Premus 2004
Fifth International Scientific Conference on Prevention of Workrelated Musculoskeletal Disorders


m1: Political and cultural responses to WRMSD in different countries

Monday July 12, 11:00 - 12:30
Chair: Prof. Barbara Silverstein, USA

This mini-symposium provides experience from a variety of countries and work environments ranging from airport check-in workers in Canada and Switzerland to agricultural workers in India. Societal response ranges from the approach to implementation of an ergonomics regulation in Brazil to using ISO/TS 20646 in Japan. In all countries, identifying the magnitude of the problem in different industries, developing and testing practical interventions in representative workplaces are critical steps in determining government levels of response that are necessary to reduce the problem. This is the process underway in Thailand. In Brazil, ergonomic regulation has been in existence since 1990 but actual implementation has been problematic. In the United States, massive industry opposition to regulation has resulted in repeal of ergonomic regulations at the state and national level. Yet, there is little indication in these environments that, in the absence of regulation and enforcement, those organizations in most need of ergonomic improvements will actually voluntarily do so.

WMSDs in Thailand : Problem to be solved.
Sudthida Krungkraiwong (Thailand)

Prevention of WMSDs using ISO/TS 20646 'Ergonomic procedures for the improvement of local muscular workloads.
Takeshi Ebara, Norihide Tachi, Hidemaro Takeyama et al. (Japan)

Prevalence of Musculoskeletal problems among female Agricultural workers.
Ruplekha Borah, Mira Kalita and Bijoylakshmi Bhuyan (India)

Musculoskeletal disorders and peripheral nervous system disorders in the workers of Nizhny Novgorod region of Russia.
Viacheslav Troshin, Nikolay Mateev, Natalia Mokeeva (Russia)

Musculoskeletal Disorders Among Airport Check-in Workers: Discovering the Unknown.
Ellen Rosskam (Switzerland)

m2: Case definitions

Monday July 12, 16:30-18:00
Chairs: Prof. Francesco Violante, Italy and Prof. Mats Hagberg, Sweden

When dealing with a disease, both at research and at preventive level, a crucial point is the case definition used to describe the health problem addressed. However, in the recent history of occupational musculoskeletal disorders different case definitions have been used in several studies and this may have hindered the possibility to compare the results obtained. To date there are no scientific consensus criteria for most ICD-10 (International Classification of Disease) musculoskeletal related diagnoses to be considered in workers. Moreover different case-definitions may be necessary for clinical, screening and surveillance purposes. The workshop will start with introductory presentations concerning the state of the art of these different purposes and the role of physical examination.
Then we will discuss the following issues:

  • What strategies can be used to improve case definitions in general?
  • What strategies can be used to improve case definitions in the specific situations discussed?
  • What actions is to be taken by an international group?
  • Are there ways to promote case definition consensus at the international and the European level?

Francesco Violante (Italy)

Criteria for case definitions for upper limb disorders to be used in epidemiologic studies considering an "evidence based" approach.
David Rempel (USA)

Criteria for case definitions for low back disorders to be used in epidemiologic studies considering an "evidence based" approach.
Hilkka Riihimaki (Finland)

Criteria for case definitions to be used in surveillance considering an "evidence based" approach.
Barbara Silverstein (USA)

Criteria for case definitions to be used in clinical assessment considering an "evidence based" approach.
Eira Viikari-Juntura (Sweden/Finland)

Does Physical examination assist in the evaluation of disorders of the neck and upper limb?
Isabel Reading (UK)

Agreement among upper limb musculoskeletal classification systems.
Dwayne van Eerd (Canada)

m3: Intervention Studies in the Construction Industry

Monday July 12, 16:30 - 18:00
Chair: Prof. Bernd Hartmann, Germany

The introduction of new ergonomic work methods and aids to reduce the muscle skeleton load is particularly difficult in relating to handwork coined industries. The session shows stage different programs in the building industry of different countries during the introduction of new work methods. Announcing with new methods insufficient, but the switching of the preventive and economic use is necessary. Both the enterprises and the persons employed must be achieved.

