Annals of Occupational and Environmental Medicine

The Korean Society of Occupational & Environmental Medicine (대한직업환경의학회)
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The Effects of Disabilities of the Upper Extremities on Daily Activities of Workers in Manufacturing Industry, and the Factors Influencing Those Disabilities

제조업 종사 근로자의 동작수행능력에 영향을 미치는 요인

Kim, Kyoo-Sang;Hong, Chang-Woo;Kim, Min-Gi
김규상;홍창우;김민기

  • Published : 20090600
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Abstract

Objectives: Discomfort in the upper extremities affects and restricts the daily activities and work of many workers. This study was conducted to apply a standardized tool for identifying musculoskeletal symptoms and measuring how greatly these symptoms affect the performance of workers in small manufacturing industries as well as to analyze the relationships between the socio-demographic characteristics of the workers, the psychosocial factors, and ergonomic risk factors on the one hand and the reported musculoskeletal symptoms and their effects on work performance on the other. Methods: Workers in small manufacturing companies were asked to self-evaluate musculoskeletal symptoms, restrictions on work performance, and the ergonomic risk in their working environments. A standardized tool (musculoskeletal symptoms table, DASH [Disability of the arm, shoulder, and hand]) was used to evaluate the musculoskeletal symptoms and the restrictions on work performance. Results: 1) The DASH score was significantly higher among women, older workers who had been in that job for a long time, married workers, those with no leisure activities or hobbies, those with long hours of housework, those who had experienced a disease in the past, and those who had had an accident in the past; 2) the DASH score was also significantly higher for those workers who were unsatisfied with their work, who worked hard, who no control over their work, and whose work required heavy equipment, tools, and materials; 3) the DASH score was significantly higher in workers with major ergonomic risk factors; 4) the DASH score was significantly higher among workers with occupational musculoskeletal disease and was distributed as follows, from highest to lowest rates of occurrence; symptoms in the upper arms, difficulty sleeping, difficulty with work, restrictions in daily activities, restrictions in social activities, and difficulties in specific work performance; 5) explanatory power increased in the model with the addition of socio-demographic variables, i.e., in analyses with the DASH total score as the dependent variable and psychosocial factors, ergonomic risk factors, and upper extremity discomfort symptoms as the independent variables. The total explanatory power found a significant effect at 35.3%. Conclusions: The results of this study show that to enhance the upper extremity performance level of workers in the manufacturing industry, preventive measures should be based on a consideration of ergonomic risk factors, psychosocial factors, and the socio-demographic characterisitics of the individual workers.

목적: 상지 근골격계 증상은 근로자의 작업과 일상 사회생활의 활동에 영향을 끼쳐 제약을 가져오게 된다. 이 연구는 표준화된 측정도구를 이용하여 중소규모 제조업체 근로자들의 근골격계 증상과 동작수행능력의 제한 수준을 파악하고, 개인의 사회인구학적 특성과 직무관련 사회심리적 요인 및 인간공학적 위험요인, 그리고 근골격계 증상이 동작수행능력의 제한에 어떠한 영향을 미치는지 분석하고자 하였다. 방법: 이 연구조사는 16개 중소규모 제조업체 1,853명의 생산직 근로자를 대상으로 근골격계 증상, 동작수행능력의 제한, 작업환경상의 인간공학적 위험에 대한 자가평가를 수행하였다. 근골격계 증상과 동작수행능력의 제한 등의 조사는 표준화된 측정도구(KOSHA Code H-30-2003의 근골격계 증상조사표와 DASH)를 활용하였으며, 인간공학적 위험에 대한 평가는 근골격계 부담작업의 범위와 관련한 정성적인 자기기입식 조사(인간공학적 작업환경조사표)를 수행하여 분석 평가하였다. 결과: 조사결과는 다음과 같다. 1) 여성, 고연령, 장기간의 근무기간, 기혼자, 여가/취미활동을 하지 않을수록, 긴 평균 가사노동시간, 과거 질병력 및 사고력이 있는 근로자에서 DASH 점수가 유의하게 높게 나타났다. 2) 직무 만족도가 낮을수록, 직무 요구도가 높을수록, 직무 자율성이 낮을수록 DASH 점수가 유의하게 높게 나타났다. 3) 주요 인간공학적 위험요인을 가진 작업에서 DASH 구성요소 및 전체점수가 유의하게 높게 나타났다. 4) 작업관련성 근골격계 질환자에서 유의하게 높은 DASH 점수를 보였으며, 부문별 DASH 점수를 보면 상지의 증상, 수면활동장애, 일/작업관련의 어려움, 일상활동의 제한, 사회활동의 제한, 구체적인 동작 수행 능력의 어려움 등의 순으로 높은 점수 분포를 보였다. 5) DASH 전체 점수를 종속변수로 한 인구사회학적 변수, 직무 관련 사회심리적 요인, 인간공학적 위험요인과 상지근골격계 증상 관련 변수를 각각 투입한 모형에서 설명력이 증가하였으며, 전체 설명력은 35.3%로 유의하게 영향을 미치고 있음을 알 수 있었다. 결론: 이 연구 결과를 통해 제조업 사업장 근로자의 상지 동작수행능력은 개인의 사회인구학적 특성과 직무관련 사회심리적 요인 및 인간공학적 위험요인과 관련이 있어 이에 대한 예방대책을 마련할 필요가 있다. 증상의 여부에 따른 동작수행능력, 사회활동과 일상활동의 제한, 상지의 증상, 수면활동장애 등과 일/작업관련 및 스포츠/예술활동 관련에 미치는 영향의 역학적 의의는 있지만 근골격계 질환의 진단을 통해 그 연관성과 정확성은 더 규명 되어야 할 것이다.

