Managing musculoskeletal disorders — UK

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  • Observatory: EurWORK
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  • Published on: 07 lokakuu 2007



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This is the UK contribution to the Study on the existing situation regarding the impact of work changes on the resurgence of work-related musculoskeletal disorders.

Section 1: Definitions

  1. 1.1 Please, report the official definition of WR-MSDs if any, or the most widespread one. Please specify whether it includes backaches.

There is no official general definition of WR-MSDs. However, the Health and Safety Executive (HSE), operationally, adopts a ‘broad definition’ that ‘is not focussed on any one type of musculoskeletal problem or body region’ (HSE 2005a; see http://www.hse.gov.uk/msd/information.htm). As a result, the neck and upper limb and back and lower limb are all included.

1.2 Please check whether criteria illustrated in the above EODS paper have been updated in the meantime. Are recognition criteria by NIAs taking into account gender differences? Have there been any changes in the last years with regard to gender issues in particular.

There has been only one change in the criterion detailed in the EODS paper. This is a widening of the prescription of Hand Arm Vibration (HAV) under the Industrial Injuries Disablement Scheme so that it now encompasses not only vascular symptoms but also sensorineural ones. None of the prescriptions, or the qualifying levels of disability, take into account gender differences.

Section 2: Reporting

2. 2.1 Please describe the main sources of information about WR-MSDs (NIAs and other insurance agencies empowered by the government and/or social partners, WCSs, public health authorities, statistical bureaux). Please describe the way WR-MSDs are categorised by public authorities and NIAs according to the part of the body affected (upper/lower limb, bone joint or muscle problem, hips, legs, knees, back, neck, shoulders, arms, etc…..), causes (repetitive work, vibrations, heavy loads, postures, PCs, etc….) and occupational and demographic characteristics (labour contracts, occupation, age, gender).

There are four main sources of information available (see http://www.hse.gov.uk/statistics/causdis/musc.htm). These are as follows:

  • Self-reported, work-related ill health (SWI) surveys conducted in 1990, 1995, 2001/02, 2003/04 and 2004/05;

  • Musculoskeletal Occupational Surveillance Scheme (MOSS), a voluntary reporting scheme under which occupational physicians report the relevant cases they have seen during a given month and the figures so provided are then multiplied by 12 to arrive at estimated annual totals;

  • Occupational Physicians Reporting Activity (OPRA) scheme which operates on a similar basis as MOSS but in relation to all types of work-related disease; and

  • Benefit claims made under the Industrial Injuries Scheme (IIS) in respect of a limited number of MSDs, namely beat hand, beat elbow, beat knee, cramp of the hand or forearm, and inflammation of tendons of the hand, forearm or associated tendon sheaths (tenosynovitis).

By far the most important of these sources, statistically, are the SWI surveys. The estimates produced from these surveys are analysed, for those who have worked in the past 12 months, in terms of their distribution by:

  • Age and gender;

  • Country and region;

  • Employment status as between ‘employees’ and ‘self-employed’;

  • Full-time or part-time status and hours worked;

  • Socio-economic group;

  • Occupation;

  • Industry; and

  • Size of workplace.

Separate analyses along the above lines have been conducted in more recent surveys in relation to disorders involving (a) bone, joint or muscle problems mainly affecting upper limbs or neck and (b) such problems that affect the back. In the 1995 survey information was also collected on respondent’s views as to what caused the disorder from which they suffered (see table 4 below).

Some data are also available from the MOSS and OPRA schemes in terms of the distribution of MSD cases by age, gender, country, diagnostic category, work activities, occupation and industry. In addition, the IIS data similarly allows a breakdown of claims by gender, country, and industry.

3. 2.2 Please describe the number, type and variety of questions advanced in relation to MSDs? Please report the exact formulation of questions advanced in working conditions surveys. What is the evolution over time of question formulation?

