Klussmann Andre, Liebers Falk, Gebhardt Hansjürgen, Rieger Monika A, Latza Ute, Steinberg Ulf
Institute of Occupational Health, Safety and Ergonomics (ASER), Corneliusstrasse 31, D-42329, Wuppertal, Germany.
University of Wuppertal, School of Mechanical Engineering and Safety Engineering, Chair of Human Engineering, Gaussstr. 20, D-42119, Wuppertal, Germany.
BMC Musculoskelet Disord. 2017 May 10;18(1):184. doi: 10.1186/s12891-017-1542-0.
Manual handling operations (MHO) are known to be risk factors for work-related upper limb disorders (WRULDs), e.g. symptoms and conditions such as carpal tunnel syndrome. To estimate the risk of WRULDs, a Key Indicator Method (KIM) for the risk assessment of MHO was developed. The method was validated in regard to different criteria, including face validity, criterion validity, reliability and further aspects concerning utility. This paper describes the KIM-MHO and criterion validity of this method with reference to prevalence of musculoskeletal disorders (MSDs).
A cross-sectional sample of 643 employees exposed to MHO was compared to a reference group of 804 unexposed subjects predominantly working at visual display terminals. The Nordic Questionnaire and a standardized clinical examination were used to obtain the 7-day and 12-months prevalence of symptoms and clinical conditions of the musculoskeletal system. Job specific exposure levels to MHO were assessed by ergonomists using the KIM-MHO. The resulting risk scores were categorized into risk categories 1 - low risk (reference group), 2 - increased risk, 3 - highly increased risk, and 4 - high risk. Log-linear Poisson regression models were applied to obtain adjusted prevalence ratios (PR) with 95%-confidence intervals.
The 7-day prevalence of symptoms for subjects in risk category 3 compared to risk category 1 was significant for the regions shoulder [women (w): PR 1.8 (1.2-2.7), men (m): PR 2.3 (1.2-4.4)], elbow [w: PR 3.3 (1.5-7.2), m: PR 2.4 (0.8-7.3)], and hand/wrist [w: PR 3.0 (1.7-5.3), m: PR 5.5 (2.7-11.3)]. The 7-day prevalence of symptoms for risk category 4 was also significant for the regions shoulder [w: PR 1.9 (1.3-2.8), m: PR 1.9 (1.3-2.7)], elbow [w: PR 4.5 (2.3-8.7), m: PR 3.3 (2.1-5.4)], and hand/wrist [w: PR 4.2 (2.6-6.9), m: PR 5.5 (3.5-8.5)]. The 12-months prevalence in these joint regions show comparable increases in the risk categories 3 and 4.
The KIM-MHO is valid in regard to criterion validity. The hypothesis could be confirmed, that high risk scores were associated with an increased prevalence of symptoms and clinical conditions especially in the shoulder, elbow and hand/wrist regions among employees exposed to MHO.
人工搬运操作（MHO）是与工作相关的上肢疾病（WRULDs）的风险因素，例如腕管综合征等症状和疾病。为了评估WRULDs的风险，开发了一种用于MHO风险评估的关键指标法（KIM）。该方法在不同标准方面得到了验证，包括表面效度、标准效度、可靠性以及与实用性相关的其他方面。本文参照肌肉骨骼疾病（MSDs）的患病率描述了KIM-MHO及其标准效度。
将643名暴露于MHO的员工的横断面样本与主要在视觉显示终端工作的804名未暴露受试者的对照组进行比较。使用北欧问卷和标准化临床检查来获取肌肉骨骼系统症状和临床疾病的7天和12个月患病率。人机工程学专家使用KIM-MHO评估特定工作的MHO暴露水平。将所得风险评分分为风险类别1 - 低风险（对照组）、2 - 风险增加、3 - 风险高度增加和4 - 高风险。应用对数线性泊松回归模型以获得调整后的患病率比（PR）及95%置信区间。
与风险类别1相比，风险类别3受试者的7天症状患病率在肩部区域[女性（w）：PR 1.8（1.2 - 2.�），男性（m）：PR 2.3（1.2 - 4.4）]、肘部区域[w：PR 3.3（1.5 - 7.2），m：PR 2.4（0.8 - 7.3）]以及手/腕部区域[w：PR 3.0（1.7 - 5.3），m：PR 5.5（2.7 - 11.3）]有显著差异。风险类别4受试者的7天症状患病率在肩部区域[w：PR 1.9（1.3 - 2.8），m：PR 1.9（1.3 - 2.7）]、肘部区域[w：PR 4.5（2.3 - 8.7），m：PR 3.3（2.1 - 5.4）]以及手/腕部区域[w：PR 4.2（2.6 - 6.9），m：PR 5.5（3.5 - 8.5）]也有显著差异。这些关节区域的12个月患病率在风险类别3和4中呈现出类似的增加。
KIM-MHO在标准效度方面是有效的。可以证实该假设，即高风险评分与症状和临床疾病患病率的增加相关，尤其是在暴露于MHO的员工的肩部、肘部和手/腕部区域。