Keywords

References

  1. National Institute for Occupational Safety and Health(NIOSH). Musculoskeletal Disorders(MSDs) and Workplace Factors: A Critical Review of Epidemiologic Evidence for Work-Related Musculoskeletal Disorders of the Neck, Upper Extremity, and Low Back (2nd printing). Cincinnati: U.S. Department of Health and Human Services(DHHS), 1997
  2. Fan ZJ, Smith CK, Silverstein BA. Assessing validity of the quick DASH and SF-12 as surveillance tools among workers with neck or upper extremity musculoskeletal disorders. J Hand Ther 2008;21:354-65 https://doi.org/10.1197/j.jht.2008.02.001
  3. Kitis A, Celik E, Aslan UB, Zencir M. DASH questionnaire for the analysis of musculoskeletal symptoms in industry workers: a validity and reliability study. Appl Ergon 2009;40:251-5 https://doi.org/10.1016/j.apergo.2008.04.005
  4. Turchin DC, Beaton DE, Richards RR. Validity of observer- based aggregate scoring systems as descriptors of elbow pain, function, and disability. J Bone Joint Surg 1998;80A(2):154-62
  5. Beaton DE, Katz JN, Fossel AH, Wright JG, Tarasuk V, Bombardier C. Measuring the whole or the parts? Validity, reliability and responsiveness of the disabilities of the arm, shoulder and hand outcome measure in different regions of the upper extremity. J Hand Ther 2001;14(2):128-46 https://doi.org/10.1016/S0894-1130(01)80043-0
  6. Beaton DE, Cole DC, Manno M, Bombardier C, Hogg- Johnson S, Shannon HS. Describing the burden of upperextremity musculoskeletal disorders in newspaper workers: What differences do case definitions make? J Occup Rehabil 2000;10(1):39-53 https://doi.org/10.1023/A:1009489712094
  7. Beaton DE, Davis AM, Hudak P, McConnel S. The DASH (disability of the arm, shoulder and hand) outcome measure: What do we know about it now? Br J Hand Ther 2001;6(4):109-18 https://doi.org/10.1177/175899830100600401
  8. Fayad F, Lefevre-Colau M-M, Mace Y, Gautheron V, Fermanian J, Roren A, Roby-Brami A, Revel M, Poiraudeau S. Responsiveness of the French version of the disability of the arm, shoulder and hand questionnaire (FDASH) in patients with orthopaedic and medical shoulder disorders. Joint Bone Spine 2008;75:579-84
  9. Lucado AM, Li Z, Russell GB, Papadonikolakis A, Ruch DS. Changes in impairment and function after static progressive splinting for stiffness after distal radius fracture. J Hand Ther 2008;21:319-25 https://doi.org/10.1197/j.jht.2008.01.002
  10. Wong YP, Fung KK, Chu ML, Chan KY. The use of disabilities of the arm, shoulder, and hand questionnaire in rehablitation after acute traumatic hand injuries. J Hand Ther 2007;20:49-56 https://doi.org/10.1197/j.jht.2006.10.004
  11. McDermid JC, Drosdowech D, Faber K. Responsiveness of self-report scales in patients recovering from rotator cuff surgery. J Shoulder Elbow Surg 2006;15(4):407-14 https://doi.org/10.1016/j.jse.2005.09.005
  12. Atroshi I, Gummesson C, Andersson B, Dahlgren E, Johansson A. The disabilities of the arm, shoulder and hand (DASH) outcome questionnaire. Reliability and validity of the Swedish version evaluated in 176 patients. Acta Orthop Scand 2000;71(6):613-8 https://doi.org/10.1080/000164700317362262
