Repetitive use of handheld nutrunners contributes to the development of musculoskeletal disorders (MSDs) among assembly operators. Tool-using organizations control the physical exposures resulting from nutrunners through their own, company-specific methods and recommendations. The aim of this study was to explore an automotive organization's current practice when conducting ergonomics assessments of nutrunner use. Fourteen employees representing different professional roles within the automotive manufacturing organization were interviewed about their involvement in, and approaches to, ergonomics evaluations of nutrunners. Findings show that the objective criteria tightening torque and tool type are combined with the operators' subjective assessments of the load to identify MSD risks associated with nutrunner use. This way, the effects of factors such as working posture could be integrated into the assessment. Further, it was found that information and knowledge availability could influence the resulting exposures estimates, where for example information about how to appropriately select tool settings is not readily available. In addition, there are negotiating criteria such as quality considerations which need to be balanced with health and safety management, influencing the physical demands associated with power tools. Relevance to industry: By providing insight into an automotive manufacturer's approach to managing and assessing handheld tightening tools, policy-makers can form recommended limits and methods for standardized assessments of reaction load exposure from nutrunners.

Introduction: Chronic low back pain (CLBP) is a debilitating condition that affects millions of people worldwide. Healthcare providers play a crucial role in improving access to care for patients with CLBP, but they face numerous challenges in doing so. This study focuses on healthcare provider perspectives of CLBP healthcare access. Methods: Semi-structured interviews were conducted with 16 healthcare providers across a variety of disciplines who care for people with CLBP across Saskatchewan, Canada. A qualitative interpretive research approach with inductive thematic analysis was employed. Results: Years of experience ranged from 1 to >20 years. Participants represented 11 disciplines across urban, rural, and/or remote settings. Four overarching themes were identified: (1) Challenges for healthcare providers; (2) Anticipating and recognizing barriers and consequences for patients; (3) Facilitators for healthcare providers and patients; (4) Recommendations on improving accessibility to healthcare. Several barriers were identified for healthcare providers to provide optimal, evidence-based care across Saskatchewan, including patient complexity and past experiences, access to resources and coordinating care. Healthcare providers recognized barriers for patients, which ultimately influenced healthcare provider decisions and care provision. Coordinated care and funding were identified as facilitators that support healthcare provider recommendations of multidisciplinary care and improving provider education to enhance provision of care for chronic low back pain. Conclusion: Future care models should build on these identified factors, while considering clinical and community-specific contexts.

Background: Healthcare access for chronic low back pain is complex and should consider not only the health system, but patient care seeking experiences as well. People who live in rural and remote communities and/or identify as being Indigenous may often encounter additional barriers to accessing care for chronic low back pain; thus, these contexts must be considered to fully understand barriers and facilitators. Aims: The aim of this study was to understand care-seeking experiences of people living with chronic back pain in Saskatchewan and determine unique experiences facing urban, rural, remote, and/or Indigenous peoples. Methods: Thirty-three participants with chronic low back pain completed a preliminary survey followed by individual semistructured interviews. Participants were categorized as urban, rural, or remote including Indigenous status. A qualitative interpretive research approach with inductive thematic analysis was employed. Results: Three overarching themes were identified with the following subthemes: (1) healthcare access challenges: challenges to accessing care, challenges within the health system, and challenges leading to self-directed management/coping strategies; (2) healthcare access facilitators: funded care, participant education and knowledge, patient–provider communication, and care closer to home; and (3) participant recommendations for improved care provision: coordination of care, integrative and holistic care, and patient-centered care and support. Rural and remote participants highlighted travel as a main barrier. Indigenous participant experiences emphasized communication with healthcare providers and past experiences influencing desire to access care. Conclusion: Participants identified a range of challenges and facilitators as well as recommendations for improving access to care for chronic low back pain, with unique barriers for rural, remote, and Indigenous participants.

