Work-related musculoskeletal disorders (WMSDs) continue to present a substantial personal and economic burden. Biomarkers, in providing objective measures of physiological changes, may offer advantages over current tools for WMSD risk assessment. Existing work has identified biomarkers of cartilage and muscle damage, and demonstrated responsiveness to various forms of physical activity and biomechanical loading. Here, three studies were complete to further assess the occupational relevance/utility of three selected biomarkers: Cartilage Oligomeric Matrix Protein (COMP), Interleukin-6 (IL6), and Creatine Kinase (CK). First, the effects of age, obesity, gender, and diurnal variation was investigated. Significant effects of time, age, and gender were evident, as well as some interactive effects, for COMP and CK, but not IL6. Second, biomarker levels were compared between individuals in occupations having relatively high and low WMSD risk. IL6 levels were greater in the high-risk group, while COMP levels demonstrated an oscillatory pattern, and CK levels did not vary between groups. Third, physical demands were imposed on the lumbar spine during a repetitive flexion/extension task, under conditions with different loading and frequency. IL6 levels varied significantly over time and between added load levels, while CK levels varied over time and was influenced by load and frequency. These studies demonstrate important features of biomarkers; that personal confounding factors need to be considered, that select biomarkers may be sensitive to occupational risk factor exposure, and particularly to task parameters in lifting activities involving the lower back. Further, these studies reveal important information concerning the relevance of the selected biomarkers, favorable time points for biomarker collection, and approximate biomarker levels expected between occupations and exposure to common risk factors. These results support the use of biomarkers in occupational settings for assessing exposure and WMSD risk imposed by common risk factors. Sensitivity to exposure levels is an important precursor to risk prediction, however prospective work is needed to verify predictive validity. / Ph. D.

Hairdressers’ exposure to work-related musculoskeletal disorders (WMSDs) appears to be insufficiently described in the literature. Knowledge regarding musculoskeletal disorders in this group is also sparse. The purpose of the research was to investigate the status of work-related musculoskeletal disorder cases found in Taiwanese hairdressers and to develop user-centred, strategic solutions to prevent the accumulation of musculoskeletal disorders in this group, especially newcomers to the industry. The study involved a series of investigations into the status of WMSDs for hairdressers in Taiwan as a first step towards their prevention. A hairdresser-oriented, musculoskeletal questionnaire was used to discover the risk factors associated with WMSDs and a validated, on-line, rapid, upper-limb assessment tool was used to identify critical hairdressing working postures. Improvements to the main critical hairdressing working postures identified by the first stage of the research have been addressed by an ergonomics training programme. The effectiveness of this is validated using 3D-motion analysis based on a pre- and post-test evaluation of awkward movements. A scientific approach to 3D-motion analysis has been achieved specifically by the study of the awkward working postures of the upper extremity during hair-blow-waving and hair-straightening activities. The relationship between working postures and WMSDs in various body regions is discussed. In this regard, poor posture and movement can lead to local mechanical stress on the muscles, ligaments and joints, resulting in discomfort in the musculoskeletal system, particularly the neck, back, shoulder and wrist. This research has provided a WMSDs prevention framework as a strategic method of securing a continuous improvement in the awkward working postures adopted during various hairdressing activities. Topics for further studies are suggested.

