fitness and the Development of Medical and Orthopaedic Conditions in Military Executives. Scientific World J. 2016:3929104. https://dx.doi.org/10.1155%2F2016%2F3929104

134. Serra MVGB, Camargo PR, Zaia JE, Tonello MGM, Quemelo PRV. Effects of physical exercise on musculoskeletal disorders, stress and quality of life in workers. Int J Occup Saf Ergon. 2018;24(1):62-7. https://doi.org/10.1080/10803548.2016.1234132

135. de Carvalho MP, Schmidt LG, Soares MCF. Musculoskeletal disorders and their influence on the quality of life of the dockworker: A cross-sectional study. Work. 2016;53(4):805-12. https://doi.org/10.3233/WOR-162249

136. Kurustien N, Mekhora K, Jalayondeja W, Nanthavanij S. Trunk Muscle Performance and Work-Related Musculoskeletal Disorders among Manual Lifting with Back Belt Wearing Workers. J Med Assoc Thai. 2015;98(Suppl. 5):S74-80.

137. Rasotto C, Bergamin M, Simonetti A, Maso S, Bartolucci GB, Ermolao A, et al. Tailored exercise program reduces symptoms of upper limb work-related musculoskeletal disorders in a group of metalworkers: A randomized controlled trial. Man Ther. 2015;20(1):56-62. https://doi.org/10.1016/j.math.2014.06.007

138. Taulaniemi A, Kankaanpää M, Tokola K, Parkkari J, Suni JH. Neuromuscular exercise reduces low back pain intensity and improves physical functioning in nursing duties among female healthcare workers; secondary analysis of a randomised controlled trial. BMC Musculoskelet Disord. 2019;20:328. https://doi.org/10.1186/s12891-019-2678-x

139. Jakobsen MD, Sundstrup E, Brandt M, Andersen LL. Effect of physical exercise on musculoskeletal pain in multiple body regions among healthcare workers: Secondary analysis of a cluster randomized controlled trial. Musculoskelet Sci Pract. 2018;34:89-96. https://doi.org/10.1016/j.msksp.2018.01.006

140. Al-Marwani Al-Juhani M, Khandekar R, Al-Harby M, Al-Hassan A, Edward DP. Neck and upper back pain among eye care professionals. Occup Med (Lond). 2015;65(9):753-7. https://doi.org/10.1093/occmed/kqv132

141. Nastasia I, Coutu MF, Tcaciuc R. Topics and trends in research on non-clinical interventions aimed at preventing prolonged work disability in workers compensated for work-related musculoskeletal disorders (WRMSDs): a systematic, comprehensive literature review. Disabil Rehabil. 2014;36(22):1841-185. https://doi.org/10.3109/09638288.2014.882418

142. Schaafsma FG, Anema JR, van der Beek AJ. Back pain: prevention and management in the workplace. Best Pract Res Clin Rheumatol. 2015;29(3):483-94. https://doi.org/10.1016/j.berh.2015.04.028

143. Holtermann A, Jørgensen MB, Gram B, Christensen JR, Faber A, Overgaard K, et al. Worksite interventions for preventing physical deterioration among employees in job-groups with high physical work demands: Background, design and conceptual model of finale. BMC Public Health. 2010;10:120. https://doi.org/10.1186/1471-2458-10-120

Recebido em 20 de Dezembro de 2018.
Aceito em 5 de Setembro de 2019.

Fonte de financiamento: nenhuma


© 2024 Todos os Direitos Reservados