Paper Metodos Ergonomicos

Finnish Institute of Occupational Health
Danish National Research Centre for the Working Environment

Norwegian National Institute of Occupational Health
Systematic evaluation of observational methods assessing biomechanical exposures at work

Author(s): Esa-Pekka Takala, Irmeli Pehkonen, Mikael Forsman, Gert-Åke Hansson, Svend Erik
Mathiassen, W Patrick Neumann, Gisela Sjøgaard, Kaj Bo Veiersted, Rolf H Westgaard and
Jørgen Winkel
Source: Scandinavian Journal of Work, Environment & Health, Vol. 36, No. 1 (January 2010),
pp. 3-24
Published by: the Scandinavian Journal of Work, Environment & Health, the Finnish Institute of
Occupational Health, the Danish National Research Centre for the Working Environment, and the
Norwegian National Institute of Occupational Health
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Review
Scand J WorkEnvironHealth201 0,36(1):3-24
evaluation
Systematic methods
ofobservational assessingbiomechanical
atwork
exposures
Takala,
byEsa-Pekka PhD,1Irmeli MSc,1Mikael
Pehkonen, Forsman,
PhD,2Gert-Âke
Hansson,
PhD,3
SvendErik
Mathlassen, W
PhD,4 Patrick
Neumann,
PhD,5Gisela PhD,6
Sjßgaard, KajBoVeiersted,
PhD,7
RolfH Westgaard,
PhD,8 PhD9
Winkel,
Jörgen
TakalaE-P,Pehkonen
I, Forsman
M,Hansson G-Â,Mathiassen
SE, Neumann G,Veiersted
WP,Sjogaard KB,
WestgaardRH,Winkel
J.Systematic
evaluation
ofobservational
methods biomechanical
assessing at
exposures
work.
ScandJWork Environ
Health.
2010;36(1):3-24.
Objectives Thissystematic reviewaimedtoidentify publishedobservational
methodsassessingbiomechanical
inoccupational
exposures andevaluatethemwithreference
settings totheneedsofdifferent users.
Methods Wesearched scientific
databasesandtheinternetformaterialfrom1965toSeptember 2008.Methods
wereincludediftheywereprimarily basedon thesystematic observationofwork,theobservation was
target
thehumanbody,andthemethod intheliterature.
was clearlydescribed A systematic
evaluation procedurewas
developedto assessconcurrentandpredictive validity, andaspectsrelatedto utility.
repeatability, Atleasttwo
evaluators
independently carriedoutthisevaluation.
Results We identified 30 eligibleobservationalmethods.Of these,19 hadbeencompared withsomeother
method(s),varyingfromexpert evaluation todataobtained
from videorecordingsorthrough theuseoftechnical
instruments. theobservations
Generally, showedmoderate-to-goodagreement withthecorresponding assessments
madefrom videorecordings;agreement wasthebestforlarge-scalebodypostures andworkactions.Posturesof
wristandhandas wellas trunk rotation
seemedtobe moredifficulttoobservecorrectly.Intra-andinter-observer
werereported
repeatability for7 and17methods, andwerejudgedmostly
respectively, tobe moderate orgood.
Conclusions Withtraining, observers can reachconsistent
results
on clearlyvisiblebodypostures andwork
activities.
Manyobservational toolsexist,butnoneevaluated
inthisstudyappearedtobegenerally When
superior.
a method,
selecting usersshoulddefine theirneedsandassesshowresults willinfluencedecision-making.
Keyterms posture;
review;riskassessment;
workload.
Observational methods are probably the most often methodsand diversityin user needs, the selectionof an
used approach to evaluate physical workload in order appropriatetool can be challenging.
to identifyhazardsat work,monitortheeffectsof ergo- The selectionof a methodshould be based on (i) the
nomie changes, and conduct researchon these issues. objectives of its use, (ii) the characteristicsof thework
The numberof available methodsis large,butno single to be assessed, (iii) the individual(s) who will use the
one is suitable forall purposes - different
approaches method,and (iv) the resourcesavailable forcollecting
are needed for differentgoals. Due to differencesin and analyzing data. In epidemiological research, the
* FinnishInstitute
ofOccupational Finland.
Health,Helsinki,
2 KarolinskaInstitutet,
Stockholm,Sweden.
3 andEnvironmental Medicine,LundUniversity,
Occupational Lund,Sweden.
4 CentreforMusculoskeletalResearch, ofGavie,Sweden.
University
5 Canada.
Toronto,
Ryerson University,
6 ofSouthern
University Denmark,Odense,Denmark.
7 NationalInstitute
ofOccupational Health,Oslo,Norway.
° ofScienceandTechnology,
Norwegian University Trondheim, Norway.
UniversityofGothenburg,Gothenburg,SwedenandtheNationalResearchCentrefortheWorking
Environment, Denmark.
Copenhagen,
Correspondenceto: Dr E-P Takala,FinnishInstitute
of OccupationalHealth,Topeliuksenkatu
41, FI-00250 Helsinki,Finland.[E-mail:
esa-pekka.takala@ttl.fi]
Scand J WorkEnvironHealth 2010, vol 36, no 1 3

Systematicevaluationofobservationalmethods
appropriate methods forstudying healthhazardsusually to identify sourcesvia theinternet. The searcheswere

differfrom thosemoresuitablefortheassessment ofthe conductedcoveringmaterialfrom1965 to September
needsforchangeat a singleworkplace, theevaluation 2008.
of theeffects of specificergonomie improvements, or Thesearchesweremadeusingseveralcombinations
thestudyoftheusability ofhandtools.Officialregula- of thefollowingsearchtermsrelatedto observational
tionsmaymakeexplicitdemandson theassessment, methods(using"OR"): observation, workload,lining,
forinstancein safetyinspections, or whenevaluating manualmaterial handling, riskassessment, taskanalysis,
theworkload inordertomakecompensability decisions posture,ergonomie, and occupational exposure.These
forinjuredworkers. terms werecombined (using"AND") with terms related
Potentialusersrarelyknowaboutmorethana very to themusculoskeletal system(using"OR"): musculo-
limitedselectionofmethods. Thereareseveralreasons skeletal,back,neck,extremities (eg, [observation OR
forthisknowledge gap. The reports describing methods workload] AND [back OR neck]). A search strategy
maybe in a languagethatis unfamiliar to theuser,or using only thesetermswas ineffective in identify-
theymayhavebeenpublished inunknown media.Meth- ing severalknownmethodsand,therefore, additional
ods mayhavebeendevelopedforspecificoccupations searcheswereperformed withthenamesoftheidenti-
onlyand,consequently, notbe suitableforthesetting fiedmethodsandusingtheoptionof "relatedarticles"
thattheuser needs to address. ofthekeyreferences. The reference listsofkeypapers
In orderforobservational data to provide a sound were also scanned to identify additional references.
basisfordecision-making, theassessment should be valid We screened the articles by titleand abstractfirst.
forthetargetedpurpose andtheresult should be reproduc- About 580 potential references were identified, includ-
ible.Anidealwaytoassessvalidity is tocompare results ing original scientific reports,reviews, and internet
witha "goldstandard". Thereis, however, no general sources.Full textsof thesereferences werecollatedin
"goldstandard" forassessingbiomechanical exposures, electronic format for further evaluation. The inclusion
eventhoughpostures can be accurately measuredwith criteria were as follows: (i) systematicobservation
directtechnicalmeasurements. Another aspectofvalid- of workshould be the principalexposureassessment
-
ity theabilityofthemethod to predict -
risks can be tool; (ii) themethod should be describedin a manner
studied byanalyzing theassociations between exposures allowingtheprocedure to be reproduced; and (iii) the
obtainedby themethodand theoutcomesof interest, observationtargetshould be the human locomotor
suchas musculoskeletal disorders(MSD). Assessment of system(eg, back/trunk, or
neck, extremities). Many
shouldcoverbothintra-
reproducibility andinter-observer originalarticlesdescribing a methodused onlyin one
(1,2) and,inthecaseofoff-line
repeatability observation specificstudywerediscardedbecausethetoolwas too
usingvideorecordings, thepossibleerrors andvariances inadequately described tobe reproduced andevaluated.
associatedwiththefilming procedure itself. Onlymethods thatwerepublically availableinscientific
Severalaspectsofobservational methods forassess- or otherreportsor commontextbooks wereincluded;
ingphysical workload havebeenreviewed earlier(3-8). thisexcludedcommercial productslackinga detailed
However, wecouldnotfindanup-to-date systematic and publicdescription. Wealso excludedmethods thatwere
criticalcomparison ofmethods devotedtoguiding users notdevelopedforvisualobservations in occupational
inselecting appropriate toolsfordifferent purposes. fieldsettings, suchas thosebasedentirely on themea-
Thus,theaimsofthisprojectweresystematically to surements ofposturalanglesfromvideorecordings.
identify published observational methodsforassessing
physicalworkload(biomechanicalexposures)and to Developing theframework forevaluation
evaluatecriticallythesemethods from theperspective of
differentusers,suchas researchers, occupational health Thereis no generallyacceptedprocedureto evaluate
andsafety personnel, safetyinspectors, ergonomists, and methodsfortheassessmentof workloadeventhough
work-system designers. severalpreviousreviewshave addressedthis issue
(3-9). In meetings to discussourreview,we developed
thestructure and contents of theevaluationprocedure
in an iterative manner.The procedureincludeditems
Methods describing thebasic featuresof themethods,as well
as assessmentsof theirvalidityand repeatability and
Searchandselection ofreference literature practicalissuesfor the users.
Validity assessment includedconcurrent validity (ie,
Literature searcheswereconductedin the following how well does the method correspond withmorevalid
electronic databases:PubMed,Embase,CISDOC, and methods?)and predictive validity(ie, how well have
ScienceDirect.We used Google and Google Scholar riskestimates generated bythemethodbeenshownto
4 Scand J WorkEnvironHealth2010, vol 36, no 1

