Educational intervention for reducing work-related musculoskeletal disorders and promoting productivity

Abstract

Background and objectives. Work-related musculoskeletal disorders (WMSDs) are the main causes of pain, suffering, absenteeism, disability and reduction in productivity. This research aims to determine the role of training intervention based on protection motivation theory in reducing WMSDs and promoting productivity. Methodology. The conducted study was based on a quasi-experimental design (control) that was carried out on 158 employees of the Kabl Khodro factory which were divided into two groups of 79 people. After splitting the 158 workers, an experimental and control group was formed. The data collection instruments were made up of two questionnaires and were analysed using a quick exposure check (QEC) method. Result.Before intervention in both the experimental and control groups, there were no significant differences among the average protection motivation theory constructs, productivity and QEC scores (p < 0.05). However, following training intervention there was a significant increase in these factors within the investigated group apart from the perceived response costs and efficacy. Conclusion. The conducted study shows that ergonomic training based on the protection motivation theory is effective in reducing musculoskeletal risk factors and that increased knowledge of the subject can lead to an increase in productivity.

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International Journal of Occupational Safety and
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Educational intervention for reducing work-
related musculoskeletal disorders and promoting
productivity
Fatemeh Abareshi, Rasoul Yarahmadi, Mahnaz Solhi & Ali Asghar Farshad
To cite this article: Fatemeh Abareshi, Rasoul Yarahmadi, Mahnaz Solhi & Ali Asghar Farshad
(2015) Educational intervention for reducing work-related musculoskeletal disorders and
promoting productivity, International Journal of Occupational Safety and Ergonomics, 21:4,
480-485, DOI: 10.1080/10803548.2015.1087729
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International Journal of Occupational Safety and Ergonomics (JOSE), 2015
Vol. 21, No. 4, 480–485, http://dx.doi.org/10.1080/10803548.2015.1087729
Educational intervention for reducing work-related musculoskeletal disorders and promoting
productivity
Fatemeh Abareshi, Rasoul Yarahmadi∗, Mahnaz Solhi and Ali Asghar Farshad
Iran University of Medical Sciences, Iran
Background and objectives. Work-related musculoskeletal disorders (WMSDs) are the main causes of pain, suffering, absen-
teeism, disability and reduction in productivity. This research aims to determine the role of training intervention based on
protection motivation theory in reducing WMSDs and promoting productivity. Methodology. The conducted study was
based on a quasi-experimental design (control) that was carried out on 158 employees of the Kabl Khodro factory which
were divided into two groups of 79 people. After splitting the 158 workers, an experimental and control group was formed.
The data collection instruments were made up of two questionnaires and were analysed using a quick exposure check (QEC)
method. Result.Before intervention in both the experimental and control groups, there were no significant differences among
the average protection motivation theory constructs, productivity and QEC scores (p<0.05). However, following training
intervention there was a significant increase in these factors within the investigated group apart from the perceived response
costs and efficacy. Conclusion. The conducted study shows that ergonomic training based on the protection motivation the-
ory is effective in reducing musculoskeletal risk factors and that increased knowledge of the subject can lead to an increase
in productivity.
Keywords: ergonomic training; work-related musculoskeletal disorders; productivity; protection motivation theory
1. Introduction
Work-related musculoskeletal disorders (WMSDs) are
functional disorders caused by external factors such as
awkward posture and vibration. The accumulation of minor
injuries afflicted upon tissues can lead to musculoskele-
tal disorders (MSDs). The body parts most commonly
affected are the waist, neck, shoulders, arms and wrists.[1]
WMSDs are the leading causes of occupational injury,
disability and absenteeism in both developed and indus-
trially developing countries.[2–4] The economic losses
suffered as a result of such disorders affect not only indi-
viduals but organizations and the society as a whole.
