Institute for Occupational Safety and Health of the

German Social Accident Insurance

Workshop

Ergonomic Work Design and Prevention of

Work-Related Musculoskeletal Disorders
(MSDs)
The Use of Databases
Dirk Ditchen

XIX World Congress on Safety and Health at Work

September 11-15, 2011 - Istanbul

Introduction

Why shall we use databases for preventive

purposes?
What kind of databases are suitable for our
purpose?
How can databases help me?
Example: Database of work-related kneestraining postures

Dirk Ditchen, XIX World Congress 2011

11.09.2011

page 2

Why databases?
Risk factors for diseases of the knee: e.g. work-related
activities like kneeling or squatting.
To research dose-response-relationships or similar there is
a need for detailed information on working activities in the
past, partly decades ago.
Epidemiological studies: Retrospectively self-assessed
data on the daily amount of work-related stresses are a
common method in occupational science and medicine.

How valid is such information?

Dirk Ditchen, XIX World Congress 2011

11.09.2011

page 3

Method Comparison: 1. Field Measurements

trunk bending,
lateral flexion,
trunk inclination

CUELA*

thoracic spine
(flex./ext./lat.flex.)

torsion
lumbar spine
(flex./ext./lat.flex.)

hip joint
(flex./ext.)

knee joint
(flex./ext.)
*Ellegast, RP, Hermanns I, Schiefer C. Workload Assessment in Field Using the Ambulatory CUELA System. In: Duffy, V.G.
(Ed.) Digital Human Modeling HCII. 2009, Springer, Berlin 2009: 221-226
Dirk Ditchen, XIX World Congress 2011

11.09.2011

page 4

Analysis of Knee Straining Postures

Example:
floor tiler

knee postures in total

IFA-Activity-Code

kneeling (unsupported)
kneeling (supported)
sitting on heels
squatting
crawling
Percentage of time [%]

Dirk Ditchen, XIX World Congress 2011

11.09.2011

page 5

Method Comparison: 2. Self-Reports

Questionnaire (extract)
Have you worked in one or more of the following postures during todays measurement:
kneeling, squatting, sitting on heels or crawling?
No

Yes

If yes, please complete the table on

the right hand.

Posture
kneeling
(unsupported)

kneeling
(supported)

squatting

No/yes

Frequency

Average
duration
of one event

no
times

min

times

min

times

min

times

min

times

min

yes
no
yes
no
yes

Reference period:
Measurement duration
(mean: 118 min ( 44min)

sitting
on heels

no
yes
no

crawling

yes

N=190
Dirk Ditchen, XIX World Congress 2011

11.09.2011

page 6

Results: Means and Variance

Mean
[min]

Posture

M
Kneeling
(unsupported)
Kneeling
(supported)
Sitting
on heels

Median
[min]

Standard Deviation
[min]

20,9

52,8

15,3

20,0

20,3

116,6

9,2

44,9

2,9

11,0

14,3

115,1

4,2

16,7

1,4

1,5

6,8

46,0

Squatting

5,0

17,3

0,9

2,5

11,5

37,8

Crawling

0,2

19,2

0,0

0,0

0,9

90,5

TOTAL

39,3

152,2

32,7

60,0

32,3

279,4

M = measurement, Q = questionnaire
Dirk Ditchen, XIX World Congress 2011

11.09.2011

page 7

Results: Bland-Altman-Plot

Difference: measurement - questionnaire

Knee postures in total (without 8 outliers, n = 182)

Bland JM, Altman DG.

Statistical methods for
assessing agreement between
two methods of clinical
measurement.
Lancet.1986(i):307-10.
Average of measurement and questionnaire

Dirk Ditchen, XIX World Congress 2011

11.09.2011

page 8

What sort of databases?

Job Exposure Matrix (JEM):

Occupational loading for a whole job
category
Task Exposure Matrix (TEM):
Occupational loading for different tasks
(within a job category)

Dirk Ditchen, XIX World Congress 2011

11.09.2011

page 9

Example: Screed layer

Total knee
load
[min]

Flowing screed:
Installing insulation

235 (35)

49,3 (7,3)

3,3 (3,8)

Flowing screed:
Installing flowing screed

35 (30)

7,3 (6,5)

Sand & cement screed:

Screeding the floor
(3-Men)

250 (40)

Sand & cement screed:

Planing the screed
(3-Men)

Sand & cement screed:

Mixing the screed
(3-Men)
Sand & cement screed:
Mixing the screed
(2-Men)

Task

Total knee
load
[%]

Unsupported
kneeling
[%]

Supported
kneeling
[%]

3,3 (2,9)

27,2 (12,4)

12,3 (8,4)

3,2 (2,6)

3,3 (4,7)

0,4 (0,9)

3,2 (3,2)

0,4 (0,7)

0,0 (0,0)

52,2 (8,0)