Takala et al
be associatedwithMSD?) (1,2). In addition, we evalu- Results

atedtheintra- andinter-observer repeatability.We also
assessedfacevalidity(ie, does themethodappearto A totalof30 eligibleobservational methods wereiden-
measurewhatitis intended tomeasure?)tohelppoten- tified.These 30 methodswere,altogether, described
tialusers,especiallyin cases whereno formalstudies and referenced in 285 documents, rangingfrom1-50
on validity havebeenperformed. references fora particularmethod. Additionalmethods
Foreachindividual reportdescribing thevalidity ofa referred to in 70 paperswereexcluded,mainlydue to
method, we evaluated thefollowing questions relatedto insufficient information on theparticular method.In
concurrent validity: (i) "Is thereference method validfor the followingdescription, methodsare classifiedin
comparison?" (ii) "Whatisthequality ofthecomparison?" threegroupsaccordingto whether themainfocuswas
and(iii)"Areresults generated bythemethod valid?"The toassess(i) generalworkload, (ii) upper-limbactivities,
ratingwas done on a 4-step scale from
(ranging "perfect/ or(iii) manualmaterial handling.
almostperfect" to"majorerror/mistake") withcomments The methodsare presented in chronological order
our
justifying rating. We evaluatedthe predictive of
validity of appearancein the literature, since newermethods
a method incross-sectional andlongitudinal trials,ifavail- generallysharesome featureswitholderones. Table
able,withfouroptions ("yes";"no";"conflicting results"; 1 summarizes thebasic characteristicsof themethods,
"cannot be estimated from documents"). table2 showstheevaluationofvalidityandrepeatabil-
In assessingtherepeatability of each method,we ity,andtable3 describesouropinionsrelatedto practi-
considered theresultsandtheirinterpretation - as given cal issuesfortheuser(s)of themethod.A descriptive
by the authors of the report- and rated the methods overviewof findings foreach tool is providedbelow.
on thefollowing scale: "probablyreliable";"potential Detailedinformation oftheevaluatedmethods withfull
error";"obviouserror";"cannotbe estimated". references canbe foundina websiteassociatedwiththe
Finally,on thebasis of all available information present project(10).
on concurrent validityandrepeatability, we ratedeach
method overallas "good","moderate", or"low"relative
totheseperformance
Methods
toassessgeneral
workload
aspects.
Weevaluated yâcevalidity withthefollowing Ovakoworking
ques- postureassessment system (OWAS). OWAS
tions:(i) "Is thecontent of themethodsuchthata rel-
was developedin a steelindustry companyto describe
evantassessment can be expected?"(ii) "Do theitems
workloads during theoverhauling ofironsmelting ovens
tobe observedhavea soundbasis?"(iii) "Is theopera- (11). Aspects to be observed includetheweightof the
tionalizationoftheitemstobe observed sound?"(iv) "Is
loadhandled(threecategories) andpostures oftheback
theprocessofdatacollectionandanalysissound?"(v) (fourpostures),arms(threepostures), andlowerextremi-
"Can theoutputhelpin decision-making?" In addition,
ties(sevenpostures), resulting in252 possiblecombina-
we evaluated thetool'sstrengths andlimitations, andthe
tions,whichhavebeenclassified tofouractioncategories
user
potential groups thereof. indicatinga needforergonomie change.Theobservations
weremadeas "snapshots" andsampling hasusuallybeen
carriedoutusingfixed-time intervals. OWAS ratings of
Evaluation
postureshavebeenwellassociated withperceived loading
Tworesearchers fromourgroupreadtheselectedpubli- anddiscomfort (12, 13).Fortimespentinbentpostures,
cationsandindependently completed thebasicdescrip- agreement between OWASanddirecttechnical measure-
tionanddocumentation ofall themethods intheevalua- mentshas beenratherlow (14), whichmaypartlybe
tionform. Afterthat,theydiscussedanydifferences and explainedbydifferences in sampling strategiesbetween
reacheda consensuson thewritten documentation. themethods. Inanevaluation oflifting situations,OWAS
Based on thisdocumentation and theoriginalarti- resultswereclearlydifferent fromthoseobtained bythe
cles, each methodwas evaluatedin termsof validity, NIOSH lifting equation(see pi 3- 14), probablydue to
and practicalissuesindependently
repeatability, by at thedifferentbasicapproaches ofthesetwomethods (15).
leasttwoevaluators blindedto eachother.The original Associations betweenOWASratings andtheoccurrence
tworesearchers evaluatedall identifiedmethods;a third of backdisorders havebeenreported in cross-sectional
member ofourgroupevaluated14 additional methods. studies(16). Themethod has showngoodintra- (17, 18)
Discrepancies wereresolvedbydiscussionamongst the andinter-observer repeatability (11, 17, 19,20).
evaluatorsinordertoestablish consensus.Ifno consen-
sus was reached,an additionalevaluatorwas prepared Arbeitswissenschaftliches erhebungsverfahren zur tätig-
to participate
in thediscussion, in accordancewiththe keitsanalyse[(AET) ergonomiejob analysis procedure].
predetermined protocol.Thisoptionwas notneededin AET is a job and stress analysis procedure offeringa
any case. broad-spectrumdescription of work characteristics.

Table 1. Description
ofobservationalmethods.Exposuresincludedinthe method:posture(P), force(F), duration(D), frequencyofac-
(Vib). (RPE=ratingof perceivedexertion;NIOSH=NationalInstitute
tions(Fr),movements(M), and vibration of OccupationalSafetyand
Health;VAS=visualanalogscale; TLV=thresholdlimitvalue; MMH=manualmaterialhandling)
Method and Target

exposures Metrics Observation Modeofrecording
yearoffirst
publication anddimensions strategy
Generalmethods
Ovakoworking posture P,F ofitems
Frequency Timesampling Pen& paper,
assessment system (OWAS),1973 computerized
erhebungsyerfahrenP,F,Fr,Vib
Arbeitswissenschaftliches Profile
ofitems Nodetailed
rules Pen& paper
zurtätigkeitsanalyse
[(AET)ergonomiejob
analysis
procedure], 1979
Posture 1979
targeting, P Frequencyofpostures Nodetailedrules Pen& paper
Ergonomie analysis
(ERGAN), 1982 - BorgRPEscale Nodetailedrules Video,computerized
Taskrecordingandanalysis oncomputer P,F,D,Fr, Timesampling/
Distribution/duration Computerized
(TRAC),1992 ofobserveditems continuousobservations
Portable
ergonomie observation (PEO),1994 P,F,D,Fr,M Start/end
ofpostures Continuous observations video
Computerized,
Handsrelativetothebody(HARBO), 1995 P ofpostures Continuous
Start/end observations video
Computerized,
av belastningsfaktorer P,F,Fr,M
Planforidentifiering Yes/noanswers; Selection
bygeneral Pen& paper
[(PLIBEL)a method assignedfortheidentification ofitems
profile knowledgeofwork
ofergonomics hazards], 1995 andobservations
Posture, toolsandhandling
activity, 1996 P,F,workactivity
(PATH), Timespentinpostures Timesampling Pen& paper,
(video)
computerized
check(QEC),1999
Quickexposure P,F,D,Fr,M Sumscoreof "Worstcase" Pen& paper
weighteditems ofthetask
bodyassessment
Rapidentire 2000
(REBA), P,F Sumscoreof Mostcommon/ Pen& paper
weighteditems prolonged/loaded/postures
Stateergonomie
Washington checklists,
2000, P,F,D,Fr,M,Vib Yes/noanswers fortasks
Screening Pen& paper
thatareregularinwork
Video-ochdatorbaseradarbetsanalys
[(VIDAR) P,F,D,Fr,M Borg RPE scale Byworker's
needs video
Computerized,
a video-andcomputer-basedmethodfor
ergonomie 2000
assessments],
Posturalloadingontheupper-body P Posture
discomfort
scoreMostcommon/loaded Pen& paper,
video
assessment (LUBA),2001 postures
Chung's workload
postural 2002
evaluation, P Posture scoreNodetailed
discomfort rules video
Computerized,
Methodsassessingworkload onupperlimbs
HealthandSafety Executive risk
(HSE)upper-limb P,F,D,Fr,Vib Yes/no
answers Tasksinvolving
high Pen& paper
assessment method,1990 variety
repetition/low
Stetson's 1991
checklist, P,F,D,Fr Frequency ofitems Nodetailed
rules Pen& paper
bytheirduration
assessment
Rapidupper-limb 1993
(RULA), P,F,staticaction Sumscoreofweighted Nodetailed rules Pen& paper,
video
items
cumulative
Keyserling's trauma 1993
checklist, P,F,D,Fr,Vib Sumscoreofpositive Screening ofjobwith Pen& paper
findings questionsputtotheworker
Strain 1995
index, P,F,D,Fr score;
Multiplied Nodetailed rules Pen& paper
riskindex
(OCRA),1996
Actions
Repetitive
Occupational P,F,D,Fr,Vib Sumscoreofweighted Assessment ofrepetitive Pen& paper
items;riskindex actionincl.inprofile
ofwork
Conference
American ofGovernmentalIndustrial M,F, Handactivity& force "Typical activity" Pen& paper,
(video)
handactivity
Hygienists level(ACGIHHAL),1997 requirementonVAS
Stateergonomie
Washington 2000
checklists, P,F,D,Fr,Vib Yes/notoquestions Itemsselectedby Pen& paper
combining riskfactors cautionzonechecklist
Ketola's
upper-limb tool,2001
expert P,F,D,Fr,Vib Yes/noanswers; Nodetailed rules Pen& paper
ofitems
profile
Methods
assessingmainlymanualmaterial
handling
NIOSHlifting 1981(revised
equation, 1991) P,F,D,Fr Multipliedscore; Nodetailed rules Pen& paper,
riskindex computerized
1997
Arbouw, P,F,D,Fr 3 levelsofrisktables Nodetailed rules Pen& paper
NewZealandcodeformaterial 2001
handling, P,F,D,Fr Sumscoreofweighted Flowchart; tasksincluding Pen& paper
itemsindicating risk hazardous MMH
charts(MAC),2002 P,F,Fr
assessment
Manualhandling Itemprofile; sumscore Selectionbygeneral Pen& paper,
(video)
indicatingrisk knowledge ofwork
Stateergonomie
Washington 2000
checklists, P,F,D, Fr limit
Lifting computed Worst & most Pen& paper
as multiplied score common lifts
tasksriskassessment
Manual 2004
(ManTRA), P,F,D, Fr,Vib Sumscoreofrisk RulesstatedinQueensland Pen& paper
manual tasksadvisorystandard
ACGIH TLV,
lifting 2004 P,F,D, Fr Hazardous TLV Nodetailed
lifting rules Pen& paper
Sampling
Back-Exposure 2008
Tool(BackEst), P,F,Vib Frequency ofitems Timesampling Pen& paper

