Development of Self Administered Questionnaire and Validity Evaluation for

American National Standards Z-365 Checklist

Self administered checklist is needed to be developed toevaluate ergonomic risk factors. This study was conducted todevelop self administered form of American National StandardsInstitute (ANSI) Z-365 checklist which representscomprehensive ergonomic risk factors, and to evaluate validityof this checklist. This study had been conducted from May 2004to July 2005, of which subjects were 147 workers from 4workplaces. Response rates for every items of self administeredform of ANSI Z-365 were evaluated. To estimate the validity ofchecklist, relationship between the checklist grade that ANSIrecommended and work-related musculoskeletal disorders(WMSDs) symptom were calculated with and withoutadjustment of related variables. To evaluate the utility ofchecklist, sensitivity, specificity, positive predictive value (PPV),and negative predictive value (NPV) were calculated. Because

response rates of almost items were over 90 %, itemdevelopment was successful. Because the checklist was relatedwith WMSDs symptom after adjusting related variables, thechecklist might represents ergonomic risk well. Because of lowsensitivity and NPV, high specificity and PPV, the checklist isnot suitable for screening tool. The checklist has betterrelationship with more severe symptom. Because of highspecificity of the checklist, using it with high sensitive toolwould enhance it's utility. Further study to develop high sensitiveand comprehensive self administered ergonomic checklist isneeded.

ANSI Z-365, self administered checklist,work-related musculoskeletal disorders

Kyung Sik Park1 Dongmug Kang2 Yong Hwan Lee1 Ji Hoon Woo2 Yong Chul Shin3

1Kosin University Medical School Department of Preventive Medicine 2Pusan University Medical School Department of Preventive and Occupational Medicine

3Department of Health and Safety Engineering, Inje University

2006 4 6 2006 5 25

Tel : 051-240-7741, Fax : 051-243-1925, E-mail : kangdm@pusan.ac.kr)

16 2 (2006 6 )J Korean Soc Occup Environ Hyg 2006;16(2):172-182

work related musculoskeletal

disorders: WMSDs

2001

173

200444.8% 4,112

2005

54.7 % 43.2 %2.1 % 2002

OSHA, 2000

checklistKarhu 97; McAtamney & Corlett, 1993; Hignett &

McAtamney, 2000; Li & Buckle, 1998Ovako Working Posture Analysing System OWAS Karhu1977

OWAS

RULA Rapid Upper Limb Assessment)(McAtamney & Corlett,1993

RULA

REBA Rapid Entire Body Assessment Hignett &McAtamney, 2000 RULA

REBARULA

RULA

American National StandardsInstitute: ANSI

ANSI ANSI Z365 Quick Checklist Appendix ANSI, 1996

ANSI Z 365

goniometric systemoptical scanning system sonic systemelectromagnetic system

accelerometer based system Li & Buckle, 1999

Winkel & Mathiassen, 1994

ANSI Z 365

ANSI Z 365

4 147

174

exclusioncriteria 2004 3 2005 7

1 ANSI Z 365 ANSI Z 365

3m

8ANSI

10 action criteria 16

2

NationalInstitute of Occupational Safety and Health: NIOSH

Criteria

I

II

III

symptom occurred more than once a month or sustained longer than a week, and pain severity more than moderate

symptom occurred more than once a month or sustained longer than a week, and pain severity more than severe

symptom occurred more than once a month or sustained longer than a week, and pain severity more than most severe

Definition

N %

Age (yr)

Body Mass Index (kg/m2)

Marital status

Smoking status

Drinking status

Exercise

Education (yr)

20 - 2930 - 3940 - 4950 -< 2020 - 25> 25 not married

etcpresent smokingpresent no smoking1 - 2 times / week more than 3 times / weekno drinkingregular irregular or no< 1010 - 12> 12

