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The Shoulder posterior circumflex humeral artery Pathology and digital Ischemia - questionnaire (SPI-Q) has been developed to enable periodic surveillance of elite volleyball players, who are at risk for digital ischemia. Prior to implementation, assessing reliability is mandatory. Therefore, the test-retest reliability and agreement of the SPI-Q were evaluated among the population at risk. A questionnaire survey was performed with a 2-week interval among 65 elite male volleyball players assessing symptoms of cold, pale and blue digits in the dominant hand during or after practice or competition using a 4-point Likert scale (never, sometimes, often and always). Kappa (κ) and percentage of agreement (POA) were calculated for individual symptoms, and to distinguish symptomatic and asymptomatic players. For the individual symptoms, κ ranged from "poor" (0.25) to "good" (0.63), and POA ranged from "moderate" (78%) to "good" (97%). To classify symptomatic players, the SPI-Q showed "good" reliability (κ = 0.83; 95%CI 0.69-0.97) and "good" agreement (POA = 92%). The current study has proven the SPI-Q to be reliable for detecting elite male indoor volleyball players with symptoms of digital ischemia.

Purpose Application of normative values for functional capacity evaluation (FCE) is controversial for the assessment of clients for work ability. The objective of this study was to study when clinicians and researchers consider normative values of FCE useful or of no use for their purposes. Methods A focus group meeting was organized among 43 FCE experts working in insurance, occupational and/or rehabilitation medicine from eight countries during the first international FCE research meeting on October 25th, 2012 in the Netherlands. Participants were asked to rate to which degree they agree or disagree with a statement concerning their position toward normative values for FCE on a 10 cm VAS ranging from 0 (completely disagree) to 100 (completely agree) at T0 and T1. Arguments for aspects that are useful and of no use for normative values were systematically collected during the meeting and afterwards independently clustered by two researchers in higher order topics. Results Baseline opinion of participants on their position toward normative values was 49 +/- A 29 points. After the meeting, mean VAS was 55 +/- A 23 (p = 0.07), indicating that participants did not significantly change their opinion toward normative values. Based on arguments provided by the experts, seven higher order topics were constructed namely 'Comparison with job demands or treatment goals'; 'Comparison with co-workers physical ability'; 'Sincerity of effort'; 'Validity for work ability and return to work'; 'Experience of referrer with assessment method'; 'Clinimetrics compared to alternative assessment methods or reference values'; and 'Ease of use for clinician and stakeholders'. Conclusions Although experts state useful aspects for the use of normative values of FCE for these assessments, it may also lead to over-interpretation of results, leading to dualistic statements concerning work ability, with potential harmful consequences for work ability of patients.

‘Je bent coassistent bij een huisartsenpraktijk in Amsterdam. Op je ochtendspreekuur komt Timo, een 42-jarige barman uit de Pijp. Bij het in elkaar zetten van het kinderbedje voor z’n aanstaande eerste kind is het in z’n rug geschoten. Hij kan ‘geen kant meer op’. Vanmiddag wil hij gewoon weer aan het werk, kun jij dat niet even voor hem regelen?’ Zo begint de Team-Based Learning (TBL) voor de eerstejaarsstudenten geneeskunde bij het Academisch Medisch Centrum (AMC), gegeven door de afdelingen huisartsgeneeskunde, revalidatiegeneeskunde en het Coronel Instituut voor Arbeid en Gezondheid. De 2e herziene NHG-standaard voor aspecifieke lagerugpijn is het belangrijkste studiedocument voor de studenten in deze TBL. 1

Recent zag ik op mijn WIA-spreekuur een 60-jarige vrouw (BMI van 21), uitgevallen voor haar werk als ziekenverzorgende op de afdeling orthopedie van een ziekenhuis (32 uur per week).

Background: Until recently, no evidence-based criteria were available to determine the work-relatedness of low back pain (LBP) in an individual worker. Incidence figures for LBP that can be qualified as occupational disease (OD) are scarce. We studied the trend in the number of OD notifications due to LBP in the Netherlands and estimated incidence rates of LBP-related OD notifications. Methods: We developed an instrument for the assessment of work-relatedness of non-specific LBP (NLBP) in 2004, accompanied by an OD registration guideline. We analysed the trend in LBP-related OD notifications in the register of the Netherlands Centre for Occupational Diseases (NCOD) from 2004 to 2011. We estimated incidence rates for LBP-related OD notifications with data from a prospective cohort study, performed by NCOD in 2009‐2011. Results: After implementation of the instrument and guideline, we noticed a huge increase in numbers of LBP-related OD-notifications, from 0.7% of all notified ODs in 2004, via 8.6% in 2005 and 13.6% in 2008, to 9.1% in 2011. We estimated the incidence rate of ODs due to LBP at 24.1 per 100,000 worker years (19.2 for NLBP), with a large difference between men and women (31.3 and 3.2, respectively). Conclusions: The instrument for the assessment of work-relatedness of NLBP played an important role in the recognition of LBP-related ODs. It provides a basis for a more uniform and objective evaluation of the role of work-related risk factors in the occurrence of NLBP. This knowledge can be used to initiate or direct preventive actions towards subgroups with higher incidence rates.

