Luu- ja lihaskonna vaevused – milleks end nendega vaevata? Rakendusnäited ja riskiohjamise meetodid

Musculoskeletal Disorders – Why bother?Applied examples and risk management methods

Ergonomics Conference in Tallinn October 10, 2013 arranged by the Ministry of Social Affairs, Estonian Ergonomics Society and the Estonian University of Life Sciences

Linda Rose KTH, Royal Institute of TechnologyStockholm, Sweden

Ergonomics and its two objectives

Ergonomics (or human factors) is the scientific

discipline concerned with the understanding of

interactions among humans and other elements of

a system, and the profession that applies theory,

principles, data and methods to design in order to

optimize human well-being and overall system

performance. [IEA, 2000]

Linda Rose, 2013

Some statistics on work and MSDs

About 60% of all sickness absence in the EU can be attributed to musculoskeletal problems. [Eurostat, 2010]

A study with 15 000 workers in the EU shows a clear trend of work intensification over the last decades. [Parent-Thirion et al., 2007]

There is a trend of increased occurrence of work-related health problems in the EU, where MDSs play a mayor part. [Eurostat, 2010]

MSDs form 0.5 - 2 % of GNP in the EU [Hemphälä & Nylén, 2013]

Effects on individuals, organisations and societies

Linda Rose, 2013

Muscle force [Grandjean, 1980]

The demographic challenge…

50 % of all born today may achieve the age of 92. [SCB, 2013]

Many abilities decline with age [Ilmarinen, 1992; Grandjean, 1980]

In several professions many employees cannot work until retirement age, due to MSDs, e. g. in the construction industry. [Byggnads, 2013]

Needs: to stay healthy & work longer & for sustainable jobs

Linda Rose, 2013

How to tackle MSDs?

Awareness – Knowledge – Methods – Systematic

work – Communication & co-operation - Power

?

Linda Rose, 2013

59%

39%

2%QualityImprovements

Productivityimprovements

Reduced directsick-leave costs[Abrahamsson, 2000]

“Old” ladle- handling: Quality problems, production stops, accidents and illnesses at SSAB

New, improved methods for handling ladles

Awareness… Example of Economic effects of the working environment at company level

Investment 11 million SEK“Saving” 5 million SEK/ year

Or 110 years for ROI?

Linda Rose, 2013 Informed decision making…

Systematic review evaluating Human & System Effects (N= 38)

Conclusion regarding “balancing”?

Linda Rose, 2013

[Neumann & Dul, 2010]

Some paths to improvements Dialogue - Look, talk, and LISTEN - and fix early

Systematic approach (use methods, check equipment, flow,working techniques, …)

Observational methods (observe, checklists, …)

Subjective methods (interviews, surveys, Borg scales, …)

Technical measurement and calculation methods (biomechanics, EMG, force, vibration, light, repetitiveness, …)

Training and education methods (job introduction, technique, …)

Risk assessment methods (RULA, REBA, NIOSH equation, … )

Risk management methods (OHSCO, SCA & MAWRIC, RAMP, …)

Development methods (technical, organisational, technique,…)

Linda Rose, 2013

Example of systematic approach: OHSCO MSD prevention guidelines

Linda Rose, , KTH, 2013

[Occupational Health and Safety Council of Ontario, OHSCO]

Examples of risk assessment methods in an applied example: Veterinarians work in and around their cars

Linda Rose, 2013

[Rose & Larsson, 2006]

Biomechanical analysis (with “Jack”)Based on the NIOSH equation [Waters et al, 1993]

• The compression force exceeds the recommended force limit 3400 N.

• The shear force is near the limit 1000 N.Actions should be taken to reduce the strain and the injury risks.

Linda Rose, 2013 [Rose & Larsson, 2006]

RULA, Rapid Upper Limb Assessment[Mc Atamney & Corlett, 1993]

Result: Investigation &changes are requiredimmediately

Method: Positions of 7 body regions are assessed. Assessment for left and right hand/arm. Score based on body part assessments, handled load weight and type of movements (dynamic or static). The higher the score, the higher the risk.

Linda Rose, 2013 [Rose & Larsson, 2006]

An example of ”ergonomic design”- Why engineers need ergonomics competence

[After Bo Lindqvist, Atlas Copco]

Linda Rose, 2013

Basic knowledge is vital

An example of technical development and examples of some analysis methods

Trying to move material carriages, brick trolleys, et c over obstacles …

Linda Rose, 2013

[Rose, 2004]

Reflect on how you would tackle the problem

Material carriages with a new type of wheel suspension

Movie time !

