Ergonomic Issues in the Workplace - Research Paper Example

? Ergonomics Research Paper Outline Introduction Ergonomics is concerned with the various interactions between human beings and other elements in a system. The basic idea is to create systems that are healthy for human beings to operate in and interact with. (IEA, 2010) These interactions could be both long term and short term. Well figured out ergonomics are necessary to produce designs that prevent repetitive strain injuries. These injuries could turn into disabilities in the longer run hence the need for their prevention. (Berkeley University, 2008) This text is an outline for a research proposal concerned with ergonomic principles, ergonomic issues in the workplace and their effective solution through research. Ergonomic principles and problems will be discussed followed by the research methodology for finding solutions. This will be followed by the solutions and an accompanying conclusion. Background Ergonomics can be broadly classified into three major distinctions: 1. Physical Ergonomics: related to human’s anatomical, biomechanical, physiological and some anthropometric activities. 2. Cognitive Ergonomics: related to mental processing in human beings. 3. Organizational Ergonomics: related to optimizing social and technical systems along with organizational structure, processes and policies. This research focuses solely on physical ergonomics in general and on physiological and anatomical issues in particular. The ergonomic problem under focus is carpal tunnel syndrome. Carpal tunnel syndrome has been chosen as it is a common and well investigated problem. The chances of locating reliable sources for carpal tunnel syndrome are high. A discussion is available below for carpal tunnel syndrome in context of applicable ergonomic principles. Carpal Tunnel Syndrome Carpal Tunnel Syndrome (CTS) is experienced as pain, numbness, burning or tingling sensation in the hand and fingers. Repeated actions of the hand and wrist in certain postures are known to cause CTS in certain workers. (Hutson, 1997) The carpal tunnel is a narrow passageway that connects the lower palm to the wrist’s bottom. This passageway houses various tendons that aid finger movement as well as the median nerve. The median nerve is responsible for movement of the hand as well as for sensation in it. The carpal tunnel is enclosed on the inner side of the wrist by tissue better known as transverse carpal ligament. If CTS sets in, the passageway is made narrower by the surrounding tissues. This could occur due to increased pressure on tissues or due to fluid buildup inside tissues (also known as oedema). As the tissue size increases, the median nerve is stressed out. Pressure on the median nerve is enhanced whenever flexion (bending of the fingers and wrist) occurs. Pain and numbness are felt as the median nerve is stressed and compressed. (NHS, 2010) Symptoms of CTS The biggest symptom of CTS is sporadic numbness experienced within the thumb, index finger, long finger and in the radial half of the ring finger. (Walker, 2010) In most cases, the numbness is more pronounced at night because most people sleep with their wrists flexed. As the wrist is flexed, the median nerve is compressed more thereby causing the numbness. (Shiel, 2010) The persistence of CTS over a long period is known to cause permanent nerve damage. This results in a constant feeling of numbness as well as loss of picking power of the wrist. (Uemura, Hidaka, & Nakamura, 2010) The pain experienced in CTS is actually numbness that is intense enough to cause a person to wake up from sleep. Causes behind CTS Currently the causes behind CTS are classified as idiopathic1. Investigation over the years has revealed that CTS arises from a variety of causes that pressurize the median nerve present at the wrist. These conditions can be common such as the use of oral contraceptives, diabetes, obesity, arthritis, trauma and hypothyroidism. (Katz & Simmons, 2002) Other than these causes, intrinsic and extrinsic complications that exert pressure on the carpal tunnel may cause CTS too. These problems could include (but are not limited to) benign tumors as well as vascular malformation. (Tiong, Ismael, & Regan, 2005) CTS has been known to be associated with typing and other similar kinds of hand use where repetitive actions are prevalent. (Scangas, Lozano-Calderon, & Ring, 2008) The occurrence of CTS in workers with repetitive hand use has been demonstrated in meat packers, checkout clerks as well as assembly workers. (Hutson, 1997) Though it is well established that CTS results from repetitive strain injury (as well as other causes) but there is still some controversy as to demonstrating causality. (Werner, 2006) Investigation of connection between HAL (Hand Activity Level) and CTS has also been carried out in a recent study that shows strong connections between HAL and CTS occurrence especially