lable at ScienceDirect International Journal of Industrial Ergonomics 44 (2014) 817e820 Contents lists avai International Journal of Industrial Ergonomics journal homepage: www.elsevier .com/locate/ergon Assessing exposure to risk factors for work-related musculoskeletal disorders using Quick Exposure Check (QEC) in taxi drivers Emre €Ozgür Bulduk a, *, Sıdıka Bulduk b, Tufan Süren b, Feride Ovalı c a Health Faculty, Physiotherapy and Rehabilitation Department, Nuh Nazi Yazgan University, Kayseri, Turkey b Faculty of Vocational Education, Department of Food and Nutrition, Gazi University, Ankara, Turkey c Faculty of Industrial Arts and Education, Gazi University, Ankara, Turkey a r t i c l e i n f o Article history: Received 17 December 2013 Received in revised form 25 July 2014 Accepted 6 October 2014 Available online 7 November 2014 Keywords: Ergonomics Taxi drivers Quick Exposure Check Musculoskeletal disorders * Corresponding author. E-mail address:
[email protected] (E.€O. Bulduk http://dx.doi.org/10.1016/j.ergon.2014.10.002 0169-8141/© 2014 Elsevier B.V. All rights reserved. a b s t r a c t Work-related musculoskeletal disorders (WMSDs) are a common health problem throughout the world. This study aimed to examine the risk factors that are involved in the development of WMSDs in taxi drivers. In total 382 taxi drivers were observed using Quick Exposure Check (QEC) observational tool, which allows practitioners and workers to assess four key areas of the body. Results of the QEC scores were found to be very high for the shoulder/arm, wrist/hand and neck, whereas the scores for the back were found to be high for static use and moderate for moving. The results also showed that the occu- pational risk factors for WMSDs were associated with restricted postures, repetitive movements, vi- bration, work related stress. Essential ergonomic interventions are needed to eliminate risk of exposures to WMSDs in taxi drivers. Relevance to industry: The study results have relevance for ergonomists, health and safety practitioners as well as the drivers themselves, and helpful for estimating the main physical risk factors for WMDSs before choosing a method prior to an ergonomic intervention in industry. © 2014 Elsevier B.V. All rights reserved. 1. Introduction Work-related musculoskeletal disorders (WMSDs) are a major public health concern, which often result in work restriction, work- time loss and consequently low retirement age (Cheng et al., 2013). WMSDs are considered to be the most common and costly occu- pational health issue among taxi drivers (Ferguson et al., 2012). Work related risk factors for taxi drivers include physical demands imposed by prolonged periods of sitting, deviations from neutral body alignments, repetitive motions, vibration, noise, strenuous tasks, and frequent handling of luggage. A number of studies have shown that WMSDs are commonly reported by drivers of buses, trucks and taxis (Raanaas and Anderson, 2008; Kankaanp€a€a et al., 2005; Sullman et al., 2013; Thamsuwan et al., 2013; Okunribido et al., 2007). WMSDs have serious effects on the human body and have been found to be associated with psychological stressors in the workplace including anger, anxiety and time pressure, and low perceived social support. Additional risk factors forWMSDs include hormonal and individual characteristics such as gender, age, socio- economic status and domestic workloads that can cause serious ). hormonal and cardiovascular responses at work (Eatough et al., 2012; Feuerstein, 2004). When examining risk factors, studies limit their analysis by controlling or adjusting for the individual factors (Darasieh et al., 2010). Ergonomics focuses on how work affects people in their working environment developing solutions, with the aim of improving productivity, reducing discomfort and minimizing the hazards of work (Bube, 1985; Boocock, 2007). Discomfort has been assessed using the psychophysical methods such as discomfort scales and body maps for preventing musculo- skeletal disorders and improving work environment (Kee and Karwowski, 2003). WMSDs are one of the most important health problems that ergonomists encounter all over the world. Physio- logical, psychological and individual stressors can cause pain, tenderness, swelling and even loss of function of hands, wrists, elbows, shoulders, the neck and back (Karimfar, 2008; Sancini, 2013). Several observational techniques were developed for assessing risk factors related with musculoskeletal disorders (Kee and Karwowski, 2007). The Quick Exposure Check (QEC) was the one of these obser- vational techniques and developed for ergonomists, health and safety practitioners in order to investigate musculoskeletal risk factors in workers (David et al., 2008). The present study aimed to investigate the risk factors for WMSDs using QEC in taxi drivers. The results of this study will inform practitioners engaged in Delta:1_given name Delta:1_surname Delta:1_given name Delta:1_surname mailto:
