Ergonomics Interventions: What Works

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Ergonomics Interventions What Works And How?

• As Seen By Richard Wells
• Research Team Wells RP1,2 , Cole DC2, 3, ,
  Norman RW1, Frazer MB1, Theberge N.1,5, Kerr
  MS2,4
• (1) Department of Kinesiology, University of
  Waterloo, Waterloo, ON, Canada,
• (2) Institute for Work and Health, Toronto, ON,
  Canada,
• (3) Department of Public Health Sciences,
  University of Toronto, Toronto, ON, Canada,
• (4) School of Nursing, Faculty of Health
  Sciences, University of Western Ontario, London,
  ON, Canada
• (5) Department of Sociology, University of
  Waterloo, Waterloo, ON, Canada,

2
Story 1

• XXX, a metal furniture manufacturing company,
  established an ergonomics program that cut lost
  workdays from work-related musculoskeletal
  disorders from 176 in 1991 to 0 in 1997.
  Ergonomic changes increased productivity 25.
• Source CTD News

3
How are we to interpret this story?

• What exactly was changed?
• Were there no co-interventions?
• Did these change(s) improve the musculoskeletal
  symptoms
• Did these change(s) reduce exposures
  substantially?
• Are the change(s) and success generalizeable?

4
Story 2 Ergonomics Intervention in a Small
Company

• Feedback from supervisors and workers determined
  that
• people in the were not familiar with the use of
  the lift assists and didnt use them.
• breakdowns meant that they were not available
  much of the time.
• These process measures indicated that both the
  intensity of the intervention and compliance were
  low.

A review of the specifications of the lift
assists and in efficacy tests (in the
laboratory), the assists reduced low back loads
for the weights of interest.

• A small company had two low back compensation
  cases in a department with heavy lifting within
  one year.
• Powered lifting assists were introduced as an
  engineering intervention.
• One year later no reduction in the costs
  associated with back claims was found.
• Conclusion The intervention was a failure

• Upon review of the cost data it was determined
  that most of the costs were due to an injury
  which occurred in the previous year.
• Cost data were also deemed to be unstable due to
  the small size of the company and the limited
  follow up time

• The original conclusion was not correct

5
The Need for Evidence

• Workplace parties have faced conflicting
  messages The validity of workplace-based
  evaluations of ergonomic interventions has been
  questioned in both scientific and public forums
  due to
• research design
• quantitative vs qualitative methods
• inadequate reporting of uncontrolled
  co-interventions and limited consideration of
  them in analysis and interpretation
• poor descriptions of populations, exposures and
  interventions
• inadequate accounting for the timing or impact of
  interventions.
• inadequate accounting of outcomes
• But what is good evidence?

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Evidence?
7
Evidence?
8
Evidence?
9
Evidence? Review of 35 Health Promotion
Intervention Studies
Results Design N Encouraging Mixed Disc
ouraging No comparison 11 100 0 0
group Non-randomized 16 56 31 13
comparison group Randomized 9 22 56
22 comparison group
Heamy Goetzel. Am J Health Promot 1997
11290-307 (adopted from TS Kristensen, EPICOH
2001, Copenhagen) Slide courtesy of Hilkka
Riihimäki
10
Point of View
Health Outcomes
Interventions
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How Can We Do Better?

• Maximise the change in exposure, using, as
  appropriate
• Best science on risk factors and mechanisms
• Macro ergonomic perspective
• Production system level interventions
• Participatory change processes
• Evaluate a range of leading to lagging indicators
  to assess critical modifiers and road blocks and
  to improve

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Approach for Evaluation of an Ergonomics
Intervention for Reducing WMSD
LEADING
0 Societal, Medico-legal , business and
compensation climate
Cole, Wells et al., Methodological issues in
evaluating workplace interventions to reduce
work-related musculoskeletal disorders through
mechanical exposure reduction, IWH Working Paper
190. 2003
LAGGING
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Story 3 An Example of an Intervention

• An automotive parts company had concerns about
  increasing back and shoulder problems on a line.
• Automotive Tier 1 supplier of molded foam
  assemblies for impact protection
• Process involves extracting, cleaning and
  re-waxing molds (tools) moving around a closed
  track (conveyance system) then trimming,
  inspecting and packing the parts
• Parts mass up to 1kg

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Design Quasi-Experimental Non-Randomized
Control Groups
1999 2000
2001 2002
2003 2004
Auto Foam Plant A1 Plant A2 Plant B Plant
C Plant D Courier Plant E Plant
F Manufacturing Plant G Plant H

Intervention
Follow-up
Pre
Legend Evaluation Questionnaire Field
Measures Intervention Control
Control
Follow-up
Pre
I

Intervention
Follow-up
Pre
Control
Follow-up
Pre

Intervention
Follow-up
Control
Follow-up

Intervention
Follow-up
Control
Follow-up
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Evaluation of Ergonomic Interventions Targeting
Exposure for Reducing WMSD
LEADING
0 Societal, Medico-legal , business and
compensation climate

Conditions Pathway and Modifiers
Measures

• Corporate OHS policy, culture and practice
• Management/labour relations

LAGGING
16
Evaluation of the Case Study

• Within one province, these factors are similar
• evaluation not performed
• These companies are self-selecting and wish to
  change
• evaluation not performed