Magister Scientiae (Physiotherapy) - MSc(Physio) / Lack of adherence to the correct working conditions exposes workers to ergonomics-related hazards and eventually work-related musculoskeletal disorders (WRMDs) which are estimated at 160 million per year globally. Literature shows that with modernization by use of computers, administrators are exposed to prolonged sitting and long working hours which predisposes them to ergonomic hazards. Low back pain and neck pain are the leading work-related musculoskeletal disorders with a lifetime prevalence of 70 - 80% and 50 - 60% respectively.Both low back pain and neck pain have a multifactorial aetiology that includes work-related and individual related factors. Lack of reporting of work-related injuries has led to paucity of statistical literature with regards to work-related low back pain and neck pain, especially in the developing countries. The aim of this study was to determine the prevalence of ergonomics related low back pain and neck pain, and describe the effect of a knowledge-based ergonomic intervention among administrators in Aga Khan University Hospital, Nairobi (AKUH, N). A mixed method design was used in this study using a survey and two focus group discussions(FGD). A self-administered questionnaire that is in four sections was administered to 208 participants. The questionnaire sought the prevalence of musculoskeletal disorders, the knowledge of participants with regards to low back pain and neck pain as well as the work-related and individual risk factors related to the same. The dissemination of the study results involved a one hour knowledge-based ergonomic session given to all interested participants, based on the information from the survey. Two FGD with purposive selection of eight participants were held to explore their experience on the value of the information provided.The statistical package for social sciences (SPSS) version 20 was used to capture and analyze the quantitative data. Descriptive statistics was used to summarize the study findings in the form of means, frequencies, standard deviations and percentages. Inferential statistics (chi-square) was used to test the associations between different categorical variables (p<0.05). For the qualitative data, the tape recorded interviews were transcribed verbatim, field notes typed, sorting and arranging data was done and themes were generated. Thematic content analysis was used to generate the themes. The aim of the study, confidentiality and the participants‘ freedom to withdraw from the study were explained. Informed consent was also obtained before the survey and FGD and referral was made where necessary. The findings of the current study revealed that the study participants were knowledgeable about ergonomics-related low back pain and neck pain however this knowledge was not directly translated into behaviour. Low back pain (LBP) had the highest twelve month prevalence at 75.5% followed by neck pain at 67.8%, and LBP showed significant associations at p< 0.05 with some work-related and individual risk factors. The results of the FGDs showed that most participants had positive behavioural and attitudinal change post the knowledge-based ergonomic intervention despite the challenges they met in implementing the behavioural change. These results therefore show the need for continual education about ergonomics to create awareness on the predisposing factors to work-related LBP and neck pain, hence promoting a healthier quality of life amongst employees through adherence to healthy work behavioural practice.

Philosophiae Doctor - PhD / Occupational health (OH) in physiotherapy is well known for addressing workrelated musculoskeletal disorders (WRMDs), which are high in number according to the available statistics (Fingerhut, Concha, Punnet, Steenland, & Driscoll, 2014). The introduction of the Bachelor of Science in Physiotherapy degree in Kenya in 2010 created a good platform for the development and review of occupational health content in the curriculum

This research is to validate a risk assessment model?s ability to predict work-related musculoskeletal disorders (WMSDs). The model looks at the primary risk factors of repetition, force, deviated posture, tool design, duration, and frequency. The sum of the ratings for each factor is the risk assessment score for the person doing a certain job task. According to the score, the task is rated as a ?no risk? to an ?extreme risk? task. The data used for this research was from an epidemiological study preformed at a fish processing facility. To validate the model, the scores from the risk assessment model were compared to the operators? severity and frequency of pain in the median nerve distribution of the hand and to previous risk model. The statistical tests show that the risk assessment model can predict if the operator performing a task is at risk for forming a WMSD.

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The construction industry, one of the largest employers of labor in the United States, has long suffered from health and safety issues relating to work-related musculoskeletal disorders. Back-related injuries are one of the most prevalent of all musculoskeletal disorders in the construction industry. Due to advancements in the field of wearable technologies, wearable robots such as passive back-support exoskeletons have emerged as a possible solution. Exoskeletons have the potential to augment human capacity, support non-neutral work positions, and reduce muscle fatigue and physical exertion. Current research efforts to evaluate the potential of exoskeletons in other industry sectors have been focused on outcome measures such as muscle activity, productivity, perceived discomfort and exertion, usability, and stakeholders' perspectives. However, there is scarce evidence regarding the efficacy of using exoskeletons for construction work. Furthermore, the risks and sociotechnical challenges of employing exoskeletons on construction sites are not well documented. Thus, through the lens of human-centric and socio-technical considerations, this study explores the prospects of adopting back-support exoskeletons