Productivity is the key to understanding the health and
cost burden associated with WMSDs. Lately, the ability
to produce merchandise or deliver services when suffer-
ing from WMSDs has been of particular interest in the
area of occupational research.[5] Several research stud-
ies have shown that the application of ergonomic prin-
ciples and programmes in almost all workplaces results
in an increase in productivity and,in fact,decreases
WMSDs.[6–8] Prior investigations conducted on the effec-
tiveness of office ergonomic training reported improve-
ments in knowledge and workstation habits reduced the
incidence of MSDs.[9] One particular study used vari-
ous educational interventions that included posters, emails,
*Corresponding author. Email: yarahmadi.r@iums.ac.ir
stretching diagrams, information on stress relief activities,
workshops and informational booklets.[10] The provided
material was shown to increase the overall understanding
of the workers regarding the issue of cumulative trauma
disorders. Furthermore, the support enabled the work-
ers to make substantial changes to their hand/wrist and
neck/shoulder posture when using computers.[10] Another
study into WMSDs examining workers at a petrochemi-
cal research and development facility reported improve-
ments in workstation posture and symptom severity, but
no reduction in overall symptoms.[11] Several investiga-
tions employing various ergonomic training methods have
reported positive results. For instance, those receiving edu-
cational programmes such as participatory training (an
active learning session involving discussions and problem-
solving exercises) and traditional training (lectures and
handouts) reported less pain/discomfort and had a posi-
tive perception of psychosocial work stress compared with
those who did not receive such training.[12] In another
study, intervention consisted of a physician contacting the
workers’ supervisor and an occupational physiotherapist
conducting an ergonomic assessment at the worksite. The
results demonstrated that, after eight weeks, both the pro-
portion and magnitude of productivity loss was lower in
the intervention group in comparison to the control set.
© 2015 Central Institute for Labour Protection – National Research Institute (CIOP-PIB)
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International Journal of Occupational Safety and Ergonomics (JOSE) 481
However, of note was that these differences were only
statistically significant at a period of 12 weeks.[13] Recent
research by Heuvel et al. examined the effect of two modi-
fications, namely taking extra breaks and performing exer-
cises during these breaks and their influence on sick leave
and productivity. The findings from the study demonstrated
positive and encouraging results. There was an increase in
terms of productivity upon utilizing both amendments. No
effects on sick leave were conformed.[14]
This study explores some of the ambiguities in previous
studies.[6–14] This research aims to determine the role of
application of intervention based on protection motivation
theory in reducing WMSDs and promoting productivity.
2. Material and methods
2.1. Subjects
The studied groups were made up of assembly workers
employed at Kabl Khodro factory. A total of 79 employees
formed a case group; an additional 79 made up the con-
trol group. Each set was studied one month prior and one
month post-intervention. The respondents were fully aware
of the conditions of the study, but did not know whether
they belonged to the experimental or control group. In
addition, both the case and control subjects were selected
from two separate shift patterns so that they would not be
connected in any way.
2.2. Data collection instrument
The data was gathered with the aid of two question-
naires and verified using the quick exposure check (QEC)
method.[15]
2.2.1. Questionnaire based on protection motivation
theory (PMT)
PMT provides a model to assist in promoting healthy
behavior through persuasive communication. PMT is orga-
nized along two cognitive mediating processes: threat-
appraisal and coping-appraisal.[16] Altogether the con-
structed self-report questionnaire consisted of four seg-
ments:
(1) Demographic characteristics (age, education, mar-
ital status, wages and experience).
(2) Four articles to help better understand ergonomics.
(3) Eighteen items based on protection motivation
theory components made up of the following:
•Perceived vulnerability means how probable it
is to contract the disease (4 items). For example,
one of the options was ‘Musculoskeletal disor-
ders secondary to work-related ergonomic issues
cause me a lot of pain and discomfort’.
•Perceived severity means how severe the conse-
quences of the disease are (2 items). For exam-
ple, one of the options was ‘I need no treatment
if I have musculoskeletal disorders and it will be
treated spontaneously’.
•Perceived response cost (3 items). For example,
one of the options was ‘Following ergonomic
principles decrease my speed at work’.
•Perceived self-efficacy means to what extent is
the person able to perform the recommended
behavior successfully (3 items). For example,
one of the options was ‘I can accurately follow
the ergonomic principles in my work place’.
•Perceived response efficacy means how effec-
tive the recommended behavior in avoiding the
negative consequences is (4 items). For exam-
ple, one question asked the subjects the follow-
ing: ‘How much does following the ergonomic
principles protect you against the work-related
musculoskeletal disorders?’.
•Behavior means performing the recommended
behavior (2 items). For example, one question
asked the subjects the following: ‘To what extent
have you followed the ergonomic principles in
your work place during the past month?’.