[email protected] http://crossmark.crossref.org/dialog/?doi=10.1016/j.ergon.2014.10.002&domain=pdf www.sciencedirect.com/science/journal/01698141 http://www.elsevier.com/locate/ergon http://dx.doi.org/10.1016/j.ergon.2014.10.002 http://dx.doi.org/10.1016/j.ergon.2014.10.002 http://dx.doi.org/10.1016/j.ergon.2014.10.002 Table 1 Characteristics of the study subjects. Age (years) Number % 22e32 102 26.70 33e43 109 28.53 44e54 97 25.39 55e65 71 18.59 66 and above 3 0.79 Total 382 100.00 Working experience (in years) Number % 1e5 96 25.13 6e10 101 26.44 11e15 112 29.32 16e20 47 12.30 21e25 21 4.60 26 and above 5 1.31 Total 382 100.00 E.€O. Bulduk et al. / International Journal of Industrial Ergonomics 44 (2014) 817e820818 planning appropriate ergonomics programmes for taxi drivers in the city of Ankara in Turkey. 2. Materials and methods 2.1. Participants The participants in this study were recruited through The Public Vehicle Owners and Drivers' Union and a total of 382 Turkish taxi drivers from the city of Ankara (Turkey). In Ankara, taxi drivers work approximately 10e12 h per day, with 6 days on and 1 day off. All taxi drivers must be 18 years or older and the members of The Public Vehicle Owners and Drivers' Union in order to work. Taxi drivers were informed as to the purpose of the study. Taxi drivers completed the survey voluntary. All participants were male and aged between 22 and 66 and above. Only one driver was aged above 66. Drivers' occupational experience was evaluated in terms of the number of years they had been employed as taxi drivers. 2.2. Task The physical exposure risk factors of WMSDs and changes in exposure can be measured by various observational assessment techniques. QEC was developed by Li and Buckle in 1998 and modified by David, Woods and Buckle in 2003. Evaluation of the inter-user reliability, validity and usability of QEC were determined in two phases of development, with participation of 206 practi- tioners (David et al., 2005). This technique has been previously applied to taxi drivers and includes assessment of four areas of the body, namely the back, shoulder/arm, wrist/hand and neck, with regards to postures and repetitive movements. A combination of exposures between different risk factors is shown in a scoring table. The exposure levels for back, shoulder/arm, wrist/hand and neck are categorised into four exposure categories: low, moderate, high and very high. The range of score for back (static) is 8e15 for low, 16e22 for moderate, 23e29 for high and 29e30 for very high. The range of score for back (moving), shoulder/arm and wrist/hand is 10e20 for low, 21e30 for moderate, 31e40 for high and 41e60 for very high. Exposure scores of the neck range from 4 to 6 for low, 8e10 for moderate,12e14 for high and 16e20 for very high. Finally, QEC analysis also checks the exposure levels of categories including; driving, vibration, work pace and occupational stress. These exposure scores, ranging from 1 to 4, correspond to low, moderate, high and very high risk levels respectively. In 2008, the reliability of the Turkish translation of the QEC used for risk as- sessments of WMSDs was investigated by €Ozcan and colleagues and they suggested that, QEC is a useful and sensitive observational technique for assessing exposure to risk factors for WMSDs (€Ozcan, 2011). Possible questions about socio-economic status of the taxi drivers could not be included as being too sensitive and intrusive of privacy. The required papers on the objective, the subjects and the method of the study; where the study would be conducted and confidentiality for study participants were submitted to The Public Vehicle Owners and Drivers' Union in Ankara and permission was obtained before starting the study. 2.3. Statistics The association that represents taxi drivers working in the city of Ankara was approached and informed about this study. Direct contacts were established between the researchers and taxi drivers with the permission of The Public Vehicle Owners and Drivers' Union. The Study was briefly described to taxi drivers whose participation was voluntary. No names were attached to the ques- tionnaires that were carefully administered by the researchers. Statistical analysis was performed with SPSS (version 15.0). The Chi-square test was used to identify the relationship of the musculoskeletal disorders between drivers' age and duration of service. p Values Table 2 Exposure level standards for back, shoulder, wrist and neck (David et al., 2005). Exposure level Score Low Moderate High Very high Back (static) 8e15 16e22 23e29 29e40 Back (moving) 10e20 21e30 31e40 41e56 Shoulder/arm 10e20 21e30 31e40 41e56 Wrist/hand 10e20 21e30 31e40 41e56 Neck 4e6 8e10 12e14 16e18 Table 3 Exposure level (quick exposure check). Back (moving) Back (static) Shoulder/arm Wrist/hand Neck Score 32.1 ± 4.4 19.3 ± 4.7 43.7 ± 3.2 43.4 ± 6.3 17.1 ± 2.2 Exposure level High Moderate Very high Very high Very high Table 6 Relationship between risk factors for musculoskeletal disorders and age. Age N Risk factors for musculoskeletal disorders Available Not available N % N % 22e32 (102) 13 12.75 89 87.25 33e43 (109) 26 23.85 83 76.15 44e54 (97) 81 83.51 16 16.49 55e65 (71) 71 100.00 e e 65 ve üstü (3) 3 100.00 e e c2 ¼ 5.89, df ¼ 4, p < 0.05. E.