Background Work-related musculoskeletal disorders (WRMDs) are often caused by inadequate use of the musculoskeletal system during work. Evidence suggests that multimodal intervention through exercises, massage, education, and ergonomic guidelines reduces pain and symptoms in the neck and upper extremities and help to prevent musculoskeletal disorders. The purpose of this study will be to assess the additive effectiveness of a specific and individualized workplace strengthening exercise program to an ergonomic guidance in reducing fatigue, pain and discomfort in the upper extremities and neck perceived by workers. Methods This trial was designed according to the Consolidated Standards of Reporting Trials - CONSORT guidelines. Participants will be employees of a tertiary hospital, with any complaints of pain or discomfort in the upper extremities during the past 12 months, without clinical musculoskeletal diagnosis. 166 participants will be randomized into parallels groups as control and workplace exercises. The primary outcomes will be Numerical Pain Scale, isokinetic muscle strength of abduction and isometric handgrip strength. Secondary outcomes on discomfort, fatigue, work capacity and dysfunction will be assessed by QuickDASH, Patient Specific Functional Scale, Neck Disability Index, Need for recovery, Work Ability Index self-report questionnaires and FIT-HANSA performance test. The Ergonomic Work Analysis will be done by Quick Expose Check, RULA, REBA, RARME, ROSA and HARM risk assessment ergonomic tools. We will analyze the difference between baseline and 12 weeks of intervention by T test of independent samples (95% confidence interval, p < 0.05). Clinical significance will be analyzed by the minimum clinically important difference and effect size by Cohen index. The association between the variables will be analyzed by construct validity with the hypothesis of correlations between pain and muscle strength, strength and functionality and strength and fatigue. Discussion Although studies have shown promise outcomes for workplace exercises as an available therapeutic resource used to minimize complaints of pain and discomfort related to work, the results of this study aim to bring evidence about the benefit of a specific resistance exercise as an effective modality to facilitate mechanisms of neuromuscular adaptations, with gradual and posterior hypertrophy in the later phases. Trial registration (NCT04047056, https://clinicaltrials.gov/ct2/show/NCT04047056?term=NCT04047056&draw=2&rank=1) on Dec 03, 2020.
Background Upper extremity musculoskeletal disorders negatively affect ability to perform activities of daily living, self-care and work. Therefore, outcome measurements that address muscle strength, fatigue resistance, functionality and work physical capacity must be defined to assess and plan specific actions to minimize them. Objective To investigate the association of upper extremity muscle strength with upper extremity fatigue resistance, work ability and upper extremity dysfunction in a sample of workers from a tertiary hospital. Methods Shoulder and elbow isokinetic strength were assessed by Biodex System 4™, isometric hand grip by JAMAR™, upper extremity fatigue resistance by Functional Impairment Test Hand and Neck/Shoulder/Arm (FIT-HaNSA), ability to work by the Work Ability Index and upper extremity dysfunction by the Quick-Disabilities of the Arm, Shoulder and Hand QuickDASH-Br questionnaire. The Nordic questionnaire and Numeric Pain Rating Scale (NPRS) were used for pain description. The associations were analysed by Spearman’s correlation coefficient (rho) (p < 0.05). Results Twenty-seven participants: 59.2% women; mean age 46 years old; 70.3% obese/overweight; 62.9% active with predominantly dynamic muscle contraction work. Besides predominance of good to moderate work ability (81.4%) and comorbidities (37%), all participants had symptoms of the upper extremities for at least 12 months, with a predominance of low-intensity in the shoulder (55.5%). In addition, 88.8% reported pain in other segments. Muscle strength of abduction (rho = 0.49), adduction (rho = 0.40), internal rotation (rho = 0.44) and hand grip (rho = 0.68) presented moderate correlation with FIT-HaNSA. Hand grip (rho = − 0.52) showed moderate correlation with upper extremity dysfunction. Conclusions The results of this preliminary study suggested the association of shoulder strength with fatigue resistance. Also, hand grip strength was associated with upper extremity dysfunction and fatigue resistance. No association was found with the Work Ability Index in this sample. So, it is suggested that hand grip and shoulder strength could be outcome measurements used for future interventions focused on upper extremity preventive exercises to improve strength and fatigue resistance of workers at risk for the development of musculoskeletal disorders. Other individual, psychosocial and organizational risk factors must also be considered as influences on upper extremity function.
Lesões musculoesqueléticas nos membros superiores estão intimamente ligadas a limitações funcionais e incapacidades. Estas lesões podem estar relacionadas ao trabalho e são conhecidas como Lesões por Esforços Repetitivos (LER) ou Distúrbios Osteomusculares Relacionados ao Trabalho (DORT). A avaliação ergonômica visa detectar os fatores de riscos para o desenvolvimento das LER/DORT e assim, intervenções e/ou ações preventivas possam ser implementadas. Para isso, são necessárias ferramentas observacionais de avaliação traduzidas e validadas para que resultados fidedignos sejam alcançados. O questionário HARM 2.0 é uma ferramenta de avaliação específica que indica se há risco de lesão em diversas tarefas que utilizam majoritariamente os membros superiores durante sua jornada de trabalho. Objetivo: Conduzir a tradução e adaptação transcultural do questionário HARM 2.0 para ser usado para avaliação e prevenção de riscos de lesões relacionadas ao trabalho. Métodos: A tradução e adaptação transcultural seguiu um protocolo composto por quatro estágios: tradução, síntese, retrotradução, revisão pelo comitê de especialistas e aprovação do conteúdo pelas autoras da versão original. Resultados: O estágio inicial (Estágio I) de tradução do questionário HARM 2.0 transcorreu sem intercorrências. Com relação ao grau de dificuldade, o tradutor expert referiu facilidade ao traduzir os itens e instruções do instrumento, enquanto a tradutora leiga considerou a dificuldade como moderada. Conclusão: O instrumento HARM-BR 2.0 apresentou resultados satisfatórios no processo de tradução e adaptação transcultural, estando sua versão disponível para uso. Futuros estudos são necessários para analisar as suas propriedades de medidas para a população brasileira de trabalhadores.
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