Costs and effects of ergonomic improvements for floor layers.
Alex Burdorf, Willem-Jan Meerding and Judith Windhorst (The Netherlands)

Reduction of knee straining working activities and knee disorders in the floor laying trade. An intervention study. Results from the Questionnaire study.
Lilli Kirkeskov Jensen and Claus Friche (Denmark)

How does we succeed in implementation of new working methods? An example from an intervention study on floor layers.
Claus Friche and Lilli Kirkeskov Jensen (Denmark)

Phases in the implementation process of evidence-based measures to reduce physical work demands in bricklaying.
Henk F. Van der Molen, Judith K. Sluiter and Monique H.W. Frings-Dresen (The Netherlands)

Machinery Tools in Bricklaying - Preventive Advantages.
Bernd Hartmann, Horst Necker, Sonja Werner, Ludwig Donker (Germany)

m4: The NEW project: Neuromuscular assessment in the Elderly Worker

Tuesday July 13, 9:00 - 10:30
Chairs: Hermie Hermens

Work related neuromuscular disorders, repetitive strain injuries (RSI) and cumulative trauma disorders (CTD) in the aging working population cause pain, slowing of responses, an increased probability of accidents, and a reduced quality of life and working ability. As a consequence, a substantial group of elderly people throughout Europe are forced into early retirement. There is a great need to identify and monitor work related neuromuscular disorders and to obtain a better understanding of the determinants of these disorders; how they are related to personal psychosocial characteristics and occupational conditions. in addition, there is a need for methods for assessing the conditions of the neuromuscular system to enable warning when they may be leading to pathology (e.g. insufficient relaxation in vulnerable muscles, chronic fatigue, etc.).

Introduction to the ideas and the backgrounds of the NEW project.
Hermie Hermens (The Netherlands)

Functional capacity in low back cases and controls related to physical work exposures - The NEW study.
Hanne Christensen, H., Juul-Kristensen, B., Strøyer, J. et al. (Denmark)

Low back pain and neuromuscular functions in female administrative personal and nurses: local results from the NEW studies.
Thomas Läubli, T., Schenk, P., Spillmann, S. et al. (Switzerland)

Neuromuscular assessment in Elderly Workers from 4 EU countries with and without work related musculoskeletal disorders: Working conditions and muscle activation -The NEW-study.
Sjøgaard, G., Hermens, H., Sandsjö, L. et al. (Denmark)

Effects of a myofeedback training on muscle activation, pain and disability.
Vollenbroek-Hutten, M., Voerman, G., Sandsjo, L. et al. (The Netherlands)

Future perspectives and challenges in neuromuscular assessment using surface EMG.
Merletti, R., Pozzo, M. Farina, D. et al. (Italy)

m5: Duration of computer use and MSD risk

Tuesday July 13, 14:30 - 18:00
Chairs: Dr. Johan Hviid Andersen, MD, PhD and Sigurd Mikkelsen, MD, DMSc

Computers have become increasingly common in workplaces over the past 20 years. In the lay press there has been alarms concerning adverse health effects of computer use, and scientific literature also has suggested that computer users are at an increased risk of upper extremity pain and disorders, but most of the suggestions have been made on the background of cross sectional studies. In recent years several cohort studies have been completed and others initiated, and new methods of exposure measurements have been introduced.
It is the purpose of this Minisymposia to report from those studies, and to specifically address questions on thresholds for mouse and keyboard use, and to evaluate the role of ergonomic and psychosocial risk factors in upper extremity MSDs. The session will be closed by a discussion of main messages to the public concerning adverse effects of computer use.

Estimating computer time and type of work

Data collection using software, email and internet in the PROMO study among office workers.
Ijmker S, Blatter B, van der Beck, Bongers P, van Mechelen W. (The Netherlands)

Factors influencing self-reported computer use compared to objectively measured computer use in the NUDATA study.
Mikkelsen S, Vilstrup I, Andersen JH. (Denmark)

Job differences in computer usage: typing, clicking and viewing the screen.
Douwes M, Blatter B, de Kraker H. (The Netherlands)

Shedding light on risk associated with gender in computer work.
Vilstrup I. (Denmark)

Is it possible to establish a threshold for time using a mouse or a keyboard? From the NUDATA-study.
Andersen JH, Mikkelsen S. (Denmark)

Monitoring of keystrokes and mouse clicks in an ergonomic intervention study among VDU workers.
Toivonen R, Viikari-Juntura E. (Finland)