in the construction industry. Firstly, a laboratory experiment was conducted to quantify the impact of using a passive exoskeleton for construction work in terms of muscle activity, perceived discomfort, and productivity. In order to investigate the acceptance of exoskeletons among construction workers and the challenges of adopting exoskeletons on construction sites, field explorations evaluating usability, perceived discomfort and exertion, social influence, and workers user perceptions were executed. Using sequential mixed methods approach, the stakeholders and factors (i.e., facilitators and barriers) critical for the adoption of exoskeletons on construction sites were investigated. Thereafter, by employing the factors and leveraging the constructs of the normalization process theory, an implementation plan to facilitate the adoption of passive exoskeletons was developed. The study contributes to the scarce body of knowledge regarding the extent to which exoskeletons can reduce ergonomic exposures associated with construction work. This study provides evidence of the perceptions of the contextual use of wearable robots, and workers' interaction with wearable robots on construction sites. The study contributes to the normalization process theory by showing its efficacy for the development and evaluation of implementation frameworks for construction industry. Furthermore, this study advances the socio-technical systems theory by incorporating all its subsystems (i.e., human, technology, organization and social) for investigating the potential of using a passive back support exoskeleton in the construction industry. / Doctor of Philosophy / Construction workers are often subjected to harsh working conditions and physically demanding work postures, which are ergonomics risks causing back-related musculoskeletal injuries. These injuries have the potential to cause permanent disabilities, lead to early retirement of experienced labor, and is one of the causes of the shortage of skilled workforce in construction. Wearable robots, such as passive back-support exoskeletons, are increasingly been looked upon as a potential solution to mitigate the problem. Exoskeletons are wearable technologies that can support and reinforce workers' body parts. Studies have shown that the use of exoskeletons could lead to reduced muscle fatigue thereby decreasing injuries in the long run. However, most of the research on the use of exoskeletons is focused on other industrial sectors. Scarce evidence regarding the use of exoskeletons in construction is documented in the literature. Furthermore, the use of exoskeletons on construction sites could have certain unintended consequences. Thus, the objective of this research was to understand the risks and challenges of using passive exoskeletons in the construction industry. A laboratory experiment was conducted to measure the impact of using exoskeletons on physical demand and productivity while performing construction tasks. An increase in productivity and a reduction in discomfort in the lower back were observed while using an exoskeleton. Thereafter, field studies were conducted where construction workers performed their usual tasks using an exoskeleton to understand their user experience and acceptance. To help construction companies in the adoption of exoskeletons, facilitators and barriers to the adoption of exoskeletons were identified. Thereafter a plan was developed to facilitate the implementation of passive exoskeletons in construction organizations. This plan can guide construction companies in the adoption of passive exoskeletons. The outcomes of this study will help other researchers to conduct similar studies with other wearable technologies.

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Work-related repetitive strain injury (RSI), one of the work-related musculoskeletal disorders, is the most commonly reported occupational illness, yet the pathophysiological mechanisms are not yet clear. Using our unique RSI animal model, pathophysiological tissue responses can be examined simultaneously with behavioral responses that serve as indicators of sensorimotor function. Studies in humans and with this animal model have shown that prolonged performance of repetitive tasks leads to declines in grip strength and increased of serum pro-inflammatory cytokines, both valuable biomarkers of underlying tissue injuries. Identification of biomarkers would help to elucidate the time course of the inflammatory stage of these disorders and disease progression. Sickness responses/behaviors, normal responses and behaviors occurring as a consequence of infection or illness, are responsible for re-organizing perceptions and actions to enable individuals to respond appropriately to the infection, injury and other illnesses. These behaviors can include malaise, fatigue, increased irritability and social withdrawal, behaviors that can be beneficial when ill for avoiding others and enhancing wellness. However, sickness behaviors can also include depression, sleep disorders and an enhanced perception of illness. Although recent studies have shown that circulating pro-inflammatory cytokines in serum may trigger sickness behaviors, only a few studies have examined if there is an association between work-related musculoskeletal disorders and subsets of sickness behavior; no one to date has elucidated any plausible biological cause of this association. Also, the combined effects of both aging and performance of repetitive tasks needs more evaluation since several epidemiological studies have shown a relationship between advancing age and susceptibility to musculoskeletal disorders. Therefore, using female Sprague-Dawley rats, the aims of this dissertation project are to: 1) To determine if a systemic inflammatory response is maintained long-term in rats exposed to a moderate demand lever-pulling task with high repetition, low force (HRLF) requirements; if aging enhances this systemic inflammatory response and if this response correlates with functional motor declines; 2) To determine if performance of repetitive upper extremity tasks leads to the development of sickness