in obsess people. (Burt, Crombie, Jin, Wurzelbacher, Ramsey, & Deddens, 2011) As yet there is still controversy between major professional organizations as per CTS. OSHA (Occupational Safety and Health Administration) has enforced rules and regulations that deal with cumulative trauma disorders. Various occupational risk factors have been identified such as repetitive assigned tasks, posture during work, application of force as well as vibration. On the other hand, the ASSH (American Society for Surgery of the Hand) holds that there is little evidence in the literature at hand to demonstrate a casual relationship between CTS and work related activities. In contrast, review of scientific data by NIOSH (National Institute for Occupational Safety and Health) has shown that repetitive tasks incur the risk of CTS but causation could not be firmly established. Deterioration of the upper limbs due to workplace conditions is an established fact and easing work conditions has been shown to relieve symptoms in a large number of cases. (Cole, Hogg-Johnson, Manno, Ibrahim, Wells, & Ferrier, 2006) One of the leading schools of thought associating CTS to work related activities indicates that CTS is displayed largely by the adult working population (especially patients above 30 years of age). However, other schools of thought suggest that CTS is more often displayed by older patients who are beyond working age anymore. (Lozanocalderon, Paiva, & Ring, 2008) There is little doubt though that CTS occurrence in the workplace has increased significantly but certain evidence suggests that CTS is a gradual genetic development more than anything else. (Lozanocalderon, Anthony, & Ring, 2008) Methods This research relies exclusively on secondary research methods. One reason for this is the fact that there is a large amount of material related to investigation of CTS. Another reason is the fact that primary research would involve the use of far more time than the research in question could provide. This would come about as surveys and questionnaires would have to be filled out by hundreds of people in different situations placing stress on their hands through repetitive tasks. Once the completed surveys and questionnaires would be received, then they would have to be sorted out and the data analyzed. This would add to the time required for conducting the research. On the other hand, the secondary research techniques provide rich literature sources that have been construed through primary research. By referring to secondary research from a number of different sources, it would be possible to investigate various aspects on CTS without using too much time. (Crouch & Housden, 2003) Moreover, medical research is widely based on secondary research and its effectiveness is widely recognized. The ergonomic investigation required for repetitive hand actions and their consequences (in the shape of CTS) closely resembles medical research. (Greenhalgh, Robert, Bate, Macfarlene, & Kyriakidou, 2005) On the basis of the factors listed above, secondary research has been chosen as the preferred method for this research. Results In general terms, a study indicates that CTS is far more common in women than in men. The study indicates that each year some 60 to 120 women out of every 100,000 develop CTS while only 35 to 60 men develop CTS out of 100,000. Also, CTS is more prevalent amongst older patients than younger ones. The most common age ranges for CTS were 50 to 54 years and 75 to 84 years. (NHS, 2010) Gender Number of CTS Patients (out of every 100,000 Patients) Male 35-60 Female 60-120 Another study investigated the relationship between CTS and workplace tasks in groups of healthcare and manufacturing workers. The participants were analyzed against a standard definition of HAL (hand activity level) and all forceful exertions were videotaped for further analysis by studying the frequency and duration of exertion and postural deviation. (Burt, Crombie, Jin, Wurzelbacher, Ramsey, & Deddens, 2011) Electro diagnostic testing was carried out and questionnaires were filled out by all 477 participants. The results are shown below. Condition OR 70% ? maximum voluntary contraction > 20% 2.74 1.32 – 5.68 BMI ? 30 and exertions per minute ? 