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Self-assessed and direct measured physical workload among dentists in public dental clinics in Sweden during a period of rationalizations
Linköping University, Department of Medical and Health Sciences, Work and Rehabilitation. Linköping University, Faculty of Health Sciences.
2010 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Much research has been done on interventions to reduce work-related musculoskeletal disorders (WMSDs) at the workplace. However, this problem is still a major concern in working life. The economic cost for WMSDs corresponds to between 0.5% and 2% of the gross national product in some European countries, and in 2007, 8.6% of workers in the EU had experienced work-related health problems during the previous 12 months. In Sweden, one in five of all employees have rated occurrence of WMSDs during the previous 12 months.

In spite of comprehensive ergonomic improvements of workplace and tool design in dentistry the prevalence of musculoskeletal disorders in neck, upper arms and back is reported to be between 64% and 93%.

The present thesis investigates if the perceived high exertion during work corresponds to actual physical exposures. Further, it is investigated if risk full physical exposures may be generated due to rationalisations. Specifically, changes in physical exposures are investigated prospectively during a period of rationalisations. Empirical data on production system performance, individual measured physical workload, and self-rated physical workload are provided.

High estimates of self-rated workload were found. These high scores for perceived workload were associated with high measured muscular workload in the upper trapezius muscles. Also, negative correlations were found between low angular velocities in the head, neck and upper extremities on the one hand, and estimates for perceived workload on the other. Both measured muscular workload and mechanical exposure among dentists indicate a higher risk of developing WMSDs than in occupational groups with more varied work content. Value-Adding Work (VAW) comprised about 57% of the total working time and compared to industrial work an increase with about 20 percent units is hypothesised. Furthermore, VAW compared to non-VAW (“waste”) implies more awkward postures and especially low angular velocities interpreted as constrained postures.

Consequently, when increasing the proportion of time spent in VAW due to rationalisations, work intensification is expected. However, at follow up, we did not find such work intensification.

Previous research indicates that rationalisation in working life may be a key factor in the development of WMSD. The present thesis suggests that ergonomics may then be considered proactively as part of the rationalisation process.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press , 2010. , 65 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1192
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-65422ISBN: 978-91-7393-347-6 (print)OAI: oai:DiVA.org:liu-65422DiVA: diva2:395577
Public defence
2010-10-28, Aulan, Länssjukhuset Ryhov, Jönköping, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2011-02-07 Created: 2011-02-07 Last updated: 2013-09-03Bibliographically approved
List of papers
1. Evaluation of muscular activity, local muscular fatigue, and muscular rest patterns among dentists
Open this publication in new window or tab >>Evaluation of muscular activity, local muscular fatigue, and muscular rest patterns among dentists
2005 (English)In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 63, 189-195 p.Article in journal (Refereed) Published
Abstract [en]

In a previous study, dentists reported very high scores for perceived physical workload, but only low to moderate scores for the musculoskeletal system. This is difficult to explain when other occupational groups in the dental services are compared, and is the main reason why the present study was performed. To measure muscular activity, a surface electromyography (sEMG) study was done, and included the subjects who reported neck and shoulder complaints in the previous study. A portable sEMG system (MyoGuard) was used to collect a myoelectric signal on-line and analysis of the myoelectric signal in a computer. sEMG was recorded from both trapezius muscles for approximately 4 h during an ordinary working day. Twentyseven dentists participated in the study. The results show accumulated rest% fairly close to that of female cashiers and supermarket employees and increased average rectified value percent (ARV%) during work that could contribute to the very high workload perceived by dentists.