Takala et al
Table 2. Validity
and repeatability methods[- insufficientinformation;
ofobservational NIOSH=l'lational
Institute
ofOccupationalSafety
and Health;MMH=manualmaterialhandling]
Method Correspondencewith Associationwith Intra-observer Inter-observer

a
'valid'reference musculoskeletal repeatability repeatability
disorders(MSD) b
Generalmethods
Ovakoworkingposture Moderate(discomfort, X Good Good
assessmentsystem(OWAS) technicalmeasures)
Arbeitswissenschaftliches - -
erhebungsverfahren
zurtätigkeitsanalyse
[(AET) ergonomiejob
analysisprocedure]
Posturetargeting - -
- -
Ergonomieanalysis(ERGAN)
Taskrecordingand analysison computer(TRAC) Moderate(technicalmeasures) X -
Moderate-good
Portableergonomieobservation(PEO) Moderate(video,technicalmeasures) X Good Moderate-good
Hands relativeto the body(HARBO) Moderate(technicalmeasures) - - Good
Planforidentifiering
av belastningsfaktorer Moderate(AET) - - Moderate
[(PLIBEL) a methodassignedforthe identification
ofergonomicshazards]
tools and handling(PATH)
Posture,activity, Moderate-good -
Moderate-good Moderate-good
(video,technicalmeasures)
Quickexposurecheck(QEC) Good (video,technicalmeasures) X Moderate Moderate
Rapidentirebodyassessment (REBA) Moderate(OWAS) - - Low-moderate
WashingtonStateergonomiechecklists Moderate X - Moderate
Video-och datorbaseradarbetsanalys[(VIDAR) - -
a video-and computer-basedmethodfor
ergonomieassessments]
Posturalloadingon the upper-body
assessment (LUBA) - -
Chung'sposturalworkloadevaluationsystem - -
Methodsto assess workloadon upperlimbs
Healthand SafetyExecutive(HSE) upper-limb - -

riskassessment method
Stetson'schecklist - - Moderate
assessment (RULA)
Rapidupper-limb Low-moderate(technicalmeasures,
ACGIHHAL,OCRA,strainindex) X -
Moderate-good
cumulativetraumachecklist
Keyserling's Moderate(video,workplacedata) - - Low-moderate
Strainindex(SI) Moderate(RULA,ACGIHHAL) L, X Moderate-good Moderate-good
Actions(OCRA)
OccupationalRepetitive Moderate(SI, RULA,ACGIHHAL) X -
AmericanConferenceofGovernmentalIndustrial Moderate(video,SI) L, X Good Moderate
handactivity
Hygienists level(ACGIHHAL)
WashingtonStateergonomiechecklists - X - Moderate
Ketola'supper-limb
experttool Low-moderate(technicalmeasures) - - Moderate
Methodsto assess mainlymanual materialhandling
NIOSH lifting
equation ■ X
Arbouw Moderate(NIOSH lifting
equation) - -
NewZealandcode formaterialhandling - -
Manualhandlingassessmentcharts(MAC) - -
Moderate-good Moderate-good
WashingtonStateergonomiechecklists Moderate(NIOSH lifting
equation) X - Moderate
Manualtasks riskassessment (ManTRA) - -
ACGIHlifting
thresholdlimitvalue Moderate(NIOSH lifting
equation) -
Back-exposuresamplingtool (BackEst) Low-moderate(technicalmeasures) - - Moderate

a withvalidreference/repeatability:
Correspondence Good, Moderate,Low,
bAssociationwithmusculoskeletaldisorders:X = associationin cross-sectionalstudies;L = predictionin longitudinal
studies,

to observationalmethods.(R=Researchers;(^Occupational safety/health
Table 3. Practicalissues relating practitioners/ergonomists;
W=Workers/supervisors; - insufficientinformation;
?=notclear;l'IIOSH=National
Institute
ofOccupationalSafetyand Health)
Method Strengths Limitations Decisionrules Potential
users
Generalmethods
Ovakoworking as-
posture usedanddocumented
Widely Doesnotseparate
rightandleft Decisionrules R
sessment
system(OWAS) upperextremities.
Assessments basedonfrequency
ofneckandelbows/wrists
are distribution
are
Posture
missing. coding crudefor arbitrary
shoulders. Does
Time-consuming.
notconsider orduration
repetition
ofthesequential
postures
Arbeitswissenschaftliches Givesa broaddescriptionofworkcharacteris- Only17 itemsof216 aretargetedTentative:"high" R
zurtätig- tics.Largeexperience
erhebungsverfahren anddatabank ofresults toassess musculoskeletal load scoresindicate
poten-
keitsanalyse
[(AET)ergonomie from variousfieldsofoccupations
tobe usedas harmful
tially jobs
jobanalysis
procedure] reference.
Posture
targeting Illustrative
output:The ofthepos-
presentation Suitable
onlyforstaticpos- - O,R
turesinpolarcoordinatesprovidesquantitative tures.Does notconsider dura-
measures onordinal arepossibleto tionandfrequency.
scales,which Itis hardto
validate
using,forexample, technical
measures, observemanybodysegments
simultaneously.
Ergonomie (ERGAN) Computerized

analysis illustrative
registration; output Time-consuming. of -
Availability ?
thesoftwareunknown.
Taskrecording on Computerized
andanalysis thesoftware
registration; counts Mainlyfocussedonassessing - O,R
computer(TRAC) distribution andduration
offrequency ofthe exposure can
levels;frequencies
events. toselecttheitemstobe
Flexibility onlyinthereal-time
be retrieved
observed tothepurpose.
according set-upofthemethod.
Portable observa- Themethod
ergonomie ofposture
enablesregistration ofsoftware
Availability unknown.- R
tion(PEO) Thedataallowsfurther
duration. for
analysis Time-consuming ifdetailed
data
different
purposes is needed.Ifworkpaceis rapid,
theassessment ofseveralexpo-
surecategoriesis notpossible
tothebody
Handsrelative simpleto use.Registers
Easyto learn, the only5 postures
Registers tobe - R
(HARBO) durationoftheposturesoncomputer. usedas proxy forbodypostures.
ofsoftware
Availability unknown
av be-
Planforidentifiering General tool.
andsimplescreening Does notquantify therisk. Taskswitha higher 0
lastningsfaktorer
[(PLIBEL) Relative
lowrepeatabilitydue numberof"Yes"ticks
a method assignedforthe tothesubjectivedecisionsof mayrequire more
ofergonomics
identification "noVyes". immediateaction
hazards]
Posture, toolsand Thoroughly foreasyuseatworksite, Themethod
developed onlyaddresses - R
activity,
handling(PATH) including formaking
a procedure job-specific exposure levels,andonlyin
forobservation.
templates Thesamplingapproachrelative
durations.Requires
is systematic Dataarepro- considerable
andwell-designed. training
cessedinanautomatizedprocedureoncomputer.
check(QEC)
Quickexposure Easyto use.Applicable fora widerangeoftasks. Notsuitable, whentasksare Tentativelimits 0, W,
Takesaccountinteraction ofriskfactors. highly varied.
Concentrateson indicatinglevelofrisk R(?)
worktasks;theusermustdecide,
which tasksaremostloaded
bodyassessmentRapidtouse.Computerized
Rapidentire available Right
registration andlefthandhavetobe Tentativelimits 0, R(?)
(REBA) inpublicdomain. assessedseparately andthereis indicating levelofrisk
nomethod tocombine thisdata;
theuserhastodecidewhatto
observe.Duration andfrequency
ofitemsnotincluded
WashingtonStateergonomie Simple, quick,andtakesintoaccountmostrisk Limited toscreeningofrisks forward
Straight 0, W(?)
rulechecklists factorswithduration andfrequency. decisionrules.
Video-ochdatorbaserad Easytouse.Encourages ofworkers.Subjective
participation evaluationofloading BasedonQECand 0, W
arbetsanalys
[(VIDAR)a video-Illustrative
outputcanhelpworkers to understand is basedondiscomfort, which Swedishregulations
andcomputer-based method ergonomie problems intheirwork. mayhamper thedecisiononthe
forergonomie assessments] numerical in
valueespecially
groupassessment. General
ofvideo-recordings.
limitations
Postural
loading onthe Simple, easyto use.Scoring basedonphysio- Doesnotconsider force,durationFouractioncategories0(?), R(?)
upper-body logicaldata.Numeric output canmakethe andrepetition proposed bythe
assessment(LUBA) decisions easierthana qualitative
description. posturalindex
workload Computerized output. Does notconsider
Illustrative external - R,0(?)
Chung'spostural registration;
evaluation
system Combines video andratingof postures. forces.
(continued)