€O. Bulduk et al. / International Journal of Industrial Ergonomics 44 (2014) 817e820 819 nature of all outcome measures. The data may be influenced by the self-reported assessment techniques. Second, the lack of evaluation of the lifestyle factors such as smoking, eating habits and alcohol consumption of the taxi drivers. The results of our study indicated that taxi drivers in Ankara had very high scores of risk exposures for shoulder/arm (43.7 ± 3.2), wrist/hand (43.4 ± 6.3) and neck (17.1 ± 2.2). However the risk exposures for back (static) and back (moving) were found high (32.1 ± 4.4) and moderate (19.3 ± 4.7) respectively. It was suggested that working style or how a person responds to work demands may be related to upper extremity symptoms (Haufler et al., 2000). According to the literature the most affected body regions for WMSDs are shoulders, arms, wrists, fingers and the neck (Akbal, 2012; €Oztürk and Esin, 2012; Eatough et al., 2012; Ronchese and Bovenzi, 2012). Lewis et al. (2002) and Esmaeilzadeh et al. (2012) indicated that ergonomic interventions are very necessary and effective for reducing the risks of muscu- loskeletal disorders in neck and upper extremities. Daily exposure to constrained body postures and deviations from neutral postures over a long period may result in discomfort in joints, muscles and soft tissues (Kee and Karwowski, 2001). Gourdeau (1997) investi- gated the prevalence of neck and shoulder musculoskeletal disor- ders in 126 schoolbus drivers. The results showed that schoolbus drivers had more musculoskeletal problems in their necks and Table 4 Exposure level standards for other factors. Exposure level Score Low Moderate High Very high Driving 1 4 9 e Vibration 1 4 9 e Work pace 1 4 9 e Stress 1 4 9 16 Table 5 Exposure level for other factors. Score Driving Vibration Working pace Stress N % N % N % N % 1 91 23.80 98 25.65 21 5.50 3 0.79 4 104 27.20 135 35.34 145 39.00 89 23.31 9 187 49.00 149 39.01 216 56.50 91 23.80 16 e e e e e e 199 52.10 Total 382 100.00 382 100.00 382 100.00 382 100.00 shoulders in the previous 12 months (Lewis et al., 2002; Esmaeilzadeh et al., 2012; Gourdeau, 1997). Alperovitch-Najenson et al. (2010) studied the prevalence of upper body quadrant pain among 384 Israeli professional urban bus drivers. According to their results; the 12-month prevalence of neck pain was 21.2%, followed by shoulder: 14.7%, upper back: 8.3%, elbow and wrist: 3.0% pain. In our study, exposure levels for shoulder/arm, wrist/hand and neck were found to be very high (Alperovitch-Najenson et al., 2010). Szeto and Lam (2007) investigated the prevalence and character- istics of WMSDs among 481 urban bus drivers in Hong Kong. They found that long driving hours put the bus drivers in a high risk group for musculoskeletal disorders. Stress associated with long working hours causes musculoskeletal disorders, depression of the immune system and psychosomatic problems. In our study 49% of the taxi drivers reported a high level of driving hours. These taxi drivers had been driving a vehicle more than 4 h per a day. Based on biomechanical knowledge, continuous vibration, working pace and work stress affect the spine and the soft tissues. In our study, vi- bration and working pace scores were found to be high and the work stress scores were very high (Szeto and Lam, 2007). Pope et al. (2002) found that when the spine was loaded axially for long pe- riods, the muscles and soft tissues became fatigued (Pope et al., 2002). Prolonged seated exposures and long car journeys could have potential for lumbar spine stiffness, back pain and injury. Potential causes for low back pain, vibration exposure and exposure to flexed postures for prolonged periods had been shown to in- crease the stress on the posterior elements of the spine and intra- discal pressures (De Carvalho and Callaghan, 2011). It is known that low back pain causes reflexive muscle spasms and alters kin- aesthetic awareness (Solomonow et al., 2003). In our study, expo- sure levels for back (moving) and back (static) were found to be high and moderate respectively. Okunribido et al. (2007) investi- gated the exposures to posture demands, manual materials handling and whole-body vibration in bus drivers. They found that drivers were exposed to high levels of vibration. Our results also supported these results (Okunribido et al., 2007). Massaccesi et al. (2003) and Hulshof et al. (2006) found that musculoskeletal Table 7 Relationship between risk factors for musculoskeletal disorders and work experience. Year of work experience N Risk factors for musculoskeletal disorders Available Not available N % N % 1e5 (96) 16 16.67 87 90.63 6e10 (101) 24 23.76 77 76.24 11e15 (112) 61 54.46 51 45.54 16e20 (47) 45 95.74 2 4.26 21e25 (21) 21 100.00 e e 26 and above (5) 5 100.00 e e c2 ¼ 6.81, df ¼ 5, p < 0.05. E.€O. Bulduk et al. / International Journal of Industrial Ergonomics 44 (2014) 817e820820 problems increased in drivers due to age and the number of years they had been driving. These findings are closely related with our results. We observed that an increase in drivers' age and the number of years they had been driving were key indicators of their risk of developing musculoskeletal problems. Based on our find- ings, there are significant correlation between our study and the studies about WMSDs in the literature. 5. Conclusion In summary, the present research was the first to investigate the exposure to risk factors for WMSDs among taxi drivers in Ankara. 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Introduction 2. Materials and methods 2.1. Participants 2.2. Task 2.3. Statistics 3. Results 4. Discussion 5. Conclusion References