Keyword
Dentistry, ergonomics, surface electromyography
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-45097 (URN)10.1080/00016350510019964 (DOI)79663 (Local ID)79663 (Archive number)79663 (OAI)
Available from: 2009-10-10 Created: 2009-10-10 Last updated: 2017-12-13
2. Relation between perceived and measured workload obtained by long-term inclinometry among dentists
Open this publication in new window or tab >>Relation between perceived and measured workload obtained by long-term inclinometry among dentists
2009 (English)In: Applied Ergonomics, ISSN 0003-6870, E-ISSN 1872-9126, Vol. 40, no 3, 309-315 p.Article in journal (Refereed) Published
Abstract [en]

Dentists reported high perceived physical work conditions. Working postures and movements of the head and upper extremities during dental work were registered with inclinometry measurements during four hours. The aim was to clarify the relationship between measured working postures/movements and perceived physical work conditions. Dentists worked with elevated arms and a rather steep forward inclination of the head. Correlations (r = -0.52 to -0.66) between inclination velocity and perceived workload on VAS scales were found, but there were only weak correlations between observed working postures. The different tasks involved in dental work provide limited variation in work movements and postures, measured by inclinometry. By alternating between sitting and standing, it might be possible to achieve variation in physical workload during dental work.

Keyword
Questionnaire, Inclinometry, Dentistry
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-17629 (URN)10.1016/j.apergo.2008.12.002 (DOI)
Available from: 2009-04-07 Created: 2009-04-06 Last updated: 2017-12-13
3. Mechanical exposure among general practice dentists in Sweden and possible implications of rationalization.
Open this publication in new window or tab >>Mechanical exposure among general practice dentists in Sweden and possible implications of rationalization.
Show others...
2011 (English)In: Ergonomics, ISSN 0014-0139, E-ISSN 1366-5847, Vol. 54, no 10, 953-560 p.Article in journal (Refereed) Published
Abstract [en]

The present study investigates dental work in terms of time distribution and mechanical exposure in value-added and non-value-added tasks. Further rationalization of dental work would typically involve an increase in the proportion of value-added tasks. Information on mechanical exposure within classes of value-added and non-value-added tasks can be used to predict possible implications of rationalization.

Twenty-four dentists were investigated. Using a data logger, postures and movements were continuously recorded for each subject during four hours of work, which included 45 minutes of video recording. Time distribution and mechanical exposure for each work activity were calculated from the video recordings, using a loss analysis technique. Value-added tasks, which comprised 57% of the total working time, generally implied significantly more constrained mechanical exposures as compared with non-value-added tasks.

The results indicate that future rationalization of dental work, involving a reduction of nonvalue-added tasks, may increase the risk of developing musculoskeletal disorders.

Place, publisher, year, edition, pages
Taylor & Francis, 2011
Keyword
Dentistry; Efficiency; Value-added; Workload
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-65419 (URN)10.1080/00140139.2011.606919 (DOI)000299924800007 ()
Available from: 2011-02-07 Created: 2011-02-07 Last updated: 2017-12-11
4. Rationalisation in public dental care - impact on clinical work tasksand biomechanical exposure for dentists: a prospective study
Open this publication in new window or tab >>Rationalisation in public dental care - impact on clinical work tasksand biomechanical exposure for dentists: a prospective study
Show others...
(English)Manuscript (preprint) (Other academic)
Abstract [en]

Comprehensive rationalisations in Swedish dentistry suggest contribute to increase risk for MSDs among dentists. This prospective study focused on assessing changes in degree of rationalisation of clinical dental work by dentists during a six years period, with particular emphasis on time aspects and mechanical exposure. Twelve dentists were followed up by the means 45 minute’s video recordings and synchronised inclinometry measurements. The video recordings were analyzed by a loss analysis technique.

The results shows that non-VAW time proportion (waste) at the follow up was not reduced, but rather showed a trend towards an increase. Mechanical exposures during non-VAW and VAW were essentially not changed during the follow up time. The risk for MSDs for dentists due to mechanical exposure is unchanged. The used loss analysis technique has a lot to contribute in health care settings but the used concept applied needs further elaboration in the future.

Keyword
Dentistry; Rationalisations: Value-added; Workload
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-65421 (URN)
Available from: 2011-02-07 Created: 2011-02-07 Last updated: 2013-09-03Bibliographically approved

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