One in every four elite male volleyball players in the Netherlands reported blue or pale digits in the dominant hand. Little is known about risk factors. To assess whether personal-, sports-, and work-related risk factors are associated with these symptoms in these volleyball players, a survey was performed among elite male volleyball players in the Dutch national top league and in the Dutch beach volleyball team. The questionnaire assessed the presence of symptoms and risk factors. Binary logistic regression was performed to calculate odds ratios (ORs). A total of 99 of the 107 athletes participated - a response rate of 93%. Two sports-related risk factors were associated with symptoms of blue or pale digits: 18-30 years playing volleyball [OR = 6.70; 95% confidence interval (CI) 1.12-29.54] and often/always performing weight training to increase dominant limb strength (OR = 2.70; 95% CI 1.05-6.92). No significant other sports-, personal-, or work-related risk factors were found. Playing volleyball for more than 17 years and often/always performing weight training to increase dominant limb strength were independently associated with an increased risk on ischemia-related complaints of the dominant hand in elite male volleyball players

Promoveren op musculoskeletale klachten onder muziekstudenten, dat klonk Vera Baadjou als muziek in de oren. Zij werkt als revalidatiearts op de ‘kunstenaarspoli’ van de afdeling revalidatiegeneeskunde van Adelante, locatie MUMC+, waar kunstenaars, dansers en musici terecht kunnen voor aan hun werkgerelateerde klachten.

Het toonaangevende tijdschrift The Lancet besteedt een speciale serie van vier artikelen aan lagerugpijn: www.thelancet.com/series/low-back-pain .

Een orthopedisch proefschrift dat eindigt met een laatste paragraaf die speciaal over arbeidsparticipatie gaat en met een laatste zin die oproept tot actie ‘Early identification and subsequent appropriate interventions involving all relevant health care providers, may change the course of recovery of a Total Hip Arthroplasty and Total Knee Arthroplasty in a more favourable way for the patient, thus adding value to the patient and not only “adding” an implant into a patient’, laat het belang van werk ook in de orthopedie zien.

De incidentie van de achillespeesruptuur is 21,5 per 100.000 persoonsjaren en de incidentie lijkt toe te nemen: van 2,1 in 1979, 4,7 in 1981, 5,5 in 1998, 9,9 in 2002, naar 21,5 in 2011.1 De meest voorkomende locatie waar de achillespeesruptuur scheurt, is 3-6 cm boven de calcaneusinsertie.

Een prospectief cohortonderzoek is uitgevoerd onder 138 PIM-bedrijfsartsen gedurende 3 jaar om voorspellers van het aantal beroepsziektemeldingen te bepalen. Als mogelijk voorspellend zijn factoren van het gedragsmodel ASE onderzocht: attitude, sociale invloeden, zelfvertrouwen, kennis, ervaring en ervaren barrieres. De analyses zijn verricht met behulp van lineaire en multivariate regressieanalyse. Het aantal beroepsziektemeldingen over 3 jaar was 3914 met een gemiddelde van 28 (SD 34,3) en een mediaan van 17. De somscores voor zelfvertrouwen (p=0,019), kennis (p=0,114), gebruik van de helpdesk (p=0,079) en barrieres (p=0,055) correleerden met de uitkomst en verklaarden samen 7% van de meldingen. Op vraagniveau kwamen zelfvertrouwen bij het melden (p=0,003) en (gebrek aan) tijd voor melden (p=0,003) het sterkst naar voren. Het NCvB faciliteert PIM-deelnemers op zelfvertrouwen en efficientie door de jaarlijkse workshop en het efficienter maken van het meldingsproces. De bedrijfsarts en de arbodienst kunnen meer prioriteit geven aan het melden en aan preventie van beroepsziekten.

Het signaleren van beroepsziekten is een belangrijke reden om preventie op het werk op gang te brengen. De bedrijfsarts kan dit alleen bereiken samen met de werknemer en de werkgever. Deze kwalitatieve studie heeft als doel om in kaart te brengen wat werknemer en werkgever kunnen bijdragen om preventie bij de bedrijfsarts te stimuleren.

Vangnetters zijn, in vergelijking met werknemers met een vast dienstverband, een kwetsbare groep voor het risico op ziekteverzuim. Dit komt mogelijk mede door een groter risico op beroepsziekten. In dit onderzoek is bepaald hoe vaak beroepsziekten voorkomen in de vangnetpopulatie en hoe lang vangnetters met een beroepsziekte verzuimen. Met behulp van het vijfstappenplan (diagnose → relatie met werk → blootstelling → factoren buiten werk → beoordeling), en in samenwerking met het Nederlands Centrum voor Beroepsziekten (NCvB) werd, binnen de praktijk van een verzekeringsarts, een half jaar lang beoordeeld of er bij de verzuimende vangnetter (n=197) sprake was van een beroepsziekte.

