International Journal of Epidemiology 2002;31:702
© International Epidemiological Association 2002
Book Review |
Musculoskeletal Disorders and the Workplace: Low Back and Upper Extremities. Panel on Musculoskeletal Disorders and the Workplace, Commission on Behavioral and Social Sciences and Education, National Research Council and Institute of Medicine. Washington DC: National Academy Press, 2001, pp. 429, £39.95. ISBN: 309-07284-0 (HB).
Musculoskeletal disorders of the back and the upper limb are a major source of morbidity, particularly occupational morbidity. They are a major cost in terms of loss of productivity to the health service and to the sufferer, and impose a substantial economical burden in compensation costs. This book, prepared by a panel on musculoskeletal disorders and the workplace, is based on a report of a comprehensive review of the scientific literature on the relationship of work and the workplace to musculoskeletal disorders of the low back and upper extremities. The impetus for this review came from a series of questions posed by the US Congress about, amongst other things, the incidence and prevalence of work-related musculoskeletal disorders, the evidence about the role of work and non-work factors in causation of such disorders, and about preventative strategies.
The screening criteria used to select the research literature for review were: (1) focus on low back and upper extremity musculoskeletal disorders, (2) conducted within the last 20 years (3) published in peer-reviewed publications and (4) published in English.
The book consists of an executive summary and three parts plus five appendices. In Part 1 there is an introductory chapter containing contextual material followed by chapters on the prevalence, incidence and costs associated with musculoskeletal disorders and their economic and social influence. The final chapter in this part contains an overview of the methodological issues and approaches used in the research on musculoskeletal disorders. The second part provides the reviews of the evidence and consists of five chapters containing detailed descriptions of epidemiological studies about the importance of physical and psychosocial factors, tissue mechanobiology, biomechanics, physical and behavioural responses to stress, workplace interventions and general characteristics of the workplace now and in the future. The final part presents a synthesis of the evidence and the panel's conclusions and recommendations, including an agenda for future research. The appendices include a report by a dissenting voice and the panel's response.
The review and analysis of the evidence led to a number of conclusions. One of these suggests that because workplace disorders and individual risk and outcomes are difficult to disentangle, musculoskeletal disorders should be approached in the context of the whole person rather than focusing on body regions in isolation. This is mainly because of the lack of congruity between the pain reported by sufferers with low back or upper limb disorders and the clinical evidence of abnormalities i.e. the lack of fit between disease and illness.
The literature on the risk factors for upper limb extremities is less well developed than that for low back pain. However, despite this a similar set of explanations emerges for both in that external loads and psychosocial factors are associated with work-influenced outcomes. More specifically, the panel concluded that there is a clear relationship between back disorders and physical load, i.e. manual , material handling, load movement, frequent bending and twisting, heavy physical work and whole-body vibration. For disorders of the upper extremities, repetition, force and vibration are particularly important work-related factors. In terms of psychosocial factors, rapid work pace, monotonous work, low job satisfaction, low decision latitude and job stress are associated with low back disorders. High job demands and high job stress are work-related psychosocial factors that are associated with upper limb extremities. These risk factors are mediated by individual risk factors, including age, gender, body mass index, and a number of individual psychosocial factors.
They conclude that modifying the various physical and psychosocial factors could reduce substantially the risk of symptoms for low back and upper extremity disorders. The approach suggested to reduce both types of risk factors is mainly through the application of ergonomic principles.
What are the implications of the predicted changes in working patterns and activities for musculoskeletal disorders? It is suggested that work in the future may pose a lower risk for back problems and a higher risk for upper extremities. The latter is explained by the increasing diversity of jobs and work which will lead to increasing interactions with computers and the rapid movement of a large variety of relatively lightweight products. Heavy lifting may decrease because of automation. However, continued long working hours and the increasing requirement for shift work increase the opportunities for fatigue and exposure to musculoskeletal disorder risk factors. In addition, psychosocial stress is expected to play a greater role in the workplace of the future.
A well-written and structured book which provides a wealth of carefully analysed evidence. A useful handbook for those who require an up-to-date picture of the relationship between work and musculoskeletal problems, and to identify priorities for policy and future research. Of particular interest is the role of stress and other psychosocial factors in the development of musculoskeletal disorders. What appears to be lacking in this research is a coherent theory which links the working environment, how workers experience it and how their experiences are translated into signs and symptoms of musculoskeletal disorders. This requires a truly interdisciplinary perspective which seems to be lacking in this area.
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