The MOSS and OPRA schemes operate on the basis of medical diagnosis and the IIS scheme enables benefits to be awarded in relation to 20% disability arising from the conditions previously mentioned.

The questions utilised in the SWI surveys have varied over time. In the 1990 and 1995 surveys respondents who reported a work-related illness caused or made worse by work were asked to ‘describe their illness’ in terms of a number of pre-determined categories – bone, joint or muscle problems; breathing or lung problems; skin problems; hearing problems; stress, depression and anxiety; headache and/or eyestrain; heart disease/attack, other circulatory system; infectious disease (virus, bacteria) and ‘other’; although the 1995 survey went on to subsequently enquire about the part of the body affected and the symptoms involved. In the more recent surveys, 2001/02, 2003/04 and 2004/05, the pre-determined categories have drawn a distinction between:

  • ‘Bone, joint or muscle problems which mainly affect (or is mainly connected with) arms, hands, neck or shoulder’;

  • ‘Bone, joint or muscle problems which mainly affect (or is mainly connected with) hips, legs or feet’; and

  • ‘Bone or muscle problems which mainly affect (or is mainly connected with) the back.

4. 2.3 Is there any analysis of causes available?

Yes, as indicated above, from the 1995 SWI, in terms of respondent views of what caused their disorders and from the MOSS and OPRA schemes in relation to the work activities associated with the occurrence of them. See Tables 4 and 5 below and http://www.hse.gov.uk/statistics/causdis/musc.htm.

Section 3: Trends of MSDs and their social impact

5. 3.1 Please report figures on absence days caused by MSDs (from NIAs and other Agencies, or WCS where the former are not available) according to parts of the body affected and causal agent, and their trends over the last 10 years, disaggregated by labour contracts, occupation, age, if it were possible in an engendered way, according to the sources available described in Q2. Please report these trends for the following sectors (with the same caveat): manufacturing and mining, health and education, transport and communications.

Estimates of total working days lost as a result of WR-MSDs have only been published on the basis of the 2001/02/, 2003/04 and 2004/05 SWI surveys. The last of these estimates suggests that disorders of this type resulted in the loss of 11.6 million working days (full-time equivalent) during the previous 12 months in Great Britain and that each person suffering from such a condition took, on average, 20.5 days off during the year concerned (See http://www.hse.gov.uk/statistics/causdis/musc.htm). It also suggests, as shown in Table 1 below, that the number of working days lost as a result of such disorders has been falling over the period 2000/01 – 2004/05.

Table 1 Estimated number of working days lost (full-day equivalent) due to WR-MSDs
Estimated number of working days lost (full-day equivalent) due to WR-MSDs
Year Days lost (thousands) Days lost per worker
2001/02 11810 0.52
2003/04 11844 0.52
2004/05 11602 0.50

Base: Working days lost by those who reported a WR-MSD in the 2003/04 SWI and had worked in the last 12 months

Source: HSE (2005b). See http://www.hse.gov.uk/statistics/overall/hssh0405.pdf

Disaggregation of the 2003/04 estimates for total working days lost figure, by age, gender, employment status, occupation, industry and workplace size, for those working in the last 12 months, revealed the following patterns (Jones et al. 2005):

  • males accounted for 60% of days lost;

  • 80% of days lost related to ‘employees’ rather than the self-employed;

  • just over half of days lost related to ‘process, plant and machine operatives’ and those employed in ‘skilled trades occupations’ and ‘elementary occupations; and

  • construction, along with the health and social work sectors, accounted for over a third of days lost.

In terms of average days lost per case, this disaggregation further revealed the following significant differences:

  • for both males and females, those in the oldest age group (45+ years) had a higher rate of days lost than those in younger age groups;

  • rates were higher for ‘skilled trades occupations’, and ‘process, plant and machine operatives’; and

  • the rate in construction was higher than for other sectors (see Table 2).

