Upper-limb Work-related Musculoskeletal Disorders Research Articles

Generalizability of a Musculoskeletal Therapist Electronic Health Record for Modelling Outcomes to Work-Related Musculoskeletal Disorders.

Electronic Health Records (EHRs) can contain vast amounts of clinical information that could be reused in modelling outcomes of work-related musculoskeletal disorders (WMSDs). Determining the generalizability of an EHR dataset is an important step in determining the appropriateness of its reuse. The study aims to describe the EHR dataset used by occupational musculoskeletal therapists and determine whether the EHR dataset is generalizable to the Australian workers' population and injury characteristics seen in workers' compensation claims. Variables were considered if they were associated with outcomes of WMSDs and variables data were available. Completeness and external validity assessment analysed frequency distributions, percentage of records and confidence intervals. There were 48,434 patient care plans across 10 industries from 2014 to 2021. The EHR collects information related to clinical interventions, health and psychosocial factors, job demands, work accommodations as well as workplace culture, which have all been shown to be valuable variables in determining outcomes to WMSDs. Distributions of age, duration of employment, gender and region of birth were mostly similar to the Australian workforce. Upper limb WMSDs were higher in the EHR compared to workers' compensation claims and diagnoses were similar. The study shows the EHR has strong potential to be used for further research into WMSDs as it has a similar population to the Australian workforce, manufacturing industry and workers' compensation claims. It contains many variables that may be relevant in modelling outcomes to WMSDs that are not typically available in existing datasets.

English

Overhead work is a main risk factor for upper limb work-related musculoskeletal disorders. In this paper, the research team evaluated the effectiveness of a passive exoskeleton(PE) with a mechanical arm linked to the exoskeleton body as an assistive device for overhead work. Ten male volunteers participated in the research by effectuating repetitive overhead lifting tasks using each of three payloads: (1kg, 3kg, and 6kg) and with/without passive exoskeleton (PE). The performance evaluation was then conducted by analyzing the electromyography (EMG) and ratings of perceived discomfort(RPD) of the shoulders and back muscles obtained from experiments.

A Passive Upper Limb Exoskeleton With Tilted and Offset Shoulder Joints for Assisting Overhead Tasks

Overhead tasks, mostly in the industrial sector, frequently cause upper limb work-related musculoskeletal disorders (WMSDs) leading to low productivity. Although passive upper limb exoskeletons have been used in industry to decrease upper limb WMSDs, they are limited to assist in overhead tasks, as they lack sufficient range of motion (ROM), assistive performance, and wearability. Here, we propose a passive upper limb exoskeleton with tilted and offset shoulder joints, enhanced ROM, and assistive mechanisms to effectively assist the upper limb. The ROM of the shoulder joint, tilted and offset to the rear of the user to increase the range, was sufficient at a 165° elevation angle, revealed by simulations and experiments. The assistive mechanism loads and unloads a spring to passively generate assistive torque. Our results showed that 9.5 N·m of maximum assistive torque was generated at 120°, which is sufficient to assist overhead task with a 1-kg tool. The assistive torque profile can be adjusted by changing the design parameters. Finally, assistance performance was evaluated by user verifications via electromyography experiments in welding-like tasks. The muscle activities of the anterior deltoid and lateral deltoid, the main muscles of shoulder flexion, were reduced to 32.4% and 45.2%, respectively.

Resistance Training Improves Physical Fitness and Reduces Pain Perception in Workers with Upper Limb Work-Related Musculoskeletal Disorders: A Pilot Study

Work-related musculoskeletal disorders (WRMDs) are a cause of productivity loss and disability. Resistance training (RT) and stretching seems to relieve pain, reducing the relative workload via an improvement in range of motion. Sixteen women (age: 48.69 ± 5.88 years old, working career duration as a packager: 22.75 ± 2.18 years) were recruited to participate in a 14-week work-based RT and stretching program. Specific exercise training (SET) targeting all body areas affected by WRMDs was performed after week 6. Physical fitness was measured via the 2 min step test (2MST), the back scratch test and the handgrip test (HG). To evaluate the level of pain in the cervical spine, shoulder, elbow and wrist, the visual analogue scale (VAS) was used. Differences were verified with a t-test. The cervical spine (p = 0.02) and left wrist (p = 0.04) VAS decreased, whereas the HG for both right (p = 0.01) and left (p = 0.01) hands and the 2MST (p = 0.01) improved. Participants with WRMDs affecting the cervical spine reported a 3.72 higher VAS score for the neck at the beginning of the protocol (p = 0.03). The protocol improved the physical fitness of participants but showed a limited effect on WRMD pain. The mean adherence was 86.2%, which indicated that exercise performed in the workplace is well accepted and could be used for pain management.

