Beyond biomechanics : psychosocial aspects of musculoskeletal disorders in office work ; [... conference convened at Duke University in the fall of 1993

There is now widespread recognition that psychosocial factors play a key role in the aetiology, perpetuation, management and prevention of cumulative trauma disorders CTDs. This text addresses the strength, direction and importance of links between psychosocial factors and CTDs.; The book's contributors examine critically current research data, identify potential link mechanisms, and recommend measures for control and prevention. Topics covered include socio-organizational psychology, medical anthropology, occupational medicine, rehabilitation, orthopaedics, job stress and ergonomic interventions. The book aims to demystify the concept of the "psychosocial", so as to promote and assure effective prevention in the workplace. Book Cover......Page 1 Half-Title......Page 2 About the editors......Page 3 Title......Page 4 Copyright......Page 5 Dedication......Page 6 Contents......Page 7 Contributors......Page 9 Foreword......Page 11 Preface......Page 13 PART ONE Evidence, Models, and Mechanisms......Page 15 INTRODUCTION......Page 16 PSYCHOSOCIAL FACTORS......Page 17 PSYCHOSOCIAL PATHWAYS TO MUSCULOSKELETAL DISORDERS......Page 20 EVIDENCE FOR THE MODEL......Page 22 Pathways from Work Organization to Musculoskeletal Outcomes......Page 23 Psychological Mediation of the Path from Biomechanical Strain to Musculoskeletal Outcomes......Page 26 Feedback Effects......Page 27 NOTES......Page 28 REFERENCES......Page 29 INTRODUCTION......Page 33 THEORIES OF STRESS......Page 34 A MODEL OF JOB STRESS AND DISEASE......Page 35 WORK ORGANIZATION AND STRESS......Page 36 MECHANISMS OF WORK ORGANIZATION, STRESS, AND CTDs......Page 37 PSYCHOBIOLOGICAL MECHANISMS OF STRESS AND CTDs......Page 39 PSYCHOLOGICAL AND BEHAVIORAL REACTIONS TO STRESS......Page 42 CONCEPTUAL FRAMEWORK FOR EXAMINING JOB STRESS AND CTDs......Page 44 CONCLUSION......Page 45 REFERENCES......Page 46 INTRODUCTION......Page 51 The Assumptions of Social Psychology......Page 52 The Tools of Somatic Inference......Page 53 Attribution theory......Page 54 Mental representations of illness and symptoms......Page 55 Process features......Page 56 Model components......Page 57 Some derivations of the model......Page 59 The Interactive Level of Analysis......Page 60 Implications for research theory and method......Page 61 Implications for intervention and prevention......Page 64 NOTE......Page 65 REFERENCES......Page 66 EPIDEMIOLOGICAL STUDIES......Page 70 MECHANISMS......Page 71 PHYSICAL LOAD AND PSYCHOSOCIAL FACTORS......Page 74 CONCLUSIONS......Page 75 REFERENCES......Page 76 MUSCLE ACTIVITY AS A PATHOPHYSIOLOGICAL FACTOR IN THE DEVELOPMENT OF MUSCLE PAIN SYNDROMES......Page 78 MUSCLE ACTIVITY RELATED TO MENTAL DEMANDS AND PSYCHOSOCIAL FACTORS......Page 81 THE NEUROPHYSIOLOGICAL BASIS OF NONVOLUNTARY MUSCLE ACTIVITY......Page 83 THE MODIFICATION OF SENSORY-MOTOR REFLEXES ASSOCIATED WITH MUSCLE PAIN SYNDROMES......Page 84 PERIPHERAL MECHANISMS IN MUSCLE PAIN SYNDROMES OF PSYCHOSOCIAL ORIGIN......Page 85 IS OVEREXERTION OF LOW-THRESHOLD MOTOR UNITS A CAUSAL FACTOR IN SOME MUSCLE PAIN SYNDROMES?......Page 86 GENERAL DISCUSSION......Page 87 REFERENCES......Page 88 SOFT TISSUE CHANGES ASSOCIATED WITH CTD......Page 92 Modulation of These Effects by the Nervous and Immune System......Page 93 IMPLICATIONS......Page 94 REFERENCES......Page 96 TELECOMMUNICATIONS STUDY I......Page 98 TELECOMMUNICATIONS STUDY II......Page 99 Phase I......Page 100 Phase 2......Page 101 CONCLUSIONS......Page 102 REFERENCES......Page 103 PART TWO Issues for Management, Prevention, and Further Research......Page 104 CHAPTER EIGHT A psychosocial view of cumulative trauma disorders......Page 105 WHAT IS A PSYCHOSOCIAL FACTOR?......Page 106 WHAT IS CTD?......Page 107 A Potentially Multifactorial Problem......Page 108 A Disability Process......Page 109 A Legally Defined Portion of all Relations between Work and Activity-related Pain Syndromes......Page 110 A Marker of Ergonomic Deficiency or Disharmony......Page 112 HOW IS A CTD MEASURED?......Page 113 THE ERGONOMIC INTERFACE......Page 114 ETHICAL CONCERNS......Page 115 DYNAMICS OF DISABILITY: CYBERNETIC AND COMPLEX......Page 116 IS MEDICALIZATION RISKY?......Page 120 ROLE OF THE ‘PHYSICIAN’: EVALUATOR OF HEALTH STATUS, PROVIDER OF HEALTH CARE14......Page 121 TRANSITIONAL IMPLICATIONS FOR