(4) Four articles to help better understand promotion.
Each item was scored using a 5-point system scale (i.e.,
strongly agree to strongly disagree) apart from the last two
items which were scored by means of a 4-point scale (i.e.,
none to high).
2.2.2. Productivity questionnaire based on subjective
productivity measurement (SPM)
Productivity data was gathered for one month on either
side of the intervention process via a questionnaire based
on SPM. SPM is a measuring approach that collects infor-
mation related to productivity by means of either a ques-
tionnaire or an interview targeted at an interest group such
as employees, customers or supervisors.[12] The question-
naire entailed 14 questions on the subject of SPM and a
5-point Likert scale (from 5 =very much to 1 =seldom)
was used to examine the pulled data.
2.2.3. Quick exposure check (QEC)
QEC was used to assess working posture along with its
associated muscular effort and exerting forces. A quick,
comprehensive and practical method for evaluating MSDs
was developed by Buckle and Li in 1999 at the Robens
research facility within Surrey University. The action level
of the technique was proposed by Li’s colleagues in
2003.[15,17] This tool evaluates specific areas on the body;
these include the back, shoulder/arm, hand-wrist and neck.
With regards to observant encounters, type of work and
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482 F. Abareshi et al.
employee’s answer; factors are determined and indepen-
dently placed into score tables. These tables are made up
of: the work duration, maximum applied force using one or
two hands, bending or moving the mentioned body parts,
conducting repetitive motions, conducting work in a static
or dynamic form, existing vibrations and level of eyesight
when performing the tasks. One special characteristics of
the QEC method is the special attention given to the psy-
chological aspects or stresses resulting from work. Finally,
all points gained from each posture are independently cal-
culated using the following formula: E% =(E/E max ) 100,
where E is the exposure level. Using this principle the con-
tact or action level can be determined to gauge the effect of
specific ergonomic interventions. The action level is subdi-
vided into four parts, the third and the fourth of which are
required for amendment measures. Taking that into consid-
eration, the measurements due to be processed during the
fourth step must be performed immediately.
2.2.4. Validity and reliability of the questionnaire
The internal consistency of the questionnaire was calcu-
lated in a total of 15 subjects that were similar to the
original ones. The overall reliability coefficient for the
PMT questionnaire used in the experiment was 0.808 and
0.823 for the productivity questionnaire. Eight experts
from among the academic staff confirmed the validity of
the test. The content validity ratio (CVR) and content
validity index (CVI) was calculated for both question-
naires. Identical figures of 0.95 and 0.74 in terms of CVI
and CVR values were achieved upon analysis of both
questionnaires, respectively.
2.3. Intervention
The data accumulated from the pre-test demonstrated that
the educational intervention, which was designed based
on theoretical constructs, included four 30–40 min training
sessions over the span of three weeks. Sequence of mea-
sures and intervention in this project is shown as Study
timeline and measures in Figure 1. The interval between
the sessions was 7 days.
The first training session was an introduction to the
importance of MSDs for trainers and group discussion.
In addition to the mentioned material, 26 slides were also
presented regarding ergonomics and its appropriate appli-
cation to enable the prevention of WMSDs. The slides
covered many other aspects concerning the ergonomics
that included a better understanding of the relation-
ship between repetitive motions and the development of
WMSDs, improvements and adjustments of workstations,
and finally information on suitable stretching exercises.
In the second session, the trainer in the experimental
group was informed about ergonomic risk factors and haz-
ardous conditions using a film. Also, the standard guideline
on ergonomic activities was given to the trainers. An
educational pamphlet was provided to familiarize the par-
ticipants with the principles of ergonomics and the goals
of the programme. Following the awareness session the
workers discussed their problems with their instructor. The
trainer then made suggestions on how best to solve their
difficulties if at all feasible.[18]
The third session focused on strategies to increase
perceived self-efficacy for ergonomic and production.
The two groups were followed up one month after the
intervention and the post-test survey was administered to
them.
2.4. Statistical analysis
Statistical analysis was performed using SPSS version 19.
A paired ttest was used to compare the groups before and
after the intervention in terms of their QEC score, produc-
tivity score and PMT components. The Wilcoxon test was
applied to compare the action levels before and after the
intervention.