Takala et al
Table 3. Continued.
Method Strengths Limitations Decision rules Potential

users
toassess workload
Methods onupperlimbs
Healthand SafetyExecutive Easyto use. Straightforwardquestions.Advice Does notconsiderinteraction of Tasks witha "Yes" 0, W(?)
(HSE) upper-limbrisk forpotentialsolutions. the riskfactors.Subjectiverating: ticksrequire
assessment method definitionofobserveditemsnot moredetailedrisk
alwaysclear.No metricmeasure assessment.
to quantifythe risk.
Stetson'schecklist Selectionof mostitemsbased on research Too manyitemsto be observed - R
literature. simultaneously. Does notconsid-
er the interaction
of riskfactors.
Evaluationofdurationofcycle
lengthsis probablyimpossible
withouta chronometer.
assessment Easyto use. Computerized
Rapidupper-limb available
registration Rightand lefthands haveto be Tentativelimits 0, R
(RULA) in publicdomain. assessed separatelybutthereis indicatinglevelof risk.
no methodavailableto combine
these scores. Does notconsider
durationofexposures.
cumulative
Keyserling's Quickand easy to use. Ratingsystemis qualitative.Does Itemswith"yes"ticks 0, R
traumachecklist notconsiderthe interaction
of should be considered
riskfactors. potentialforactions.
Strainindex(SI) The methodincludesmainriskfactorsfordistal Limitedto distalupperlimbexpo- Sensitivity and specifi- 0, R
upper-limbdisorders.Takes intoaccountthe sure/risk assessmentinmonotask cityof indexdescribed
interaction
ofobservedvariables.One figuregives jobs. Multipliervaluesare hypo- inthe literature,
comparisonofjobs. thetical.Subjectiveassessment;
definitions ofthecriteria
are not
veryclear.Does notconsider
vibration and contactstress.
OccupationalRepetitive Takes intoaccountrecoveryperiods.Estimates The use is timeconsuming.Well Cut-off
limitsindicai- 0, R
Actions(OCRA) theworkersrisklevelbyconsideringall the trainedobserversneeded. ingneeds foractions.
tasks ina complexjob. The checklistis
repetitive
easy and quickto use.
AmericanConferenceof Rapidand simpleto use. Intheassessment Subjectiveassessment. Coversa Clearthreshold 0, R
Governmental Industrial individual
capacityis considered. limitednumberof riskfactors. values foractionsfor
Hygienistshandactivity
level monotaskworkwith
(ACGIHHAL) duration>4 hours.
WashingtonStateergonomie Simple,quick,takes intoaccountmostrisk Limitedto screeningof risks. Straightforward 0, W(?)
checklists factorswithdurationand frequency. decisionrules.
Ketola'supper-limb
experttool Quick,easy to use. Ratingsystemis qualitative.Does Itemswith"yes"ticks 0
notcombinethedurationand should be considered
otherriskfactors. potentialforactions.
Methodsto assess mainlymanual materialhandling
NIOSH lifting
equation Welldocumentedand testedinseverallaboratory Plentyof practicallimitationsfor Clearthresholdvalues 0, R
studies.Sound backgroundbased on scientific use. Requirement ofseveraltech- indicating
actions,
studies.Outcomerelatedto the riskofthe health nicalmeasuresand calculations
ofback. Calculatorsavailablein internet means increasedrequirements
forskillsand timeto makethe
estimation.
Arbouw Coverslifting, pushing,and pulling.
carrying, Relativetime-consuming,but Clearthresholdvalues 0
does notgiveverydetailed actions,
indicating
information.
NewZealandcode formaterial Includesinformation on riskfactorsand solution The user has to makemany Clearthresholdvalues 0
handling ideas; takesaccountmanyimportant factorssuch decisionswithvague rules. actions,
indicating
as size and shape ofthe load and slipperyfloor.
Manualhandlingassessment Relativesimpleand easy to use. Welldescribed Assesses onlymonotonous Fourlevelgradingfor 0, W(?)
charts(MAC) process forassessment. tasks,notjobs or com- actionlimits.
lift/carry
poundtasks. Includesfrequency
butnotdurationofthe lifting.
WashingtonStateergonomie Simple,quick,takes intoaccountmostrisk Limitedto screeningof risks. Straightforward 0, W(?)
checklists factorswithdurationand frequency. decisionrules.
Manualtasks riskassessment Quickand easy to use. Takes intoaccountforthe Definitionofthe criterianotvery Proposed limitsfor 0, R(?),
(ManTRA) generalriskof manualmaterialhandling(also clear;subjectiveassessment. Not actioncategories. W(?)
durationand repetition). clear howto combinemultiple
tasks to geta job levelexposure.
ACGIHlifting
thresholdlimit Quick,easy to use Limitedto two-handedmono- Clearthresholdvalues 0
value tasks.
lifting foractions.
Back-exposuresamplingtool Quitesimple.A thoroughvalidationdata against Time-consuming due to the - R
(BackEst) technicalmeasuresgivesa possibility to samplingstrategy.
transformtheobservedresultsaccordingly

Thejob itselfis evaluated- nottheindividualdoing correspondencewithtechnicalmeasurements (30).

thejob. Of216 items,143 concerntheperson-at-work Inter-observer has
repeatability been to
moderate good
system,31 deal withthe analysisof tasks,and 42 (29-31).
relateto an analysisofjob demands.Of theselast42
items,17 are directlyrelatedto muscularwork(ie, Portableergonomieobservation(PEO). PEO is a method
analysisof demands/activity). In codingthe items, forthecontinuous computer-based observation ofwork-
theusershouldcombineobservations at theworksite ersattheworkplace. Every time the worker adoptsa new
withinterviews. The datacan be used to characterize predefined posture, performs an action, or movesfrom
thejob ortaskprofile.A databasewithover7000jobs oneposture toanother, theobserver hitsthecorrespond-
servesas a referenceforcomparisons(21-23). We ingkeysand thesoftware recordsthestarttimeof the
foundno studiescomparing AET observations related event.Whentheposturechanges,or whentheactivity
to musculoskeletal load withmorevalid measures. is terminated,theobserver hitsthesamekeyagain.This
Inter-observer has been studied,butthe
repeatability triggersthe software to calculate andstoretheduration
reportsonlygivefigures thewholemethodandno
for ofthisparticular event.Fromthisinformation, anchored
separateresultsforthepartrelatedto musculoskeletal in realtime,thesoftware calculatesthefrequency and
workload(21, 23-25). durationof each itemforthe observationperiod.If
thefrequency and/or totaltimeof theobservedtaskis
Ergonomieanalysis (ERGAN,formerly ARBAN). In the known, the software calculates thecumulative frequency
ERGAN method, the work situationis filmed and the and duration of postures or actions fora longerperiod
workload ondifferent bodypartsis assessedfromsingle (day/week). Theinformation ondailyfrequency oftasks
framesof the video using Borg's scale. Events are needed for the calculation of cumulative exposuresis
in
countedand registered timefrom video recordings. obtained by interviews or production output(32). The
Theseobservations have beenused as input for com- method has shown moderate-to-good correspondence
putersoftware thatgivestheworkloadprofilein time withdata obtainedby video (32) and directtechni-
sequences(26). No studiestesting thevalidity orrepeat- cal measures(33, 34). An associationbetweenPEO
abilityofthemethod werefound. observations and musculoskeletal discomfort has been
seen in cross-sectional studies(35, 36). Intra-observer
Posture Theposture
targeting. targetingmethod involves repeatability has beengood(32, 37) andinter-observer
theobservation of staticpostureswithrespectto the repeatability beenmoderate
has to good(32).
"standard"anatomicalposition,whichis selectedas
thecentreof the"target"of each bodypart.A target Handsrelativeto thebody(HARBO).The HARBO method
comprisesfourconcentriccircles- similarto polar was developedto assess exposuresin epidemiological
-
coordinatesrepresenting anglesof45°,90°,and 135° studiesor ergonomie prevention and intervention pro-
deviations fromtheneutral, centerposition.Deviations gramsinall typesofjobs. Five postures, defined through
are markedby a cross on targets,whichshows the thepositionof thehands,can be measuredforseveral
frequency ofpostures duringtheobservedperiod(27). hours:(i) standing/walking withhandsabove shoulder
Fieldobservations havebeencomparedwithobserva- level;(ii) standing/walking withhandsbetween shoulder
tionsmadefromsimultaneous photographs (27). How- andknuckle level,notfixedwithload;(iii)standing/walk-
ever,thetrialwas so inadequately describedthatwe ingwithhandsbetween shoulder andknuckle level,fixed
couldnotevaluatevalidity orrepeatability. withload;(iv) standing/walking withhands fixed below
knucklelevel;and(v) sitting. Thepositionofthehands
Taskrecording and analysison computer(TRAC).TRAC is regardedas a proxyforpostural demandsontheneck,
is a genericmethod torecordtasks,actions,orpostures shoulders, and lowerback.Observations are madeand
in realtimeor withcomputerized timesampling.The registeredin realtimewith a hand-held computer using
eventsto be observed(eg, posturesin a particular cat- thesoftware originally developedforthePEO method
egory)mustbe defined a priori.Real-time observations (38). Observations havebeenmoderately correlated with
allowusersto analyzeboththeduration andsequence direct technical measurements of arm and trunk postures.
oftheselectedeventsandcontextual factorsofinterest The inter-observer repeatabilityhas beengood(38). No
during theseevents(28). In themulti-moment applica- reports on associations withMSD werefound.
tion,theobserver mustmonitor thesituationrepeatedly
atpreviously selectedtimeintervals, givenas auditory Plan foridentifiering av belastningsfaktorer [(PLIBEL) a
signalsfromthecomputer. Posturecategories inTRAC methodassigned forthe identificationof ergonomicshaz-
are user-configurable and a numberof applications ards]. PLIBEL is a simplechecklist, intended as a rapid
have adoptedtheOWAS categorization scheme(29). screening tool of majorergonomie riskswhich mayhave
TRAC observations ofpostureshaveshownmoderate injurious effects on the musculoskeletal system.Time