Short Break

Ergonomic and psychosocial factors

A randomized controlled trial of postural instructions among computer users.
Gerr, F. et al. (USA)

Work-related predictors for incident neck pain and ergonomic intervention among office employees with video display work.
Ketola R, Toivonen R, Viikari-Juntura E. (Finland)

The role of ergonomic and psychosocial risk factors in pain reporting from the neck and upper extremity. From the NUDATA-study.
Kryger, A., Mikkelsen, S. and Andersen, JH. (Denmark)

Associations between psychosocial stress and MSDs among computer users
Gerr, F. et al. (USA)

m6: Low Back Pain in Schoolchildren

Tuesday July 13, 14:30 - 16:00
Chairs: Prof. Gary J. Macfarlane (UK) and Dr. Federico Balague (CH)

Until recently there had been relatively little research about low back pain in schoolchildren. It was perceived to be uncommon and rarely presenting to health care services. The observation however that amongst adults the strongest predictor of future back pain is a previous episode and that adults often reported that their back pain started in childhood has meant that an increasing number of studies have been published in the last two years on this topic. They have examined the role of specific disorders, mechanical load (e.g. schoolbags), ergonomic factors in school and the role of psychological factors. This topic has been of enormous recent interest not only to scientists but also the media. The main questions are 1) What is the burden of low back pain in children and is it a problem? 2) What are the risk factors for having low back pain as a child? 3) Should we be concerned about preventing low back pain amongst schoolchildren ? 3) Is low back pain as a child related to low back pain as an adult? These topics will be covered in the mini-symposium.

Introduction: Low back pain in children: is there a problem?
Dr. Federico Balague (Switzerland)

Risk factors for low back pain in children: developmental disorders.
Dr. Rob de Bie (The Netherlands)

Risk factors for low back pain in children: ergonomic factors.
Prof. Peter Buckle (UK)

Risk factors for low back pain in children: psychosocial factors
Dr. Gareth Jones (UK)

Is low back pain in children related to low back pain as an adult?
Prof. Gary J Macfarlane (UK)

Summary of current knowledge and way forward
Dr. Federico Balague (Switzerland)

m7: Randomized trials for RTW interventions including a workplace component

Tuesday July 13, 14:30 - 18:00
Chair: Prof. Patrick Loisel, MD

Work disability from musculoskeletal disorders is a major societal problem that has been addressed by researchers in many countries. Causes of work disability are many, not only related to the causal musculoskeletal disorder but also to a bunch of psycho-social and environmental factors including the workplace. Involving the workplace in work rehabilitation interventions looks as a new promising avenue that has been recently addressed through a number of randomized controlled trials in several countries with a different socioeconomic context. The investigators of most of these RCTs will present a summary of their findings on return to work, quality of life and cost-effectiveness. Future research directions to improve RTW figures will be discussed from an international perspective.


  1. To present and discuss the findings of the randomized controlled trials having tested RTW interventions including a workplace component
  2. Bring out recommendations for practice and policy
  3. Bring out recommendations for future research directions

Evidence based practice for RTW-programs - A challenge.
Lindström, I. (Sweden)

Two successive steps in return to work program development, implementation and assessment for sub-acute occupational back pain in Quebec.
Loisel, P., Durand, MJ., Vacon, B. et al. (Canada)

Participatory Ergonomics for workers on sick leave due to low back pain: results of a randomised controlled trial.
Anema, JR., Steenstra, IA., Bongers, PM. et al. (The Netherlands)

Graded activity for workers on sick leave due to low back pain results of a trial.
Steenstra, IA., Anema JR., Bongers, PM. et al. (The Netherlands)

Effects of an ergonomic intervention on return-to-work following a musculoskeletal disorder.
Evanoff, B., Grayson, D., Bohr, P. et al. (USA)

A randomized, controlled trial of case management services to overcome barriers to work related upper extremity disorders.
Feuerstein, M. and Shaw, W. (USA)

Early workplace intervention for employees with musculoskeletal-related absenteeism: A prospective controlled intervention study.
Bengt B. Arnetz, Berit Sjögren, Berit Rydéhn, and Roland Meisel (Sweden).

