Upper Limb Musculoskeletal Disorders: Quantifying Risk

描述（由申请人提供）：本提案要求继续我们的多中心、前瞻性队列研究，该研究之前仅关注远端上颌骨（DUE）疾病。最初的研究是对RFA OH-02-010的回应，涉及两个不同州的600多名工作人员。这项研究资助了4年，截至2006年9月。我们正在跟踪来自15个以上不同行业的600多名低（n=251），中等（n=249）和高（n=197）工作物理暴露组的工人，以提高研究结果的普遍性。对数据的初步分析表明，我们将在2006年9月之前实现这项研究的原定目标。这一拟议的延续申请是额外的3年（共7年）。本持续申请的主要目的是：（1）在该队列中继续监测上肢疾病2.25年，以发展足够的能力来识别工作身体、个人和心理社会因素之间的相互作用，以及（2）确定2.25年期间特定肩关节疾病和症状的基线患病率和随后的发病率，风险（最初分为低、中、高）。除了最初的目的，这项多中心前瞻性队列研究将（1）研究各种风险因素内部和之间的相互作用（例如，个人、心理社会和工作身体因素），以更好地量化DUE肌肉骨骼疾病（MSD）的风险，（2）开发一个全面的工作分析模型，包括用于确定DUE MSD风险的相互作用，（3）验证现有的肩部工作分析模型（主要基于姿势），以及（4）开发用于确定肩部MSD风险的综合肩部工作分析模型。工作身体暴露主要依赖于测量来量化暴露，以最大限度地提高客观性和准确性，同时还利用行业中实用且易于使用的方法[从研究到实践（r2 p）]。所有参与者都有经过认证的手部治疗师和合格医生的健康结果评估。所有受试者均具有：（i）基线问卷，（ii）结构化访谈，（iii）标准化体格检查和（iv）神经传导研究（NCS）。每季度对工作实际暴露的变化进行监测。每月对所有参与者进行结构化访谈和体检，评估具体的疾病和症状。感觉异常者接受后续NCS。工作身体暴露和健康结果评估小组都对另一个小组不知情。将利用多变量逻辑回归模型和生存分析来探索风险因素（工作身体、心理社会和个人）与特定疾病、聚集性疾病和症状之间的关系。除了量化人体工程学的风险因素，内部和各种工作之间的相互作用的物理，心理和个人的风险因素将进行探讨。该项目预计将导致DUE和肩工作分析模型，具有强大的预测能力，为广泛的工作。

DESCRIPTION (Provided by applicant): This proposal is a request for continuation of our multi-center, prospective cohort study that previously focused solely on Distal Upper Extremity (DUE) Disorders. The original study was in response to RFA OH-02-010 and involved 600+ workers in two diverse states. The study was funded for 4 years, ending September 2006. We are following 600+ workers in low (n=251), medium (n=249) and high (n=197) job physical exposure groups from 15+ different industries to improve generalizability of the study results. Preliminary analyses of the data suggest that our original objectives of the study will be met by September 2006. This proposed continuation application is for 3 additional years (seven years total). The main purposes of this continuing application are to: (1) continue monitoring upper limb disorders in this cohort for an additional 2.25 years to develop sufficient power to identify interactions within arid between job physical, individual and psychosocial factors, and (2) determine baseline prevalence rates and subsequent incidence rates over a 2.25 year period for specific shoulder disorders and symptoms for a broad range of exposures (initially classified as low, medium, and high). In addition to the original aims, this multi-center prospective cohort study will (1) study interactions within and between various risk factors (e.g. individual, psychosocial, and job physical factors) to better quantify risks for DUE musculoskeletal disorders (MSDs), (2) develop a comprehensive job analysis model including interactions for determining risk for DUE MSDs, (3) validate existing shoulder job analysis models (which are primarily based on posture), and (4) develop a comprehensive shoulder job analysis model for determining risk of shoulder MSDs. Job physical exposures primarily rely on measurements to quantify exposures to maximize objectivity and accuracy, while also utilizing methods that are practical and readily usable in industry [Research to Practice (r2p)]. All participants have health outcomes assessments by Certified Hand Therapists and qualified physicians. All subjects have: (i) baseline questionnaires, (ii) structured interviews, (iii) standardized physical examinations and (iv) nerve conduction studies (NCS). Changes in job physical exposures are monitored quarterly. Specific disorders and symptoms are assessed monthly on all participants using structured interviews and physical examinations. Those with paresthesias receive a follow-up NCS. Both Job Physical Exposure and Health Outcomes Assessment Teams are blinded to the other team. Multivariate logistic regression models and survival analyses will be utilized to explore relationships between risk factors (job physical, psychosocial and individual) and specific disorders, aggregate disorders and symptoms. In addition to quantifying ergonomic risk factors, interactions within and between various job physical, psychosocial and individual risk factors will be explored. This project is expected to result in DUE and shoulder job analysis models that have robust predictive capabilities for a broad range of jobs.