Incidence and Risk Factors of the Upper-Limb Musculoskeletal Disorders Among Occupational Groups in Key Industries - China, 2018-2021.

The burden of illness and economic losses due to upper-limb work-related musculoskeletal disorders (UL-WMSDs) is high; thus, they have become a major global public health problem. At present, the epidemiological characteristics of UL-WMSDs in China's occupational population are still unknown. The incidence of UL-WMSDs among key occupational groups in China is 22.5%, with distinct occupational characteristics. This study has primarily determined the occurrence and potential risk factors of UL-WMSDs in key industries in China and provided data support for recommending prevention and control of the occurrence of such diseases in key industries in China, and in facilitating the addition into the China's List of Legal Occupational Diseases.

The effect of different work-rest schedules on ergonomic risk in poultry slaughterhouse workers.

BACKGROUND:Rest breaks are an organizational measure to reduce the high risk of upper limb work-related musculoskeletal disorders (UL-WMSDs) to which slaughterhouse workers are subject.OBJECTIVE:To analyze the effect of different work-rest schedules on ergonomic risk in poultry slaughterhouse workers.METHODS:A total of 36 repetitive tasks was selected in a Brazilian slaughterhouse. Using the Occupational Repetitive Action (OCRA) Checklist, the level of exposure of workers to risk factors of UL-WMSDs in two work-rest schedules was evaluated. In the real condition, 6 rest breaks of 10 minutes were performed, and in the simulated condition, 3 rest breaks of 20 minutes.RESULTS:The right side of the body presented a higher score on the OCRA Checklist (72%of the tasks) than the left side (p = 0.037) in the real condition. Additionally, the OCRA score (18.3±2.5) was significantly lower (p < 0.001) than the simulated condition (21.9±3.0). It was verified that the risk level in simulated condition remained the same in 13 (36%) tasks, while in 23 (64%) tasks there was an increase in the risk level.CONCLUSIONS:Work-rest schedule of 6 breaks of 10 minutes was better than 3 breaks of 20 minutes to reduce the risk of UL-WMSDs in poultry slaughterhouse workers.

Rest Break Frequency and Duration: Self-Reported Preference of Brazilian Poultry Slaughterhouse Workers

ABSTRACT The work pace in poultry slaughterhouses is high and the risk of developing upper limb work-related musculoskeletal disorders is moderate to high. Thus, through risk management and the use of technical, organizational, and administrative means, the employer should ensure the well-being of workers, as well as safe and healthy working environments and conditions. The aim of this study was to identify the self-reported preference of poultry slaughterhouse workers regarding rest break frequency and duration, and to verify the reasons for their choice. The participants in the study included 311 workers from four poultry slaughterhouses. The workers were asked what rest break schemes they preferred: 6x10 min, 3x20 min, 4x15 min or another schedule, as well as the reasons for their selection. According to the workers’ opinions, 3x20 min was the best break schedule (90.7%), mainly because it allowed time to rest (64.5%), as they had more time to carry out their activities calmly. Unanimously, these workers responded that a 10-min break is very short, which only allows one to reach the rest area or the bathroom and return, no time to rest. Only 8.7% of workers wanted to have a higher rest break frequency (6 or 4 times per day) to leave the sector more, go to the bathroom often, have shorter work intervals, in addition to warming up the body and resting more. This paper provides guidelines for slaughterhouse managers to determine the best rest break schedules for their workers to promote health and safety.

Exertion Perception When Performing Cutting Tasks in Poultry Slaughterhouses: Risk Assessment of Developing Musculoskeletal Disorders.

Brazil is the leader in poultry meat exports, in which most products are in the form of cuts. This study analyzed the exertion perception of poultry slaughterhouses workers when performing cutting tasks, as well as the influence of knife sharpness on the risk of developing musculoskeletal disorders by Occupational Repetitive Action (OCRA) method. Participants (n = 101) from three slaughterhouses were asked to rate their perceived exertion on the Borg scale during the cutting task when the knife was well and poorly sharpened. The OCRA results showed that the score for cutting with a dull knife was greater (43.57 ± 13.51) than with a sharp knife (23.79 ± 3.10) (p < 0.001). Consequently, there was a significant increase in the risk level of acquiring upper-limb work-related musculoskeletal disorders (UL-WMSD) by using a “poorly sharpened” knife (29%; p < 0.001; Borg scale 2–8). Thus, maintaining well-sharpened knives for optimal performance of the cutting task (fewer technical actions) is suggested, as well as including knife sharpening in the standard operating procedure to reduce musculoskeletal disorders.

