Punnett Laura, Wegman David H
University of Massachusetts Lowell, One University Avenue, Lowell, MA 01854, USA.
J Electromyogr Kinesiol. 2004 Feb;14(1):13-23. doi: 10.1016/j.jelekin.2003.09.015.
The debate about work-relatedness of musculoskeletal disorders (MSDs) reflects both confusion about epidemiologic principles and gaps in the scientific literature. The physical ergonomic features of work frequently cited as risk factors for MSDs include rapid work pace and repetitive motion, forceful exertions, non-neutral body postures, and vibration. However, some still dispute the importance of these factors, especially relative to non-occupational causes. This paper addresses the controversy with reference to a major report recently commissioned by the US Congress from the National Research Council (NRC) and Institute of Medicine (IOM) (2001). The available epidemiologic evidence is substantial, but will benefit from more longitudinal data to better evaluate gaps in knowledge concerning latency of effect, natural history, prognosis, and potential for selection bias in the form of the healthy worker effect. While objective measures may be especially useful in establishing a more secure diagnosis, subjective measures better capture patient impact. Examination techniques still do not exist that can serve as a "gold standard" for many of the symptoms that are commonly reported in workplace studies. Finally, exposure assessment has too often been limited to crude indicators, such as job title. Worker self-report, investigator observation, and direct measurement each add to understanding but the lack of standardized exposure metrics limits ability to compare findings among studies. Despite these challenges, the epidemiologic literature on work-related MSDs-in combination with extensive laboratory evidence of pathomechanisms related to work stressors-is convincing to most. The NRC/IOM report concluded, and other reviewers internationally have concurred, that the etiologic importance of occupational ergonomic stressors for the occurrence of MSDs of the low back and upper extremities has been demonstrated.
关于肌肉骨骼疾病（MSDs）与工作相关性的争论，既反映了对流行病学原理的困惑，也反映了科学文献中的空白。经常被 cited 为MSDs风险因素的工作物理工效学特征包括工作节奏快和重复动作、用力、非中性身体姿势以及振动。然而，一些人仍然对这些因素的重要性提出质疑，尤其是相对于非职业性原因而言。本文参考了美国国会最近委托国家研究委员会（NRC）和医学研究所（IOM）（2001年）撰写的一份主要报告，探讨了这一争议。现有的流行病学证据很充分，但将受益于更多的纵向数据，以便更好地评估在效应潜伏期、自然史、预后以及健康工人效应形式的选择偏倚可能性方面的知识空白。虽然客观测量在建立更可靠的诊断方面可能特别有用，但主观测量能更好地反映患者的影响。对于工作场所研究中常见的许多症状，仍然不存在可以作为“金标准”的检查技术。最后，暴露评估往往仅限于粗略的指标，如职位名称。工人自我报告、研究者观察和直接测量都有助于理解，但缺乏标准化的暴露指标限制了比较不同研究结果的能力。尽管存在这些挑战，但关于与工作相关的MSDs的流行病学文献——结合与工作压力源相关的病理机制的大量实验室证据——对大多数人来说是有说服力的。NRC/IOM报告得出结论，国际上的其他评审者也表示赞同，即职业工效学压力源对腰背部和上肢MSDs发生的病因学重要性已得到证实。