0,4 (0,3)

2,1 (1,6)

14,0 (3,6)

35,4 (6,3)

0,2 (0,2)

160 (65)

33,3 (13,6)

1,0 (0,9)

2,7 (1,9)

9,4 (6,7)

19,6
(11,8)

0,5 (0,4)

0 (0)

0,4 (0,1)

0,0 (0,0)

0,0 (0,1)

0,3 (0,1)

0,0 (0,0)

0,0 (0,0)

85 (10)

17,7 (2,5)

1,3 (0,3)

0,2 (0,1)

8,4 (0,1)

7,8 (2,1)

0,0 (0,0)

Squatting
[%]

Sitting on
heels
[%]

Crawling
[%]

Range: 0 min to 250 min per shift (shown: arithmetic means and SD)
Dirk Ditchen, XIX World Congress 2011

11.09.2011

page 10

Example: Roofer
Total knee
load
[%]

Sitting on
heels
[%]

Unsupported
kneeling
[%]

0,3 (0,3)

0,1 (0,1)

2,9 (2,6)

0,9 (1,8)

0,0 (0,0)

48,9 (13,5)

2,6 (2,0)

1,0 (0,9)

36,8 (5,7)

8,2 (5,1)

0,2 (0,2)

35 (35)

7,2 (7,6)

0,5 (0,6)

1,3 (2,2)

3,5 (3,9)

1,9 (1,8)

0,1 (0,2)

130 (90)

27,2 (18,8)

2,0 (2,6)

0,7 (0,8)

17,4 (16,0)

7,2 (5,7)

0,0 (0,0)

Slate roofing

235 (75)

48,7 (16,1)

0,3 (0,1)

3,1 (2,6)

29,2 (9,5)

16,1 (9,1)

0,0 (0,0)

Mansard slate roofing

90 (40)

18,7 (8,3)

2,1 (2,5)

9,5 (5,2)

6,8 (5,9)

0,2 (0,2)

0,0 (0,0)

Installing corrugated panels

35 (30)

7,0 (6,0)

2,7 (3,6)

0,3 (0,6)

3,8 (6,6)

0,2 (0,3)

0,0 (0,0)

Reed roofing

20 (30)

3,7 (6,0)

0,1 (0,1)

0,0 (0,0)

3,6 (6,0)

0,0 (0,0)

0,0 (0,0)

Torch-on roofing

85 (50)

18,1 (10,9)

1,7 (3,0)

1,3 (1,5)

11,5 (6,5)

3,6 (2,4)

0,0 (0,1)

Sealing roof to wall

310 (5)

64,7 (0,7)

0,4 (0,3)

3,5 (0,8)

39,9 (21,4)

20,8 (20,1)

0,0 (0,0)

Installing PVC membranes

105 (85)

22,1 (17,4)

10,5 (14,5)

0,6 (0,6)

8,5 (4,7)

2,5 (3,7)

0,1 (0,1)

Total knee load

[min]

Installing battens

20 (20)

4,2 (4,0)

Installing insulation

235 (65)

Installing roof tiles

Installing plain tiles

Task

Squatting
[%]

Supported
kneeling
[%]

Crawling
[%]

Range: 20 min to 310 min per shift (shown: arithmetic means and SD)
Dirk Ditchen, XIX World Congress 2011

11.09.2011

page 11

How can databases help me?

To find situations or tasks where

preventive measures are needed.
To focus preventive measures on key
aspects of occupational loading.
To develop suitable measures of
prevention.

Dirk Ditchen, XIX World Congress 2011

11.09.2011

page 12

How can databases help me?

Examples:

How can knee-straining activities be

avoided?

Dirk Ditchen, XIX World Congress 2011

11.09.2011

page 13

Example 1:
e.g. Readjustment of working height

Pipe laying (welding)

Dirk Ditchen, XIX World Congress 2011

11.09.2011

page 14

Example 2:
e.g. use of special equipment

Floor layer, preparing the floor

Dirk Ditchen, XIX World Congress 2011

11.09.2011

page 15

Example 3:
e.g. use of special equipment
Truck tarp maker, welding tarps

Dirk Ditchen, XIX World Congress 2011

11.09.2011

page 16

Example 4

Ramp agent, loading luggage

No chance of
avoiding!
(as long as the belly of the
aircraft has a heigth of
approx. 1 m)

Dirk Ditchen, XIX World Congress 2011

11.09.2011

page 17

Example 4

Solution:
e.g. job-rotation
Ramp agent, loading luggage

Dirk Ditchen, XIX World Congress 2011

11.09.2011

page 18

THANK YOU !
dirk.ditchen@dguv.de

http://www.dguv.de/ifa/de/pub/rep/pdf/reports2009/ifar0110/report1_2010.pdf

Dirk Ditchen, XIX World Congress 2011

11.09.2011

page 19