In a previous study, an unexpected u-shaped relationship was observed between load level andfatigue/recovery responses. Moderate load levels resulted in lower perceived discomfort, pain,and fatigue, and shorter recovery times compared to either low or high load levels. Thisphenomenon has been reported in other studies, but no article has examined the possiblemechanisms that might explain this u-shaped relationship. In this paper, we re-examined thepreviously published data and found that the phenomenon does not appear to be due to theexperimental artefact; the u-shape may be due to unexpectedly lower fatigue effects at moderateloads, and higher fatigue effects at lower loads. We then conducted a literature review andidentified several possible physiological, perceptual, and biomechanical explanatory mechanisms.No single mechanism explains the entirety of the phenomenon. Further research is needed onthe relationship between work exposures, fatigue, and recovery, and the mechanisms related tothe u-shaped relationship.

Practitioner summary: We examine a previously observed u-shaped relationship between loadlevel and fatigue/recovery, where moderate force resulted in lower perceived fatigue andshorter recovery times. A u-shaped fatigue response suggests that simply minimising load levelsmight not be an optimal approach to reduce the risk of workplace injuries.

Companies use risk observations and work environment (WE) deviations such as occupationalaccidents and occupational illnesses to prevent injuries. There is no standard for how risks andoccupational injuries are reported. Praktikertjänst's management requests a standard as ameasure that can be used to work more proactively with health and safety and supportsustainable business development. Therefore, the SRA method was developed for calculatingand visualizing a work environment KPI related to the severity of WE deviations, the SRA Index.(Sustainable Risk Awareness Index for management support). Existing data (risk observations,near misses, work-related accidents and work-related illnesses) are used for calculating the SRAIndex. In this study the usability of the SRA Index was evaluated with a questionnaire amongwork environment experts. They assessed the SRA method to be easy to understand, to havehigh usability and to be valuable for assessing an organisation’s risk awareness.

It can be challenging to motivate decision-makers to invest in work environmentimprovements (WEIs). One success factor is to use the same vocabulary as companymanagement and express suggested WEIs in a way that management can understand and usein their decision-making. This paper has two objectives, to present: 1) examples of realorganisations’ ergonomics problems, suggestions for improvements and financial estimationsof effects of the suggested interventions, carried out by students in a Master’s course; 2)course-design features evaluated as important for this type of course. Results from six studentprojects, using several financial methods, are presented. The discussion focuses on the valueof increasing the availability of such a course, as well as competencies needed to be successfulinWEIs. In conclusion: by applied training as in this course, non-economists can rather rapidlylearn to assess ergonomics problems, and to develop, present and argue for suggestedsolutions, also with financial effect estimations.

Background and purpose

Our society is facing major demographic challenges in healthcare. The growing population of older people is outpacing the creation of residential care facilities like nursing homes, meaning that more and more people are ‘aging in place’. ‘Aging in place’ means continuing to reside in a private residence in the community even as care needs intensify. It is an economically efficient option and often preferred by aging people, but it also brings substantial challenges. Eventually people require support from home careworkers with the vital and personal tasks that take place in the bathroom: toileting and bathing. However, residential bathrooms are often small and not designed to accommodate a care recipient, care worker, and mobility aids such as a walker or wheelchair. There is a growing need to update residential bathrooms to meet the evolving needs of older residents. Although there exist several aids and assistive devices intended to facilitate bathroom tasks, this can be hard for users and caregivers to navigate. This project was undertaken as part of a larger study funded by AFA Försäkring. The goal of this portion was to develop an inventory of currently-available bathroom assistance devices for use by residents and their family members, health care organizations, insurance agencies, and other stakeholders. The primary research question was: What type of bathroom assistive devices are currently available, either commercially or in prototype form, intended to assist users with the tasks of toileting, bathing, and handwashing?

Methodology

The primary method was web search and document review across several domains: regulations, assistive devices, and residential bathroom renovation examples. The first set of searches investigated the legislation and guidelines on bathroom design both for residential and healthcare settings; consistent and conflicting specifications were noted. The second set of searches was for assistive devices that could be used to facilitate bathing and toileting tasks in residential bathrooms. Examples of renovated residential bathrooms were solicited through authors’ networks.