Knee arthroplasty is being increasingly performed, and also more often in a younger patient population (

Background People today are living longer and want to remain active. While obesity is becoming an epidemic, the number of patients suffering from osteoarthritis (OA) is expected to grow exponentially in the coming decades. Patients with OA of the knee are progressively being restricted in their activities. Since a knee arthroplasty (KA) is a well accepted, cost-effective intervention to relieve pain, restore function and improve health-related quality of life, indications are expanding to younger and more active patients. However, evidence concerning return to sports (RTS) and physical activity (PA) after KA is sparse. Objectives Our aim was to systematically summarise the available literature concerning the extent to which patients can RTS and be physically active after total (TKA) and unicondylar knee arthroplasty (UKA), as well as the time it takes. Methods PRISMA guidelines were followed and our study protocol was published online at PROSPERO under registration number CRD42014009370. Based on the keywords (and synonyms of) ‘arthroplasty’, ‘sports’ and ‘recovery of function’, the databases MEDLINE, Embase and SPORTDiscus up to January 5, 2015 were searched. Articles concerning TKA or UKA patients who recovered their sporting capacity, or intended to, were included and were rated by outcomes of our interest. Methodological quality was assessed using Quality in Prognosis Studies (QUIPS) and data extraction was performed using a standardised extraction form, both conducted by two independent investigators. Results Out of 1115 hits, 18 original studies were included. According to QUIPS, three studies had a low risk of bias. Overall RTS varied from 36 to 89 % after TKA and from 75 to >100 % after UKA. The meta-analysis revealed that participation in sports seems more likely after UKA than after TKA, with mean numbers of sports per patient postoperatively of 1.1–4.6 after UKA and 0.2–1.0 after TKA. PA level was higher after UKA than after TKA, but a trend towards lower-impact sports was shown after both TKA and UKA. Mean time to RTS after TKA and UKA was 13 and 12 weeks, respectively, concerning low-impact types of sports in more than 90 % of cases. Conclusions Low- and higher-impact sports after both TKA and UKA are possible, but it is clear that more patients RTS (including higher-impact types of sports) after UKA than after TKA. However, the overall quality of included studies was limited, mainly because confounding factors were inadequately taken into account in most studies. Electronic supplementary material The online version of this article (doi:10.1007/s40279-015-0421-9) contains supplementary material, which is available to authorized users.

Introduction A substantial number of patients undergoing total hip or knee arthroplasty (THA or TKA) do not or only partially return to work. This study aimed to identify differences in determinants of return to work in THA and TKA. Methods We conducted a prospective, observational study of working patients aged Results Of 67 THA and 56 TKA patients, 9 (13%) and 10 (19%), respectively, returned partially and 5 (7%) and 6 (11%), respectively, did not return to work 1 year postoperatively. Preoperative factors associated with partial or no return to work in THA patients were self-employment, absence from work and a better HOOS Activities of Daily Living (ADL) subscale score, whereas only work absence was relevant in TKA patients. Type of surgery modified the impact of ADL scores on return to work. Conclusions In both THA and TKA, absence from work affected return to work, whereas self-employment and better preoperative ADL subscale scores were also associated in THA patients. The impact of ADL scores on return to work was modified by type of surgery. These results suggest that strategies aiming to influence modifiable factors should consider THA and TKA separately.

It is unclear whether the maximum acceptable weight of lift (MAWL), a common psychophysical method, reflects joint kinetics when different lifting techniques are employed. In a within-participants study (n = 12), participants performed three lifting techniques - free style, stoop and squat lifting from knee to waist level - using the same dynamic functional capacity evaluation lifting test to assess MAWL and to calculate low back and knee kinetics. We assessed which knee and back kinetic parameters increased with the load mass lifted, and whether the magnitudes of the kinetic parameters were consistent across techniques when lifting MAWL. MAWL was significantly different between techniques (p = 0.03). The peak lumbosacral extension moment met both criteria: it had the highest association with the load masses lifted (r > 0.9) and was most consistent between the three techniques when lifting MAWL (ICC = 0.87). In conclusion, MAWL reflects the lumbosacral extension moment across free style, stoop and squat lifting in healthy young males, but the relation between the load mass lifted and lumbosacral extension moment is different between techniques. Practitioner Summary: Tests of maximum acceptable weight of lift (MAWL) from knee to waist height are used to assess work capacity of individuals with low-back disorders. This article shows that the MAWL reflects the lumbosacral extension moment across free style, stoop and squat lifting in healthy young males, but the relation between the load mass lifted and lumbosacral extension moment is different between techniques. This suggests that standardisation of lifting technique used in tests of the MAWL would be indicated if the aim is to assess the capacity of the low back. © 2012 Copyright Taylor and Francis Group, LLC.

Objective: To determine whether employees with disabilities were initially assigned to jobs with work demands that matched their work capacities. Participants: Forty-six employees with various physical, mental, sensory and multiple disabilities working in a sheltered workshop. Methods: Physical and psychosocial work capacities were assessed post-offer and pre-placement using the Ergo-Kit and Melba. Work demands of the jobs were determined by workplace assessments with TRAC and Melba and were compared with the work capacities. Results: Of the 46 employees, 25 employees were not physically overloaded. When physical overload occurred, it was most often due to regular lifting. All employees were physically underloaded on six or more work activities, most often due to finger dexterity and manipulation. Almost all employees (n=43) showed psychosocial overload or underload on one or more psychosocial characteristics. Psychosocial overload was most often due to endurance (long-term work performance), while psychosocial underload was most often due to speaking and writing. Conclusion: Despite the assessment of work capacities at job placement, underload and overload occurred on both physical activities and psychosocial characteristics. Assessing both work capacities and work demands before job placement is recommended. At job placement more attention should be paid to overloading due to lifting and long-term work performance. © 2012 - IOS Press and the authors. All rights reserved.