behaviors (weight loss, decreased social interaction and increased aggression); 3) To determine if a relationship between repetitive upper extremity tasks lead to the development of dose- and age-dependent sickness behaviors, and, to determine if increased serum or brain inflammatory cytokines are plausible mechanisms for the induction of sickness behaviors in this model; and, lastly, 4) To determine if prophylactic or secondary systemic treatments with anti-inflammatory drugs (anti--tumor necrosis factor alpha or ibuprofen) reduces sickness behaviors in rats performing a high demand high repetition high force (HRHF) reaching and handle pulling task. This finding would be in further support of an underlying task-induced inflammatory mechanism contributing to these sickness behaviors. In the first study, the relationship between serum and grip strength was examined in aged and young adult rats performing a HRLF task. Serum levels of interleukin 1-alpha (IL-1&#945;), interferon-gamma (IFN&#947;) and IL-6 were higher in aged rats in general, compared to young adult rats. Each increased more in aged trained-only and 12-week HRLF rats than in young adult trained-only and 12-week HRLF rats. Serum IL-6 showed the greatest increases, with the highest levels observed in aged 12-week HRLF rats. Grip strength declined with task performance in both age groups; however, this decline correlated negatively and only moderately with serum IL-6 levels in aged rats. Thus, aging enhanced a serum cytokine response in general, a response that was even greater with repetitive task performance. Grip strength was adversely affected by task performance in both age groups, but was apparently influenced by factors other than serum cytokine levels in young rats. In the second study, the relationship between sickness behaviors (weight loss, duration of social interaction and aggression towards novel juvenile rats), serum cytokines and brain cytokines were examined in aged and young adult rats that trained to one of two task levels before performing a HRLF task. Decreased duration of social interaction and increased aggression was greater in both young adult and aged rats that trained for 10 min/day for 4-5 weeks to learn a high force (TRHF) task, compared to young adult and aged rats that learned a low force (TRLF) task. TRHF and TRLF rats of both age groups then performed a HRLF task for 6 to 24 weeks, rats termed TRHF-HRLF and TRLF-HRLF, respectively. Declines in social interaction resolved by week 3 in young adult TRHF-HRLF rats, but were still evident in 6-week aged TRHF-HRLF rats (the final endpoint for TRHF-HRLF rats). Significant increases in aggression were observed only in TRHF-HRLF rats, in both age groups. Declines in social interaction were also observed in aged rats performing a TRLF-HRLF task through week 9, but not in young adult TRLF-HRLF rats, even those performing the HRLF task for 24 weeks. These behaviors correlated moderately with increased serum IL-6 observed in the aged task rats (both TRHF-HRLF and TRLF-HRLF) and young adult TRHF-HRLF rats, although serum TNFalpha and IL-1beta also increased with task performance. Increased IL-6 and IL-6 receptor was detected immunohistochemically in brains of aged TRHF-HRLF rats, specifically in ependymal and endothelial cells, as well as glial cells and neurons of the anterior cingulate cortex and paraventricular nucleus. Thus, training to high force, even for a short time period, induced increased sickness behaviors. Aging contributed to increased sickness behaviors in repetitive task rats, and to increased expression of IL6 and IL-6 receptor in several brain regions. In the third study, the relationships between sickness behaviors (duration of social interaction and aggression towards novel juvenile rats), serum cytokines and brain cytokines were examined in young adult rats performing a high repetition high force (HRHF) task with or without anti-inflammatory medications. Rats that trained to high force (TRHF) had decreased duration of social interaction and increased aggression; these behaviors were prevented by prophylactic anti-TNFalpha or ibuprofen treatment. Untreated TRHF rats that went on to perform a HRHF task showed decreased social interaction and increased aggression through week 12; these behaviors were attenuated by secondary anti-TNFalpha and ibuprofen treatments. Untreated HRHF rats had increased serum GroKC, IFN-gamma, IL-1beta, MIP2, MIP3a and TNFalpha. These increases were attenuated after two weeks of anti-TNFalpha treatment in HRHF weeks 5-6, and after 8 weeks of ibuprofen (in HRHF weeks 5-12). The sickness behaviors correlated moderately with increased serum Gro-KC, MIP2 and TNFalpha, and were concomitant with increased IL-1beta immunoexpression in ependymal and endothelial cells in brains of untreated TRHF and HRHF rats. Both treatments reduced the increased brain IL-1beta expression. Thus, sickness behaviors induced by overuse are attenuated by anti-inflammatory interventions that reduce task-induced increases in systemic and brain inflammatory cytokines. In conclusion, both aging and task performance increased serum inflammatory cytokine responses, the latter in an exposure-dependent manner, with a greater serum cytokine response with performance of high force tasks than low force tasks. While grip strength was adversely affected by task performance in both young and aged rats, it was influenced by factors other than serum cytokine levels. In contrast, decreased duration of social interaction and increased incidence of aggression were influenced by task-induced increases in serum and brain inflammatory cytokines, responses attenuated to baseline levels with systemic anti-inflammatory treatments. Sickness behaviors were also dose- and age-dependent, with higher incidence with performance of high force tasks than with low force tasks, and higher incidence in aged rats. We postulate that the higher incidence in aged rats is due to aged-induced brain "inflamm-aging", as they also had increased immunoexpression of IL6 and IL6 receptor in blood brain barrier cells and in glial and neurons of the hypothalamic pituitary axis. / Physical Therapy