Linda Rose, 2013

Evaluation results

With the new suspension:

Easier to climb obstacles Less force needed Fewer and smaller “jerks”

Lower physical load Lower risk for sudden stoppages Lower risk to lose load & of injury

Linda Rose, 2013

[Rose, 2004]

A technical solution for a wide range of application

Risk Management MethodsDifferent approaches, for example:

Risk assessment & action guidance - RAMP

Risk assessment & time aspects as a decision base- Ergo-Index

Risk assessment, financial effects & action guidance - SCA & MAWRIC

Linda Rose, 2013

RAMP: Risk management Assessment tool for Manual handling Proactively

Need for a load ergonomics assessment tool in Sweden and globally

Initiative from Arla Sweden. Co-op project with interactive methodology

• Freely accessible method for risk

assessment for manual handling

• Including suggestions for changes

• Development in co-op with users

Background Objective

[Bohgard et al., 2009]

Linda Rose, 2013

RAMP II‐ Repetitive manual material handling work1. Time score2. Posture3. Repetitive movements

RAMP I ‐ Checklist ‐ Physical risk factors 4. Force: lifting, holding or carrying & pushing or pullingfor manual material handling 5. Recovery1. Movements and repetitive work 6. Influencing factors2. Lifting, carrying or holding loads3. Pushing or pulling work RAMP II‐ Pushing and pulling work4. Influencing factors Pushing or pulling force (one or two hands)5. Reports on physically strenuous work Worsening factors6. Perceived physical discomfort

RAMP II – Lifting, holding and carrying workWorking conditionsPosture + weight + duration/frequency/time

RAMP- a two-level Risk Management tool under development

Linda Rose, 2013

Draft of possible results presentationQuestions Assessment Planned Action When/Who Done

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Possible Results Summary 1

Suggestions for actions: An example:If work with hand/ hands above shoulder height occursCarry out RAMP 2 analysisChange the working posture so that work above shoulder height is avoided ….

Linda Rose, 2013

22

Possible Results Summary 2for management level

High risk

Increased risk

Low risk

Analyse further

Department Department A Department B

Linda Rose, 2013

A base informed decision making and for prioritization

The Ergo-Index method for comparing jobs

Chisseling/drilling in concrete wall

I: No support II: With support [Glimskär et al.]

Different ways to study time aspects

Linda Rose, 2013

Traditional comparison

ERGONOMICS ECONOMICS

Would you invest in alternative II?

UNIT TIME

Minutes/hole

3

2

1

3000

2000

1000

5.856.13

Cost for support

Cost fordrillingN SEK/hole

[Glimskär et al.]

Linda Rose, 2013

Ergo-Index comparison

SEK/hole

3

2

1

6

4

2

Cost for support

I II I II

PRODUCTION TIME ECONOMICS

Recovery

DrillingCost for drilling

Minutes/hole

5.85

3.50

Would you invest in alternative II? [Glimskär et al.]

Linda Rose, 2013

An applied exampleErgo-Index results Borg’s CR-10

& body map

Discomfort rating: 6

Discomfort rating: 0.5

Linda Rose, 2013 [Rose, 2012]

MAWRIC: Method to Analyse Work related Risks, Improve work environment and estimate total Cost

Estimation of costs

Studied work task

Risk assessment

Action

Follow-up

Risk identification

Accepta-ble risks?

Sugg

estio

ns fo

r ris

k

redu

ctio

n

Linda Rose, 2013

[Rose, 2001; Rose & Örtengren, 2000

Possible MSD risk reducing actions- experience based advice -

• Listen and co-operate. Team-work is often needed and company culture has an impact.

• Work systematically, use adequate methods and a holistic approach.

• Develop, evaluate and implement technical solutions, involving the end-users in the process.

• Supply education, good work technique information & training - early and good introduction to jobs.

• Work with organisational solutions: scheduling, job rotation patterns, job content, et cetera

Linda Rose, 2013

Elu ootabÜle purde

teisel kaldal

ELU ootamas.

On ilus samal hetkel

küll ette, küll

taha vaadata

või valida rada,

kus aeg nagu

virvatuli

kutsub ja vilgub. [Rose, 1985] [Orrenius, 2013]

(ja töö)

Linda Rose, 2013

Kontakti informatioon:

Linda RoseKTH, The Royal Institute of TechnologySchool of Technology and HealthDepartment of Health Systems EngineeringUnit of Ergonomics Stockholm, SwedenE-mail: linda.rose@sth.kth.se

Linda Rose, 2013

References 1(3)• Abrahamsson, L (2000). Production economics analysis of investment initiated to

improve working environment. Applied Ergonomics, 31(1), 1-7.• Bohgard, M., Karlsson, S., Lovén, E., Mikaelsson, L.-Å., Mårtensson, L., Osvalder, A.-L.,

Rose, L., & Ulfvengren, P. (Eds) (2009) Work and technology on human terms. Prevent. (Work environment in association with the Confederation of Swedish Enterprise, LO & PTK). ISBN 978-91-7365-058-8, Stockholm, Sweden.