3. Results
Table 1illustrates the mean and standard deviations relat-
ing to the age, educational level, marital status, salaries
and experience of both the tested (n=79) and control
groups (n=79). As shown, the two groups had similari-
ties in terms of their demographic variables but exhibited
no overall differences.
Figure 1. Study timeline and measurement.
Note: PMT =protection motivation theory; SPM =subjective productivity measurement; QEC =quick exposure check.
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International Journal of Occupational Safety and Ergonomics (JOSE) 483
Table 1. Demographic characteristics of employees studied.
Variable Case group Control group p
Age (years)
(M±SD)
31.68 ±6.77 32.95 ±5.67 0.2
Education 0.29
Below diploma 6 (7.7%) 6 (7.7%)
Diploma 43 (55.1%) 38 (48.7%)
Associate
degree
18 (23.1%) 13 (16.7%)
BSc 11 (14.1%) 20 (25.6%)
MSc 0 1 (1.3%)
Marital status 0.75
Single 6 (7.8%) 7 (9.2%)
Married 71 (92.2%) 69 (90.8%)
Wages (IRR)
(M±SD)
4770000 ±838500 4810200 ±1115500 0.85
Experiment
(years)
(M±SD)
9.82 ±3.79 9.88 ±3.87 0.92
Note: IRR =Iranian rial.
Table 2depicts mean grade scores of constructs regard-
ing protection motivation theory (knowledge, perceived
vulnerability, perceived severity, perceived response cost,
perceived self-efficacy, perceived response efficacy and
behavior) for the case subjects before and after interven-
tion. The paired ttest indicated significant differences in
terms of the mean grades scores of the variables measured
(p<0.05). However, this was not the case for perceived
response cost (p=0.1) and efficacy (p=0.7). These
two factors showed little or no noteworthy dissimilarities
whatsoever.
Table 3outlines the mean grade scores of protection
motivation theory constructs for the control subjects prior
and post-intervention. The paired ttest indicated no signif-
icant differences among the stated variables either before
or after the intervention process.
Table 4demonstrates the means and standard devia-
tions relating to the QEC scores and productivity for the
case and control group, before and after intervention. The
paired ttest revealed that there were significant differences
between the data collected prior and post-intervention in
both the case and control group.
According to Table 5, significant differences were noted
in the mean productivity scores between the case and
Table 2. Comparison of mean (±SD) grade scores of the
protection motivation theory constructs prior and post
intervention in the studied case group.
Variable Before intervention After intervention pa
Knowledge 17.59 ±1.74 20.85 ±0.9 <0.001
Perceived
vulnerability
17.13 ±2.34 18.29 ±1.92 0.001
Perceived
severity
8.49 ±1.92 9.05 ±1.57 0.04
Perceived
response cost
8.92 ±3.52 9.67 ±3.38 0.1
Perceived
self-efficacy
11.80 ±2.48 12.49 ±2.19 0.03
Perceived
response
efficacy
13.68 ±2.04 13.77 ±2.22 0.7
Behavior 5.15 ±1.53 5.82 ±1.45 0.003
Note: apaired ttest.
Table 3. A comparison of mean (±SD) grade scores
relating to protection motivation theory constructs before and
after intervention in the control group.
Variable Before intervention After intervention pa
Knowledge 17.95 ±1.81 17.97 ±1.85 0.56
Perceived
vulnerability
16.46 ±2.47 16.53 ±2.28 0.27
Perceived
severity
8.22 ±1.89 8.22 ±1.89 1
Perceived
response cost
9.73 ±3.1 9.64 ±3.09 0.3
Perceived
self-efficacy
11.29 ±2.08 11.27 ±2.08 0.32
Perceived
response
efficacy
13.31 ±2.3 13.27 ±2.3 0.08
Behavior 4.99 ±1.45 4.93 ±1.47 0.13
Note: aPaired t-test.
control group following intervention. In addition, upon
analysing the paired ttest data for the case study group
significant differences were shown for both the prior and
post intervention processes. There were no significant dif-
ferences in the mean productivity scores for the control
group either before or after the intervention.
Table 4. Comparison of mean (±SD) grade quick exposure check (QEC) and
productivity scores, before and after intervention for the case and control groups.