  13. Rosales RS, Delgado EB, Diez de la Lastra-Bosch I. Evaluation of the Spanish version of the DASH and carpal tunnel syndrome health-related quality-of-life instruments: cross-cultural adaptation process and reliability. J Hand Surg(American) 2002;27(2):334-43 https://doi.org/10.1053/jhsu.2002.30059
  14. Durand M-J, Vachon B, Loisel P. The cross-cultural adaptation of the DASH questionnaire in Canadian French. J Hand Ther 2005;18:34-9 https://doi.org/10.1197/j.jht.2004.10.010
  15. Fayad F, Lefevre-Colau M-M, Gautheron V, Mace Y, Fermanian J, Mayoux-Benhamou A, Roren A, Rannou F, Roby-Brami A, Revel M, Poiraudeau S. Reliability, validity and responsiveness of the French version of the questionnaire quick disability of the arm, shoulder and hand in shoulder disorders. Man Ther 2009; 14(2):206-12 https://doi.org/10.1016/j.math.2008.01.013
  16. Germann G, Harth A, Wind G, Demir E. Standardisation and validation of the German version 2.0 of the Disability of Arm, Shoulder, Hand (DASH) questionnaire. Unfallchirurg 2003;106(1):13-9. (German) https://doi.org/10.1007/s00113-002-0456-x
  17. Themistocleous GS, Goudelis G, Kyrou I, Chloros GD, Krokos A, Galanos A, Gerostathopoulos NE, Soucacos PN. Translation into Greek, cross-cultural adaptation and validation of the disablities of the arm, shoulder, and hand questionnaire (DASH). J Hand Ther 2006;19:350-7 https://doi.org/10.1197/j.jht.2006.04.014
  18. Lee WC, Lau SY, Chung MH, Li PS, Lo SK. Evaluation of the Chinese version of the disability of the arm, shoulder and hand (DASH-HKPWH): Cross-cultural adaptation process, internal consistency and reliability study. J Hand Ther 2004;17:417-23 https://doi.org/10.1016/S0894-1130(04)00183-8
  19. Imaeda T, Toh S, Wada T, Uchiyama S, Okinaga S, Kusunose K, Sawaizumi T. Validation of the Japanese society for surgery of the hand version of the quick disability of the arm, shoulder, and hand (QuickDASHJSSH) questionnaire. J Orthopaedic Sci 2006;11(3):248-53 https://doi.org/10.1007/s00776-006-1013-1
  20. Lee JY, Lim JY, Oh JH, Ko YM. Cross-cultural adaptation and clinical evaluation of a Korean version of the disabilities of arm, shoulder, and hand outcome questionnaire (KDASH). J Shoulder Elbow Surg 2008;17(4):570-4 https://doi.org/10.1016/j.jse.2007.12.005
  21. Occupational Safety & Health Administration. Ergonomics. Analysis tool. Basic screening tool. Available:http://www.osha.gov/SLTC/ergonomics/analysis_ tools.htlm [cited 8 April 2005]
  22. Solway S, Beaton DE, McConnell S, Bombardier C. The DASH Outcome Measure User's Manual, Second Edition. Toronto: Institute for Work & Health, 2002
  23. Wu A, Edgar DW, Wood FM. The QuickDASH is an appropriate tool for measuring the quality of recovery after upper limb burn injury. Burns 2007;33:843-9 https://doi.org/10.1016/j.burns.2007.03.015
  24. Upper Extremity Collaborative Group. Measuring disability and symptoms of the upper limb: A validation study of the DASH questionnaire. Arthritis Rheum 1996;39(9(Supplement)):S112