Takala et al
aspectsand environmental and organizationalfactors scales using "fuzzylogic" (ie, using non-technical
are also includedas hazardmodifiers(39, 40). Some languagewithoutexactbordersbetweentheclasses).
of theitemsforclassifyingtheworkplacehaveshown In addition,theobservedworkeris requiredto (self)
moderatecorrespondence withsimilaritemsin AET, ratetheweightshandled,thedailytimespentdoingthe
andtheinter-observer has beenmoderate
repeatability observedtask,thelevelof handforceinvolved,visual
to good (39). No reportson associationswithMSD demands, driving ofvehicles,theuse ofvibrating tools,
werefound. anddifficultiesto keepup withtheworkas wellas the
stressfulness
ofthework.Theratings areweighted into
Posture, tools,andhandling
activity, (PATH). The basis of scores and added to
up summary scores for different
thePATHmethod is worksampling (ie,observing "snap- bodypartsand otheritems(driving,vibration, work
from
shots"), which a frequencydistributionof observed pace,and stress).Based on thesescores,priority levels
itemsis obtained.Beforethedatacollection, a template forintervention are proposedto providea basis for
mustbe customized forrelevantworkactivities, tools, decision-making and communication withinorganiza-
andhandling. Theclassificationofpostures is basedon tions(47-49). Back and shoulderpostureresultswere
OWAS (41, 42). PATHobservations haveshowngood foundto be well correlated withtechnicalmeasuresin
correspondence with observationsmade usinganother, simulatedtasks. (47, 49). QEC practioners' evaluations
less-welldescribedtool forthepostureassessmentof corresponded well to those ofexperts, and the intra- and
video recordings (41) and technical measurements in inter-observerrepeatability was moderate (48, 49). No
simulatedtasks(42). Intra-observer repeatabilitywas studieson associations with MSD were found.
good forarmand leg posturesbutless so forthoseof
theneckandtrunk. Inter-observer
repeatability hasbeen Washington Stateergonomie checklists.Thesechecklists
moderate to good(41). No reportson associations with weredevelopedas partofa regulatory effort to control
MSD werefound. exposureto musculoskeletal hazardsin workplacesin
the stateof Washington, USA. Epidemiologicaland
Rapid entire body assessment (REBA). REBA was otherscientific studieswerethebasis fortheselection
designedas a quick and easy observational postural of itemsto be observed.The evaluationof workplaces
analysis tool forwhole-body activitiesin healthcare coveringthemainhazardsformusculoskeletal disor-
and otherserviceindustries. The basic idea of REBA dersis doneby twochecklists:(i) the"cautionzone"
is similarto thatof therapidupper-limb assessment checklistis used as a screening tool; (ii) a morecom-
(RULA) method of
(see pl2): positions individual prehensive"hazardzone" checklistis used forthose
body segmentsare observed and postural scores jobs screenedto represent potentialhazards(50). Only
increasewhenposturesdeviatefromtheneutralposi- themanualmaterialhandlingaspectofthemethodhas
tion.GroupA includestrunk,neck,and legs, while beencomparedwithothermethods(51). Jobsobserved
groupB includesupperand lowerarmsand wrists. tohaveexcessiveexposures havehadhigher occurrence
These groupsare combinedintoone of 144 possible of MSD (52). The assessment has beenshownto have
posturecombinations thataretransformed to a general goodrepeatability amongobservers (53). (See pi 3 and
postural score ("grandscore").Additionalitemsare 14 fordetailson thosepartsofthechecklist concerning
observedandscoredincluding: theload handled,cou- ofupperlimbsandmanualmaterial handling.)
plingswiththeload,andphysicalactivity. Thesescores
aresummedup togiveone scoreforeachobservation, Video-och datorbaserad arbetsanalys [(VIDAR)a video-
whichcan thenbe comparedto tablesstatingriskat andcomputer-based method forergonomie assessments].
fivelevels,leadingtothenecessity ofactions(ranging VIDAR's approachdiffers fromthoseof thepreviously
from"none"to "necessarynow") (43-45). mentioned methods, all ofwhicharebasedon theobser-
REBA observations havecorresponded moderately vationof predefined posturesand otheritemsby an
to thoseof theOWAS method,althoughthe former externalobserver.VIDAR is a participative method,
classifiedmoreposturesto have a higherlevel of mainlybased on worker'sassessment (54, 55). It was
risk(18). No reportson associationswithMSD were developed tosupport participativeinterventions andergo-
found.Inter-observer repeatabilitywas moderateto nomicstraining atworkplaces. anemployee
First, is video
good forleg and trunkposturesbut low forupper recorded whenperforming his/herdailywork.He/she then
limbs(46). makesan assessment of physicallyandpsychologically
demanding situations.Forphysicalsituations, theworker
Quick exposure check(QEC).QEC is intended fortherapid marksaffected bodyregionsandratesperceived exertion
assessment oftasksafterminimal training ofobservers. usingBorg'scategory ratio(CR-10)scale.Twochecklist
The observerwatchesand ratesposturesof theback, moduleshavebeenaddedto theprogram: one is based
shoulder-arm, wrist-hand, and neck on 2- or 3-step ontheQEC andtheotheronofficial Swedishergonomie

Thechecklists
regulations. wereimplementedto clearly scoresarethencomparedto tablesstating riskon four
pointto theneedsforintervention
and theabil-
increase levelsandtheactionsneeded(ranging from "acceptable"
ityofVID AR tomeasurethe of
effects No
interventions. to "immediate investigation and changeneeded")(60,
thevalidity
studiestesting ofthemethod
orrepeatability 61). RULA's posture scores have beenshownto have
werefound. low correspondence to thehand-useintensity scoresof
thestrainindex(see pi 3) (62). Still,in anotherstudy,
Posturalloading ontheupper-body assessment (LUBA).In it showedsaw-filers workto be riskyin linewiththe
LUBA analysis,postures areratedon scalesdeveloped evaluationsmadeusingREBA, theAmericanConfer-
frompsychophysical experiments recording discomfort ence of Governmental Industrial Hygienists threshold
incomparable postures. All scores aresummed up toone limit value for hand activity level (ACGIH HAL), the
scoredescribing theurgency ofintervention actions.The strain and
index, occupational repetitive actions(OCRA)
summary score of is to
postures compared experimental methods (see following pages)(63). Observations made
maximalholdingtimesin different postures, and this using RULA have also been compared with those using
analysisis usedtoformulate decisionrulesforthepriority theOWAS and REBA methods(18). The correspon-
ofactionsneeded(56). No studiestesting thevalidity or dencewithall thesemethods hasbeenmoderate atbest,
repeatabilityof the method were found. but it remains unknown which method better reflects
theunderlying MSD risksforvarying tasks(18). Higher
Chung's postural workloadevaluation system. In thisobser- RULA scores have shown an association withincreased
vationalmethod,posturesare ratedaccordingto a discomfort in laboratory studies(60, 64) andwithper-
"discomfort score"associatedwitheachjointposture ceptionsof MSD in two cross-sectional fieldstudies
of
orcombination postures. The more thejointposition (65, 66). The inter-observer repeatability RULA has
of
the
deviatesfromneutral, higher the score. The scores been found to be good, althoughthemethodological
havebeendetermined in a seriesof laboratory experi- information on therepeatability studiesis so scantthat
ments.Observations can be done in the workplace or the quality thereof cannot be evaluated (60, 66).
fromphotographs or videos. Computersoftwarehas
beendevelopedto helpcode andanalyzeobservations. Stetson'schecklistfortheanalysisof handand wrist.
The ratingofposturesis partlythesameas forLUBA Thismethodwas developedas a quantitative measure
(57, 58). No studiestesting thevalidityorrepeatability of repetitive hand exertions for studies of cumula-
ofthemethod werefound. tivetraumadisorders.Observedobjectsincludehand
exertionswhile usingpowertools,pinchgrip,high
force,palmas a striking tool,and "involuntary" wrist
Methods toassessworkload onupperlimbs deviation. The number of these exertions is recorded for
"standard" workcycles and classified by the duration of
HealthandSafety Executive (HSE)upper-limb riskassess- exertions. Thisinformation, multiplied by the number of
mentmethod. The HSE riskfilterand riskassessment workcyclespershift, a
produces quantifiable measure
worksheets providea two-stage assessment processto ofrepetitiveness (67). No studiestesting thevalidity of
helpreducework-related upper-limb disorders. As a first themethodwerefound.Inter-observer repeatability for
step,theriskfilter(includingquestionson symptoms thecountsof observedcycleshas beenreported to be
and generalriskfactorsforMSD) is used to identify moderate forpinchandexertion (67, 68).
situations wherea moredetailedassessment is neces-
sary.Riskassessment worksheets arethenusedto con- Keyserl ing'scumulative trauma checklist. The aim of the
ducta moredetailedriskassessment fortheseselected checklistis to determine thepresenceof ergonomie
tasks(59). No studiestesting thevalidityorrepeatability riskfactorsassociatedwiththedevelopment of upper-
ofthemethod werefound. extremity cumulative trauma disorders. Repetitiveness,
local contactstresses,forceful manualexertions, awk-
Rapidupper-limb assessment(RULA).In the RULA wardupper-extremity posture, and hand-tool usageare
method,positionsof individualbody segmentsare evaluated; each detected risk factor is recommended
observed andscored,withscoresincreasing inlinewith to be further evaluated(69). The methodhas shown
growingdeviationfromtheneutralposture.Summary moderate correspondence withobservations fromvideo
scoresare firstcalculatedseparatelyforbothupper recordings postures, of contact forces, and tooluse,as
and lowerarmsand wrists(groupA) and trunk, neck well as with productoutput data describing repetitive-
and legs (groupB), andthentransformed to a general ness (69). No studieson associationswithMSD were
postural "grandscore".Additional weightsaregivento found.The inter-observer repeatability has beenfairto
thepostures according to forces/loads handledandthe moderate for pinchgrip and shoulder elevation above
occurrence of static/repetitivemuscularactivity. These but
45°, poor for wrist deviations (68).