Table 2 Estimated days (full-day equivalent) off work and associated average days lost per case due to self-reported WR-MSDs
Estimated days (full-day equivalent) off work and associated average days lost per case due to self-reported WR-MSDs
Industry sector Days lost (thousands) Average days lost per worker
Manufacturing 1148 0.33
Construction 1926 0.94
Household goods 1149 0.34
Hotels and restaurants 316 0.36
Transport, storage and communication 1277 0.73
Real estate, renting, and business activities 307 0.11
Public administration and defence; compulsory social security 823 0.51
Education 523 0.29
Health and social work 1465 0.38

Base: Working days lost by those who reported a WR-MSD in the 2003/04 SWI and had worked in the last 12 months, by those sectors of industry where reliable estimates could be made.

Source: Adapted from Jones et al. (2005: 236)

The 2003/04 SWI estimates also indicate that 80% of working days lost stemmed from conditions mainly affecting the back, upper limbs and neck, with the bulk of the remainder being associated with disorders mainly affecting the lower limbs (see Table 2). No significant differences were found with regard to the average number of days taken off work as a result of these different types of disorder.

Table 3 Estimated days (full-day equivalent) off work and associated average days lost per case due to self-reported WR-MSDs
Estimated days (full-day equivalent) off work and associated average days lost per case due to self-reported WR-MSDs
Type of WR-MSD Days lost (thousands) Average days lost per case
Bone, joint or muscle problem 11844 19.4
Mainly affects upper limbs or neck 4736 18.3
Mainly affects the lower limbs 2211 24.3
Mainly affects the back 4897 18.7

Base: Working days lost by those who reported a WR-MSD in the 2003/04 SWI and had worked in the last 12 months

Source: Adapted from Jones et al. (2005: 137)

On the basis of the available statistical information, as indicated above, it is not possible to identify any relevant 10 year trends by sector. The sector estimates provided in Table 2 do not, however, differ significantly from those for 2001/02.

6. 3.2 Please report figures from WCSs on MSDs suffered according to parts of the body affected and causal agent, and their trends over the last 10 years, disaggregated by labour contracts, occupation, and age in an engendered way by gender, according to the sources available described in Question 2. Please report these trends for the following sectors (with the same caveat): manufacturing and mining, health and education, transport and communication.

Results from the 2004/05 SWI survey suggest that during the relevant 12 months period there were 206,000 new cases of MSD (Jones et al. 2005). Meanwhile, during 2004, 6,872 new cases were reported under the MOSS and OPRA reporting schemes.

It is not possible to breakdown the 2004/05 survey findings by causal agent and, so far, no disaggregation of them by part of the body affected has been published. Those obtained from the 2003/04 one, however, indicate that of the estimated 204,000 new MSDs, 36% mainly affected the back, 48% upper limbs or neck and 16% mainly affected the lower limbs. Findings from the 1995 survey, it should additionally be noted, indicated that over half of the people reporting MSDs considered that they had been caused by manual handling activities, mainly lifting, 28% by the posture they adopted at work and 18% by repetitive work (Jones et al. 1998).

The SWI surveys have been used to compute prevalence rates covering the period 1990 to 2004/05 for all reported MSDs in respect of those employed during the previous 12 months. These indicate that the relevant rate has fallen over the period from 2,600 to 1,800 per 100,000 employed. As far as is known, breakdowns in this trend along the lines requested have not been produced. The 2004/05 survey’s findings, however, showed the incidence rates for new MSDs among those who worked in the last 12 months to be significantly:

  • higher for males aged 55+ and lower for females in the 16-34 age group;

  • higher for full-time workers and those working more than 30 hours a week;

  • higher for ‘skilled trades occupations’ and lower for administrative and secretarial occupations;

  • higher for those working in the health and social work sector and lower for real ‘estate, renting and business activities’; and

  • lower for workplaces with 1-24 employees.