The effectiveness of back schools for occupational low back pain; short-term results of a randomized controlled trial.
Heymans, MW., de Vet, HC., Bongers, PM. et al. (The Netherlands)

Comments of Dr. Van Tulder

m8: Methodological Issues in prospective Studies

Wednesday July 14, 14:30 - 17:00
Chair: Prof. Barbara Silverstein, USA

Part I: Methodological issues in prospective studies: Health assessment

Methodological issues in prospective studies - NIOSH wmsd research consortium
Barbara Silverstein et al. (USA)

Health Outcomes Assessments in Epidemiological Studies of Musculoskeletal Disorders, Biases and Confounders
Kurt Hegmann, Matthew S. Thiese, Arun Garg et al, (USA)

Incidence and persistence of Carpal Tunnel Syndrome (CTS) and Symptoms suggesting CTS in active workers
Eira Viikari-Juntura, Barbara Silverstein, Z Joyce Fan et al. (USA)

Part II: Methodological Issues in Prospective Studies: Exposure Assessment and Analytical Issues

The Monitoring of Load Moment Exposure in the Workplace.
Marras, WS. and Lavender, SA. (USA)

Multiple-Task Jobs and Job Rotations: Some Considerations for Job Exposure Assessment
Arun Garg, Steven Moore and Kurt Hegmann (USA)

A detailed force exposure quantification method for prospective epidemiological studies.
Stephen Bao, Peregrin Spielholz, Ninica Howard and Barbara Silverstein (USA)

Analytic issues in a prospective study of work-related musculoskeletal disorders
Susan Burt and James Deddens (USA)

m9: Physical activity in the prevention of work-related musculoskeletal disorders

Wednesday July 14, 14:30 - 17:00
Chair: Prof. Gisela Sjøgaard

Regular physical activity has been proven to decrease the risk of development of a number of diseases such as cardiovascular diseases, diabetes, and osteoporosis. Some studies also report on benefits regarding the musculoskeletal system. Although it seems obvious that physical activity may have positive effects in relation to work-related musculoskeletal disorders, there is a surprising lack of documentation. The present symposium includes 4 invited lectures ranging from novel knowledge on physical activity and health to detailed experiences on intervention programs at the worksite. Also, discrepancy between individual physical capacity and physical demand in the work place will be addressed. Finally, a discussion on future research needs in this area will close the session.

Physical activity in the prevention of musculoskeletal disorders.
Gisela Sjøgaard, Ernst Albin Hansen, Laila Birch et al. (Denmark)

Perspective on human health -an exercise scientist's view.
Michael Kjær (Denmark)

State of the art on the effect of physical activity programs at the worksite.
Allard J. van der Beek (The Netherlands)

Work-related physical activity beyond physical capacity: a risk factor for musculoskeletal disorders.
Lena Karlqvist (Sweden)

A successful rehabilitation program for low back injured workers, but without significant impact on sick leave.
Phillippe Mairiaux (Belgium)

Discussion on future needs and plans, e.g. Questionnaires and objective measures for quantification of physical activity and -capacity.
Gisela Sjøgaard

m10: Gender differences in the risk of work-related musculoskeletal disorders

Wednesday July 14, 14:30 - 17:00
Chair: Dr. Allard van der Beek, The Netherlands

Gender differences in the prevalence of work-related musculoskeletal disorders have been reported in many studies. In several working populations women have been found to experience more complaints than men. This difference seems to be most distinct for neck and upper extremity disorders.
Roughly, three explanations for this gender difference can be given. Firstly, there could be differences in expression of pain. Either because it is socially more accepted for women to report pain, or because women have a lower threshold for detecting pain. Even so, some of the largest gender differences have been found in studies in which objective measures, rather than self-reports, were used. Secondly, there could be differences in exposure to either work-related risk factors or risk factors outside work. Due to the sex segregation of the labour market men and women have different jobs, and, as a result, different exposures. Furthermore, even when men and women have the same job-title, there seems to be a gender difference in exposure due to differences in task allocation. Thirdly, equal exposure to work-related risk factors could have different effects on male and female workers. One reason for this might be that tasks performed with the same exposure results in a higher relative workload for women than for men, because of, on average, smaller body dimensions, lower muscle force and lower aerobic capacity. Another reason could be that males and females use different coping strategies to deal with work-related stressors.
In this mini-symposium we focus on the 2nd and 3rd explanation: i.e. gender differences in exposure to work-related physical and psychosocial risk factors for musculoskeletal disorders, and gender differences in the relations between work-related physical and psychosocial risk factors and musculoskeletal disorders. Further insight into these differences is important to initiate a 'gender-conscious prevention' of musculoskeletal disorders.