17
Evaluation of Ergonomic Interventions Targeting
Exposure for Reducing WMSD
LEADING
0 Societal, Medico-legal , business and
compensation climate

Conditions Pathway and Modifiers
Measures

• Resources
• Commitment to change
• Management competence

• Type of changes
• Engineering
• Administrative
• Personal/ behavioral modifiers
• Number of changes

LAGGING
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Evaluation of the Case Study

• The team implemented a total of 21 changes during
  the 9 month project

• Handle cutout on boxes
• New trim tools
• Aluminum scrapers
• EZ Lift-assist devices
• Wire scrap racks
• Sit/stand stools
• Hammer stamp
• Vacuum de-mould device
• Green rack lid holder
• Box flap holder

Blower to break seal Air pop-its Divider
racks Redesigned counter table New trim
tables New packing racks Ergonomics Change
board Upper body support Changes to line
layout Feedback board Improved wax
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Evaluation of Ergonomic Interventions Targeting
Exposure for Reducing WMSD
LEADING
0 Societal, Medico-legal , business and
compensation climate

Conditions Pathway and Modifiers Measures

• Type
• Intensity
• Compliance
• Ergonomic quality of interventions

• Individual and system level exposure
• self report
• observation
• technical measures

LAGGING
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Evaluation of the Case Study

• Mechanical exposure had been lowered when
  evaluated at a change specific level.

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Evaluation of the Case Study

• Mechanical exposure had been lowered when
  evaluated at a change specific level.

New Trim Tools Evaluation Results


High
Effort
Worse
Better
Low
Effort




Worker felt the tools with handles were easier on
shoulders/arms.

Increased Forearm Muscle Recovery Time for
tools with handles.


Better
Worse

Task was completed faster using Trim tools with
handles.

Lower (better) muscle activity for tools with
handles (curve further left).
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Evaluation of the Case Study

• Mechanical exposure had been lowered when
  evaluated at a change specific level.

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Evaluation of the Case Study Evaluation of
Change Intensity
Laing, 2002
Time-weighted impact evaluation of the Packing
Protocol change with relative APDF 0.5 values for
the dominant trapezius as the dependent measure.
In each case the original methods were assigned a
relative value of 100.
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Evaluation of the Case Study Evaluation of
Change Intensity
LBPRI Low Back Pain Reporting Index, Norman et
al., 1998, Kerr et al, 2001, Laing, 2002

• Impact evaluation of the platform change with on
  LBPRI.

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Evaluation of Ergonomic Interventions Targeting
Exposure for Reducing WMSD
LEADING
0 Societal, Medico-legal , business and
compensation climate

Conditions Pathway and Modifiers Measures

• Time delay
• Distribution of WMSD symptoms
• Psychosocial Factors

• Self- report pain and discomfort symptoms

LAGGING
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Evaluation of the Case Study

• Despite higher initial physical job demands, the
  Intervention Line workers underwent a smaller
  increase in pain than did the Comparison Line
  workers.

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Evaluation of Ergonomic Interventions Targeting
Mechanical Exposure for Reducing WMSD
LEADING
0 Societal, Medico-legal , business and
compensation climate

Conditions Pathway and Modifiers Measures

• Workplace Psychosocial Factors,
• e.g. Control
• Attribution
• Level of pain/discomfort
• Absolute exposure
• Filter Effects

• First-aid log (OSHA log)
• Medical visits/first aid

LAGGING
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Evaluation of Ergonomic Interventions Targeting
Mechanical Exposure for Reducing WMSD
LEADING
0 Societal, Medico-legal , business and
compensation climate

Conditions Pathway and Modifiers Measures

• Psychosocial Factors e.g. Control
• Return To Work Program
• Physiotherapy on-site
• Reactive workplace changes

• Work Disability Scales
• Work Role Function
• DASH
• WCB (No) Lost-Time Claims

LAGGING
29
Evaluation of Ergonomic Interventions Targeting
Exposure for Reducing WMSD
LEADING
0 Societal, Medico-legal , business and
compensation climate
Not considered

Conditions Pathway and Modifiers
Measures

• Psychosocial Factors
• Return To Work Program
• Physiotherapy on-site
• Reactive workplace changes

• WCB Claim costs
• Sickness Absence costs
• Indirect Costs including replacement, retraining,
  etc

LAGGING
30
Evaluation of Ergonomic Interventions Targeting
Exposure for Reducing WMSD
0 Societal, Medico-legal , business and
compensation climate
LEADING

Conditions Pathway and Modifiers
Measures
Yes Small Effect Small Effect?
Conclusion The intervention did not progress
identifiably past this point after 9 months of
team activity
LAGGING
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Issues

• Reportable Injuries and Costs should not be
  the only measures of the success of ergonomic
  interventions due to the considerable variation
  in the manner of
• collection,
• classification systems,
• routinization of aggregation, and transparency of
  reporting,

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Step Up Ladies and Gentlemen to the Circus Midway
and Try Your Luck at the Gopher Game also known
as Lower Your WMSD Injury Costs

• Caution Your mileage may differ!