Patellar tendinopathy is a common injury in jumping athletes. Little is known about work-related etiological factors for patellar tendinopathy and related work limitations. The aim of this study was to identify work-related etiological factors for patellar tendinopathy and to determine the relation between patellar tendinopathy and work limitations. Basketball and volleyball players between 18 and 35 years were invited to complete an online-questionnaire concerning knee complaints, etiological risk factors for patellar tendinopathy and related work limitations. A total of 1505 subjects were included in the analysis. Risk factors for patellar tendinopathy were gender and heavy physically demanding work. The odds for having patellar tendinopathy were significantly higher for heavy physically demanding occupations compared to mentally demanding occupations. 30% of subjects with patellar tendinopathy with a physically demanding job reported to be impaired in their work and 17% reported to be less productive. Basketball and volleyball players with heavy physically demanding work seem to have an increased risk for developing patellar tendinopathy. This finding has important clinical relevance in the treatment of this injury. Working activities should be adjusted in order to reduce the total load on the patellar tendon and help prevention and recovery. © 2011 - IOS Press and the authors. All rights reserved.

The objective of this study was to determine the differences in the number of paving stones laid (productivity), task demands, energetic workload, body region discomfort and preference when laying paving stones with or without use of a paver's trolley (n = 8) in a within-subject controlled study of pavers. The number of paving stones laid and the task demands were measured by means of systematic observations at the workplace. The energetic workload was determined using the percentage of heart rate reserve (%HRR). Body region discomfort was measured using visual analog scales, and the workers' preference was ascertained via interview. The use of a paver's trolley had no effect on productivity, %HRR or body region discomfort compared to working without a paver's trolley. The duration of knee-straining activities did not differ between working with (141 min) and without (146 min) the paver's trolley. However, six of the eight pavers indicated that, given suitable circumstances, they wanted to use the paver's trolley. Relevance to industry: To reduce the chance of work-related low back and knee complaints among pavers, the duration, frequency and intensity of lower back and knee-straining activities should be limited by means of technical measures such as mechanical paving. The paver's trolley does not appear to reduce knee-straining activities and therefore does not appear useful in reducing the risk of knee complaints and disorders. (C) 2010 Elsevier B.V. All rights reserved

Het lumbosacraal radiculair syndroom (LRS, ‘lumbale hernia’) wordt gekenmerkt door in de bil en/of het been uitstralende pijn, vergezeld van een of meerdere symptomen of verschijnselen die een aanwijzing zijn voor een aandoening aan een specifieke lumbosacrale zenuwwortel (www.neurologie.nl/publiek/beroepsinformatie/richtlijnen/nvn-richtlijnen). De meest voorkomende oorzaak van een LRS is een lumbosacrale discushernia. Het aantal nieuwe gevallen van het LRS in de huisartsenpraktijk is 9 per 1000 patienten per jaar. Bij mannen wordt de aandoening vrijwel even vaak vastgesteld als bij vrouwen. Bij jong volwassenen komt LRS nauwelijks voor. De incidentie neemt toe met de leeftijd en is het hoogst in de leeftijdscategorie van 45 tot 64 jaar: 16 per 1000 patienten per jaar. Boven het 65e levensjaar schommelt de incidentie rond de 11 per 1000 patienten per jaar (www.nhg.org/standaarden/samenvatting/lumbosacraal-radiculair-syndroom

Background Waste collectors around the world are at risk for work-related disorders and injuries. The aim of this study was to assess work demands, acute physiologic responses, illnesses, and injuries as a starting point for worker health surveillance (WHS). Methods A systematic search was performed in PubMed and Embase on work demands, acute bodily responses, health, and injuries. A quality assessment and evidence synthesis was performed. Results From a total of 379 retrieved studies, 50 studies fulfilled the inclusion criteria. Waste collecting varied from informal manual gathering to semi-automated systems. Most studies (“number of studies”) on work demands and/or acute bodily responses addressed bioaerosols (14). Studies of health effects addressed respiratory complaints (8), and those on injuries addressed acute musculoskeletal disorders (3). Strong evidence is available that exposure to bioaerosols exceeds recommendations. Moderate evidence is available for an increased risk of respiratory complaints and musculoskeletal injuries, with significant odds ratios reported varying between 1.9–4.1 and 1.5–3.3, respectively. Limited evidence exists for gastrointestinal disorders and hearing loss. Conclusions WHS in waste collection is warranted for early detection of respiratory, gastrointestinal, and musculoskeletal disorders, and hearing loss. Am. J. Ind. Med. 53:1040–1064, 2010. © 2010 Wiley-Liss, Inc.

