Work-related musculoskeletal disorders: the epidemiologic evidence and the debate
Work-related musculoskeletal disorders: the epidemiologic evidence and the debate
复制标题
DOI：
10.1016/j.jelekin.2003.09.015
复制
发表时间：
2004-02-01
影响因子：
2.5
通讯作者：
Wegman, DH
中科院分区：
文献类型：
--
作者：
Punnett, L;Wegman, DH
关于肌肉骨骼疾病（MSD）与工作相关性的争论反映了流行病学原理的混乱和科学文献的空白。经常被引用为MSD风险因素的工作的人体工程学特征包括快速工作节奏和重复运动，用力，非中性身体姿势和振动。然而，有些人仍然对这些因素的重要性提出异议，特别是与非职业原因有关的因素。本文参考美国国会最近委托国家研究理事会（NRC）和医学研究所（IOM）编写的一份重要报告（2001）来解决这一争议。现有的流行病学证据是大量的，但将受益于更多的纵向数据，以更好地评估有关效应潜伏期、自然史、预后、以及健康工人效应形式的潜在选择偏差。虽然客观的措施可能是特别有用的，在建立一个更安全的诊断，主观措施更好地捕捉病人的影响。检查技术仍然不存在，可以作为工作场所研究中常见的许多症状的“金标准”。最后，风险评估往往局限于粗略的指标。例如职称。工人的自我报告，调查观察，和直接测量每一个增加了解，但缺乏标准化的暴露指标限制的能力，比较研究之间的结果，尽管存在这些挑战，流行病学文献的工作相关的MSDs结合广泛的实验室证据的病理机制相关的工作压力是令人信服的。NRC/IOM报告得出结论，国际上其他评审员也同意，职业工效学压力源对发生下背部和上肢MSD的病因学重要性已得到证实。(C)2003 Elsevier Ltd.保留所有权利。
The debate about work-relatedness of musculoskeletal disorders (MSDs) reflects both confusion about epidemiologic principles and gaps in the scientific literature. The physical ergonomic features of work frequently cited as risk factors for MSDs include rapid work pace and repetitive motion, forceful exertions, non-neutral body postures, and vibration. However, some still dispute the importance of these factors, especially relative to non-occupational causes. This paper addresses the controversy with reference to a major report recently commissioned by the US Congress from the National Research Council (NRC) and Institute of Medicine (IOM) (2001).The available epidemiologic evidence is substantial, but will benefit from more longitudinal data to better evaluate gaps in knowledge concerning latency of effect, natural history, prognosis, and potential for selection bias in the form of the healthy worker effect. While objective measures may be especially useful in establishing a more secure diagnosis, subjective measures better capture patient impact. Examination techniques still do not exist that can serve as a "gold standard" for many of the symptoms that are commonly reported in workplace studies. Finally, exposure assessment has too often been limited to crude indicators. such as job title. Worker self-report, investigator observation, and direct measurement each add to understanding but the lack of standardized exposure metrics limits ability to compare findings among studies.Despite these challenges, the epidemiologic literature on work-related MSDs-in combination with extensive laboratory evidence of pathomechanisms related to work stressors-is convincing to most. The NRC/IOM report concluded, and other reviewers internationally have concurred, that the etiologic importance of occupational ergonomic stressors for the occurrence of MSDs of the low back and upper extremities has been demonstrated. (C) 2003 Elsevier Ltd. All rights reserved.