Upper Limb Musculosketal Disorders: Quantifying Risk

描述：这项多中心前瞻性队列研究将：(I)确定3年内特定上肢远端疾病和症状的基线患病率和随后的发病率，3个水平的工作身体暴露(低、中、高)，(Ii)量化工作和个人风险因素(例如，力量、姿势、重复等)，(Iii)验证现有的工作分析方法(特别是美国政府卫生师会议(ACGIH)手活动(HAL)、应变指数(SI)和华盛顿州检查表)的阈值(TLV)，以及(Iv)开发确定MSD风险的最终模型。来自两个不同州的5个非常不同的行业的600名工人(取代了研究辍学的人)将参与这项研究，以帮助确保研究结果的普遍性。 为了最大限度地提高客观性和准确性，工作物理暴露将主要依靠测量来量化暴露。为了最大限度地提高临床和流行病学的有效性和可靠性，所有参与者都将接受注册手部治疗师和合格医生的健康结果评估。这些措施将包括：基线问卷、结构化访谈和标准化体检。每月将监测工作身体暴露的变化。具体的障碍和症状将每月使用症状问卷对所有人进行评估，并对有症状的人进行结构化访谈/体检。在评估工人群体方面经验丰富的资深医生将为那些出现CTS样症状的工人提供电诊断测试(基线时，如果出现新症状，则在每月随访期间)。在整个实地观察阶段，工作、身体接触和健康结果评估小组将彼此视而不见。 多元Logistic回归(MLR)模型和生存分析将被用来探索工作身体风险因素与特定障碍、聚合障碍和症状之间的关系。除了量化人体工学风险因素外，还将探索各种工作、心理社会和个人风险因素之间的相互作用。预计该项目将能够改进现有的人体工程学工作评价模型，这些模型具有强大的预测能力，适用于广泛的行业。

DESCRIPTION: This multi-center prospective cohort study will: (i) Determine baseline prevalence rates and subsequent incidence rates over a 3 year period for specific distal upper extremity disorders and symptoms for 3 levels of job physical exposures (low, medium, high), (ii) Quantify job and individual risk factors (e.g., force, posture, repetition, etc.), (iii) Validate existing job analysis methods (especially American Conference of Governmental Hygienists (ACGIH) Threshold Limit Value (TLV) for Hand Activity (HAL), Strain Index (SI) and Washington State Checklist), and (iv) develop a final model for determining MSD risks. A cohort of 600 workers (study drop-outs replaced) from 5 very different industries with a total worker population of over 10,000 in two diverse states will participate in the study to help ensure generalizability of the study results. To maximize objectivity and accuracy, job physical exposures will rely primarily on measurements to quantify exposures. To maximize clinical and epidemiological validity and reliability, all participants will have health outcomes assessments by Certified Hand Therapists and qualified physicians. These will include: baseline questionnaires, structured interviews and standardized physical examinations. Changes in job physical exposures will be monitored monthly. Specific disorders and symptoms will be assessed monthly using a symptom questionnaire on all, and structured interviews/physical examinations on those with symptoms. Senior physicians experienced in evaluating worker populations will provide electrodiagnostic testing (at baseline, and during monthly follow-up if new symptoms develop) to those workers with CTS-like symptoms. Job physical exposure and health outcomes assessment teams will be blinded to each other throughout the field observation phase. Multivariate logistic regression (MLR) models and survival analyses will be utilized to explore relationships between job physical risk factors and specific disorders, aggregate disorders and symptoms. In addition to quantifying ergonomic risk factors, interactions between various job, psychosocial and individual risk factors will be explored. This project is expected to result in the ability to improve the existing ergonomic job evaluation models that have robust predictive capabilities for a broad range of industries.