Background: This study evaluated the effects of a combination of three ergonomic measures designed to reduce the risk of low back complaints among gypsum bricklayers. The measures focused on optimizing working height and reducing carrying distances. Methods: A within-subjects (N=10) controlled field study was used to compare the effects of working with the ergonomic measures with those of working with conventional working methods at the worksite during the course of a full working day. Productivity, work demands, and workload were assessed. Results: No effects were found on productivity, total work time, duration of tasks, duration of carrying, or energetic or biomechanical workload. However, the duration and frequency of working between knee and hip height during a working day increased by 25% and 15%, respectively, due to the ergonomic measures. During the finishing task, the duration and frequency of working below knee level decreased significantly by 4 min and 71 times, respectively. Conclusion: The limited impact of the ergonomic measures argues for additional measures to reduce the risk of low back complaints. Am. J. Ind. Med. 53:608-614, 2010. © 2010 Wiley-Liss, Inc.

Objective: The objective of this paper is to propose a three-step proce dure that can be used in the selection of functional tests from any full Functional Capacity Evaluation (FCE) method in order to assess efficiently physical work-ability in workers with musculoskeletal complaints (MSC) and related functional limitations. Methods: Recently, some authors have considered the selection of functional tests specific to particular jobs from within a full FCE method. In the present study, based on existing literature and on their own expertise on FCE methods, the authors develop in an analogous manner a conceptual framework for selecting functional tests specific to particular MSCs from within a fu ll FCE method. Results: The first step is to establish the worker's medical conditio n and to assign it to one or more defined MSC categories (upper extremity, back, lower extremity). The second step is to identify activities that are restricted by the medical c ondition (e.g., lifting and bending for MSC of the back). The third and final step is to select functional tests from a full FCE tests b attery to permit measurement of the restricted activities identifi ed in Step 2, striving to avoid redundancy by selecting a limited number of tests for each activity under investigation. Conclusions: The proposed three-step procedure is a new approach to enhance the efficiency and practicality of FCEs.

Vier weken lang gratis verblijven in een spa-kuuroord, thuis lekker de boel de boel laten, samen zijn met lotgenoten, diverse fitnesstrainingen en coaching krijgen onder begeleiding van experts… Welke werkende wil dit niet?

Introduction A large number of patients undergoing total knee (TKA) and hip (THA) arthroplasties are of working age at the time these procedures are performed. The objective of this study was to systematically review literature on the beneficial and limiting factors affecting return to work in patients undergoing TKA or THA. Method Pubmed and Embase were systematically searched to find studies that described factors that influence return to work (RTW) after surgery. The following inclusion criteria had to be met: (1) inclusion of patients with primary or revision TKA or THA; (2) description of return to work after surgery or employment status; and (3) description of a beneficial or restricting factor affecting return to work. Results Only three studies were found that fulfilled the three inclusion criteria. Three factors were discussed: (1) the mini-posterior approach compared to the two-incision approach; (2) patient movement restrictions after surgery compared to no restrictions; and (3) patient discharge based on guidelines compared to discharge without guidelines. Conclusions This systematic review revealed that knowledge is sparse regarding beneficial or limiting factors affecting return to work after TKA or THA. Despite that, the results suggests that the two-incision approach is beneficial, patient movement restrictions are limiting, and patient discharge guidelines have no effect on the time patients take to RTW.

Objectives: To assess the criterion-related validity of the five Ergo-Kit (EK) functional capacity evaluation (FCE) lifting tests in construction workers on sick leave due to musculoskeletal disorders (MSDs). Methods: Six weeks, 6 months and 1 year after the first sick leave day due to MSDs, construction workers underwent two isometric and three dynamic EK FCE lifting tests, and completed the Instrument for Disability Risk (IDR) for future work disability risk. Concurrent and predictive validity were assessed by the associations between the scores of the EK FCE lifting tests and the IDR outcomes (Pearson Correlation coefficients (r) and associated proportions of variance (PV) and area under receiver operating characteristic curve (AUC)). Predictive validity of the EK FCE lifting tests on the total number of days on sick leave until full durable return to work (RTW) was also evaluated (Cox regression analysis). Results: Concurrent validity with future work disability risk was poor for the two isometric EK FCE lifting tests (-0.15

Artrose staat op de negende plaats in de top tien van ziekten met de grootste ziektelast (DALY’s) en is de enige aandoening aan het bewegingsapparaat in de top tien. Op de eerste plaats staan coronaire hartziekten en op de tiende plaats dementie. Deze topnotering voor artrose komt niet door het aantal verloren levensjaren, maar door het grote aantal personen met deze aandoening inclusief de bijbehorende afname van kwaliteit van leven.1 Het RIVM stelt dat door demografische ontwikkelingen de verwachting is dat het absolute aantal personen met artrose tussen 2000 en 2020 met 38% zal stijgen.2 Het Nederlands Centrum voor Beroepsziekten concludeerde dat de arbeidsgerelateerdheid van artrose van knie en heup voor uitval uit en terugkeer naar werk in het komende decennium steeds belangrijker wordt.3 Dit komt onder andere doordat werknemers op latere leeftijd stoppen met werken, de verwachte toename van overgewicht en de aanwezigheid van risicofactoren in het werk voor deze aandoeningen. Om de mate van arbeidsgerelateerdheid van deze aandoeningen op een systematische manier te bepalen, zijn registratierichtlijnen voor artrose van de knie en de heup ontwikkeld.

