| 2. |
- Lundberg, Ulf, et al.
(författare)
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Arbetsmiljöns betydelse för ryggproblem : En systematisk litteraturöversikt
- 2014
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Rapport (refereegranskat)abstract
- The Swedish Council on Health Technology Assessment (SBU) conducted a systematic literature review of research on the association between occupational exposures and back disorders. In this review, we use back disorders as an umbrella term to include the more specific terms back trouble (a subjective experience of pain, ache or discomfort in the back), symptoms of sciatica, intervertebral disc changes and diseases of the back. The report is focused on disorders of the thoracic and lumbar spine. A wide range of occupational exposures were investigated, including: physical work load, vibration, organizational and psychosocial factors, chemical and biological factors, noise, environmental factors and contagious substances.Background: Since 2011 SBU has had a mandate from the Swedish government to systematically assess the evidence associating occupational exposures to health issues. The objective of this review was to assess the scientific basis describing the influence of occupational exposures on back disorders. Back disorders are common. Between 60 and 70 percent of the general population world-wide suffer from back pain at least once in their life. For affected individuals, back disorders are the source of both suffering and decreased functioning. The costs to society are also considerable in terms of direct health care costs, financial support to individuals with work disability, as well as costs due to loss of production.Method: A systematic review was undertaken following the PRISMA statement and standard methods used by SBU adapted to an occupational context. A literature search covering years 1980 to January 2014 was conducted in international medical and occupational data bases. The review assessed almost 8 000 abstracts. Studies that fulfilled strict inclusion criteria were assessed for relevance and quality, using pre-set protocols. Relevance and quality assessments were conducted by two experts, working in an evaluation pair. After conducting independent assessments, the two experts had to agree on a mutual relevance and quality classification. Some articles required that all exporters participated in discussion and made a collective assessment. A total of 109 studies were classified as moderate or high quality, representing more than 150 000 study participants. The strength of the scientific evidence was assessed with the GRADE system.Results: There is an association between occupational exposure and back disorders. This result is based on investigations of a large variety of work environments, mainly in Europe and North America. In most studies passing the quality criteria, researchers investigated occupational exposure and back disorders in populations consisting of both women and men with at least one year of follow up.Conclusions: People in the following groups develop more back trouble over time than those who are not subjected to the specified exposure at work:– Those who work with manual handling (e.g. lift) or in a posture where the back is bent or rotated– Those who work in a kneeling or squatting posture, or have physically demanding work tasks– Those exposed to whole body vibration– Those who experience work as mentally stressful; or those who find their work demanding, but lack decision latitude (personal control of their own working situation); or those who have insufficient opportunities for personal development– Those who work outside standard office hours.In some work environments, people have less back trouble. Those who experience high influence over work-related decisions, those who get social support at work and those with high job satisfaction develop less back trouble than others.Women and men with similar occupational exposures develop back troubles to the same extent.Those who work in forward bent postures or are exposed to whole body vibration in their work develop more symptoms of sciatica than others, while those with high job satisfaction develop less such symptoms. Those whose work entails manual handling develop more intervertebral disc changes than others.This systematic literature review has uncovered a substantial body of knowledge concerning occupational exposures and back disorders. Future research should include intervention studies, i.e. studies that scientifically test the effect of well defined interventions on back disorders over extended periods of time in authentic work situations.Project groupExperts: Karin Harms-Ringdahl (Chair), Sven Ove Hanson (Ethics), Olle Hägg, Ulf Lundberg, Svend Erik Mathiasen, Gunnevi Sundelin, Magnus Svartengren, and Hans Tropp.SBU: Charlotte Hall (Project Director), Karin Stenström (Assistant Project Director), Agneta Brolund (Information Specialist), Therese Kedebring (Project Administrator), Laura Lintamo (Investigator), Maria Skogholm (Project Administrator), Lena Wallgren (Scientific Writer)Scientific reviewers: Eva Denison, Mats Hagberg, Gunnar Nemeth, Esa-Pekka Takala.
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| 3. |
- Rezagholi, Mahmoud
(författare)
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Cost-Efficient Designs for Assessing Work-Related Biomechanical Exposures
- 2012
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Work-related disorders due to biomechanical exposures have been subject to extensive research. Studies addressing these exposures have, however, paid limited attention to an efficient use of resources in exposure assessment. The present thesis investigates cost-efficient procedures for assessment of work-related biomechanical exposures, i.e. procedures aiming at a proper balance between statistical and economic performance.Paper I is a systematic review of tools used in literature providing cost-efficient data collection designs. Two main approaches were identified in nine publications, i.e. comparing cost efficiency among alternative data collection designs, and optimizing resource allocation between different stages of data collection, e.g. subjects and samples within subjects. The studies presented, in general, simplified analyses, in particular with respect to economics.Paper II compared the cost-efficiency of four video-based techniques for assessing upper arm postures. The comparison was based both on a comprehensive model of cost and error and additionally on two simplified models. Labour costs were a dominant factor in the cost efficiency comparison. Measurement bias and costs other than labour cost influenced the rank and economic evaluation of the assessment techniques.Paper III compared the cost efficiency of different combinations of direct and indirect methods for exposure assessments. Although a combination of methods could significantly reduce the total cost of obtaining a desired level of precision, the total cost was, in the investigated scenario, lowest when only direct measurements were performed. However, when the total number of measurements was fixed, a combination was the most cost efficient choice.In Paper IV, demand functions were derived for a four-stage measurement strategy with the focus of either minimizing the cost for a required precision, or maximizing the precision for a predetermined budget. The paper presents algorithms for identifying optimal values of measurement inputs at all four stages, adjusted to integers, as necessary for practical application.In summary, the thesis shows that it is important to address all sources of costs and errors associated with alternative measurement designs in any particular study, and that an optimal determination of samples at different stages can be identified in several cases not previously addressed in the literature.
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