 Hello and welcome. I'm Dr Jody Oakman. I head the centre for ergonomics and human factors at La Trobe University. We are a WHO collaborating centre. Our research program in the centre for ergonomics and human factors has a large focus on the risk management of musculoskeletal disorders. So today I'm going to talk to you about improved risk management of musculoskeletal disorders, the need for a new approach. I'm going to pose and then address three key questions today. What does the research evidence tell us about the causal factors of MSDs? Are there gaps in current strategies used to manage MSDs? And then finally what are we doing at La Trobe University? Contribute to the knowledge of management of MSDs. Just some background. We are getting older. That's a fact. The population is aging and people will need to work until we are in our 60s and it has been postulated until we're 70. So this poses a couple of issues. The first being that we need to encourage people to want to work for longer and this requires quite a shift but that's not the focus of my presentation today. The second thing is ensuring that people are able to work for longer and that ensures that they're not exposed to excessive physical or psychosocial hazards over their life course so that they can make choices about their employment up until retirement, the time for retirement. The way we work has undergone transformational change in the past 15 to 20 years. We're now on call responding to things in our leisure time sometimes because we have to and sometimes because we've loosened the boundaries between home and work. The impact of this on health outcomes hasn't been fully explored but is part of the whole overall picture of management of occupational health issues such as MSDs. Now what are MSDs? The issue of development of MSDs is a pivotal part of the discussion and in many ways we try and fit compensation schemes to an injury rather than the other way round. Mostly in musculoskeletal disorders we're not talking about injuries at a particular point in time event we're talking about development of a disorder due to exposure over a long period of time to occupational hazards. The issue and complexity is the number of hazards and how they interact and this makes MSD risk management particularly complex. There are a number of definitions of MSDs but there is consensus on versions of the following that work-related musculoskeletal disorders affect tinsons, tendon sheaths, muscles, nerves, bursae, blood vessels in the body. So how do we know whether it's an injury or a disorder? In many cases the clinical diagnosis of MSDs is inaccurate, the reliability often poor and we've know that in recent times there's been a bit of publicity around the relationship between MRI scans, x-rays and the symptoms that people demonstrate. One of the issues in occupational health is that we often spend a lot of time to the right of the arrow rather than down the left focusing on the onset of symptoms and trying to target our risk management strategies at that end of the arrow. I'd suggest that prevention activities need to really start well before we see people move into the compensation or claim cycle which we know some people have a lot of trouble getting out of. Perhaps our over reliance on clinical diagnosis can cause us to consider events attributed to the injury in a way that may not be particularly helpful and particularly when we use these diagnoses to develop our provincial control activities it may lead us down a garden path. Mostly MSDs are cumulative in nature that is a result of exposure to a range of hazards over time and it's very difficult to attribute one single event and in fact evidence would suggest that this is in fact correct and that what we're seeing is the straw that breaks the camel's back. This model here is 2001 model developed by the National Research Council in Institute of Medicine is quite a well-known and well-described model in the literature. It was developed after an extensive review by a panel of experts who reviewed epidemiological evidence around causal factors of musculoskeletal disorders and we can see here in this model that the influence of both biomechanical hazards of which we are mostly very familiar with and they're well accepted and well entrenched in our risk management plans for reduction of musculoskeletal disorders. Down the bottom we can see organisational factors and social context which I've grouped there as psychosocial hazards which is a commonly used term here. These factors can either independently or or both influence the the person effects through biomechanical loading, internal loads and physiological responses. These in turn influences internal tolerances and how the body responds to these particular hazards resulting in a range of outcomes pain discomfort leading on to impairment and disability and of course on the right are the individual factors age, gender, different capacities. These are largely outside the sphere of influence of workplaces and so our prevention activities really need to focus on the workplace factors. This tells the same story as the last one but highlights separate but interacting causal mechanisms. We can see here that the psychosocial hazards and the biomechanical hazards can both influence the cumulative tissue damage resulting in presentation of injury. In our work of at this model in 2014 takes into account both of these models and we use this conceptual framework