Analysis of reports under the MOSS and OPRA schemes between 1998 and 2004 shows that conditions affecting the hand/wrist/arm (excluding Raynauds/HAV/Vibration White Finger) were the most commonly reported, followed by conditions affecting the lumber spine/truck.

It also reveals that:

  • while 24% more cases of upper limb disorders were reported for males, there were 49% more hand/wrist/arm conditions reported by women;

  • typists had the highest rate of new cases annually closely followed by those employed as metal plate workers, shipwrights and riveters and, then, by road construction operatives and assemblers of vehicles and metal goods;

  • the industry sectors with the highest rates were, in order, manufacturers of motor vehicles, trailers and semi-trailers, mining and quarrying, and manufacturers of ‘other transport equipment’; and

  • the most commonly associated work activities were forceful upper limb/grip (27%), lifting (15%), material handling (14%) and fine hand movements (14%).

The combined reports made under these two schemes during the period 2002/04 further reveal that 81% of new cases during this period involved those aged between 25 and 45, and that the age group most commonly concerned was the 35-44 one.

In 2003/04, virtually all of the claims assessed under the IIS scheme for beat conditions were from males, while just under three-quarters of those for hand and forearm conditions were from females. In addition, the available data indicate that the sectors with the highest rates of new assessments made under the scheme during the period 2002/04 were the extraction, energy and water supply industry and manufacturing.

7. 3.3 Please provide some cross tables of MSDs according to the part of the body affected and, if possible, causal agent, with the following organisational factors in an engendered way, showing trends from the 90s and taking into account the questions included in WCS for each country:

  • - pace of work (speed or repetitiveness, tight deadlines)

  • - autonomy (in general and where possible break opportunities, scope of pace of work, scope of methods)

  • - use of PCs and other ICTs devices

  • - scope of discussion over work organisation and/or organisational changes.

As indicated in the previous responses, detailed breakdowns of the occurrence of MSDs by most of the organisational factors listed are not possible. The most useful, related cross-tabulations that can be provided are detailed below.

Table 4 Estimated incidence of self-reported MSDs caused or made worse by work for people ever employed, 2003/04
Estimated incidence of self-reported MSDS caused or made worse by work for people ever employed, 2003/04
Type of MSD complaint Sample cases Central estimate (‘000s)
Bone, joint or muscle problem mainly affecting the upper limbs or neck 190 97
Bone, joint or muscle problem mainly affecting the lower limbs 65 33
Bone, joint or muscle problem mainly affecting the back 146 74
Total bone, joint or muscle problems 401 204

Base: Estimated number of MSD cases occurring in 12 month reference period calculated by the proportion of sample cases with such conditions extrapolated to the estimated number of people ‘ever employed’, as defined by the Labour Force Survey

Source: Adapted from Jones et al. (2005: 75)

Table 5 Characteristics of tasks identified as leading to a work-related musculoskeletal disorder, by site of complaint, in 1995
Characteristics of tasks identified as leading to a work-related musculoskeletal disorder, by site of complaint, in 1995
Characteristics of task All MSDs (%) Back (%) Upper limbs or neck (%) Lower limbs (%)
Repeating same sequence of movements many times 90 83 97 91
Working in awkward or tiring position 81 83 73 81
Working very fast 64 57 73 59
Using appreciable force 72 81 58 78
Lifting or moving heavy loads 78 94 53 75
Twisting or stooping when lifting or moving heavy loads 96 96 95 94
Repeated gripping and releasing between finger and palm 57 55 53 59
Maintaining a fixed bent position 48 40 50 55
Bending the waist a lot 70 60 79 68
Working with hands at or above shoulder height 51 52 44 62
Kneeling 46 54 25 64
Leaning forward from the waist 85 94 71 77
Sample cases 564 229 187 46

Base: All those in the 1991 SWI survey sample who reported an MSD

Source: Adapted from Jones et al. (1998: 136)

