Work-Related Musculoskeletal Disorders

Report, Workshop Summary, and Workshop Papers

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

Washington, DC

The National Academies of Sciences, Engineering, and Medicine
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--> Work-Related Musculoskeletal Disorders Report, Workshop Summary, and Workshop Papers 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 1999

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--> 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 competencies 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 0-309-06397-3 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 Copyright 1999 by the National Academy of Sciences. All rights reserved. Printed in the United States of America

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--> 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 RENAE BRODERICK, Senior Consultant 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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--> 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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--> CONTENTS Preface   ix I Steering Committee Report     1   Introduction   3     Background   3     Framework of Contributors to Musculoskeletal Disorders   5 2   State of the Evidence   8     Criteria to Determine Causality   9     Soft Tissue Responses to Physical Stressors   11     Work Factors and Biomechanics   12     Epidemiological Evidence that Physical Factors Can Cause Musculoskeletal Disorders   14     Epidemiological Evidence that Non-Biomechanical Factors Can Cause Musculoskeletal Disorders   16     Interventions   18     Future Research   21 3   Seven Questions Posed by Congressman Robert Livingston   23 4   Conclusions   27     References   29

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--> II Workshop Summary         Introduction   35     Organizing Framework   36     Biological Responses of Tissues to Stressors   39     Presentations   39     Discussion   42     Work Factors, Individual Host Factors, and Internal Loads: Biomechanics of Work Stressors   45     Presentation   45     Discussion   46     Epidemiology: Physical Factors   49     Panel Discussion   49     Workshop Discussion   51     Non-Biomechanical Factors that Can Affect Musculoskeletal Disorders   52     Presentation   52     Discussion   54     Intervention to Control Musculoskeletal Disorders   56     Presentation   56     Discussion   58     Conclusion: Integration and Overview   59     Panel Comments   59     General Discussion   60     References   61 Appendix A:   Invitees and Participants   63 Appendix B:   Workshop Agenda   67

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--> III Workshop Papers         Response of Muscle and Tendon to Injury and Overuse James A. Ashton-Miller   73     Biological Response of Peripheral Nerves to Loading: Pathophysiology of Nerve Compression Syndromes and Vibration Induced Neuropathy David Rempel, Lars Dahlin, And Göran Lundborg   98     Work Factors, Personal Factors, and Internal Loads: Biomechanics of Work Stressors Robert G. Radwin And Steven A. Lavender   116     Epidemiology Panel: Collected Papers   152     Bradley Evanoff   152     Afred Franzblau   155     Fredric Gerr   159     Laura Punnett   162     Howard M. Sandler (With Richard S. Blume)   167     David H. Wegman   172     Non-Biomechanical Factors Potentially Affecting Musculoskeletal Disorders Julia Faucett And Robert A. Werner   175     A Review of Research on Interventions to Control Musculoskeletal Disorders Michael J. Smith, Ben-Tzion Karsh, And Francisco B.P. Moro   200

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--> PREFACE This volume is the work of the Steering Committee for the Workshop on Work-Related Musculoskeletal Injuries: The Research Base, which was established in May 1998 by the National Research Council (NRC) in response to a request from the National Institutes of Health. The charge was to design a workshop to examine the scientific literature on work-related musculoskeletal disorders and to prepare a report based on the workshop discussions and the committee members' own expertise. In developing the workshop, the steering committee identified leading researchers to participate as paper presenters and discussants. Part I of this volume presents the steering committee's report, which was published as a separate document in October 1998. It contains a general framework for examining the literature, a discussion of the state-of-the-evidence regarding both work-related and non-work-related factors, a list of issues that deserve the attention of researchers, and the committee's response to a series of questions posed by Congress. Part II provides a summary of the workshop proceedings, and Part III contains the workshop papers. Because the steering committee's report and the workshop summary were initially prepared as stand-alone documents there is some overlap in their introductory sections. Many individuals have made significant contributions to the success of the project. First, we extend our thanks to the members of the steering committee, who were willing to work on a complex and controversial topic under extreme time pressure. Each offered a unique perspective that led to a fuller understanding of the issues and the relevance of the existing science base. Also, we thank the workshop participants for their interest in the topic and their work in writing papers and preparing discussion statements on a very constrained time schedule.

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--> Staff of the NRC were extremely helpful in organizing the workshop and in working through various drafts of these reports. We are particularly grateful to Renae Broderick, a consultant to the project, for her work in preparing the workshop summary. We are also indebted to James McGee for his efforts in coordinating workshop participants and activities; to Susan McCutchen who was indispensable in arranging travel, compiling agenda materials, and managing the preparation of this volume; to Eugenia Grohman, associate director for reports of the Commission on Behavioral and Social Sciences and Education, whose editing greatly improved the report; and to Alexandra Wigdor for her interest, guidance, and support. This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the NRC's Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution 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 review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We wish to thank the following individuals for their participation in the review of the steering committee report, the workshop summary, or both: 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, DC. While the individuals listed above have provided constructive comments and suggestions, it must be emphasized that responsibility for the final content of this report rests entirely with its authors and the institution. RICHARD PEW, COCHAIR COLIN DRURY, COCHAIR ANNE MAVOR, STUDY DIRECTOR