Risk of slaughterhouse workers developing work-related musculoskeletal disorders in different organizational working conditions

Job rotation is defined as workers rotating between tasks with different exposure levels and occupational demands. The aim of the present study was to analyze the risk factors for the development of upper-limb work-related musculoskeletal disorders (UL-WMSDs) in poultry slaughterhouse workers as well as compare the score of the OCRA Checklist in different organizational working conditions. In this cross-sectional study, 118 workers were involved, 68 women (32.3 ± 10.7 years) and 50 men (29.5 ± 10.5 years). Three organizational configurations (“without job rotation”, “with job rotation – tasks >1h” and “with job rotation - tasks <1h”) were evaluated using the OCRA Checklist method, totaling 36 tasks and 28 job rotation schemes composed of 2–3 tasks. The OCRA score of the right upper limbs (17.8 ± 3.2) was significantly higher (p = 0.046) relative to the left upper limbs (16.4 ± 3.6). The median score was significantly lower in the “with job rotation - tasks <1h” condition (18.6) when compared to the “job rotation – tasks >1h” (19.4) (p < 0.001) and the “without job rotation” (19.0) (p = 0.038) conditions. However, there was no significant difference between the condition “with job rotation - tasks >1h” and “without job rotation” (p = 0.155). Thus, job rotations with intervals <1h reduced the risk of developing UL-WMSDs. Job rotations with <1 h intervals in poultry slaughterhouses are recommended along with further studies to verify the effectiveness of rotations with more than two tasks, involving mild or non-repetitive tasks.

Upper Limb Work-Related Musculoskeletal Disorders in Operating Room Nurses: A Multicenter Cross-Sectional Study.

This study aimed to evaluate the association between personal and job characteristics and the risk of upper limb work-related musculoskeletal disorders (WMSDs) among operating room nurses (ORNs). To this end, we collected data from 148 ORNs working at 8 Italian hospitals and measured any upper limb disabilities experienced in the previous year using the Italian version of the disabilities of the arm, shoulder and hand (DASH) questionnaire. The associations between personal and job characteristics and risk of upper limb WMSDs were estimated by unconditional logistic regression models. The prevalence of upper limb WMSDs was 45.9%. Multivariate analysis showed the “female gender” and “monthly hours spent working as a scrub nurse” to be directly associated with a higher DASH score (adjusted OR for gender = 5.37, 95% CI: 1.65–17.51, p < 0.01; adjusted OR for monthly hours as scrub nurse = 3.09, 95% CI: 1.33–7.19, p < 0.01). Overall, our findings indicate that a full-time job (>120 h/month) as a scrub nurse significantly increases the risk of developing upper limb WMSDs among female ORNs. Thus, to reduce such risk in this particularly sensitive population, we recommend urgent implementation of ergonomic interventions on surgical equipment alongside job rotation and medical surveillance programs.

Myoelectric manifestation of muscle fatigue in repetitive work detected by means of miniaturized sEMG sensors

Upper limb work-related musculoskeletal disorders have a 12-month prevalence ranging from 12 to 41% worldwide and can be partly caused by handling low loads at high frequency. The association between the myoelectric manifestation of elbow flexor muscle fatigue and occupational physical demand has never been investigated. It was hypothesized that an elbow flexor muscle fatigue index could be a valid risk indicator in handling low loads at high frequency. This study aims to measure the myoelectric manifestation of muscle fatigue of the three elbow flexor muscles during the execution of the work tasks in different risk conditions. Fifteen right-handed healthy adults were screened using a movement analysis laboratory consisting of optoelectronic, dynamometer and surface electromyographic systems. The main result indicates that the fatigue index calculated from the brachioradialis is sensitive to the interaction among risk classes, session and gender, and above all it is sensitive to the risk classes.