Objectives: The objective of this study was to detect success and failure factors for the implementation of passive exoskeletons in agriculture. Exoskeletons have been shown to reduce musculoskeletal loads during lab-based manual tasks, but long-term implementation experiences in agriculture are lacking. Methods: We analyzed four intervention studies in agriculture focusing on methodological and contextual reasons why the trials were successful or unsuccessful. The study context, attempted intervention, and data collection of each field trial is compared. In the absence of long-term studies investigating the implementation and effectiveness of exoskeletons in agriculture, a set of multi-week pilot trials were initiated among German market vegetable farms and French vineyards from 2019 to 2022. Participant ratings, farm characteristics (e.g. employment duration and payment scheme) and intervention implementation characteristics (e.g. participation in implementation or language barriers) were analyzed using a mixed-methods approach to identify success and failure factors. Results: The comparison of the studies showed that despite the organizational issues, there were several practical issues that limit the success of exoskeleton use in agriculture. We observed that participant rejection of the intervention is a major barrier to successfully conducting long-term field trials in agriculture. Factors like pain, discomfort, heat stress, or a lack of perceived benefits have been identified as failure factors but also the implementation process itself. Conclusion: In addition to careful targeting of trial sites and inclusion of participatory elements in the implementation plan, successful implementation of exoskeletons in agriculture requires fundamental human factors development of the exoskeletons themselves. This will require better matching the physical needs of the workers, the production needs of the tasks, and compatibility with the environment.

There is accelerating development of digital Occupational Health and Safety (OHS) interventions in construction, but it is not clear whether they reduce the risk of injury and illness. This systematic mapping review summarized the state of the evidence and developed recommendations for practitioners and researchers. During a keyword search of scientific databases, 392 unique records were identified and 24 (∼6%) were included in the review. The review was conducted within an Evidence Maturity framework developed for public health interventions, which outlines criteria for intervention. Studies are characterized by innovative application of a wide variety of technologies throughout pre-construction planning, construction execution, and worker training. Targeted hazards primarily included falls, struck-by incidents, and location-based hazards. Most studies focused on technology development and provided low to no evidence of improved work conditions or reduced injury/illness among construction workers. More evidence is needed before the digital solutions are promoted for widespread use. In order to achieve this, more attention need to be paid on the conflicting logics between the evidence maturity framework and the project logic in the construction practice.

Background: Chronic back pain is a common musculoskeletal disorder, disproportionately affecting rural and Indigenous people. Saskatchewan has a relatively high proportion of rural and Indigenous residents; therefore, understanding barriers and facilitators to accessing healthcare are needed to improve healthcare service delivery. Methods: A provincial-wide telephone survey explored experiences and perceived healthcare access barriers and facilitators among 384 Saskatchewan residents who experienced chronic low back pain. Chi-squared tests were performed to determine if people who lived in urban versus rural areas differed in the proportion who had accessed services from various healthcare practitioners. T-test and Mann-Whitney U analyses were conducted to determine differences between urban and rural, and Indigenous and non-Indigenous respondents. Results: Of 384 residents surveyed, 234 (60.9%) reported living in a rural location; 21 (5.5%) identified as Indigenous. Wait times (47%), cost (40%), travel (39%), and not knowing how to seek help (37%) were the most common barriers for Saskatchewan residents seeking care, with travel being the only barrier that was significantly different between rural and urban respondents (P ⩽.001). Not knowing where to go to access care or what would help their low back pain (P =.03), lack of cultural sensitivity (P =.007), and comfort discussing problems with health care professionals (P =.26) were greater barriers for Indigenous than non-Indigenous participants. Top facilitators (>50% of respondents) included publicly funded healthcare, locally accessible healthcare services, and having supportive healthcare providers who facilitate referral to appropriate care, with urban respondents considering the latter 2 as greater facilitators than rural respondents. Telehealth or virtual care (P =.013) and having healthcare options nearby in their community (P =.045) were greater facilitators among Indigenous participants compared to non-Indigenous respondents. Conclusions: Rural, urban, Indigenous, and non-Indigenous people report overlapping and unique barriers and facilitators to accessing care for chronic low back pain. Understanding perceived access experiences will assist in developing more effective care models for specific communities or regions.