15 3.35 1.14 – 9.87 Increase of CTS odds for unitary increase on the 10 point scale 1.14 1.01-1.29 Increase of CTS odds for unitary increase on HAL 10 point scale 1.38 1.05 – 1.81 HAL greater than combined force and ACGIH TLV 2.96 1.51 – 5.80 The results of this study conclusively show that job exposure had a clear role in CTS development in individuals. Evaluation of obesity responded to increased chances of CTS which shows that obesity too has a role to play in CTS development. A study initiated as a response to the NIOSH (National Institute of Occupational Safety and Health) study linking CTS and job exposure had slightly different results. The study comprised of 78 subjects who were symptomatic. A total of 66 subjects were working at the time of the study while 12 were temporarily disabled due to upper extremity problems. (Katz, Larson, Fossel, & Liang, 1981) The pie graphs below presents the characteristics of the patients studied. The results are presented below for the study conducted. Sensitivity Specificity OR (95% CI) Median n. symptoms 0.93 0.25 4.67 (0.97, 22.57) Occupational risk factors 0.83 0.40 3.28 (1.07, 10.06) It must be noted that the occupational risk factors listed in the table above comprise of repetitive pinching, grasping, wrist flexion or vibration. This study brought about some important results including the fact that physical examination is not good enough a criterion to classify CTS because the previous NIOSH study had classified some 38% patients wrongly. Moreover, the percentage of patients suffering from CTS was higher in this study than most other studies. Thirdly, it was felt that there was a strong connection between CTS and workplace tasks relating to the hands. However, it must be noted that external symptoms such as obesity, depression or genetics have not been included in this study. Conclusions The research outline presented above has tackled the issue of CTS through the various differing perspectives available. Patients inside workplaces have been investigated and results of those investigations have been utilized as secondary research sources. The evidence presented conclusively reveals that CTS and workplace tasks especially those involving repetitive hand and wrist movements significantly increase the chances for CTS. However, it must be recognized that CTS is caused by other issues such as genetics and obesity too but their contribution has not been differentiated to date. This leads to the belief that further research is required to distinctly identify the contribution of various factors to CTS in addition to workplace tasks. Also, the use of physiotherapy, change in task routines, exercise and careful ergonomics could help to reduce the chances for CTS. Bibliography Berkeley University. (2008). Integrated Safety Management Ergonomics. Retrieved July 7, 2011, from Berkeley Lab: http://www.lbl.gov/ehs/pub811/hazards/ergonomics.html Burt, S., Crombie, K., Jin, Y., Wurzelbacher, S., Ramsey, J., & Deddens, J. (2011). Workplace and individual risk factors for carpal tunnel syndrome. Occupational and Environmental Medicine . Cole, D. C., Hogg-Johnson, S., Manno, M., Ibrahim, S., Wells, R. P., & Ferrier, S. E. (2006). Reducing musculoskeletal burden through ergonomic program implementation in a large newspaper. International Archives of Occupational and Environmental Health 80 (2) , 98-108. Crouch, S., & Housden, M. (2003). Marketing research for managers: The Marketing Series. Butterworth-Heinemann. Greenhalgh, T., Robert, G., Bate, P., Macfarlene, F., & Kyriakidou, O. (2005). Diffusion of Innovations in Health Service Organisations: A Systematic Literature Review. John Wiley and Sons. Hutson, M. (1997). Work-Related Upper Limb Disorders: Recognition and Management. Oxford: Butterworth-Heinemann. IEA. (2010). What is Ergonomics? Retrieved July 7, 2011, from IEA: http://iea.cc/01_what/What%20is%20Ergonomics.html Katz, J. N., & Simmons, B. P. (2002). Carpal Tunnel Syndrome. New England Journal of Medicine 346 (23) , 1807-1812. Katz, J. N., Larson, M. G., Fossel, A. H., & Liang, M. H. (1981). Validation of a Surveillance Case Defintion of Carpal Tunnel Syndrome. NIOSH. Lozanocalderon, S., Anthony, S., & Ring, D. (2008). The Quality and Strength of Evidence for Etiology: Example of Carpal Tunnel Syndrome. The Journal of Hand Surgery 33 (4) , 525–538. Lozanocalderon, S., Paiva, A., & Ring, D. (2008). Patient Satisfaction After Open Carpal Tunnel Release Correlates With Depression. The Journal of Hand Surgery 33 (3) , 303-307. NHS. (2010, November 16). Carpal Tunnel Syndrome. Retrieved July 7, 2011, from NHS: http://www.nhs.uk/conditions/carpal-tunnel-syndrome/Pages/Whatisitfinal.aspx Scangas, G., Lozano-Calderon, S., & Ring, D. (2008). Disparity between popular (Internet) and scientific illness concepts of carpal tunnel syndrome causation. The Journal of hand surgery 33 (7) , 1076–1080. Shiel, W. C. (2010). Carpal Tunnel Syndrome & Tarsal Tunnel Syndrome. Retrieved July 7, 2011, from Medicine Net: http://www.medicinenet.com/carpal_tunnel_syndrome/article.htm Tiong, W. H., Ismael, T., & Regan, P. J. (2005). Two rare causes of carpal tunnel syndrome. Irish Journal of Medical Science 174 (3) , 70-78. Uemura, T., Hidaka, N., & Nakamura, H. (2010). Clinical outcome of carpal tunnel release with and without opposition transfer. J Hand Surg Eur Vol. 35 (8) , 632–636. Walker, J. A. (2010). Management of patients with carpal tunnel syndrome. Nursing Standard 24 (19) , 44-48. Werner, R. A. (2006). Evaluation of Work-Related Carpal Tunnel Syndrome. Journal of Occupational Rehabilitation 16 (2) , 207-222. Read More