Beyond OCRA: Predictive UL-WMSD risk assessment for safe assembly design

In terms of occupational safety, one of the most important areas to consider is that of Upper-Limb Work-related MusculoSkeletal Disorders (UL-WMSDs), i.e. work-related disorders due to biomechanical overload of the upper limbs caused by protracted movements and/or repeated efforts throughout the workday. To estimate the risk associated with these disorders, the method known as the OCRA (OCcupational Repetitive Actions) Index is universally accepted; based on observation, it provides an index whose value is related to the expected percentage of pathological cases among the entire working population. This work introduces a different perspective to the problem in order to provide designers with a method – PRASAD: Predictive Risk Assessment for Safe Assembly Design – that makes them aware of the issues related to UL-WMSDs, starting from the earliest stages of the design of a new product and the related assembly workstation, well earlier than observing the activities associated to its production, that is when the assembly workstation is fully set and running. The main advantage of the method lies in the outcome, the PRASAD Index, which is fully comparable with the OCRA Index, so that the proposal leverages on the well-known OCRA standard approach. The new method, aimed at a use in the design phase (of a new workstation for a new product), is potentially useful for a conventional risk assessment of existing workstations as well: it combines the rapidity of a checklist for the initial screening with a level of detail that is characteristic of advanced methods, such as the OCRA Index. Finally, PRASAD represents an innovation in the risk assessment of UL-WMSDs because of its feature of modelling the concept of “Technical Actions”, which enables estimating (and taking into account) the repetitiveness of tasks, based on technical design and production management data.

Productivity and ergonomic risk in human based production systems: A job-rotation scheduling model

The competitiveness of modern manufacturing systems is based on a high production rate and a high level of flexibility. Despite the high level of automation achieved in production systems, flexibility is often provided by human dexterity and the cognitive capabilities of the workforce, as in assembly lines. In the case of repetitive manual tasks, workers are exposed to the risk of musculoskeletal disorders (MSDs). In these contexts, a high production rate leads to high physical workload, and job rotation is adopted in order to reduce the ergonomic risk. Traditionally, ergonomics and human performance issues have been investigated separately. However, in the design and scheduling of human-based manufacturing systems, a reliable description of human components is required in order to jointly evaluate production system performance and assess workers׳ risk of MSDsIn this paper, the authors propose a model which aims to find optimal job rotation schedules in work environments characterized by low load manual tasks with a high frequency of repetition (e.g. assembly lines). The model is a mixed integer programming model allowing for the maximization of production rate jointly reducing and balancing human workloads and ergonomic risk within acceptable limits. Risk and its acceptability are evaluated using the OCRA (OCcupational Repetitive Actions) method (ISO 11228-3:2007), widely recognized as an effective tool for the risk assessment of Upper Limb Work related MSDs (UL-WMSDs). Moreover, the different workers׳ performance due to their respective training levels and skills is considered in the problem formulation.The model is applied to an industrial case study. Results show the model׳s capacity to identify optimal job rotation schedules jointly achieving productivity and ergonomic risk goals. Performances of the solutions obtained improve as workforce flexibility increases.

Assessment of Risk Factors of Upper-limb Musculoskeletal Disorders in Poultry Slaughterhouse

The aim of this study was to evaluate the risks associated with the repetitive movements of the upper limbs in different meat processing tasks in a poultry slaughterhouse. The study was conducted in a company with 4,500 workers that slaughtered 450,000 chickens/poultries per day during the two shifts. The OCRA checklist was used to assess 10% of the total workforce during work tasks. Each worker was filmed for shorter periods of 5minutes. Student's t-test (p≤0.05) was used to compare the risk variable between the sides of the body. The 26 work activities analyzed were the following sectors: cutting (17); evisceration (2); freezing tunnels (2); reception (3) and scalding (2). The average of occupational repetitive actions performed by poultry workers was 63.7±25.3 per minute, representing 9 points in the OCRA's scale (0 to 10 points scale). The average score of OCRA's checklist was 18.3±2.7 (moderate risk). The scores for the right upper limb (18±2.8 - moderate risk) were significantly higher (p=0.014) than the contralateral limb (16.9±3.8 - moderate risk). Considering the five risk categories proposed by the OCRA method, 2 work tasks were considered high risk (8%); 21 represented moderate risk (81%), and 3 were within an low risk (11%). When grouping the high risk tasks with the moderate risk tasks, it was verified that the majority of the slaughterhouse workers were vulnerable to ergonomic hazards by repetitive movements. From these results, it is possible to suggest that poultry processing tasks classified as high (8%) and moderate risk (81%) predispose workers to a greater probability of developing upper limb work-related musculoskeletal disorders (>21.5% probability for high risk and 10.8 to 21.5% for moderate risk).