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Lost Time Injuries Too High? Surcharges Possible?
Reduce Those Lost Time Costs!

No-Lost Time Claims
Lost Time Claims
Modified Days
Sickness/Absence Insurance
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No-Lost Time Injuries Too High? Reduce Those
No-Lost Time Costs

No-Lost Time Claims
Lost Time Claims
Modified Days
Sickness/Absence Insurance
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Too Many Modified Duties? Reduce Overtime and
Replacement Worker Costs

No-Lost Time Claims
Lost Time Claims
Modified Days
Sickness/Absence Insurance
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Our View on What Works
0 Societal, Medico-legal , business and
compensation climate
37
What we need

• A range of indicators at different levels,
  leading to lagging, to
• Advance the methodology in Ergonomic Intervention
  Research
• Help organizations audit and improve their own
  interventions

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Ergonomics Programs?

• Tackling work-related
• WMSDs Success factors
• The use of prevention-focused interventions at
  the organizational level. These are more
  sustainable than rehabilitation or individual
  level interventions.
• Interventions should reflect a holistic,
  organizational approach
• A sound risk assessment is vital for the design
  of ergonomic interventions
• Commitment, involvement, and support from top
  management are crucial
• Training and advice should always be provided
• Evaluation is essential to ascertain the
  sustainability of efforts
• Research evidence can be used to identify and
  share good practice
• Constructive partnerships at all levels are
  important for coordination of efforts.

• What is risk assessment for
• work-related WMSDs?
• Risk assessment is designed to help employers and
  employees deal with ergonomic risks
  in an evidence based but user-friendly manner.
• It involves
• Assessment of risks
• Design of interventions
• Implementation and monitoring of interventions
• Evaluation and reassessment

39
Ergonomics Program?

• Tackling work-related
• stress Success factors
• The use of prevention-focused interventions at
  the organizational level. These are more
  sustainable than rehabilitation or individual
  level interventions.
• Interventions should reflect a holistic,
  organizational approach
• A sound risk assessment is vital for the design
  of stress interventions
• Commitment, involvement, and support from top
  management are crucial
• Training and advice should always be provided
• Evaluation is essential to ascertain the
  sustainability of efforts
• Research evidence can be used to identify and
  share good practice
• Constructive partnerships at all levels are
  important for coordination of efforts.

• What is risk assessment for
• work-related stress
• Risk assessment is designed to help employers and
  employees deal with psychosocial
  risks in an evidence based but user-friendly
  manner.
• It involves
• Assessment of risks
• Design of interventions
• Implementation and monitoring of interventions
• Evaluation and reassessment

40
Ergonomics Program? No a Stress Program

• Tackling work-related
• stress Success factors
• The use of prevention-focused interventions at
  the organizational level. These are more
  sustainable than rehabilitation or individual
  level interventions.
• Interventions should reflect a holistic,
  organizational approach
• A sound risk assessment is vital for the design
  of stress interventions
• Commitment, involvement, and support from top
  management are crucial
• Training and advice should always be provided
• Evaluation is essential to ascertain the
  sustainability of efforts
• Research evidence can be used to identify and
  share good practice
• Constructive partnerships at all levels are
  important for coordination of efforts.

• What is risk assessment for
• work-related stress
• Risk assessment is designed to help employers and
  employees deal with psychosocial
  risks in an evidence based but user-friendly
  manner.
• It involves
• Assessment of risks
• Design of interventions
• Implementation and monitoring of interventions
• Evaluation and reassessment

• Report on Workshop 1 Work-related stress, in
  Preventing Psychosocial risks at Work European
  perspectives, Forum, European Agency for Safety
  and Health at Work, 9, pp4-5, (2003)

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What we need

• Integration of ergonomic intervention research
  into a broader healthy and productive workplaces
  approach

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• Supported by
• HealNET
• Ontario Workplace Safety and Insurance Board
• The people, corporations, and unions that have
  made this program of Research at Work successful

www.iwh.on.ca www.ergonomics.uwaterloo.ca/
bprint.html wells_at_uwaterloo.ca
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Participative Ergonomics Program Blueprint
Ergonomics Process
Reactive
6 Adopt Solution
1 Identify Opportunities for Improvement
Health Outcome, Risk Factor Identification and
Integration
5 Evaluate Prototype
2 Assess Ergonomic Risk Factors and Prioritize
Jobs for Improvement
4 Implement Prototype
3 Build Solutions
45
Participative Ergonomics Program Blueprint
Ergonomics Process
Proactive
6 Adopt Solution
7a Use Feed--back from Previous designs and
plants
7b Employ Ergonomic Design Criteria and
Purchasing Guidelines
5 Evaluate Prototype
4 Implement Prototype


3 Build Solutions
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Participative Ergonomics Program Blueprint
Ergonomics Program
Participation and Consultation
Training and Education
Ergonomic Tools, Techniques
and Skills
Ergonomics Process
(Medical Management)
Evaluation Process
Management Support of Ergonomics
and Resources
(Compliance Assurance)
Corporate Ergonomics Policy
Documentation
Management of the Ergonomics Program