Work-Related Musculoskeletal Disorders:

A Review of the Evidence

Steering Committee for the Workshop on Work-Related Musculoskeletal Injuries: The Research Base

Committee on Human Factors

Commission on Behavioral and Social Sciences and Education

National Research Council

National Academy Press
Washington, DC
1998



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Work-Related Musculoskeletal Disorders: A Review of the Evidence Work-Related Musculoskeletal Disorders: A Review of the Evidence Steering Committee for the Workshop on Work-Related Musculoskeletal Injuries: The Research Base Committee on Human Factors Commission on Behavioral and Social Sciences and Education National Research Council National Academy Press Washington, DC 1998

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Work-Related Musculoskeletal Disorders: A Review of the Evidence NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance. The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Bruce M. Alberts is president of the National Academy of Sciences. The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. William A. Wulf is president of the National Academy of Engineering. The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Kenneth I. Shine is president of the Institute of Medicine. The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy's purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Bruce M. Alberts and Dr. William A. Wulf are chairman and vice chairman, respectively, of the National Research Council. This project was supported by an award between the National Academy of Sciences and the Department of Health and Human Services; the project, N01-IOD-4-2139, Task Order No. 47, received support from the evaluation set-aside Section 513, Public Health Service Act. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the view of the organizations or agencies that provided support for this project. International Standard Book Number 0-309-06327-2 Additional copies of this report are available from: National Academy Press 2101 Constitution Avenue, N.W. Washington, DC 20418 Call 800-624-6242 or 202-334-3313 (in the Washington Metropolitan Area). This report is also available on line at http://www.nap.edu Copyright 1998 by the National Academy of Sciences. All rights reserved. Printed in the United States of America

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Work-Related Musculoskeletal Disorders: A Review of the Evidence Steering Committee for the Workshop on Work-Related Musculoskeletal Injuries: The Research Base RICHARD PEW (Cochair), Independent Consultant, Cambridge, Massachusetts COLIN DRURY (Cochair), Department of Industrial Engineering, State University of New York, Buffalo GUNNAR ANDERSSON, Department of Orthopedic Surgery, Rush Presbyterian-St. Luke's Medical Center, Chicago, Illinois THOMAS ARMSTRONG, Department of Industrial and Operations Engineering, University of Michigan, Ann Arbor DAVID CORDRAY, Department of Psychology and Human Development and Vanderbilt Institute for Public Policy Studies, Vanderbilt University MARK CULLEN, Occupational and Environmental Medicine Program, Yale University School of Medicine BARUCH FISCHHOFF, Department of Social and Decision Sciences and Department of Engineering and Public Policy, Carnegie Mellon University WILLIAM HOWELL, Liaison, Committee on Human Factors; Department of Psychology, Arizona State University, Tempe WILLIAM MARRAS, Institute for Ergonomics, Ohio State University DAVID VLAHOV, Department of Epidemiology, Johns Hopkins University ANNE MAVOR, Study Director JAMES McGEE, Senior Research Associate SUSAN McCUTCHEN, Senior Project Assistant ALEXANDRA WIGDOR, Director, Division on Education, Labor, and Human Performance SUSAN COKE, Administrative Associate, Division on Education, Labor, and Human Performance

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Work-Related Musculoskeletal Disorders: A Review of the Evidence Committee on Human Factors WILLIAM C. HOWELL (Chair), Department of Psychology, Arizona State University, Tempe TERRY CONNOLLY, Department of Management and Policy, College of Business and Public Administration, University of Arizona, Tucson COLIN G. DRURY, Industrial Engineering Department, University of Buffalo, New York MARTHA GRABOWSKI, Rensselaer Polytechnic Institute and LeMoyne College DANIEL R. ILGEN, Department of Psychology and Department of Management, Michigan State University RICHARD J. JAGACINSKI, Department of Psychology, Ohio State University, Columbus LAWRENCE R. JAMES, Department of Management, University of Tennessee BONNIE E. JOHN, Human-Computer Interaction Institute, Carnegie Mellon University TOM B. LEAMON, Liberty Mutual Insurance Co. and Liberty Mutual Research Center for Safety and Health, Hopkinton, Massachusetts DAVID C. NAGEL, AT&T Laboratories, Basking Ridge, New Jersey KARLENE ROBERTS, Haas School of Business, University of California, Berkeley LAWRENCE W. STARK, School of Optometry, University of California, Berkeley KIM J. VICENTE, Department of Mechanical and Industrial Engineering, University of Toronto, Canada EARL L. WIENER, Department of Management Science, University of Miami GREG L. ZACHARIAS, Charles River Analytics, Cambridge, Massachusetts ANNE MAVOR, Director JERRY KIDD, Senior Adviser SUSAN McCUTCHEN, Senior Project Assistant

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Work-Related Musculoskeletal Disorders: A Review of the Evidence Acknowledgments This report has been reviewed by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the Report Review Committee of the National Research Council (NRC). The purpose of this independent review is to provide candid and critical comments that will assist the authors and the NRC in making the published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The content of the review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We wish to thank the following individuals, who are neither officials nor employees of the NRC, for their participation in the review of this report: Peter C. Amadio, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN; David R. Challoner, Institute for Science and Health Policy, University of Florida; Richard Deyo, University of Washington Health Science Center; Michael Feuerstein, Uniformed Services University of the Health Sciences and Georgetown University School of Medicine; Mark D. Grabiner, Department of Biomedical Engineering, The Cleveland Clinic Foundation; Jay S. Himmelstein, Center for Health Policy and Health Services Research, University of Massachusetts Medical School; Frederick Mosteller, Department of Statistics (emeritus), Harvard University; Dorothy P. Rice, School of Nursing (emeritus), University of California, San Francisco; Stover H. Snook, Harvard School of Public Health; and Laura W. Welch, Department of Occupational and Environmental Medicine, Washington Hospital Center, Washington, D.C. Although the individuals listed above have provided many constructive comments and suggestions, responsibility for the final content of this report rests solely with the authoring committee and the NRC.

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Work-Related Musculoskeletal Disorders: A Review of the Evidence Contents 1   Introduction   1     Background   1     Framework of Contributors to Musculoskeletal Disorders   2 2   State of the Evidence   6     Criteria to Determine Causality   6     Soft Tissue Responses to Physical Stressors   8     Work Factors and Biomechanics   9     Epidemiological Evidence that Physical Factors Can Cause Musculoskeletal Disorders   11     Epidemiological Evidence that Non-Biomechanical Factors Can Cause Musculoskeletal Disorders   13     Interventions   15     Future Research   17 3   Seven Questions Posed by Congressman Robert Livingston   19 4   Conclusions   23     References   25 Appendix A:   Invitees and Participants, Workshop on Work-Related Musculoskeletal Injuries: Examining the Research Base   28 Appendix B:   Agenda, Workshop on Work-Related Musculoskeletal Injuries: Examining the Research Base   32

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