Table 6 All work-related musculoskeletal disorders: estimated number of cases reported to MOSS/OPRA by reported work activities - tasks
Tasks Annual average estimated cases 2002-2004 % of total
Guiding or holding tool 1436 21
Heavy lifting/carrying/pushing/pulling 1299 19
Keyboard work 937 14
Materials manipulation 428 6
Light lifting/carrying/pushing/pulling 327 5
Packing or sorting 218 3
Other 211 3
Assembly (Large or heavy parts) 159 2
Machine operation (heavy or forceful) 158 2
Machine operation (light or technical/scientific) 146 2
Driving: automobiles 117 2
Hammering, chopping, sawing 99 1
Coordinated whole body movement 79 1
Driving screw, cutting 66 1
Assembly (small or delicate parts) 58 1
Meat boning or filleting 11 -
Driving: heavy plant, forklift 30 -
No task category assigned 1445 21
Total individuals 6888 100

Base: All those diagnosed by doctors under the MOSS/OPRA schemes. Since more than one task or movement could be given for each case, the total number of tasks/movements detailed exceeds the total number of individual cases.

Source: Adapted from http://ww.hse.gov.uk/statistics/tables/thorm14.htm

Section 4: Trends of MSDs and their economic impact

8. 4.1 Are there estimates of MSDs costs? If any, which direct and indirect costs are included? Who carries them out? If not, what indicators are monitored by policy makers and Agencies in order to propose/draw up new policies, esp in prevention?

The HSE (1996) has estimated that WR-MSDs cost employers annually between £590 million and £624 million (at 1995/96 prices). These costs encompass both direct and indirect costs, including sick pay, compensation via Employers’ Liability Compulsory Insurance, expenditure on administration and staff recruitment, damage to equipment, goods and materials, and the implications of insurance industry administrative costs for insurance premiums.

These cost estimates, along with the statistics on the scale of MSDs and their distribution between industries and occupations, have led to the HSE to identify their prevention as a key priority and to further focus particular attention on two such conditions – back pain and upper limb disorder.

9. 4.2 Are there “return to work policies” (by whom/on what level/whose initiative/involvement of the actors) developed and implemented (in general and specifically for MSDs)?

A distinction can be drawn between return to work policies aimed at those who are not in employment and those who are. Attention here focuses on those relating to the latter group.

The HSE, in a recent publication on the management of sickness absence, has provided guidance on the type of policy arrangements that employers can utilise to support the return to work of those suffering from work-related injuries and ill health. Employer responses to the HSE’s 2005 Workplace Health and Safety Survey Programme suggest that 52% of workplaces have arrangements in place to support the return of workers on long-term sickness absence, with these arrangements being much more prevalent in the public sector (85%) compared to the private one (44%) (Clarke et al. 2005). Other evidence, however, suggests that most of these arrangements do not form part of distinct ‘return to work’ policies, but instead are detailed in more wide-ranging absence management and disability based ones and further indicates that little attention is generally paid to the issue of rehabilitation in the handling cases of long-term sickness absence (James et al. 2003).

Given the previous observation, while some organisations are known to have return to work policies specifically concerned with MSDs, such policies seem likely to be relatively uncommon.

Section 5: Prevention policies and room to manoeuvre

10. 5.1 In general, are plant-level information prevention policies “risk elimination orientated” or centred around “risk information”? What is the role of social partners?

On the basis of existing evidence, it is not possible to say anything definitive about the relative usage made of ‘risk elimination’ and ‘risk information’ approaches. Some insights into the issue are, however, provided by the responses given by 1,241 organisational responses to a postal survey undertaken as part of an evaluation of the Manual Handling Operations Regulations 1992 (Entec 2001). These responses indicated that 30% of organisations had not taken any action to manage manual handling risks and that of the remainder, 77% had conducted risk assessments, 71% had carried out awareness training, 58% had reduced the significant risks and 16% had taken action to avoid, assess and reduce risks. Further analysis revealed that the taking of such actions was positively associated with organisation size and that they were more commonly undertaken in certain sectors, notably manufacturing, local government, health care, agriculture and construction.