Takala et al
Ketola'supper-limb expert tool.Thisis a semi-quantitative (normalized ona scaleof0-10) orestimated bya trained
time-based methodforassessingthepresence("yes"or observer using a modified Borg CR- 10 perceivedeffort
"no") of riskfactors for upper-limb disorders. The limits scale. Peak force is judged relativeto thepopulation
for"yes"versus"no"aredefined by the time proportion characteristics at the evaluated worksite, so depends
and
ofthecycle,during whichtheexposureoccursas inthe on factors likeage andgender. Thecombination ofHAL
Keyserling's checklist. A higher total number of "yes" and peak hand force is evaluated against two limits:one
answersleadsto a greater predicted risk of the
upper-limb indicating necessity ofthe action and the other show-
disorders (70). Whenexpertobservation was used as a ingan absolutemaximum allowanceforhand-intensive
reference standard, has
validity ranged from moderate to work (81).The method was originally validatedagainst
for
good repetitive use of the hand, hand force,pinchgrip, detailed information from video recordings(number
andnon-neutral wristposture. Correspondence was low ofexertions persecond,recovery timepercycle,cycle
whentheobservations werevalidated against wrist gonio- time)withwhichit showedmoderatecorrespondence
metrie dataandforceestimations byelectromyography.(82). Theactionthreshold levelshavebeencompared to
No studiesontheassociation withMSD werefound. The thosegenerated by the strain index. The correspondence
inter-observer repeatabilityhasbeenmoderate (70). hasbeenmoderate, eventhoughthestrainindexidenti-
fiedmorehazardousjobs thantheHAL method(74,
Strainindex.The strainindexis a semi-quantitative job 75). An associationwithupper-limb disorders hasbeen
analysis method yielding a numerical score, which is seen in several cross-sectional studies(75, 78,83,84) as
intended to correlatewiththeriskof developingdis- wellas inprospective longitudinal studies (85-90). The
tal upper-extremity disorders. Accordingto theindex intra- andinter-observer repeatability hasbeenmoderate
six taskvariablesdescribinghandexertionsmustbe to good(82, 91).
observedand scoredon fivelevels.The six variables
include:(i) intensity of exertion, (ii) duration of exer- Occupational repetitive actions(OCRA).OCRA is a syn-
tion,(iii) exertions perminute, (iv) hand-wrist posture, theticindexdescribing riskfactors relatedto repetitive
(v) speedof work,and (vi) duration of workperday. actionsat work.The indexis thetotalnumber oftech-
Each score is thenweightedbased on physiological nicalactionsperformed duringtheshiftdividedbythe
(endurance, fatigue,recovery), biomechanical (internal totalnumberof recommended technicalactions.The
forces, nonlinear relationship betweenstrainandinten- latteris countedfromobservedactionsmultiplied by
sityofeffort), andepidemiological principles. Multiply- weightsgivenforthefollowingfactors:muscleforce,
ingtheweighted scoresgivesa singlefigure: thestrain postureofthepartsoftheupperlimb,lackofrecovery
index(71, 72). Comparisonof theindexwithRULA periods,thedailyduration of therepetitive work,and
has showna limitedcorrespondence withrespectto the "additionalfactors".A simplifiedOCRA checklistis
identification of risks(62, 73). The correspondence of intendedforuse as a preliminary screeningtool (92-
thestrain indexwithACGIHHAL (see below)wasmod- 95). OCRA has shownmoderatecorrespondence with
erate,buttheformer gavegenerally higher riskestimates ACGIH HAL andthestrainindex(63, 96). Prevalence
thanthelatter(74, 75). It is notknownwhichof these ofupper-limb disorders has beengreaterinjobs witha
methodsis morevalidto assess risk.In a prospective higher, as opposedto lowerOCRA index(97, 98). No
study,thesensitivity was 0.91 andthespecificity 0.83 to studieson therepeatability ofthemethodwerefound.
predict upper-limb disorders, whenusinga cut-off point
ofstrainindex=5.0(76). Clearassociations withupper- Washington Stateergonomie checklists.
The Washington
limbdisorders havealso beendemonstrated in several Stateergonomie checklists includesthefollowing items
retrospective studies(71, 75, 77, 78). Intra-observer toevaluatetherisksforupper-limb disorders: (i) working
and inter-observer repeatability have beenreported to withelevatedarms,(ii) highhandforce, (iii)highly repet-
be moderate to good(79, 80). itivemotions, and(iv) highimpactonthehand.Thesen-
sitivityandspecificity ofthetoolto identify upper-limb
TheAmerican Conference ofGovernmental Industrial Hygien- disorders hasbeenfoundtobe low(52). Thechecklist has
iststhreshold limitvalueforhandactivity level(ACGIHHAL). shownmoderate inter-observer repeatability (53).
TheACGIHHAL evaluatestheriskofdeveloping disor-
dersinthehand,wrist,orforearm on thebasisofHAL
andpeakhandforces.It is aimedat theassessment Methods toassess manual material handling
of
single-task jobs with at least four hoursperdayofrepet- US NationalInstituteof OccupationalSafetyand Health
itivehandwork. HAL is ratedona visual-analogue scale (NIOSH)lifting equation.The NIOSH liftingequation
(VAS) of0-10 andaddressesexertion frequency, recov- methodwas developedto assess theriskof low-back
erytime,and thespeedof motion.Peak forcecan be disordersin jobs withrepeatedlifting.Six factors
measured usinga straingaugeorotherinstrumentation I relatedto the liftingconditionsshouldbe observed
Scan d J WorkEnvironHealth 2010, vol 36, no 1 13

andentered intoan equation,yieldinga recommended thereby generatesolutionsforcontrollingrisksassoci-

weight limit forthe task. Multipliersare based on atedwitheach factor. Fromthis,theimportance ofthe
biomechanical, physiological,psycho-physiological, riskis assessed and an actionplan is establishedfor
andepidemiological data.The liftingindex(LI) is the controlthereof(114,115).No studiestesting
thevalidity
ratiooftheactualweighthandledtotherecommended orrepeatabilityofthemethodwerefound.
weightlimit.LI values below 1.0 are regardedto be
safe fortheaveragepopulation,and the greaterthe Manualtasksriskassessment(ManTRA). ManTRAwas
indexthegreater theriskoflow-backinjury(99-101). developed toassistsafetyinspectorsauditing workplaces
The LI is restrictedtojobs consisting of one or a few acrossall industriesforcompliance withtheQueensland
similarliftingtasks.Forjobs withmultipletasks,pro- (Australia)manualtasksadvisory standard(116).Foreach
cedureshavebeenproposedto calculatea composite taskina job,theobserver ratesona 5-stepscale:(i) total
LI (100, 101) or a sequentialLI (102) fortheoverall timespentonthetaskduring a typicalday,(ii) repetition
job. The resultsof usingtheNIOSH liftingequation (combination of duration and cycletime),(iii) exertion
havebeencomparedwiththoseof severalothermeth- (combination of forcerequirements andspeedofmove-
ods (15, 51, 103-106),butit is notpossibleto state ments),(iv) awkwardness (deviationfrom themidrange
whether anyofthesemethodsaremorevalidthanthe of movements), and (v) vibration.The scale relatesto
liftingequation.Due to itscomplexstructure ofmulti- fourbodyregions(ie, lowerlimbs,back,neck-shoulder,
in
pliers defining the recommended weightlimit,there arm-wrist-hand). Highscoresof individual itemsor a
areno technical measures that can be used as a "gold highsummary scoreareassumed toindicate an increased
standard" forthe NIOSH evaluation. riskforMSD (117, 118).No studiestesting thevalidity
A sensitivity analysisof laboratorysimulations orrepeatability ofthemethod werefound.
has shownthatfrequency and horizontallocationare
themostdecisiveparameters in theNIOSH equation, Manualhandling assessmentcharts(MAC).MAC is a
butthattheseparameters also tendedto havethehigh- designedtohelphealthandsafety
checklist inspectorsto
est measurement errors(107). Several studieshave assessthemostcommonriskfactors inlifting,
carrying,
foundtheoccurrenceof low-backpain to be higher and teamhandlingoperations. The methodsetsout 11
in jobs witha higherLI (108-111). Inter-observer itemsof manualhandling to be evaluatedaccordingto
variabilityof measureshad littleinfluenceon the a four-grade light";a summary
"traffic scoreis counted
totalLI exceptin situations wherelargeweightswere those
to prioritize tasks that requireurgentattention
handled(112). and check the effectiveness of those improvements
(119-121). The properties the methodhave been
of
Arbouw guidelineson physicalworkload.The Arbouw benchmarked againstseveralothermethods ina qualita-
methodwas developed forthe assessmentof five tivemanner (120),but no formal comparison onvalidity
areasofmanualmaterial pushingand
lifting,
handling: was found.Theassessment has shown moderate-to-good
pulling,carrying,staticload,andrepetitivework.The intra-and inter-observerrepeatabilityon observations
guidelinesare based on theNIOSH liftingequation fromvideorecordings (122, 123).
and standardsformanualmaterialhandling.A traffic
light(green,yellow,red)approachis appliedto guide formanualhandling.
Stateergonomiechecklist
Washington
recommended actions(113). TheArbouwlifting guide- The liftinganalysisincludedin thischecklist is a sim-
linescan be consideredas a simplifiedversionof the plifiedversionof theNIOSH lifting equation,butthe
NIOSH lifting equation(15). TheArbouwmethodhas Washington checklistallowshigher acceptableweights of
showna moderatecorrespondence withresultsfrom thehandledload(124). In a comparative the
trial, method
theNIOSH method(15). No studieswere foundon indicateda substantiallylowerrisklevelin a particular
eitheritsassociationwithMSD or itsrepeatability. job thantheNIOSH lifting equation,buttheresults were
similarto thoseobtained using a biomechanical model
NewZealandcode ofpracticeformanualhandling.In the (51). Whenusedto detect jobs withan increased riskof
New Zealandcode,manualmaterial handling risksare backdisorders,thechecklist showed moderate sensitivity
firstevaluatedby meansof a checklist.If thisinitial (52). Theassessment
andspecificity hasshownmoderate
screening hazard,a detailedobser-
suggestsa potential inter-observer
repeatability (53).
vationalcheckis performed to calculatea riskscore,
whichservesas a guideon theurgencyand typeof thresholdlimitvalue forlow-backrisk.The
ACGIHlifting
controlmeasurerequiredto reducetherisk.If therisk ACGIH lifting limitvalue is estimated
threshold from
score is >10, a "factorsassessment"can be used to thelocationofthehandledmaterialrelativetothebody,
determine thesignificanceof contributingfactors(ie, and dailyduration
as well as thefrequency of lifting.
load,environment, people,task,andmanagement) and ACGIH providestablessettingoutthethreshold limit