The effect of block weight on work demands and physical workload was determined for masons who laid sandstone building blocks over the course of a full work day. Three groups of five sandstone block masons participated. Each group worked with a different block weight: 11 kg, 14 kg or 16 kg. Productivity and durations of tasks and activities were assessed through real time observations at the work site. Energetic workload was also assessed through monitoring the heart rate and oxygen consumption at the work site. Spinal load of the low back was estimated by calculating the cumulated elastic energy stored in the lumbar spine using durations of activities and previous data on corresponding compression forces. Block weight had no effect on productivity, duration or frequency of tasks and activities, energetic workload or cumulative spinal load. Working with any of the block weights exceeded exposure guidelines for work demands and physical workload. This implies that, regardless of block weight in the range of 11 to 16 kg, mechanical lifting equipment or devices to adjust work height should be implemented to substantially lower the risk of low back injuries.

Background Major depressive disorder (MDD) is often a chronic relapsing disease resulting in work disability. For evaluation purposes a practical set of aspects of work ability would be helpful. Aim To identify the most important disease-specific aspects of work ability for sick-listed employees with MDD. Methods An expert brainstorming session identified the specific abilities that were thought to be associated with work ability in sick-listed employees with MDD and that could also be associated with the items of the Hamilton Rating scale for Depression. Sixty-four insurance physicians (IPs) were then selected to participate in a two-round Delphi study. The aim of the first Delphi round was to identify the abilities that were thought to be important by at least 80% of the IPs. In the second Delphi round, the abilities ranked in the top 10 by at least 55% of the IPs were identified as being the most important items. Results Sixty-one IPs participated in the two Delphi rounds. The most important abilities to be evaluated in work ability evaluation for sick-listed employees with MDD were to take notice, to sustain attention, to focus attention, to complete operations, to think in a goal-directed manner, to remember, to perform routine operations, to undertake structured work activities, to recall and to perform autonomously. Conclusion According to 55% of the IPs, there were 10 important aspects of work ability that have to be considered in a work ability evaluation of sick-listed employees with MDD.

Objective: Identifying prognostic factors for work ability in sicklisted employees with Myocardial Infarction (MI), chronic Low Back Pain (cLBP) and Major Depressive Disorder (MDD) in order to establish an objective basis for work ability evaluation. Design: Systematic literature search in PubMed database (01/01/1990 to 01/07/2006) with the Yale prognostic research filter. Inclusion criteria were as follows: (1) work-disabled employees; (2) MI, cLBP or MDD patients; (3) longitudinal designs; and (4) return to work or compensation status as outcome measure. Results: Four studies on MI met the inclusion criteria and described the following prognostic factors for work ability in the acute phase of the disease and disablement: lower age; male gender; no financial basis on which to retire; lower physical job demands; fewer somatic complaints; no anxiety attacks; no diabetes; no heart failure; no atrial fibrillation; no Q waves; and a short time interval between MI and presentation at the occupational medicine clinic. Two studies on cLBP met the inclusion criteria and described the following prognostic factors for work ability after three months’ work disablement: lower age; male gender; no treatment before sick listing; surgery in the first year of sick listing; being a breadwinner; less pain; better general health; higher job satisfaction; lower physical and/or psychological demands at work; and a higher decision latitude at work. No relevant MDD studies were found. Conclusion: In the earlier phases of work disablement in MI and cLBP patients, only a few studies describe disease-specific, environmental and personal prognostic factors for return to work. No studies describe prognostic factors for MDD. More evidence is needed on the topic of prognostic factors for return to work in employees with chronic diseases.

Recent epidemiological studies show that pushing and pulling increase the risks of shoulder complaints and not necessarily of low back complaints. Moreover, the magnitude of the exerted hand forces during pushing and pulling is poorly related to the magnitude of the mechanical loading of the low back and the shoulder. In light of that, this paper combines results of several studies to present an approach for evaluating not only the exerted hand forces, but also the low back and shoulder load during pushing and pulling in practice. The approach specifies, based on scientific evidence, that (1) in order to validly obtain exposure (frequency and duration) to pushing and pulling, 10 workers should be observed during eight periods of 30 min; (2) how the exerted hand forces and the load of the low back and shoulder can be estimated in practice based solemnly on the weight of the object, one-handed or two-handed pushing or pulling, and the height of the handle; and finally, (3) how these outcomes can be evaluated in combination with existing guidelines regarding exerted hand forces, compression forces on the low back and the moments at the shoulder. Two cases will be presented here to illustrate the application of the approach. Relevance to industry The presented approach is the first to offer practitioners a fairly simple method for the ergonomic evaluation of pushing and pulling carts and four-wheeled containers in practice, especially as regarding the shoulder load. (c) 2007 Elsevier B.V. All rights reserved

Elite overhead athletes are at risk of vascular injury due to repetitive abduction and external rotation of the dominant arm. The posterior circumflex humeral artery (PCHA) is prone to degeneration, aneurysm formation, and thrombosis in elite volleyball players and baseball pitchers. The prevalence of PCHA-related thromboembolic complications is unknown in this population. However, the prevalence of symptoms associated with digital ischemia is 31% in elite volleyball players. A standardized noninvasive imaging tool will aid in early detection of PCHA injury, prevention of thromboembolic complications, and measurement reproducibility. A standardized vascular sonographic protocol for assessment of the proximal PCHA (SPI-US protocol [Shoulder PCHA Pathology and Digital Ischemia-Ultrasound protocol]) is presented.

