Halpern M
Baillieres Clin Rheumatol. 1992 Oct;6(3):705-30. doi: 10.1016/s0950-3579(05)80134-7.
Redesigning the job is a strategy for preventing low back injuries at work or for accommodating injured employees who return to work. An evaluation of the physical job demands is necessary in either strategy. Several job demands are associated with low back pain and injury--heavy physical work, static or postural effort, dynamic work-load and exposure to wholebody vibration. Traditional work measurement studies emphasize a rigorous task analysis. By adding biomechanical, physiological and psychophysical measurements, a comprehensive evaluation is possible. There is no standard scheme for a workplace evaluation. The method depends on the end use of the analysis. Job evaluation for workplace design requires an emphasis on equipment and work conditions; evaluation for placement of injured employees should emphasize the operational demands of the tasks. Few studies considered the multifactorial aetiology of low back pain. Most studies that measured the magnitude of biomechanical, physiological and psychophysical stresses attempted to define peak work-loads. The attempt to evaluate the effects of subacute cumulative traumas is only in the beginning. Most ergonomic intervention programmes modify the loads, the design of objects handled, lifting techniques, workplace layout and task design. The effectiveness of these interventions in controlling medical costs or morbidity has not been clearly demonstrated. Consequently, occupational risk factors may be more important for evaluating disability. Job familiarity is the key to effective medical management. Ergonomic analysis procedures may be useful within rehabilitation settings that also provide placement services. The reason is that they facilitate communication between all elements involved in the rehabilitation process. Proper communication procedures are also crucial in implementing ergonomic interventions in the workplace. A health care provider should be part of a task force that oversees these interventions. Future effort should be directed to finding a method that health care practitioners could be competent to carry out effectively in a clinical setting. Expert systems offer promising results in disseminating ergonomic knowledge in primary and secondary health care facilities.
重新设计工作是预防工作中腰部损伤或接纳重返工作岗位的受伤员工的一种策略。在这两种策略中，对工作的体力需求进行评估都是必要的。有几种工作需求与腰痛和损伤相关——繁重的体力劳动、静态或姿势性用力、动态工作负荷以及全身振动暴露。传统的工作测量研究强调严格的任务分析。通过增加生物力学、生理学和心理物理学测量，可以进行全面评估。对于工作场所评估没有标准方案。方法取决于分析的最终用途。用于工作场所设计的工作评估需要强调设备和工作条件；用于受伤员工安置的评估应强调任务的操作需求。很少有研究考虑腰痛的多因素病因。大多数测量生物力学、生理学和心理物理学压力大小的研究试图确定峰值工作负荷。评估亚急性累积创伤影响的尝试才刚刚开始。大多数人体工程学干预计划会改变负荷、所处理物体的设计、搬运技术、工作场所布局和任务设计。这些干预在控制医疗成本或发病率方面的有效性尚未得到明确证明。因此，职业风险因素对于评估残疾可能更为重要。工作熟悉度是有效医疗管理的关键。人体工程学分析程序在也提供安置服务的康复环境中可能会有用。原因是它们促进了康复过程中所有相关要素之间的沟通。适当的沟通程序在工作场所实施人体工程学干预中也至关重要。医疗保健提供者应成为监督这些干预措施的特别工作组的一员。未来的努力应致力于找到一种医疗保健从业者能够在临床环境中有效实施的方法。专家系统在初级和二级医疗保健设施中传播人体工程学知识方面提供了有希望的结果。