OCCUPATIONAL HEALTH......Page 124 CONCLUSION......Page 125 NOTES......Page 127 REFERENCES......Page 128 THE EPIDEMIC......Page 136 A MEDICAL ANTHROPOLOGY MODEL......Page 140 APPENDIX 1 AUSTRALIAN AND OVERSEAS TELECOMMUNICATIONS CORPORATION (AOTC) OCCUPATIONAL HEALTH AND SAFETY POLICY: WORK ENVIRONMENT AND DISTRESS POLICY AND GUIDELINES......Page 143 APPENDIX 2 CHAOS MODEL OF REPETITIVE WORK2......Page 144 REFERENCES......Page 147 A COGNITIVE-BEHAVIORAL MODEL OF CTD PAIN......Page 149 Behavioral observation......Page 152 Behavioral interviews......Page 153 Assessing Cognitive Variables......Page 154 The coping strategies questionnaire (CSQ)......Page 155 Educational-Behavioral Interventions for CTD Pain......Page 156 Cognitive-Behavioral Interventions Alone......Page 157 Cognitive-Behavioral Intervention Combined with Multidisciplinary Treatment......Page 159 Applying Coping Skills in Work Situations......Page 160 Maintenance Issues......Page 161 REFERENCES......Page 162 WORKSTYLE: OPERATIONAL DEFINITION......Page 165 EMPIRICAL RESEARCH......Page 167 Epidemiological Surveys......Page 168 Observational Research: Workplace, Laboratory, and Clinic......Page 173 PSYCHOBIOLOGICAL MECHANISM LINKING WORKSTYLE TO UPPER-EXTREMITY SYMPTOMS, DISORDERS, AND DISABILITY......Page 178 PREVENTION AND MANAGEMENT......Page 181 FUTURE RESEARCH......Page 186 SUMMARY......Page 189 REFERENCES......Page 190 NONSPECIFIC LOWER BACK PAIN......Page 193 A CONCEPTUAL ANALYSIS OF PAIN......Page 195 SUFFERING AND THE MEANING OF SYMPTOMS......Page 196 REPETITION STRAIN INJURY......Page 197 DISABILITY MANAGEMENT IN THE WORKPLACE......Page 198 CONCLUSION......Page 200 REFERENCES......Page 201 Skepticism by Health Professionals......Page 203 Peer Skepticism......Page 204 IMPLICATIONS FOR THE STUDY OF OFFICE CTDs......Page 206 Personological ‘Drift’......Page 207 A DEMONSTRATION STUDY OF PUBLIC REACTIONS TO CTDs......Page 208 CASE DEFINITIONS AND THE CREDIBILITY OF CTDs......Page 210 NOTES......Page 211 REFERENCES......Page 212 A HUMAN CAPITAL MODEL FOR HEALTH AND PRODUCTIVITY......Page 214 The employee benefits cost problem......Page 215 Human Capital Integrated Information Strategy......Page 216 Maldistribution of worker health costs: The Pareto phenomenon......Page 217 Workers’ compensation and group insurance demand migration......Page 218 Health and Disability Costs and CTDs......Page 219 Moral Hazard in the Disability System......Page 221 Moral Hazard Associated with Benefit Levels......Page 222 Moral Hazard in Health Care......Page 223 Empirical results......Page 226 Concluding Remarks......Page 229 REFERENCES......Page 230 Business......Page 233 Organizational Response......Page 234 CHARACTERISTICS OF A SUCCESSFUL ORGANIZATIONAL RESPONSE1.Effective worker involvement is an essential element of the successful corporate response. Early in the process, workers must receive a clear message from management that they are stakeholders in the ultimate outcome. Involvement of several levels of management, on a consistent basis, is necessary to reinforce the message that solutions are being genuinely sought, and that they will, in fact, be implemented. Training workers in basic group......Page 235 A successful organizational response......Page 239 In summary......Page 240 REFERENCES......Page 241 INTRODUCTION......Page 243 DESIGN AND DATA COLLECTION ISSUES IN CTD ETIOLOGIC RESEARCH......Page 244 PRELIMINARY RESULTS REGARDING POSSIBLE PSYCHOSOCIAL INFLUENCES ON CTDs AMONG OFFICE WORKERS......Page 251 REFERENCES......Page 261 PART THREE Commentaries......Page 264 CHAPTER SEVENTEEN Work disability in an economic context......Page 265 JOB MATCH AND INJURY RATES......Page 266 ECONOMIC INCENTIVES IN WORKERS’ COMPENSATION......Page 267 MORAL HAZARD AND THE PERCEPTION OF DISABILITY......Page 269 REFERENCES......Page 270 PROPOSED EXPLANATIONS FOR WORK-RELATED DISORDERS......Page 272 REFERENCES......Page 273 RELATIONSHIP BETWEEN PSYCHOSOCIAL FACTORS AND CTDs......Page 275 PREVENTION OF CTDs......Page 276 DEVELOPING AND IMPLEMENTING AN INTERVENTION STRATEGY......Page 277 CRITICAL INCIDENT DEBRIEFING WHEN CTDs OCCUR......Page 278 CONCLUSIONS......Page 279 REFERENCES......Page 280 Index......Page 281 There is increasing recognition that so-called 'psychosocial' factors in the workplace are somehow involved in the etiology of work-related musculoskeletal disorders, especially in the context of office work involving video display terminats (VDTs).