All employers have a statutory duty to consult over workplace health and safety issues, although only in workplaces where trade unions are recognised, does this consultation need to take place via representatives of workers (James and Walters 2005). The 2004 Workplace Employment Relations Survey found that managers consulted or negotiated with representatives over health and safety in just 22% of workplaces with ten or more employees (Kersley et al. 2005).

11. 5.2 Please illustrate some plant level good practices (at least one in manufacturing and one in services) following (or showing significant similarities with) the “room to manoeuvre” approach above sketched, showing in particular the adopted approaches and the impact both in working conditions and firm performance. Is there any specific strategy of the kind towards small and medium sized enterprises?

It has not been possible to identify clear examples of the type requested relating specifically to MSDs. However, in the area of stress management, a number of organisations from both the manufacturing and service sectors have adopted approaches that embody substantial elements of the “room to manoeuvre” approach. These include the telecommunications company BT, the Abbey bank, and the manufacturing company GlaxoSmithKline (Incomes Data Services 2004), as well as the West Dorset General Hospitals NHS Trust (Industrial Relations Services 2004).

12. 5.3 Have been developed any quality indicators measuring “room to manoeuvre” preventive strategies?

In relation specifically to MSDs, no such indicators have been officially developed. The HSE has, however, drawn attention to the relevance of such issues in its official guidance on MSDs. In addition, it has produced a set of prescribed Management Standards on work-related stress which cover six main issues, ‘demands’, ‘control’, ‘support’, relationships’, ‘role’ and ‘change’, that address many of the issues identified as being encompassed within a ‘room to manoeuvre’ approach, and enable employing organisations to assess their performance against them.

References

Clarke, S., Webster, S., Jones, J., Blackburn, A. and Hodgson, J. (2005) Workplace Health and Safety Survey Programme: 2005 Employer Survey First Findings Report, http://www.hse.gov.uk/statistics/pdf/whassnotes.pdf.

Entec UK Ltd (2001) Second Evaluation of the Manual Handling Operations Regulations (1992) and Guidance, Contract Research Report 346/2001, Sudbury: HSE Books.

Health and Safety Executive (1999) The Costs to Britain of Workplace Accidents and Work-related Ill Health in 1995/96, Sudbury: HSE Books.

Health and Safety Executive (2005a) Research Agenda for the Priority Programme on Musculoskeletal Disorders (2005/06 Edition), http://www.hse.gov.uk/msd/information.htm.

Health and Safety Executive (2005b) Health and Safety Statistics 2004/05, Sudbury: HSE Books.

Incomes Data Services (2004) Managing Stress, IDS NHS Studies, 775, London: IDS.

Industrial Relations Services (2004) ‘West Dorset Hospitals NHS Trust assesses Stress Risks’, IRS Employment Review, 792, 22-24.

James, P., Cunningham, I. and Dibben, P. (2003) Job Retention and Vocational Rehabilitation: The Development and Evaluation of a Conceptual Framework, Research Report 106, Sudbury: HSE Books.

James, P. and Walters, D. (2005) Regulating Health and Safety: An Agenda for Change? London, Institute of Employment Rights.

Jones, J., Hodgson, J., Clegg, T. and Elliott, R (1998) Self-reported Work-related Illness in 1995: Results from a Household Survey, Sudbury: HSE Books.

Jones, J., Huxtable, C. and Hodgson, J. (2005) Self-reported Work-related Illness in 2003/04: Results from the Labour Force Survey, Sudbury: HSE Books.

Kersley, B., Carmen, A., Forth, J., Bryson, A., Bewley, H., Dix, G. and Oxenbridge, S. (2005) Inside the Workplace: First Findings from the 2004 Workplace Employment Relations Survey, London, Department of Trade and Industry.

Phil James, Middlesex University

Jane Parker, IRRU

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