Occupational risk factors for musculoskeletal disorders among railroad maintenance‐of‐way workers

Abstract

Background Our objective was to examine occupational risk factors for musculoskeletal disorders of the neck, back, and knee among railroad maintenance‐of‐way (MOW) workers. Methods Four thousand eight‐hundred sixteen active, retired, and disabled members of the Brotherhood of Maintenance of Way Employes Division (BMWED) completed a survey. We computed adjusted prevalence ratios (aPRs) using Poisson regression for neck, back, and knee musculoskeletal symptoms by work exposures, adjusted for age, region, race/ethnicity, smoking, and potential second job and spare time vehicle vibration exposure. Results Among active male BMWED members, we found associations between use of high‐vibration vehicles and neck pain (aPR = 1.47, 95% confidence interval (CI): 1.07‐2.03) and knee pain (aPR = 1.38, 95% CI: 1.04‐1.82) for more than 1.9 years (vs 0) of full‐time equivalent use; but not back pain. Back pain radiating below the knee (sciatica indicator) was associated with high‐vibration vehicle use greater than 0.4 and less than 1.9 years (aPR = 1.58, 95% CI: 1.15‐2.18). We also found significant associations between often or always lifting, pushing, pulling, or bending on the job (vs seldom or never) and neck pain (aPR = 2.43, 95% CI: 1.20‐4.90), back pain (aPR = 1.94, 95% CI: 1.24‐3.03), the sciatica indicator (aPR = 5.18, 95% CI: 1.28‐20.95), and knee pain (aPR = 2.84, 95% CI: 1.47‐5.51), along with positive gradients in the outcome by exposure time. Conclusions Biomechanical work exposures, including force and nonneutral postures, were associated with neck, lower back, and knee pain. Whole‐body vibration, as measured by the duration of use of high‐vibration vehicles, was associated with neck pain, knee pain, and sciatica. Prevention programs should address occupational risk factors for musculoskeletal disorders among MOW workers.

Powered-hand tools and vibration-related disorders in US-railway maintenance-of-way workers

“…Also, it should be noted that due to the small number of reported female participants, 1,159 active workers <75 y/o who were missing data on gender were included in the analysis, due to their high likelihood of being male. In a previous manuscript, sensitivity analyses excluding all respondents missing data on gender revealed no declines more than 9% in the magnitude of any significant association between work exposures and neck, back and knee symptoms, with the exception of use of high vibration vehicles more than 1.9 years and knee pain, which declined from an aPR of 1.38 to an aPR of 1.27 6) . Therefore, we chose to include all 1,159 active workers <75 y/o who were missing data on gender in our analyses.…”

“…Compared with non-respondents, active members and retirees who completed the survey were younger, had slightly better working conditions, and tended to be healthier (except for back pain) 5) . This suggests that our current analysis may actually underestimate the associations between working conditions and musculoskeletal symptoms among MOW workers 6) .…”

“…However, HAV exposure from powered-hand tools represents a “constant factor” that cumulatively may add up to several thousands of hours of exposure during a lifetime of work. A multitude of musculoskeletal symptoms and disorders were recognized among MoW workers in a recent comprehensive health survey, sponsored by the Brotherhood of Maintenance of Way Employees (BMWED), and included injuries and disorders which involved the upper extremities, neck, back and lower extremities 5 , 6 ) .…”

Landsbergis et al. respond

“…These results suggest that our analyses may underestimate associations between working conditions and musculoskeletal symptoms among MOW workers. 2 Thiese et al also fail to mention that we explained how missing data was handled. We stated that "The prevalence of specific working conditions and measures of ill health from survey respondents were computed by dividing the number of respondents reporting that working condition, symptom, or diagnosis, by the number of respondents who completed at least one question on that page of the survey, as the response rate tended to decline in later pages of the survey."…”

Concerns re Landsbergis et al: Occupational risk factors for musculoskeletal disorders among railroad maintenance‐of‐way workers

“…We reviewed with interest the report of Landsbergis et al (2020) 1 titled Occupational Risk Factors for Musculoskeletal Disorders Among Railroad Maintenance-of-Way Workers. We commend the Brotherhood of Maintenance of Way Employees Division (BMWED) for their efforts to support their membership.…”