Results

When it came to guidelines and specifications for bathroom design, there was substantial tension between the regulations set out by the Swedish Work Environment Authority and the National Board of Housing, Building and Planning. The inventory includes images of assistive devices as well as their main features: target task (bathing, toileting, personal care, handwashing), dimensions, weight ratings, colors, materials, store, website address, accessibility, and price. Documented assistive device categories include shower benches, toilet aids, support handles, showers, washbasins, taps, alarm buttons, contrast marks, and others, with approximately 20 examples for each.

Conclusions

This project developed an inventory of currently-available bathroom assistance devices, intended to inform users’ selection of devices for growing care needs in realistic (i.e. nonideal) settings. However, it is not the intention for the inventory represent an assessmentof the quality, safety, effectiveness, or usability of the devices. While it is hoped this list will represent the variety of available devices, it is also not intended to be exhaustive. Together with an introduction that includes the examples of renovated bathrooms, the inventory will be disseminated as a searchable web-based resource.

Reaction forces from nutrunner tools constitute a risk of developing MSDs. However, recommendations for sustainable reaction force levels are lacking. The aim of this study was to inform recommendations regarding reaction load exposures from right-angle nutrunners. Through a psychophysics approach, experienced assembly workers subjectively assessed reaction loads when using a nutrunner in six combinations of tool tightening strategy, work-pace and screw-joint stiffness. Electromyography, tool and joint parameters were measured. Regardless of tightening strategy, joint stiffness and work-pace combinations, no large differences in acceptable tightening torque, peak reaction force, and handle displacement were observed. However, acceptable jerk and impulse differed substantially between the TurboTight (R) (high-acceleration) and QuickStep (R) (conventional) tightening strategies. Although the TurboTight (R) strategy overall showed reduced peak muscular activities compared to the QuickStep (R), the participant-rated acceptable torque levels were similar, plausibly due to TurboTights' high jerk levels. Jerk and impulse are hypothesized to influence the perception of reaction loads.

RAMP (Risk Assessment and Management tool for manual handling – Proactively), is arisk management tool focusing on manual handling work. Since 2017 RAMP has beenspread to over 105 countries. More than other methods, RAMP supports the entire riskmanagement process. RAMP is based on risk factors documented in scientific literature,and it has been evaluated regarding usability and reliability. It is now used for MSDrisk management in many organisations. The feedback from RAMP users is positive,and there are indications of reductions in sick absence.The purpose of the ongoing project is to investigate a selection of effects thatimplementation entails and to examine the implementation of RAMP from a leadershipand system perspective. Specific questions are: What happens when a companyimplements RAMP? Are the risk factors reduced? What affects the change? Whatstrategies do companies use when implementing RAMP? Are the effects of whichstrategies companies apply when implementing affected? What are the facilitators andbarriers to the implementation of this risk management method?The project is carried out as an implementation study based on mixed methods incollaboration between researchers and four production companies and two FHV actors.The effects and implementation of RAMP will be evaluated by comparing risk levels,qualitative interviews, document analyses, questionnaires and structured observationsof work processes. For changes in risk factors, RAMP risk assessments, which includeobservations and objectivemeasurements of push-pull forces, carried out at baseline andat follow-up will be compared. If possible, in addition to the above data collection, thecompany's own data on sick leave, productivity and quality (eg quality deficiency data)will be included and monitored over time.Implementations and effects of RAMP will be summarized in so-called logicalmodels. These models will identify inputs (e.g. time and resources set aside forimplementation), activities (e.g. training and measures implemented), intermediate(short-term) outcomes (e.g. the extent to which RAMP is used in the systematic workenvironment work and in the entire process for risk management, how much of the highrisks have been reduced, what type of measures have been taken and how the riskawareness has developed among employees), long-term outcomes (e.g. employees'perception of the workload, perceived health and perceived problems), and possiblylong-term outcomes (e.g. changes in sick absence, quality and productivity as well assharing good examples within the organisation).157At this point in the project, the questionnaire has been designed, companies havebeen contacted, and data collection at the first company, that now has assigned animplementation strategy, is about to start.The project is expected to show what effects on the work environment (possibly alsohealth, quality and productivity) that systematic application of the RAMP method canhave, aswell aswhich of the studied factors affect the implementation and to what extentthey do so. The results are expected to lead to new knowledge in the area of systematicrisk management and implementation strategies.