Allard van der Beek (The Netherlands)

Gender segregation in the labour market and exposure to awkward work postures.
Ola Leijon (Sweden)

Gender differences in self-reported physical and psychosocial exposures in jobs with female and male workers.
Allard van der Beek (The Netherlands)

Standing working postures, pain and pain-pressure threshold among women and men in Québec.
Karen Messing (Canada)

Physical exposure and disorder prevalence, among males and females with identical repetitive industrial tasks.
Catarina Nordander (Sweden)

Gender segregated workplaces and ergonomic conditions: consequences of musculoskeletal health for women and men?
Lena Karlqvist (Sweden)

Exposure to work-related risk factors during pregnancy: a longitudinal survey on women, work and health.
Gonnie Klabbers (The Netherlands)

Gender differences in the relations between work-related physical and psychosocial risk factors and musculoskeletal disorders: a systematic review.
Wendela Hooftman (The Netherlands)

To what extent can the association between female gender and musculoskeletal disorders be explained by occupational exposures?
Laura Punnett (USA)

m11: Physical Load Estimation - The first Step of Prevention of Musculoskeletal Disorders

Thursday July 15, 11:00 - 12:30
Chair: Prof. Bernd Hartmann, Germany

The meeting is to give an overview of the current conditions and new developments from methods to the estimate physical loads, which cause muskuloskeletale distorders. These methods of the load evaluation must be physiologically, biomechanical and medical-epidemiologically justified. A special role plays the determination and evaluation of the induction periods. Practical examples of individual industries and broadly applicable simpler methods are presented.

Analysis of Low-Back Load during Occupational Work: The Dortmund Lumbar Load Studies – the DOLLYs.
Matthias Jäger, Claus Jordan, Andreas Theilmeier et al. (Germany)

Whole-shift monitoring of mechanical loads applying a newly developed ambulatory measurement system.
Rolf Ellegast and Ingo Hermanns (Germany)

Load estimation in construction field studies - methods and experiences.
Bernd Hartmann and Sonja Werner (Germany)

Application of key-indicator-methods for risk assessment for lifting, holding and carrying and for pushing and pulling.
Gustav Caffier, Ulf Steinberg and Falk Liebers (Germany)

m12: Ergonomics for Patient Handling

Thursday July 15, 11:00 - 12:30
Chair: Dr. Sue Hignett, UK

This symposium will bring together experts from several countries to share their experiences in patient handling ergonomics. Musculoskeletal problems in nurses and other health care staff continue to be an international problem with patient handling activities known to be a major contributor to the high incidence of low back pain. One of the difficulties in managing moving and handling risks for nurses is the wide range in levels of mobility assistance that a patient may need during their care and treatment. There have been many recommendations for changing practice however the debate continues about how to reduce and manage the risks associated with musculoskeletal injuries. The papers will include descriptions of assessment tools which have been developed and validated for patient handling as well as discussions on intervention strategies.
Both the assessment tools and intervention strategies include micro and macro ergonomic approaches. In this way the challenges of applying ergonomics initiatives in a complex healthcare environment can be addressed.

Postural analysis of three nursing tasks.
Sue Hignett and Emma Crumpton (UK)

Organisational check list for patient handling
Emma Crumpton and Sue Hignett (UK)

DINO - A direct observation instrument for assessment of nurses' patient transfer technique.
Christina Johnsson, Katarina Kjellerg, Anders Kjellberg et al. (Sweden)

A psychophysical comparison of three patient handling methods, when assisting the geriatric patient to move from wheelchair to bed.
Leena Tamminen-Peter (Finland)

MAPO index for risk assessment of patient manual lifting in hospitals and its relationship with acute low back pain.
Natale Battevi and Olga Menoni (Italy)

Patient Comfort and Satisfaction in a "No Lift" Environment.
Tamara James, Yeu-Li Yeung, Jennifer Lawson et al. (USA)