Tailored exercise program reduces symptoms of upper limb work-related musculoskeletal disorders in a group of metalworkers: A randomized controlled trial

Work-related musculoskeletal disorders (WRMDs) are a leading cause of work-related disability and loss of productivity in the developed countries; these disorders may concur with the indirect costs of an illness or injury included losses of potential output. Literature on workplace physical activity program provided a mixed but positive impact on health and important worksite outcomes. Therefore, programs of physical activity organized and performed in the workplace could reveal as essential tool to reduce musculoskeletal symptoms.This investigation aimed to assess the effectiveness of a tailored physical activity program, performed in a work-environment, to reduce the symptoms in upper extremities and neck with the novelty in personalizing the approach applied to the exercise protocol, basing on pain and disability levels, to reduce the onset and symptoms in upper extremity and neck WRMDs increasing upper-limb strength and flexibility.68 metalworkers were recruited, 34 were randomly allocated to an intervention group (IG), while the other 34 to a control group. Primary outcomes concerned pain symptoms measured with visual analog scales while disability was measured by DASH (Disability of the Arm, Shoulder and Hand), and NPDS-I (Neck Pain and Disability Scale) questionnaires. Grip strength, upper-limb mobility, neck and shoulder range of motion were also assessed.After the 9-month intervention, IG reduced pain symptoms on neck, shoulders, elbows and on wrists. Grip strength and upper-limb mobility improved as well as scores on questionnaires. This protocol suggests that performing a tailored physical activity program is beneficial to reduce pain and disability on upper-limb WRMDs.

RISK FACTORS FOR THE PREVALENCE OF THE UPPER LIMB AND NECK WORK-RELATED MUSCULOSKELETAL DISORDERS AMONG POULTRY SLAUGHTER WORKERS

Poultry slaughtering reports a high prevalence of upper limb work-related musculoskeletal disorders (UL-WMSDs). The main risk factors associated with upper limb and neck work-related musculoskeletal disorders are repetitiveness, high frequency of action, excessive force, awkward posture, insufficient recovery time and exposure to cold temperature. The purpose of this study was to identify and describe the prevalence of upper limb and neck symptoms among poultry slaughter workers in Iran, using the Nordic standardized questionnaire and occupational repetitive action (OCRA) checklist method. The study subjects consisted of 68% male and 32% female with a mean age 28.88 ± 0.56. Two hundred twelve poultry slaughter workers were interviewed. Out of every 20 workers, in the last 12 months, 12 reported pain in the upper limb and neck. Statistical analysis showed a significant association between the OCRA level of risk and UP-WMSD symptom (ρ &lt; 0.05). The results of this study revealed that upper limb and neck symptoms occurred in high rates among poultry slaughter workers. This study provides information for the prevalence of upper limb and neck symptoms among poultry slaughter workers in Iran, and the results suggest interventions for hands/wrist, elbow, shoulder and neck pain should be important and major priority.

Bio-mechanical Analysis of the Grapevine Cluster Thinning Task using Working Chair

Objective: This study examined the effects of working chair that was developed for farmers who work in grapevine’s <BR>cluster thinning. Background: Agricultural work involves some of the nation’s highest occupational risk exposures. Fruit <BR>cultivation has been recognized as one of the most hazardous crops in which to work. Grapevine cluster thinning task <BR>involve activities related to the main risk factors associated with upper limb work-related musculoskeletal disorders. Method: <BR>An experiment was designed to test the working chair. Six healthy male(25.8±4.9years) were selected as the subjects for <BR>this study. Electromyography(EMG) was used to monitor the muscles activity, and Electro-goniometer was used to measure <BR>the ranges of motions of the elbow, trunk and knee. Subjective test was also carried out to examine discomfort body parts <BR>and their pain intensity. A grapevine’s working space was built for the experiment and working chair was installed on it. In <BR>order to examine the muscle activity and range of motion, subjects used to the working chair for 30 minutes for each <BR>experimental condition. Another test without working chair was also performed for comparison. %MVC was used to quantify <BR>the level of muscle activity. Results: Decreases of muscle activity was found in all leg muscles and significant decrease of <BR>muscle activity was found in left Gastrocnemius. The range of motion of the trunk and knee also decreased when working <BR>chair used. Discomfort in lower back, thigh and shank region were reduced significantly. However, in upper limbs muscle <BR>activity tended to increase in working chair compared with conventional task. Conclusion: Improvement for cushion in seat <BR>back and pan required to reduce discomfort in buttocks. Application: Overall findings verified that the working chair might <BR>help to prevent upper limb and lower back MSDs based on the current study. These results can be practically used for work <BR>improvement for the grapevine growers to prevent MSDs.

