Work Exposures and Musculoskeletal Disorders Among Railroad Maintenance-of-Way Workers

et al. 2020

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Background Our objective was to examine occupational risk factors for musculoskeletal disorders of the neck, back, and knee among railroad maintenance‐of‐way (MOW) workers. Methods Four thousand eight‐hundred sixteen active, retired, and disabled members of the Brotherhood of Maintenance of Way Employes Division (BMWED) completed a survey. We computed adjusted prevalence ratios (aPRs) using Poisson regression for neck, back, and knee musculoskeletal symptoms by work exposures, adjusted for age, region, race/ethnicity, smoking, and potential second job and spare time vehicle vibration exposure. Results Among active male BMWED members, we found associations between use of high‐vibration vehicles and neck pain (aPR = 1.47, 95% confidence interval (CI): 1.07‐2.03) and knee pain (aPR = 1.38, 95% CI: 1.04‐1.82) for more than 1.9 years (vs 0) of full‐time equivalent use; but not back pain. Back pain radiating below the knee (sciatica indicator) was associated with high‐vibration vehicle use greater than 0.4 and less than 1.9 years (aPR = 1.58, 95% CI: 1.15‐2.18). We also found significant associations between often or always lifting, pushing, pulling, or bending on the job (vs seldom or never) and neck pain (aPR = 2.43, 95% CI: 1.20‐4.90), back pain (aPR = 1.94, 95% CI: 1.24‐3.03), the sciatica indicator (aPR = 5.18, 95% CI: 1.28‐20.95), and knee pain (aPR = 2.84, 95% CI: 1.47‐5.51), along with positive gradients in the outcome by exposure time. Conclusions Biomechanical work exposures, including force and nonneutral postures, were associated with neck, lower back, and knee pain. Whole‐body vibration, as measured by the duration of use of high‐vibration vehicles, was associated with neck pain, knee pain, and sciatica. Prevention programs should address occupational risk factors for musculoskeletal disorders among MOW workers.

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Occupational risk factors for musculoskeletal disorders among railroad maintenance‐of‐way workers

et al. 2020

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Upper extremity musculoskeletal disorders and work exposures among railroad maintenance‐of‐way workers

et al. 2021

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Background Our objective was to examine occupational risk factors for musculoskeletal disorders of the shoulders, elbows, wrists, and hands among railroad maintenance‐of‐way (MOW) workers. Little systematic research on musculoskeletal disorders has been conducted in this occupational group. Methods In total, 3995 active members of the Brotherhood of Maintenance of Way Employes Division (BMWED) completed a standardized survey focusing on disorders caused by hand‐transmitted vibration. We computed adjusted prevalence ratios (aPRs) using Poisson regression for shoulder, elbow, carpal tunnel syndrome, and vibration white finger musculoskeletal symptoms by work exposures, adjusted for age, region, race/ethnicity, smoking, potential second job, and spare time vehicle vibration exposure, and other work exposures. Results Among active male BMWED members, we found associations between >5.2 years (vs. 0.0–0.7 years) duration of full‐time equivalent power tool use and shoulder pain (aPR = 2.01; 95% confidence interval [CI], 1.43–2.85), elbow pain (aPR = 2.88; 95% CI, 1.86–4.46), vibration white finger symptoms (aPR = 2.49; 95% CI, 1.06–5.85), hand/wrist pain (aPR = 2.40; 95% CI, 1.74–3.32), finger numbness or tingling (aPR = 1.86; 95% CI, 1.38–2.50) and self‐reported carpal tunnel syndrome diagnosis (aPR = 2.16; 95% CI, 1.24–3.77). Associations were not consistent across outcomes for the duration of non‐powered hand tool use and “repeated lifting, pushing, pulling, or bending.” Positive gradients were observed for most outcomes. Conclusions Hand‐arm vibration and some other biomechanical exposures were associated with shoulder, elbow, wrist, hand, and finger symptoms. Prevention programs should address occupational risk factors for upper extremity musculoskeletal disorders among MOW workers.

Landsbergis et al. respond

2021

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Thiese et al. 1 which raised questions about our recently published article in AJIM 2 and two other publications 3,4 from our study of working conditions and musculoskeletal symptoms among railroad maintenance-of-way (MOW) workers. We conducted the study jointly with two other research teams who were studying mortality and the social and economic impact of diseases and injuries among MOW workers. We followed guidance from our respective Institutional Review Boards (IRBs) (see publications) and an outside independent scientific advisory panel (see below).We reported the data in detail and acknowledged in our publications the potential limitations of our study, including use of workers' self-report of symptoms and workplace exposures, and a low survey response rate. However, Thiese et al. failed to mention that we assessed the possibility and direction of selection bias in two ways. First, we compared survey respondents to the national membership of the Brotherhood of Maintenance-of-Way Employes Division (BMWED), the union representing MOW workers, on available demographic information. Second, we compared survey respondents to a random sample of nonrespondents, who agreed to complete a 10-question version of the survey by telephone. 3 Compared with nonrespondents, active members who completed the survey were younger, had slightly better working conditions, and tended to be healthier (except for back pain). These results suggest that our analyses may underestimate associations between working conditions and musculoskeletal symptoms among MOW workers. 2 Thiese et al. also fail to mention that we explained how missing data was handled. We stated that "The prevalence of specific working conditions and measures of ill health from survey respondents were computed by dividing the number of respondents reporting that working condition, symptom, or diagnosis, by the number of respondents who completed at least one question on that page of the survey, as the response rate tended to decline in later pages of the survey." 3 p. 587 There was no imputation of missing data.