to underpin our research here at La Trobe which is heavily focused on on risk management of workplace MSDs. So we can see here that what we're what we're seeing is this match between or poor match between individual factors those work-related abilities and skills personality genetic vulnerabilities and the workplace factors so those psychosocial factors, organisational factors and physical loads. When these are not well matched so we have a demand capacity imbalance we see that we get effects within the person so biomechanical loads, we get a stress response, fatigue, reduced internal tolerance resulting in tissue damage and or pain. Workplace hazard categories can be broadly grouped as manual handling hazards which are focused at on the task or psychosocial hazards and there are two groups of these one is the organisational factors which are around the organisation of work and job design and then there's the social context the support the communications the relationships with managers many there's some examples of organisational and social context hazards. Organisational hazards can be around working hours workloads, how jobs are designed, levels of control for individuals, pace of work conflicting work demands. Social context is around communications with management, the value of individuals, health and safety culture, relationships with colleagues and supervisors. Many organisational hazards are actually the responsibility of managing supervisors they arise from how work is organised and job designed. There is an overlap between these two groups, managers and supervisors play a key role in creating these hazards but also in developing effective controls. MSD risk is determined by many hazards organisational and psychosocial and these interact or additive but we're still faced with a big question by many people aren't manual handling hazards the main problem that is isn't it the physical aspects of work that are primarily responsible for the development of musculoskeletal disorders? In the literature of which there is a large substantial body of evidence to support the role of both physical and psychosocial factors this particular paper by Johnson et al was focused on retail material handlers so very physically orientated job, large population 6,311, good study design what they found was that what these odds ratio is predictors of new back pain and we can see there that job intensity had a odds ratio of 1.8 or predictive ratio of 1.8 compared to the lifting the physical aspects of the work 20 pounds at work. So in summary the psychosocial factors were at least or even more so influential on the development of new back pain. In this review really was a systematic review of a large number of papers about 50 which they undertook statistic rigorous statistical and analysis to examine the impact of psychosocial factors on MSD development and so what they found was that again looking at these odds ratios or predictors of the likelihood of developing low back pain was that high job demands were had a higher likelihood than low job satisfaction supervisor support or low social support although they're fairly close but the key message here is that these factors were important in determining new cases of low back pain. I don't think it's helpful to focus particularly on the numbers but just that both factors are important both psychosocial and physical factors are important. In Australia more specifically at La Trobe University we've had a long-standing research program on musculoskeletal disorders beginning in 2003 was the first piece of work but here we can see in 2006 we started with a review up until 2015 where we're currently working on a project looking at workplace barriers to reduce the incidence of musculoskeletal and mental health disorders. In addition to that we're currently working on an intervention project in the aged care sector to look at new ways to reduce risks associated with MSDs and more locally in in our work we found that taking together a number of studies in healthcare manufacturing logistics when we start looking at those odds ratios or predictive contributions is a good way to describe these contributions to increasing MSD risk we see that physical and psychosocial hazards contribute very similarly to increased MSD risk and low job satisfaction equally makes a contribution to the increased likelihood of developing a musculoskeletal disorder. So in terms of MSD risk management it's clear assessment and management of psychosocial hazards is essential it's not optional there is sufficient evidence and sufficient good quality evidence to support the role of both physical and psychosocial factors. In addition the severity of exposure to any single hazard isn't necessarily a good indicator of overall MSD risk so and the output of tools for assessing adverse postures and biomechanical loads indicates severity or riskiness of the particular hazards it doesn't necessarily indicate overall MSD risk because they often take a very narrow focus rather than looking at the job as a whole. There are a number of barriers to improving current workplace practices for reducing MSD risk or prevention of MSDs. We still have an ongoing widespread erroneous belief that MSD risk is largely due to physical hazard exposures. Many of the guidance materials that we use still focus on the physical aspects of work including the sorts of tools that we use to identify and control hazards and risks associated