Self-administered questionnaire and direct observation by checklist: Comparing two methods for physical exposure surveillance in a highly repetitive tasks plant

Background We evaluated the agreement between a questionnaire and an observational checklist for exposure assessment in the setting of an upper-limb work-related musculoskeletal disorders (UWMSD) surveillance program in a population with a high level of physical exposures. Methods A surveillance program was implemented in a large shoe factory. Physical exposures were assessed in 1996 by a self-administered questionnaire and by the direct observation of work tasks assessed using a checklist filled out by trained assessors. Items were summed into a “questionnaire” score and an “observational” score. These scores were compared by Pearson's correlation. The association between exposure assessment by each method and UWMSD incidence between 1996 and 1997, defined by a standardized examination, was also studied. Results Correlation between the “questionnaire” score and the “observational” score was low among the 196 workers (77%) who received both evaluations (rho=0.06, p>0.05). Only exposure assessed by the questionnaire method was significantly associated with high incidence of UWMSD between 1996 and 1997, with good sensitivity (97%) and poor specificity (27%). Conclusion In this surveillance program, self-reported physical exposures assessed by questionnaire and by direct observation did not evaluate same dimensions of high physical exposures. In this sample, exposures assessed by questionnaire identified workers at high risk of incident UWMSD more precisely than exposures identified by direct observation.

Selected questions on biomechanical exposures for surveillance of upper-limb work-related musculoskeletal disorders.

Questionnaires for assessment of biomechanical exposure are frequently used in surveillance programs, though few studies have evaluated which key questions are needed. We sought to reduce the number of variables on a surveillance questionnaire by identifying which variables best summarized biomechanical exposure in a survey of the French working population. We used data from 2002 to 2003 French experimental network of Upper-limb work-related musculoskeletal disorders (UWMSD), performed on 2,685 subjects in which 37 variables assessing biomechanical exposures were available (divided into four ordinal categories, according to the task frequency or duration). Principal Component Analysis (PCA) with orthogonal rotation was performed on these variables. Variables closely associated with factors issued from PCA were retained, except those highly correlated to another variable (rho > 0.70). In order to study the relevance of the final list of variables, correlations between a score based on retained variables (PCA score) and the exposure score suggested by the SALTSA group were calculated. The associations between the PCA score and the prevalence of UWMSD were also studied. In a final step, we added back to the list a few variables not retained by PCA, because of their established recognition as risk factors. According to the results of the PCA, seven interpretable factors were identified: posture exposures, repetitiveness, handling of heavy loads, distal biomechanical exposures, computer use, forklift operator specific task, and recovery time. About 20 variables strongly correlated with the factors obtained from PCA were retained. The PCA score was strongly correlated both with the SALTSA score and with UWMSD prevalence (P < 0.0001). In the final step, six variables were reintegrated. Twenty-six variables of 37 were efficiently selected according to their ability to summarize major biomechanical constraints in a working population, with an approach combining statistical analyses and existing knowledge.

Validity of Nordic-style questionnaires in the surveillance of upper-limb work-related musculoskeletal disorders

The study aimed at comparing results of standardized Nordic-style questionnaires with those of clinical examinations in two surveys on upper-limb work-related musculoskeletal disorders. The "repetitive task" survey (1757 workers in 1993-1994 and 598 workers in 1996-1997) studied risk factors of the disorders among those exposed to repetitive work. The "Pays de la Loire" survey (2685 workers in 2002-2003) was part of a population-wide surveillance system. In both surveys, each worker completed a Nordic-style questionnaire and underwent a standardized clinical examination. The presence of at least one upper-limb work-related musculoskeletal disorder was compared, with an evaluation of sensitivity, specificity, and kappa values, with a clinical examination as reference. In the second survey, a global score of a numerical scale for the severity of symptoms at the time of the examination was evaluated in the same way (plus ROC curves). Agreement between the questionnaire and the examination differed in the two surveys, from kappa 0.22 [95% confidence interval (95% CI) 0.19-0.23] in the "Pays de la Loire" survey to kappa 0.77 (95% CI 0.74-0.80) in the "repetitive task" survey in 1993-1994. Overall, sensitivity was excellent (82.3-100%). The specificity varied, from 51.1% in the "Pays de la Loire" survey to 82.4% for the >or=2 score based on the severity of symptoms in the survey. Nordic-style questionnaires exploring symptoms in the past year can be useful tools for monitoring upper-limb work-related musculoskeletal disorders, especially if they include numerical rating scales of symptom severity. Physical examination remains essential for a medical or clinical diagnosis.