The effectiveness of commonly used lifting assessment methods to identify industrial jobs associated with elevated risk of low-back disorders.
The effectiveness of commonly used lifting assessment methods to identify industrial jobs associated with elevated risk of low-back disorders.
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常用的举重评估方法来识别与腰背疾病风险升高相关的工业工作的有效性。
作者：
W. Marras;L. Fine;S. Ferguson;T. Waters
下背部疾病（LBD）仍然是当今社会面临的最昂贵和最常见的肌肉骨骼问题。研究人员已经开发出了一些工具或措施，旨在确定可能与腰背痛风险升高相关的工作。然而，与这些工具和程序有关的一个重要但未得到广泛讨论的问题是这些工具的有效性或效力。因此，本研究的目的是评估的有效性和有效性的两种常用类型的LBD评估方法的能力，正确地将工作与LBD风险。1981年NIOSH的工作实践指南手动起重和1991年NIOSH修订的起重方程，沿着心理物理措施进行了评估，以正确识别高，中，低风险（LBD）的工作。风险是根据353个工业工作的数据库定义的，这些工作代表了超过2100万人小时的暴露。结果表明，两种NIOSH指标均具有预测性，比值比在3.1至4.6之间。与平均水平距离相比，当使用最大水平距离来评估工作时，发现了更高的优势比。进一步的分析表明，这两种NIOSH评估方法以非常不同的方式对风险进行分类。1981年的NIOSH指南表现出良好的特异性（91%），因为它很好地识别了低风险工作，但它也显示出低灵敏度，仅正确识别了10%的高风险工作。而1993年NIOSH修正的升力方程则具有更好的灵敏度。它正确识别了73%的高风险工作，但没有很好地识别低风险和中等风险工作。使用心理物理标准，据观察，60%的高风险工作将被判断为是可以接受的，而64%和91%的中风险和低风险的工作，分别被判断为是可以接受的。这项研究表明，不同的措施有不同的优点和缺点。在控制职业性LBD时，应认识到存在多种措施，最适当评估风险的措施取决于工作的特点。
Low-back disorders (LBD) continue to be the most costly and common musculoskeletal problem facing society today. Investigators have developed tools or measures that are intended to identify jobs that will probably be associated with an elevated risk of low-back disorders. However, an important and not widely discussed issue associated with these tools and procedures has been that of the validity or effectiveness of the tools. Therefore the objective of this study was to evaluate the validity and effectiveness of two commonly used types of LBD assessment methods in terms of their ability to correctly associate jobs with LBD risk. The 1981 NIOSH Work Practices Guide for Manual Lifting and the 1991 NIOSH revised lifting equation, along with psychophysical measures were assessed for their ability to correctly identify high-, medium-, and low-risk (of LBD) jobs. Risk was defined according to a database of 353 industrial jobs representing over 21 million person-hours of exposure. The results indicated that both NIOSH measures were predictive and resulted in odds ratios between 3.1 and 4.6. Higher odds ratios were found when the maximum horizontal distance was used to assess a job compared to the average horizontal distance. Further analyses indicated that the two NIOSH assessment methods classified risk in very different ways. The 1981 NIOSH Guide demonstrated good specificity (91%) in that it identified low-risk jobs well but it also displayed low sensitivity by only correctly identifying 10% of the high-risk jobs. The 1993 NIOSH revised lifting equation, on the other hand, had better sensitivity. It correctly identified 73% of the high-risk jobs but did not identify low- and medium-risk jobs well. Using psychophysical criteria it was observed that 60% of the high-risk jobs would be judged to be acceptable, whereas, 64% and 91% of the medium- and low-risk jobs, respectively, would be judged to be acceptable. This study indicates that the different measures have various strengths and weaknesses. When controlling for occupational LBD it should be recognized that a variety of measures exist and that the measure that most appropriately assesses risk depends upon the characteristics of the job.