Objectives: This qualitative study explored how Dutch experts perceive the utility of functional capacity evaluation (FCE) for return to work (RTW) and disability claim (DC) assessment purposes. Methods: Twenty-one RTW case managers and 29 DC experts were interviewed by telephone using a semi-structured interview schedule. Results: The RTW case managers valued the utility of FCE on a scale of 0–10. Their mean valuation was 6.5 (SD 1.5). The average valuation for DC experts was 4.8 (SD 2.2). Arguments in favor of FCE were (1) its ability to confirm own opinions and (2) the objectivity of its measurement method. Arguments against FCE were (1) the redundancy of the information it provides and (2) the lack of objectivity. Indications for FCE were musculoskeletal disorders, a positive patient self-perception of ability to work, and the presence of an actual job. Contraindications for FCE were medically unexplained disorders, a negative patient self-perception of ability to work, and the existence of disputes and legal procedures. Conclusions: The responding RTW case managers perceived FCE to be more useful than the responding DC experts. The question of whether the arguments presented for and against the utility of FCE are valid is one that should be addressed in a future study.

Dit artikel is eerder verschenen in het European Journal of Pain en wordt met toestemming van dat tijdschrift in een Nederlandse vertaling in twee delen in TBV gepubliceerd.

The aim of this systematic review was to survey methods to assess the functional capacity of the musculoskeletal system within the context of work, daily activities, and sport. The following key words and synonyms were used: functional physical assessment, healthy/disabled subjects, and instruments. After applying the inclusion criteria on 697 potential studies and a methodological quality appraisal, 34 studies were included. A level of reliability > 0.80 and of > 0.60 resp 0.75 and 0.90, dependent of type of validity, was considered high. Four questionnaires (the Oswestry Disability Index, the Pain Disability Index, the Roland-Morris Disability Questionnaire, and the Upper Extremity Functional Scale) have high levels on both validity and reliability. None of the functional tests had a high level of both reliability and validity. A combination of a questionnaire and a functional test would seem to be the best instrument to assess functional capacity of the musculoskeletal system, but need further examined.

Background Job rotation might be an effective preventive measure to reduce the prevalence ofmusculoskeletalcomplaints,althoughits effect hasnotbeenyet established. The aim of the present study is to evaluate the effect of job rotation in refuse collecting on need for recovery, prevalence of musculoskeletal complaints, and sick leave due to musculoskeletal complaints. Methods A 1-year prospective study among refuse collectors was performed, using standardized questionnaires. Job rotation was performed between collecting two-wheeled containersanddrivingarefusetruck.Theexperimentalgroupsofrotatingrefusecollectors at t0 and t1 (group R-R) and non-rotating refuse collectors at t0 and rotating refuse collectors att1(group NR-R)were comparedwith areferencegroupofnon-rotatingrefuse collectors at t0 and t1 (group NR-NR). Results The adjusted need for recovery of group R-R was marginally significantly lower than need for recovery of the referencegroup. Groups R-R and NR-R had a more than two times higher risk for complaints of the low back than the reference group. No other significant results were found. Conclusions Job rotation seemed to coincide with a reduced need for recovery and was associated with an increased risk of low back complaints. No effects were found on sick leave due to musculoskeletal complaints. The results might be influenced by the healthy workerselectioneffectinthereferencegroupanditsinverseintherotatinggroups. Am. J. Ind. Med. 47:394–402, 2005. 2005 Wiley-Liss, Inc.

Objective: To assess whether participants were able to select the handgrip position on a Jamar hand dynamometer with which the maximal handgrip strength could be delivered, while sitting and while standing. Design: A criterion standard comparison study. Setting: A university campus in the Netherlands. Participants: Fifty-six healthy subjects (30 men, 26 women; mean age, 30y; range, 19-60y) voluntarily participated. Interventions: Not applicable. Main Outcome Measures: Maximal handgrip strength for the self-selected and non-self-selected handgrip position of the hand dynamometer (positions 2 or 3), while sitting and while standing. Results: The self-selected handgrip position resulted in the highest mean maximal grip strength compared with the non-self-selected handgrip strength, both for sitting (mean difference, 2.3kg; Pless than or equal to.001) and for standing (mean difference, 2.1kg; Pless than or equal to.001). Results: The self-selected handgrip position resulted in the highest mean maximal grip strength compared with the non-self-selected handgrip strength, both for sitting (mean difference, 2.3kg; Pless than or equal to.001) and for standing (mean difference, 2.1kg; Pless than or equal to.001). Conclusions: Both in sitting and in standing, participants were able to self-select the handgrip position on the hand dynamometer with which the maximal handgrip strength could be delivered. Therefore, it may be useful to introduce self-selection of the handgrip position in protocols to assess the maximal handgrip strength

