We are planning to create a series of consecutive, well designed, small-scale, interventional studies nested within our successful prospective cohort study of Distal Upper Extremity Musculoskeletal Disorders (DUE MSDs). The cohort for this proposal is derived from our 4-year, multi-center study (n=600+, 15 diverse industries, 2 states) that was recently extended through 2009 after a successful competing continuation application. This proposal is to: 1) take jobs that are being identified as high risk, 2) design feasible, low cost interventions, and 3) follow-up these sub-cohorts to determine if injury rates are reduced.
The research team has successfully assembled a major prospective cohort study of DUE MSDs with 2 diverse states, 15 employment settings, and over 600 workers. The research methods are addressing most of the weaknesses identified in the available MSD epidemiological literature as well as other common epidemiological study weaknesses. We have begun to publish the results from this study in conference proceedings and submissions of manuscripts.
This research team has completed ALL baseline health outcomes assessments on this cohort with electronically administered questionnaires, electronically administered structured interviews, standardized physical examinations, and nerve conduction studies (NCS). Subsequently, monthly follow-up of the entire cohort has been ongoing. Our success rate in obtaining personal contact for monthly follow-ups has averaged 83.5%. Reasons for worker absences are tracked. Most are not absent for reasons of MSDs, though some are. Every six months, NCS are conducted on every subject who has had any hand paraesthesias at any of 6 monthly follow-ups. We completed baseline job physical exposure data collection on all but 39 workers (those individuals were laid off prior to job measurements). We have complete baseline data (health status and job physical exposure) on all the study participants.
Given the success of this study, we intend to design, implement and evaluate an Interventional program to quantify efficacy in reducing the incidence of DUE MSDs nested within an existing, well-established cohort population. In studying the population we have found numerous documented factors that are associated with UE MSDs that can be grouped into three general areas, job risk factors, personal risk factors, and psychosocial risk factors. In these interventions we intend to look at how changing job risk factors impacts the incidence of DUE MSDs.
We hypothesize that there will be a measurable reduction in the incidence of DUEMSDs after implementation of a well designed interventional program among an established cohort population, as well as a measurable reduction in the incidence of DUE musculoskeletal symptoms.
The intent is to design a feasible intervention program to reduce DUE MSDs. We will select a plant for intervention that has medium and/or high risk jobs and design the intervention that incorporates both worker and management input. We will present the preliminary program to the workers prior to implementation and make the final adjustments required.
Throughout a one year period we will continue to perform monthly health outcomes structured interviews for changes in health outcomes status, as well as perform standardized physical examinations for new symptoms or changes in symptoms. After one year, we will measure post-intervention for health outcomes and measure Job Physical Exposures and quantify them by various factors including force, repetition, percent duration of exertion, posture, hours of exposure, etc.
Each plant is expected to require about one year for the intervention procedures. At the end of this one year period we will be performing statistical analyses to determine disorder-specific incidence rates after intervention and compare them to the disorder rates which occurred before the intervention. We will also quantify the costs and benefits of the interventions with economic modelings. Upon completion, the next plant’s intervention project will be developed. We anticipate 3 or 4 intervention projects in this proposed 5-year timeline. As resources are limited, we will focus upon those plants we feel have the most to gain from an intervention program.