  25. Park CY, Cho KH, Lee SH. Cervicobrachial disorders od female international telephone operators. I. subjective symptoms. Kor J Occup Med 1989;1(2):141-50. (Korean)
  26. Jette AM. Physical disablement concepts for physical therapy research and practice. Physical Therapy 1994;74(5):380-6 https://doi.org/10.1093/ptj/74.5.380
  27. Jester A, Harth A, Germann G. Measuring levels of upperextremity disability in employed adults using the DASH questionnaire. J Hand Surg Am 2005;30(5):1074.e1- 1074.e10 https://doi.org/10.1016/j.jhsa.2005.04.009
  28. Vordemvenne T, Langer M, Ochman S, Raschke M, Schult M. Long-term results after primary microsurgical repair of ulnar and median nerve injuries: a comparison of common score systems. Clin Neurol Neurosurg 2007;109:263-71 https://doi.org/10.1016/j.clineuro.2006.11.006
  29. Themistocleous GS, Goudelis G, Kyrou I, Chloros GD, Krokos A, Galanos A, Gerostathopoulos NE, Soucacos PN. Translation into Greek, cross-cultural adaptation and validation of the disabilities of the arm, shoulder, and hand questionnaire (DASH). J Hand Ther 2006;19(3):350-7 https://doi.org/10.1197/j.jht.2006.04.014
  30. Atroshi I, Gummesson C, Andersson B, Dahlgren E, Johansson A. The disabilities of the arm, shoulder and hand (DASH) outcome questionnaire. Acta Orthop Scand 2000;71(6):613-8 https://doi.org/10.1080/000164700317362262
  31. Cordobes-Gual J, Lozano-Vilardell P, Torreguitart-Mirada N, Lara-Hernandez R, Riera-Vazquez R, Julia-Montoya J. Prospective study of the functional recovery after surgery for thoracic outlet syndrome. Eur J Vasc Endovasc Surg 2008;35:79-83 https://doi.org/10.1016/j.ejvs.2007.07.013
  32. MacDermid JC, Drosdowech D, Faber K. Responsiveness of self-report scales in patients recovering from rotator cuff surgery. J Shoulder Elbow Surg 2006;15(4):407-14 https://doi.org/10.1016/j.jse.2005.09.005
  33. Feuerstein M, Nicholas RA, Huang GD, Dimberg L, Ali D, Rogers H. Job stress management and ergonomic intervention for work-related upper extremity symptoms. Appl Ergon 2004;35:565-74 https://doi.org/10.1016/j.apergo.2004.05.003
  34. Hunsaker FG, Cioffi DA, Amadio PC, Wright JC, Caughlin B. The American Academy of Orthopaedic Surgeons'Outcomes Instruments - Normative values from the general population. J Bone Joint Surg 2002;84-A(2):208-15
  35. Fournier K, Bourbonnais D, Bravo G, Arsenault J, Harris P, Gravel D. Reliability and validity of pinch and thumb strength measurements in de Quervain's disease. J Hand Ther 2006;19:2-11 https://doi.org/10.1197/j.jht.2005.10.002
  36. Fayad F, Lefevre-Colau M-M, Mace Y, Fermanian J, Mayoux-Benhamou A, Roren A, Rannou F, Roby-Brami A, Gautheron V, Revel M, Poiraudeau S. Validation of the French version of the disability of the arm, shoulder and hand questionnaire (F-DASH). Joint Bone Spine 2008;75:195-200 https://doi.org/10.1016/j.jbspin.2007.04.023
  37. Sauerbier M, Kluge S, Bickert B, Germann G. Subjective and objective outcomes after total wrist arthrodesis in patients with radiocarpal arthrosis or Kienbock's disease. Chir Main 2000;19:223-31 https://doi.org/10.1016/S1297-3203(00)73484-6