Takala et al
valueforweights, belowwhichnohealthriskis assumed presentevaluation we includedonlythosemethods with

to occur.The method was developedto ensurea lifting observations as theprincipal component.
guidelinethatwas accurate,basedonthelatestscientific Theaimofourevaluation wastopresent information
information,and easyto use (125). TheACGIH lifting thatmayhelppotential usersselectthemostappropri-
threshold limitvalue methodhas shownmoderate-to- ate method(s)fortheirparticular purpose.In situations
highcorrespondence withresultsobtained
bytheNIOSH wherepracticalergonomie problems haveto be solved,
equationandSnook'spsychophysical
lifting methodfor simplicity, and
utility, face of
validity themethodare
setting
liftinglimits
(51). No studies
werefoundoneither moreimportant thanexpressing resultsinexactnumeric
associationswithMSD orrepeatability. figures 8, and
(6, 128).Validity repeatability ofdataare
particularly important in research and when comparing
Back-exposure samplingtool(BackEST).In connectionwith exposuresto safetylimits.Thus the selectionof the
a large-scaleepidemiological study,BackEST aimedto mostappropriate toolmustinvolveconsideration ofthe
evaluatephysicalbackinjury riskfactorsindemanding analysis'objectivesandhowtheresultswillbe used- a
workconditions. In thedevelopment phase,a literature tooltohelpidentify improvement opportunitiesmaynot
reviewsuggested 53 relevant exposure variables; these have the same precision requirements as one beingused
werereducedto 20 itemsconcerning posture, manual to the
judge safety job ofa in a pass-fail determination
materialhandling, andwhole-body vibration.Theitems process.
wereobservedonceevery60 secondsovera full-shift
to producedatathatcan be analyzedaccordingto the
and
research(126). The propor- Validity repeatability
ofobservational methods
purposesof theindividual
tionoftimeindemanding backpostures was compared The conceptofvalidityincludesseveralaspects(1,2).
withtechnical measuresandthematchwas foundtobe Since thereis no "gold standard" to measurephysical
moderate at best,although thefinding may have been workload, criterion in
validitywas, thisstudy, assessed
affected by the different samplingprocedures of the interms of concurrent validity(ie, theagreement ofthe
comparedtools(126). Inter-observer repeatability has observationalmethodwithsome othermeasurement
beenmoderate (126). methodconsidered to be morevalid).Of the30 meth-
ods includedinourreview,19 hadbeencomparedwith
someothermethod(s), varying fromexpertevaluations
to observations madefromvideorecordings, anddirect
Discussion measurements withtechnical instruments. the
Generally,
worksite observation methods showedmoderate-to-good
Observation-based assessments ofbiomechanical expo- agreement withmeasuresbased on visualrecordings,
sures(physicalloads) on themusculoskeletal system and thecorrespondence was bestformacro-postures and
havemostly beentargeted atpostures ofthewholebody workactions.Micro-postures [likethoseofthewristand
or individual bodyregions,as well as exertedmanual hand(67, 70, 129),neck(34) andtrunk rotation(126)]
forcesor weightshandledmanually. Still,thereare no seemto be moredifficult to observewithsatisfactory
commonmetricswhichenablea directcomparison of accuracy.
thedifferent methods, although previous reviews have Whentechnical measurements haveservedas refer-
applied several approaches toovercome this problem. In ence, correspondence has generallybeen lowerthan
hisreviewof12methods, Genaidy(3) classified postures whenusingvideo-basedobservations as thereference
intomacro-or micro-postural or postural-work activi- (14, 30, 33, 34, 70, 126). In thesecomparisons, the
ties.In otherreviews,anglesusedfortheclassification variablesof interesthave been mainlyfrequency or
of posturesand scales of otheritemsof methodshave durationof posturesclassifiedaccordingto category
beentabulated (4, 5, 7). A generalconclusionof these limitsset by theobservational method.This kindof
reviewsis thattheobservational variablesgenerated by comparison maybe sensitiveto the"borderlines"of
differentmethodsare notdirectly comparable, mainly thecategories(32, 34, 67, 129-132). In otherwords,
duetotheuse ofdifferent bodyanglesoranglesectors. iftheobserver'sperception is systematically biasedin
Somereviewshavemainlybeendevotedto describing comparison to thelimitused by theaccuratetechnical
existingmethods published intheliterature(6, 8). Valid- method, theprobability ofhavinga highcorrespondence
and
ity repeatability ofthe methods has been addressed will decreaseifthetruepostureis close to a category
intwoprevious reviews(4, 7), inwhichsomestatistical borderline("boundary zone problem").Thissourceof
figuresof intra- andinter-observer repeatabilityas well disagreement was seen in some reports,forinstance
as descriptions oftestson internal andexternal validity whencategorizing severeand moderatetrunkflexion
havebeentabulated.Severalworkloadstandards also postures inPATH(41). Unfortunately, noneofthestud-
containitemsmeantto be observed(127), butin the ies had conducteda sensitivity analysisto see if the

shiftof thetechnicalmeasurelimitmightchangethe and specificity, whichcan supportconclusionson the

correspondence withobservations. In theQEC method, predictivevalidityof the method(75, 85-90, 138,
exactlimits between theobserved categories haveinten- 139). Outcomesused in theseriskstudieshavevaried
tionallybeen omitted in order to tool
improve usability fromdiscomfort and fatiguein laboratory settingsto
(47). Another possibleexplanation fordivergent results well-defined clinicaldiseases in prospective cohorts;
may be thatthe technical reference measures were col- thisvarietyin outcomealso hindersthecomparisons
lectedona continuous time-line, while the observations ofresultsfromdifferent studies,andthusobstructs the
weredoneusinglimited sampling atfixed-time intervals drawing of conclusions on the validity of risk limits
(14,30,41, 126). givenbyanyparticular method.
Differentmethods usedsimultaneously on thesame Intra-andinter-observer repeatabilitywerereported
object have given different results in several studies.If only for 7 and 17 methods,respectively. Theywere
oneofthemethods is knownorsuspected to givemore mostlyreported to be good or moderate. Generally the
accurateinformation thananother, itcanbe regarded as repeatability is better within observers than between
a validationreference, provided the two methods are them, as suggested forthosemethods wherebothsources
measuring thesamevariable.Still,manyofthesestudies of variancehad been studied.However,it shouldbe
havechosento comparemethods rather thanvalidating notedthatin mostcases inter-observer reliabilitywas
one using the other as a reference since noneof the assessedwithoutconsideration of theeffectsof intra-
methods has been shown to be systematically more observer variability.If thiseffectis notacknowledged,
accuratethantheothers(eg, comparisons between the estimatesof inter-observer variabilitywill be system-
strainindex,ACGIH HAL andOCRA). If the outputof aticallyinflated. The inter-observer reliabilityofmany
theassessment methodis a compound risk index (as in methods may,therefore, be betterthan what is reported
QEC, REBA,RULA,strain index,OCRA,NIOSH equa- inthestudies.
tion),itsconcurrentvalidity can,intheory, be estimated Repeatability is highlyrelatedto theuser skills,
on thebasis of technicalmeasurements of each indi- whichcan be enhancedwithappropriate training (4).
vidualitem.However, compound indicesandsumscores In sometrials,theobservers hadto improve theirskills
are sensitiveto theweightsgivento individualitems untila presetagreement was reached(ie,TRAC,PATH)
in thecalculationof theindexor score.For example, thisresultedin a good reliability ratingin ourevalua-
a laboratory simulation of lifting tasksshowedthatthe tion.For mostmethods, theliteraturedid notmention
valueof theNIOSH lifting indexwas highlysensitive thedurationof training neededto reacha satisfying
tothefrequency oflifting andthehorizontal locationof proficiency inusingthetool.
theload(107).
observational
Historically, methods havedeveloped
ofreferences
andselection
Identification
from thecommonexperience thatsomevisuallydetect-
able posturesand actionsare relatedto discomfort or Guidelines onhowtoconductsystematic reviews(140-
disorders inthemusculoskeletal system; a notionwhich 142) havestressed theimportance ofsystematic search
has laterbeendemonstrated in numerous experimental strategiesin electronicdatabases.Using thevarious
and epidemiologicalstudies.Theoreticalconstructs, combinationsof searchtermsset out earlierand a
combining thephysiological, epidemiological, andbio- manageablenumberof references, we wereunableto
mechanicalknowledge,have shownthatmechanical identifyall of therelevantmethodsin ourpreliminary
forcesactingonthetissuesis probably themostimpor- searches.Therefore, we continued searchingusingthe
tantfactorin explaininghow MSD can develop.In namesof theidentified methodsand theoptionof an
addition tothemagnitude oftheexposures, timeaspects automaticsearchfor"relatedstudies",followedby a
relatedto physiologicalresponsesare of importance visualscreening oftheresulting listsofpublications.We
(133-137). Therefore an observationmethodwitha werealso awarethatpractitioners mayuse methods that
good content validity(1,2) formechanicalexposures havenotnecessarily beensubjectedto scientific testing
shouldincludethe frequency and durationof items and,therefore, willnotbe foundindatabasescompiling
quantifying exposures - likeexternal forcesorpostures scientificreports.Consequently, we supplemented our
- inaddition totheirmagnitude. searcheswithinternet searching once we had identified
In our evaluation,we addressedwhetherfindings thenamesofthemethods. In addition topapersinEng-
usinga particular observation methodhadbeenassoci- in
lish,we acceptedreports German, Italian,and
French,
ated withMSD (the so-called"predictivevalidity"). Scandinavian languages.Through thisextensivesearch,
Even thoughassessmentsof several methodshave we haveprobably identifiedmostobservational methods
correlated withtheoccurrence of MSD in cross-sec- usedfortheassessment ofbiomechanical exposures.We
tionalsettings,onlya fewcohortstudieshaveanalyzed acknowledge the existenceof additional methods that
possibleassociationsusingtermssuch as sensitivity werenotaccessibletous duetotheirlimited availability