Variable Group Before intervention After intervention p
QEC Case (n=79) 48.09 ±11.84 45.76 ±10.45 0.001
Control (n=79) 47.77 ±10.8 48.62 ±10.97 0.04
p0.861 0.09
Productivity Case (n=79) 39.78 ±7.68 43.10 ±6.28 0.04
Control (n=79) 39.99 ±7.8 39.86 ±7.75 0.11
p0.87 0.007
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484 F. Abareshi et al.
Table 5. A comparison of mean grade scores relating* to
quick exposure check (QEC), productivity and the perceived
self-efficacy after intervention in the case group.
QEC Productivity
Perceived
self-efficacy
Var ia ble rp R p r p
QEC 1 <0.001 –0.306 0.01 –0.141 0.22
Productivity 1 <0.001 0.428 <0.001
Perceived
self-efficacy
1<0.001
Note: *Pearson correlations test.
There was significant positive correlation (Table 5)
between the perceived self-efficacy and productivity
scores. However, a significant negative correlation was
found among the data gathered analysing the productivity
action levels and QEC scores in the case group following
intervention. This series of acquired data was assessed with
the aid of the Pearson correlation test.
4. Discussion
During this study, 79 workers employed at the Kabl
Khodro factory were examined as case subjects. The
results revealed that mean grade scores of protection
motivation theory constructs significantly increased post-
intervention. This shows that interventional programmes
can be highly effective in improving the understanding,
attitude and behavior of manual workers. No modification
was observed in the studied control set for either part (prior
and post) of the intervention process. The findings of this
study are in agreement with the outcomes from comparable
studies that reported an increase in the mentioned variables
subsequent to training attendance.[15,19–21] Perceived
response cost and efficacy increases were not significant in
the case group upon intervention. This was due to the fact
that the case subjects were sceptical of the ergonomic prin-
ciples outlined by the health and safety unit. The workers
agreed to participate nonetheless, when the benefits of such
values were clearly explained to them by the health and
safety team. It was made clear to them how steps relating
to ergonomics if properly applied could help to decrease
MSDs within the workplace and those steps were not a
waste of their time.
The QEC results showed that the case group exhib-
ited a higher level of behavioral translation leading to
less awkward postures. Workers subjected to intervention
were more likely to make appropriate behavioral changes
to their workstation than those from the control group. A
lower QEC grand score in case group post- intervention
was the key indication of this finding. These outcomes
were consistent with findings from other comparable stud-
ies where a reduction in MSDs was also reported following
testing.[6,7,9,22] The minimal outcomes of significance
based on the QEC of the control group post-intervention
are possibly due to the fact that job rotation within the con-
trol group caused subjects to have much more difficult jobs
with far more risk factors. This can be clearly seen from the
increase in the QEC scores post-intervention for the control
subjects.
With regards to productivity, the paired ttest showed
marginal significant increases in the mean productivity
scores in case group after intervention.[8] There were no
significant differences found in the control group. These
negligible findings may be due to several factors such
as how training alone did not improve productivity. A
study conducted by De Rengo et al. gives a better insight
into this theory. This investigation reported that the chair-
with-training intervention is associated with productivity
improvements of up to USD 354 per worker per day with
a benefit-to-cost ratio of 22:1. These outcomes coupled
with those from the current study suggest that a highly
adjustable chair along with office ergonomic training can
help improve productivity.[23,24] These results and the
subsequent conclusions drawn are very much supported by
other similar studies.[14]
There was a significant positive correlation between the
productivity and perceived self-efficacy score, while there
was negative correlation between the QEC score with pro-
ductivity perceived self-efficacy score in the case group
after intervention.
It can be inferred from the results of present research
that intervention based on protection motivation theory
showed its role in reducing ergonomic risk factors and
promoting production rate and productivity.
This is in line with the results achieved by Conway,
who analysed the relationship between industry MSDs and
productivity changes during the 1990s in the USA.[25]
This study showed how an increase in productivity can be
accomplished by a lowering of the MSD rates.
Although the study carried out has shown highly
promising results, it is nevertheless important to point out
its limitations. A minimum period of six months should
be considered when undertaking such an investigation.
This is so individuals can become acquainted with all
of the training involved and get well informed about
ergonomics. These factors will enable the final outcomes
of any research conducted to be much more accurate. A
further limitation of using survey data only is that there is
a likelihood of self-report bias.
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