In 2017 RAMP (Risk Assessment and Management tool for manual handling – Proactively), a risk management tool focusing on manual handling work, was launched with the objective to contribute to reducing musculoskeletal disorders (MSDs). RAMP has since then been spread to over 105 countries and is used as the standard method for MSD risk management in several organisations. Different usability, reliability and validity aspects of RAMP have been evaluated as being good. To enhance RAMP’s application range and to further increase its usability, the RAMP 2.0 project started in 2018. Results from this ongoing project have been reported at several conferences, e.g. IEA 2021.The objective of this conference-contribution is to provide an overview of the results of the project this far, whereas the objectives of the project are to: i) expand RAMP’s application range to include hand-intensive work, ii) in addition to the existing Excel-based version, provide RAMP in a system version, and iii) enable practitioners to use RAMP results in forming key performance indicators, KPIs, as a means to follow the results of systematic work environment progress at an organisation, and to provide managers with relevant data for informed decision making.The project is carried out with a participatory, iterative methodology. It is led by re-searchers at KTH, and carried out in a collaboration between researchers and practitioners from over a dozen organisations. Methods used include needs analyses, literature studies and iterative development of the three parts, where workshops with different types of experts are regarded as crucial.The results this far for each one of the three parts are: i) Enhanced application range. Based on a needs analysis among the participating organisations, the first version of RAMP’s “Hand model” has been developed. An evaluation study of this model in planned for the spring 2022 where usability and reliability are in focus; ii) Also a version of the RAMP system version has been developed, as well as iii) methods for forming KPIs, i.e. both KPIs formed by using only RAMP results data and KPIs formed by combining RAMP results and company data, as for example quality and sick-leave data.By the inclusion of hand intensive work in RAMP’s application range, a large part of commonly performed work tasks can be assessed and managed. However, limitations of the tool’s application range is discussed, as well as how adequate input data can and determined.

This qualitative study aims to identify challenges, needs and gaps for home care bathroom tasks and gather information that will allow for user-centered, sustainable solutions for home care in the bathroom. Twenty-one interviews were carried out with participants with the perspective of client, health care worker or care orga-nization. The data were analyzed using qualitative content analysis and interpretive description. The findings identify important factors for enabling both independent living for clients and a sustainable work environment for the health care workers. They include adequate space, access to assistive devices and regular risk assessments to recognize changing needs. Enabling independent living is one strategy that can be used to manage the ongoing demographic change as well as the expected future labor shortage in the care sector. Changes can be made in the physical environment (the residential bathroom) in order to facilitate safer task performance for both the clients and the health care workers.

RAMP (Risk Assessment and Management tool for manual handling – Proactively), a freely accessible MSD risk management tool for manual handling work, was launched 2017 to contribute to the reduction of musculoskeletal disorder (MSD) risks for manual handling work-tasks. The tool is currently developed further, using an iterative participative methodology, to: i) enhance the RAMP tool’s application range, mainly to include hand-intensive work, ii) develop a system version of the tool, and iii) include key performance indicators (KPIs). A needs analysis resulted in 99 identified needs. Regarding i), six needs were assessed as “very important to include” to enhance the application range. A literature study focusing on relevant risk factors and how exposure to them is associated with MSD risks was carried out and first drafts of a model for assessing risks in hand-intensive work are iteratively developed, using feedback from intended users. Regarding ii), 50 needs and suggestions on what to consider when developing a databased system version of the RAMP tool were identified. Prototypes of parts of the system-version are iteratively developed, using intended users’ feedback. Regarding iii), the needs analysis resulted in 16 suggested KPIs, including KPIs based solely on RAMP results and KPIs which can be established combining RAMP results and company data. The project is ongoing. An enhanced RAMP tool, RAMP 2.0, with the abovementioned expansions could support MSD risk assessment and risk management in systematic MSD risks reduction work for a wide range of work tasks.