• Byggands (2013) http://www.byggnads.se/.• Eurostat (2010) Health and safety at work in Europe (1997-2007) A statistical portrait.

Statistical book from European Commission, European Union. ISBN 979-92-79-14606-0.• Glimskär et al. Presentation material developed at BELAB, Byggergolab AB, during the

1980-1990’es.• Hemphälä, H & Nylén, P (2013) Synergonomi gäller så mycket ( In Swedish: Vision

ergonomics concers so much. Ljuskultur No. 4, 2013: 4-7.• Ilmarinen,J(1992) Job design for the aged with regard to decline in their maximal aerobic

capacity: Part II-The scientific basis for the guide, Int J Ind Ergonomics, 10,65-77.• International Ergonomics Association Council. (2000). The discipline of ergonomics.

International Ergonomics Society. Retrieved from http://www.iea.cc/browse.php?contID=what is ergonomics

• McAtamney L & Corlett E N (1993) RULA: a survey method for the investigation of work-related upper limb disorders, Institute of Occupational Ergonomics, Nottingham.

• Orrenius, C (2013) Original photo.

Linda Rose, 2013

• Neumann, W. P. & Dul, J. (2010). Human factors: spanning the gap between OM and HRM. International Journal of Operations & Production Management, 30, 923-950.

• OHSCO, Occupational Health and Safety Council of Ontario (2007?). Musculoskeletal disorders prevention series: Par1 1- 3: 1_MSD Prevention Guideline for Ontario; 2_ Resource Manual for the MSD Prevention Guideline for Ontario; 3A&B_MSD Prevention Toolbox.

• Parent-Thirion, A., E. F. Macias, J. Hurley and G. Vermeulen. (2007), Fourth European Working Conditions Survey, European Foundation for the Improvement of Living and Working Conditions, Luxembourg.

• Rose, L. (2012) Ergo-Index Etapp 2: Vidareutveckling av metod för analys av produktionsmetoder – samband mellan belastningsfaktorer, återhämtning, risk och produktionstid. Technical report (In Swedish.) Ergo-Index: Further development of a method for analysis of production methods – relationships beteween loadin factors, recovery, risk and production time. KTH, the Royal Institute of Technology. School of Technology & Health, Division of Ergonomics. Available at http://www.kth.se/sth/forskning/ergonomi/forskning/produktionsmetoder-1.60374.

• Rose, L. (2004) Ergonomisk utvärdering av materialvagnar med Yoyo hjul. (In Swedish) Ergonomic evaluation of Utility Trucks with Yoyo Wheel Suspension) ERAK Report 2004:1, Täby, Sweden.

Linda Rose, , KTH, 2013

References 2(3)

References 3(3)• Rose, L (2001) Models and Methods for Analysis and Improvement of Physical Work

Environments. Thesis for degree of doctor of philosophy, Dept. of Productand Production Development, Div. of Human Factors Engineering, Chalmers University of Technology, Göteborg, Sweden.

• Rose LM (1985) Elu Ootab. Tulimuld, Eesti kirjanduse ja kultuuri ajakiri. Nr 2:57. Lund, Wallin & Dahlholm Boktr. AB.

• Rose, L. & Larsson T. J. (2006) DiB, Distriktsveterinär i bil, (District Veterinarians in and around their car) Report (in Swedish), The Royal Institute of Technology, School of Technology and Health, June 2006, Sweden.

• Rose, LM, Orrenius UE & Neumann, WP (2013) Work Environment and the Bottom Line: Survey of Tools Relating Work Environment to Business Results. Human Factors and Ergonomics in Manufacturing & Service Industries, 23 (5) 368–381.

• Rose, L & Örtengren, R (2000) Risk management of personal injury risks in companies. Proceedings of the International Seminar on Risk Management and Human Reliability in Social Context, European Safety, Reliability & Data Association, Karlstad, Sweden, June 15-16.

• SCB, Statistics Sweden (2013) Information found at http://www.scb.se/.• Waters, TR, Putz-Anderson, V, Garg, A & Fine, LJ (1993) Revised NISOH equation for

the design and evaluation of manual lifting tasks. Ergonomics, 36 (7):749-776.

Linda Rose, , KTH, 2013