with MSDs. The conventional OHS risk management paradigm that we use doesn't necessarily help us to develop and promote effective risk management for MSDs. It tends to operate quite separately to other business management strategies and procedures and it would be beneficial to see these better integrated. One of the issues is this focus on hazard by hazard rather than looking more holistically at all the factors so rather than taking into account the job as a whole and you'll see there an example of perhaps a moderate force for pushing a trolley might be a problem if it's done a lot and there is a lot of time pressure associated with the job but if it's done only occasionally and without time pressure it may not be a problem so we need to be much better at looking at the contextual factors around particular tasks that individuals are undertaking. In addition our conventional aim in terms of eliminating or reducing hazards isn't always appropriate. Sometimes physical hazards shouldn't be always eliminated. Workloads should not always be minimized. We know that people having interesting challenging work is actually good for them and that work without challenge is actually hazardous in itself. So we need expansion of our standard risk management paradigm and there's a parallel here with the approach needed to reduce the risk of major accidents and I quote here, take a quote here from James Reason who argued that errors like mosquitoes you can swap them one by one but they still keep coming. This is an alleges to MSD hazards and they're a bit like human error that you can swap them one by one but it's not the most effective way to reduce risk. We need MSD risk management tools and associated guidance that covers both physical and psychosocial hazards and it encourages a high level of work of participation. We know and encourage worker consultation but we need to encourage participation in terms of risk management for MSDs. It needs to include appropriate assessment methods and advice on how to develop appropriate controls for both physical and psychosocial hazards. At La Trobe University we have been developing an MSD risk management toolkit over the past number of years. We are currently implementing this toolkit in the age care sector and testing various aspects of the implementation process. It very much the toolkit follows a standard risk management process with some key differences to address these identified gaps in current practices. So it's highly participative involving the gathering of a risk management team and collation of available data on MSDs. It involves education of management and supervisors in what are all the relevant associated factors with increased MSD risk physical and psychosocial. A key plank of this risk management toolkit is the use of staff survey results which measure both hazards in the psychosocial workspace and the physical workspace and these are helped to develop a hazard and risk profile. These are then developed used to develop risk controls with the risk management team. Of course then there's an implementation phase and a review and evaluate phase consistent with a risk management cycle. The toolkit has been developed under the guise of the WHO framework for all toolkits which involves a base which is based on the WHO healthy workplace model. The toolkit is currently being tested in the age care sector as I said before and we're working to customize the toolkit to their existing IHS management systems. It'll be interactive allowing users to customize as they need and enter their own workplace data. Future work from our end will involve implementation and evaluation and comparison of data across different sectors. So we come back to the three questions that I posed at the beginning of the presentation. What does the research evidence tell us about the causal factors today? I hope that from the presentation today you can see that there is very strong evidence to support the role of physical and psychosocial factors in the development of MSDs that identification and of both physical and psychosocial factors is not optional but mandatory if we do effectively develop risk controls for MSDs. Are there gaps in current strategies used to manage MSDs? I think I hope again that you see from the presentation today that there are, that we currently still focus on the physical aspects of work predominantly in the management of MSDs and I would suggest that this is in part why we find perhaps difficult at times to significantly reduce the large numbers of MSDs and thirdly what are we doing at La Trobe University to contribute to knowledge of management of MSDs? Well we've been working over the last 10 to 15 years to help further that evidence base and then really working on translation taking that research out into practice to develop more effective materials and supports to help organisations manage their MSDs more effectively. So I thank you today for listening to this presentation and if you're interested in further discussion there are my details. We will be seeking partners in the coming year to work further on implementing the toolkit in a range of different organisations and we welcome discussions about potential partnerships and if you're interested in learning more we have a short course coming up called Health and Design of Work and we also offer a graduate certificate of Masters or Masters in Ergonomics Safety and Health at La Trobe University. Thank you very much.