Objectives: Functional Capacity Evaluation methods (FCE) claim to measure the functional physical ability of a person to perform work-related tasks. The purpose of the present study was to systematically review the literature on the reliability and validity of four FCEs: the Blankenship system (BS), the ERGOS work simulator (EWS), the Ergo-Kit (EK) and the Isernhagen work system (IWS). Methods: A systematic literature search was conducted in five databases (CINAHL, Medline, Embase, OSH-ROM and Picarta) using the following keywords and their synonyms: functional capacity evaluation, reliability and validity. The search strategy was performed for relevance in titles and abstracts, and the databases were limited to literature published between 1980 and April 2004. Two independent reviewers applied the inclusion criteria to select all relevant articles and evaluated the methodological quality of all included articles. Results: The search resulted in 77 potential relevant references but only 12 papers were identified for inclusion and assessed for their methodological quality. The interrater reliability and predictive validity of the IWS were evaluated as good while the procedure used in the intrarater reliability (test–retest) studies was not rigorous enough to allow any conclusion. The concurrent validity of the EWS and EK was not demonstrated while no study was found on their reliability. No study was found on the reliability and validity of the BS. Conclusions: More rigorous studies are needed to demonstrate the reliability and the validity of FCE methods, especially the BS, EWS and EK.

The efficacy of ergonomics measures to reduce physical work demands in a real working situation is often assumed, but seldom studied. In this study, the effect of adjusting working height and mechanization of transport on physical work demands and local discomfort of bricklayers' work was evaluated during a field experiment in the construction industry. In a within-subjects controlled experiment, 10 bricklayers and 10 bricklayers' assistants worked in two different conditions. Working height of bricks and mortar, and transport of materials were manipulated. The physical work demands were assessed through real time observations at the work site. Local discomfort of the lower back and of the shoulder region was measured by means of a visual analogue scale. Working with a scaffolding console to adjust the working height of the storage of materials resulted in a significant reduction of the frequency and duration of trunk flexion (> 60 degrees) by 79% and 52% respectively, compared with bricks set out on the ground floor. Mechanization of transport of materials resulted in a significant reduction of the frequency and duration of trunk flexion (> 60 degrees) by 94% and 92% respectively, compared with the condition of manual handling. The frequency of handling objects (> 4 kg) reduced significantly by 86%. Local discomfort of the lower back was significantly less in the ergonomic conditions, while no significant difference was found for local discomfort of the shoulder between both conditions in bricklayers' assistants.

A discussion of risks of the job and measures to protect the workers Refuse is collected all around the world. The following collecting methods are mentioned in the literature:1 bags (plastic and paper), bins (110–150 l), drums (110–210 l), two-wheeled containers (80–360 l), and four-wheeled containers (300–1800 l). Over all, the job of a refuse collector can be characterised by frequent lifting, carrying, pushing, and/or pulling of heavy objects. In the Netherlands, most production systems to collect domestic refuse make use of a closed refuse truck with an automatic lifting device to empty two-wheeled containers (fig 1) or four-wheeled containers (fig 2).2,3 Only in a few parts of the Netherlands, especially in city areas where households have no space to place a container, are bags collected.4 In general, the wheeled containers are collected by a team of a truck driver and one or two refuse collectors. Table 1 presents the time spent on the different tasks and activities.2 An average work day of a refuse collector lasts about 8 hours (range 6–12). A refuse collector of two-wheeled containers collects about 11 000 kg of refuse per day, and a refuse collector of four-wheeled containers about 14 000 kg. This is about 500 (22 kg of refuse per container) two-wheeled containers and 130 (110 kg of refuse per container) four-wheeled containers each day. In general, a refuse collector pushes and pulls one two-wheeled container at a time. Pulling of the two-wheeled container is often done with one hand behind the back. A four-wheeled container is in general transferred by two persons.2 View this table: Table 1 Mean (SD) of the duration of the most important tasks and activities for refuse collectors of two-wheeled and four-wheeled containers in the Netherlands2 Figure 1 Collecting of two-wheeled containers. Figure 2 Collecting of a four-wheeled container. The …

Klinische arbeidsgeneeskunde voorziet in een behoefte bij medisch specialisten en bedrijfsartsen omdat zij complexe vragen over de wisselwerking tussen gezondheid en werk onvoldoende alleen kunnen beantwoorden.1,2 Een multidisciplinair team waarin de arbeidsgeneeskunde is opgenomen, kan een etiologische diagnose bij vermoede beroepsziekten stellen en adviezen formuleren voor effectieve interventies bij (dreigende) arbeidsongeschiktheid door multifactoriele aandoeningen. Vanwege de daar aanwezige expertise is in 2005 de Polikliniek Mens en Arbeid (PMA) opgericht vanuit het Nederlands Centrum voor Beroepsziekten (NCvB).