Takala et al
(eg,commercial methods oradditional academicstudies didnotmakea formalassessment on thequalityofthe

notlistedin theinternet Previous
databases). reviews assessments ofagreement, butconsidered thequalityas
havealsomentioned inconference
references booksthat sufficient ifno obvioussourceoferror was detected. We
werenotavailabletous. believethatthisevaluationwillbe morevaluablethan
Wedidnotmakea formal qualityassessment ofstud- simplylabelingmostof thestudiesas having"insuffi-
ies tobe includedorexcludedforevaluation. Ourselec- cientinformation", as thereaderscanobtaintheoriginal
tionofmethods wasmoreinclusive thanrestrictive.
This if
reports they wish to scrutinize thedatafurther.
decisionwasdeliberate - eventhemethods thathavenot Likewise, we did not make a formalassessment of
beentestedina formal waymayhavefeatures thatmake content validity with a predefined listof items that the
themsuitableforsomeusers,ortheymayprovideideas observational methodsshouldaddressbased on theo-
forfurtherdevelopment forspecific
purposes. Ourresults reticalconstructs. In theassessment offacevalidity and
showedthatmostof theincludedmethods,although practical issues forthe use of methods, the contents of
appearing toa largeextentinthescientific had
literature, eachmethodwas evaluatedkeepingthepurposeofthe
notbeentestedina systematic, scientificway. methodinmind.Duringtheevaluation, we noticedthat
theranking scalewe plannedtouse forfacevalidity was
notusedconsistently by all theevaluators. Therefore, in
Evaluation process table3 we havereported the
only expert's verbal com-
Thereare no standards fortheevaluationof methods mentson practicalaspects.
assessingbiomechanicalexposures.Therefore,our Futuredevelopmentand evaluationof methods
group had to develop the evaluation procedure. The would probablybenefitfroma set of guidelineson
selectionof items to be evaluated was based on a con- "minimal requirements forreporting", similarto those
sensus of what are perceived to be important matters adopted for clinical trials (146) and epidemiological
associatedwiththeassessmentof physicalworkload studies(147).
inthepracticeandresearchof occupational healthand
safety(4, 6, 8, 134, 143-145).The evaluationmodel Selection ofmethods fordifferent
was developedin an iterative manner andtestedwitha purposes
subsetofmethods. Weaimedtobasetheconclusions of The aim of thisprojectwas to analyzeobservational
concurrent validity andrepeatability on originalstudies methods inordertohelpusersselectthemostappropriate
of goodquality.We had to relinquish thisrequirement method(s) fortheirspecificpurposes. Noneoftheevalu-
becausepeer-reviewed reports wereveryfew,or even atedmethods willbe universally idealforall purposes,
absent,fora majorityof themethods.However,the dueto thevariety ofuserneedsandthediversity ofset-
evaluationsof themethods,done by expertsblinded tingsin workinglife.Besidesvalidityissues,theuser
to theeach others'results, weremostlyidentical.This will have to considerthetrade-off betweenaccuracy,
probably reflects thefactthata commonunderstanding complexity, costs,and ease-of-use whenidentifying an
ofitemsandevaluation criteria
was reachedduringthe appropriate methodin a particular setting (134). Some-
development oftheevaluation process. timesroughandqualitative information maybe sufficient,
We do notconsiderdirectnumericalcomparisons whilein othersituations detailedpreciseinformation is
betweenstudiesand methodsto be warranted. This requiredas a soundbasis fordecision-making. When
is a resultof considerable differences in studydesign selecting a method, usersshouldfirst definetheirneeds
and settings, thenumberand definition of itemsto be andconstraints, after whichourevaluation of,andfurther
observed, samplesizes (including theamountof work detailsin,theoriginal reports mayhelpthemtoselectthe
observedand thenumberof observersused),and the optimalmethod tobe usedormodified fortheirspecific
statistical
methodsused,forinstanceto quantify reli- purpose.Since theobservation methodsdescribedin
Therefore,
ability. we decidedto evaluatevalidityand thisreport areoftenonlypartlycorrelated, andall have
repeatability in qualitativeterms("good","moderate", at leastfacevalidity, it maybe usefulforpractitioners
"low") without strictlydefinedbordersbetweenthese to applyseveralmethods whilein thefield.In addition,
categories. morequalitative assessments, including interviews are
Information on therepeatability of mostmethods recommended, so as to improvethe"coverage"of the
was limited intheoriginal reports,excluding thedetails assessment andminimize theriskofmissingpotentially
oftherepeatability studyitself.In ourevaluation, this hazardous elements inthejob.
information wastakenforgranted ifthemainpartofthe Mostjobs andtasksshowdailyorseasonalvariabil-
reportseemed tobe otherwise credible.Studiescompar- ityinbiomechanical exposures, and,therefore, thesam-
ingobservations withothermethodsgenerally gave a plingstrategy - in termsofthenumber of subjectsand
moredetaileddescription oftheirdesign,andso itwas measurements persubject- is decisivefortheprecision
to
possible identify potentialbiases in some reports.We andcredibility oftheobtained result(148-156).Someof

themethods includedinthepresent selectionarebased iftheyhaveadoptedsimilarconceptsandskillsthrough

onsampling atfixed-time intervals (eg,OWAS,PATH), sufficient Visualobservation
training. of smallerbody
whileothersapplycontinuous observation forlonger regionsand movements seems to be more challenging
periods(eg, PEO, TRAC). In both cases, variability and,hence,lessreliable,
especially whenthemovements
withinandbetweendays,as well as betweensubjects, are fast.Observationalresultshave in generalagreed
has to be considered whendesigning themeasurement moderately withdetailed information collectedfrom
strategy;even a random sampling maybe efficient (157, videorecordings, whilecorrespondence withtechnical
158). Examples of random interval samplingexistthat measurements has generallybeenlower.
mayovercomeproblemswithregularobservations on No singletoolappearstohavea clearadvantage over
routinecyclejobs (157). A particularproblemwith any other. When tryingto select themost appropriate
instantaneous worksampling("snapshots")is thatthe methodin a specificsetting, usersshouldthoroughly
frequency durationof actionscannotreadilybe
and definetheirneedsand howtheinformation will affect
assessed.Veryfewof thereviewedreportsgive any decision-making.In additionto an
choosing appropriate
adviceon appropriate samplingstrategies whenusing method, thesamplingstrategy is essentialiftheresults
themethod,and in most cases reliabilityis assessed aretobe generalized beyondtheobservedsample.
-
usingindices typically thekappa coefficient- thatcan-
notbe used fordesigning newmeasurement strategies
withan appropriate performance. Identifying an appro-
priatesampling strategycanbe at leastas important for Acknowledgements
thecredibility and interpretation of theobtainedresult
as thechosenassessment instrument perse. This studywas financiallysupportedby theNordic
Based on theanalysisofthemethods andtheitems (Project411040- 70107)
CouncilofMinisters
discussedbefore, we makethefollowing recommenda-
tions:(i) Beforecommencing theobservation, clearly
defineaimsandneedsas well as resourcesanda sam-
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Finnish Institute of Occupational Health

Danish National Research Centre for the Working Environment

Systematic evaluation of observational methods assessing biomechanical exposures at work

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Scand J WorkEnvironHealth 2010, vol 36, no 1 3

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appropriate methods forstudying healthhazardsusually to identify sourcesvia theinternet. The searcheswere

4 Scand J WorkEnvironHealth2010, vol 36, no 1

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be associatedwithMSD?) (1,2). In addition, we evalu- Results

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Method and Target

6 Scand J WorkEnvironHealth2010, vol 36, no 1

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Method Correspondencewith Associationwith Intra-observer Inter-observer

Healthand SafetyExecutive(HSE) upper-limb - -

Back-exposuresamplingtool (BackEst) Low-moderate(technicalmeasures) - - Moderate

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Ergonomie (ERGAN) Computerized

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Method Strengths Limitations Decision rules Potential

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Thejob itselfis evaluated- nottheindividualdoing correspondencewithtechnicalmeasurements (30).

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andentered intoan equation,yieldinga recommended thereby generatesolutionsforcontrollingrisksassoci-

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valueforweights, belowwhichnohealthriskis assumed presentevaluation we includedonlythosemethods with

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shiftof thetechnicalmeasurelimitmightchangethe and specificity, whichcan supportconclusionson the

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(eg,commercial methods oradditional academicstudies didnotmakea formalassessment on thequalityofthe

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themethods includedinthepresent selectionarebased iftheyhaveadoptedsimilarconceptsandskillsthrough

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10. Observationalmethodsassessingbiomechanicalexposuresat questionnaire(DT-EJDQ)]. IntArchOccup EnvironHealth.

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70. Ketola R, Toivonen R, Viikari-Juntura E. Interobserver of carpaltunnelsyndromeand assessmentof riskfactors.J

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assessmenttools foroccupationalergonomics.Boca Raton SystematicReviews of Interventions