Punnett L
Department of Work Environment, University of Massachusetts, Lowell 01854, USA.
Occup Environ Med. 1998 Jun;55(6):414-20. doi: 10.1136/oem.55.6.414.
To evaluate the association between upper extremity soft tissue disorders and exposure to preventable ergonomic stressors in vehicle manufacturing operations.
A cross sectional study was conducted in one vehicle stamping plant and one engine assembly plant. A standardised physical examination of the upper extremities was performed on all subjects. An interviewer administered questionnaire obtained data on demographics, work history, musculoskeletal symptoms, non-occupational covariates, and psycho-physical (relative intensity) ratings of ergonomic stressors. The primary exposure score was computed by summing the responses to the psychophysical exposure items. Multivariate regression analysis was used to model the prevalence of disorders of the shoulders or upper arms, wrists or hands, and all upper extremity regions (each defined both by symptoms and by physical examination plus symptoms) as a function of exposure quartile.
A total of 1315 workers (85% of the target population) was examined. The prevalence of symptom disorders was 22% for the wrists or hands and 15% for the shoulders or upper arms; cases defined on the basis of a physical examination were about 80% as frequent. Disorders of the upper extremities, shoulders, and wrists or hands all increased markedly with exposure score, after adjustment for plant, acute injury, sex, body mass index, systemic disease, and seniority.
Musculoskeletal disorders of the upper extremities were strongly associated with exposure to combined ergonomic stressors. The exposure-response trend was very similar for symptom cases and for physical examination cases. It is important to evaluate all dimensions of ergonomic exposure in epidemiological studies, as exposures often occur in combination in actual workplaces.
评估汽车制造作业中上肢软组织疾病与可预防的工效学应激源暴露之间的关联。
在一家汽车冲压厂和一家发动机装配厂进行了一项横断面研究。对所有受试者进行了标准化的上肢体格检查。一名访员通过问卷调查收集了有关人口统计学、工作史、肌肉骨骼症状、非职业协变量以及工效学应激源的心理-生理（相对强度）评分的数据。主要暴露分数通过对心理-生理暴露项目的回答进行求和计算得出。多元回归分析用于将肩部或上臂、手腕或手部以及所有上肢区域（均通过症状以及体格检查加症状来定义）疾病的患病率建模为暴露四分位数的函数。
共检查了1315名工人（占目标人群的85%）。手腕或手部症状性疾病的患病率为22%，肩部或上臂为15%；基于体格检查定义的病例频率约为前者的80%。在对工厂、急性损伤、性别、体重指数、全身性疾病和工龄进行调整后，上肢、肩部以及手腕或手部的疾病均随着暴露分数的增加而显著增加。
上肢肌肉骨骼疾病与工效学应激源的综合暴露密切相关。症状性病例和体格检查病例的暴露-反应趋势非常相似。在流行病学研究中评估工效学暴露的所有维度很重要，因为在实际工作场所暴露往往是综合发生的。