Background & Objective: Negative health effects from occupational whole-body vibration (WBV) exposure during machinery operation include alterations in proprioception, vestibular function, reaction time, stress, motor response, and decrements in musculoskeletal health. To reduce WBV exposure during machinery operation, it may be possible to incorporate short rest break activities throughout the day. This study aims to determine if there are intervention activities that can minimize decrements in cognitive, proprioceptive, and musculoskeletal effects related to WBV exposure during machine operation. Materials & Methods: Eleven healthy adults participated in four 1-hour sessions of ecologically valid WBV exposure followed by one of four 5-minute activities: sitting, walking, 2 min of gaze stabilization exercise (GSE) coupled with 3 min of trunk mobility exercise (GSE + MOBIL), or 2 min of GSE coupled with a 3-minute walk (GSE + WALK). Baseline and post-activity measurements (rating of perceived discomfort, balance and postural sway measurements, 5-minute psychomotor vigilance task test) were submitted to a paired t-test to determine the effect of WBV exposure and activities on physical, cognitive, and sensorimotor systems and to a repeated measures ANOVA to determine any differences across activities. Results: We observed degradation of the slowest 10% reaction speed outcomes between baseline and post-activity after walking (7.3%, p < 0.05) and sitting (8.6%, p < 0.05) but not after GSE + MOBIL or GSE + WALK activities. Slowest 10% reaction speed after GSE + MOBIL activity was faster than all other activities. The rating of perceived discomfort was higher after SIT and WALK activities. There were no notable differences in balance outcomes. Conclusion: When compared to sitting for 5 min, an activity including GSE and an active component, such as walking or trunk mobility exercises, resulted in maintenance of reaction time after WBV exposure. If confirmed in occupational environments, GSE may provide a simple, rapid, effective, and inexpensive means to protect against decrements in reaction time after WBV exposure.

Background Breast cancer survivors may be at risk of experiencing rotator cuff disease after treatment. Biomechanical alterations following surgery potentially predispose survivors to develop this disorder. Objective To examine scapular kinematics in breast cancer survivors with and without impingement pain during an overhead reach task. Design A cross-sectional study. Methods Three surgery groups were included: non-cancer controls, mastectomy-only survivors and post-reconstruction survivors. Breast cancer survivor groups were also categorized by the presence of impingement pain. Scapular motion was tracked during an overhead reach task, performed separately by both arms. Maximum scapular internal rotation, upward rotation and tilt were calculated. Two-way analyses of variance with interactions (p < .05) were used to test the effects of group (control, mastectomy-only, reconstruction) and impingement pain (pain, no pain) on each variable within a (left/right) side. Results Scapular kinematics varied with the group by pain interaction. On the right side, the mastectomy-pain group had reduced upward rotation, while the reconstruction-pain group had higher upward rotation (mastectomy-only: 22.9 degrees vs. reconstruction: 31.2 degrees). On the left side, the mastectomy-pain group had higher internal rotation, while the reconstruction-pain group had reduced internal rotation (mastectomy-only: 45.1 degrees vs. reconstruction: 39.3 degrees). However, time since surgery was longer in the mastectomy-pain group than reconstruction-pain group, suggesting there may be a temporal component to kinematic compensations. Conclusions There are kinematic alterations in breast cancer survivors that may promote future development of rotator cuff disease. Compensations may begin as protective and progress to more harmful alterations with time. KEY MESSAGES Scapular kinematics varied with surgery and pain interaction: upward rotation was lower and internal rotation higher in mastectomy-pain group, while upward rotation was higher and internal rotation lower in reconstruction-pain group. Kinematics alterations may also be associated with time since surgery, as the mastectomy-pain group had longer time since surgery than the reconstruction-pain group. Kinematic alterations may transition from protective to harmful over time. In-depth analyses by reconstruction type are needed to determine surgery-specific effects on kinematics and their potential impact on the development of rotator cuff disease.

Background: Back pain is common and costly, with negative impacts on both individuals and the health care system. Rural, remote, and Indigenous populations are at greater risk of experiencing back pain compared to urban and non-Indigenous populations. Potential barriers to health care access among Canadians with chronic back pain (CBP) have been identified; however, no study has used lived experiences of people with CBP to drive the selection, analysis, and interpretation of variables most meaningful to patients. Objective: The aims of this study are to (1) engage with rural, remote, and urban Indigenous and non-Indigenous patients, health care providers, and health system decision makers to explore lived experiences among people with CBP in Saskatchewan, Canada; (2) cocreate meaningful indicators of CBP care access and effectiveness; and (3) identify program and policy recommendations to overcome access barriers to CBP care. Methods: In phase 1, one-on-one interviews with 30 people with current or past CBP and 10 health care providers residing or practicing in rural, remote, or urban Saskatchewan communities will be conducted. We will recruit Indigenous (n=10) and non-Indigenous (n=20) rural, remote, and urban people. In phase 2, findings from the interviews will inform development of a population-based telephone survey focused on access to health care barriers and facilitators among rural, remote, and urban people; this survey will be administered to 383 residents with CBP across Saskatchewan. In phase 3, phase 1 and 2 findings will be presented to provincial and national policy makers; health system decision makers; health care providers; rural, remote, and urban people with CBP and their communities; and other knowledge users at an interactive end-of-project knowledge translation event. A World Café method will facilitate interactive dialogue designed to catalyze future patient-oriented research and pathways to improve access to CBP care. Patient engagement will be conducted, wherein people with lived experience of CBP, including Indigenous and non-Indigenous people from rural, remote, and urban communities (ie, patient partners), are equal members of the research team. Patient partners are engaged throughout the research process, providing unique knowledge to ensure more comprehensive collection of data while shaping culturally appropriate messages and methods of sharing findings to knowledge users. Results: Participant recruitment began in January 2021. Phase 1 interviews occurred between January 2021 and September 2022. Phase 2 phone survey was administered in May 2022. Final results are anticipated in late 2022. Conclusions: This study will privilege patient experiences to better understand current health care use and potential access challenges and facilitators among rural, remote, and urban people with CBP in Saskatchewan. We aim to inform the development of comprehensive measures that will be sensitive to geographical location and relevant to culturally diverse people with CBP, ultimately leading to enhanced access to more patient-centered care for CBP. International Registered Report Identifier (IRRID): DERR1-10.2196/42484

Objective Although Saskatchewan appears to have the greatest burden of work-related fatality (WRF) in Canada, it is unclear how WRF rates have varied over time. We investigated the WRF rate in Saskatchewan over the past decade and modeled potential risk factors for WRF, including economic indicators. Methods In this cross-sectional, population-based study, Saskatchewan workplace traumatic fatalities grouped by year, season, and worker characteristics (eg, age, industry) were used in addition to Statistics Canada labor force survey total employment, total labor force, and the number of unemployed workers by year and season. WRF rates were calculated as fatalities per total number of employed workers. A Poisson generalized additive model was employed to examine the association between WRF rates and personal characteristics, and economic indicators. Results The rate remained fairly stable between 2013-2014 and 2015-2017 but sharply increased from 2017 to 2018. On average, the highest rate was observed among workers aged >= 60 years (0.70 +/- 0.21 per 100 000). Men had a more than 13-fold greater risk of WRF than women [relative risk (RR)13.7, 95% confidence interval (CI) 10.48-17.9), with the highest RR of WRF observed in the construction industry (RR 9.2, 95% CI 6.1-13.8). The risk of mortality increased non-linearly with increasing unemployment rate, with instability as the unemployment rate reaches the highest modeled values. Conclusion Workplace fatality in the province has fluctuated over the past decade, with differential impact observed among industry groups. Furthermore, an increase in the unemployment rate was followed by an increase in mortality risk. Prioritizing and encouraging prevention strategies during periods of economic recessions could help address the incidence of fatalities at work.