10695810

9102

3618

1222

75717272

3717610

12111

6.8 46.9 39.5

6.8 6.1

69.4 24.5 12.7 85.9

1.4 51.4 48.6 49.0 49.0

2.0 48.3 51.7

7.0 85.2

7.8

175

1 1 1 1

NIOSH4

NIOSH3 Table

1

3SAS version 8.1

ANSI3 1, 2, 3

ANSIANSI

action criteria

1, 2, 3p 0.05

147 3046.9% 40 39.5% Table 2

69.4%24.5%85.9% 12.7%

51.4% 1 2

49.0%51.7% 85.2%

I, II, III

I 89.8% II 68.0% III 32.0%I

II IIII

Table 3

ANSI Z 365 Fig. 1Fig. 2

11

NeckShoulderArmHandBackKneeFootAt least one body part

841016078817752

132

57.1 68.7 40.8 53.1 55.1 52.4 35.4 89.8

47642535413728

100

32.0 43.5 17.0 23.8 27.9 25.2 19.1 68.0

1525

91417151047

10.2 17.0

6.1 9.5

11.6 10.2

6.8 32.0

Criteria I Criteria II Criteria III

N % N % N %

176

Risk Factor

REPETITIVEevery few secondsevery few minutes

LOAD/FORCE(lift)> 5-15 lbs>15-30 lbs>30-50 lbs>50 lbs*

LOAD/FORCE(Push/Pull)easymoderateheavy

LOAD/FORCE(Carry>10ft)>5-15 lbs>15-30 lbs>30 lbs

AWKWARD POSTURENeck/shoulder: overhead/bendExtended reachElbow/forearm: twistHand/wrist: bend/pinchTrunk: twist/bendKnee: squat/kneel

USE POWER TOOLSPRESSURE POINTSSAME POSITIONENVIRONMENT: cold, hot,

light/glare, vibrationCONTUNUOUS KEYBOARD USEINCENTIVE WORKER orNO WORKER CONTROL OVER JOB PACETOTAL SCORE = 10 or more

00

0123

001

001

0000000000

00

10

0123

012

012

1111111111

11

31

1233

123

123

2222222222

22

1 hr 1 4 hr 4 hrCause of

Risk FactorProposedSolution

Comment

177

178

ANSI Z 3651

1115.0% 10 13.6%90% 10

11

Table 4

ANSI Z 365 ANSII, II, III

ANSI Ip 0.0654 II III

p 0.05 ANSI

Item number

11_122_133_144_15_15_25_35_45_55_667891011

146145143142142141137133143143145138143143139136133138127125

99.3 98.697.396.696.695.993.290.597.398.693.997.397.394.692.590.593.991.286.485.0

124556

1014

429448

1114

9132022

0.7 1.42.73.43.44.16.89.52.71.46.12.72.75.47.59.56.18.8

13.615.0

Respondents

N % N %

Non respondents

ANSI class

Low risk

Moderate risk

High risk

14(93.3)

1( 6.7)

0( 0.0)

83(62.9)

28(21.2)

21(15.9)

0.0654*

no yes p-value

39(83.0)

7(14.9)

1( 2.1)

58(58.0)

22(22.0)

20(20.0)

0.0041

no yes p-value

74(74.0)

19(19.0)

7( 7.0)

23(48.9)

10(21.3)

14(29.8)

0.0006

no yes p-value

Symptom criteria I Symptom criteria II Symptom criteria III

179

Table 5

ANSIANSI

ANSII, II, III

Ip 0.0581 II, IIIp 0.05

p 0.05 II, IIIp 0.05 ANSI

Table 6

ANSI Z 365ANSI Z 365

I, II, III ANSI Z 365

Table 7

ANSI

ANSI Z 365

ANSI class

Low risk vs moderate & high risk

Low & moderate risk vs high risk

Symptom criteria ISymptom criteria IISymptom criteria IIISymptom criteria ISymptom criteria IISymptom criteria III

7.4 3.6 3.5 >999.99910.8 6.1

0.9 1.5 1.6

<0.0011.4 2.2

59.3 8.6 7.5

>999.99984.3 17.2

0.05810.00460.00130.96610.02320.0007

Effect Odds Ratio p - value95% Confidence

Interval

Sensitivity

Low risk vs moderate & high risk

Low & moderate risk vs high risk

Symptom criteria ISymptom criteria IISymptom criteria IIISymptom criteria ISymptom criteria IISymptom criteria III

37.1 42.0 52.2 15.9 20.0 30.4

93.3 83.0 74.3

100.097.9 93.1

98.0 84.0 48.0

100.0 95.2 66.7

14.4 40.2 77.3 11.9 36.5 74.6

SpecificityPositive

predictive value

Negative predictive

value

180

Receiver operator characteristic ROC curve Fig.3ANSI

B ANSIII

WMSDs

De Krom 1992Nordstrom 1997

Cannon 1981;Silverstein 1986a; Silverstein 1986b; Armstrong 1987;Rempel 1992Knava 1985

Tecumsehquestionnaire Leon 1981; LaPorte 1982 Baeckequestionnaire Jacobs 1993 Stockholm public healthquestionnaire Ola 2002

2003

ANSI Z 365

90%

85%

3

6

8

0.00 0.20 0.40 0.60 0.80 1.00

1.00

0.80

0.60

0.40

0.20

0.00

1-Specificity

Sens

itivi

ty

181

ANSIANSI

ANSI

ANSI

ANSI

ANSIANSI

ANSI

ANSI

ANSI

ANSI Z 365& 1998

2001ANSI Z 365

gold standard

1

ANSI Z 365

REFERENCES

1998;8(2):25 362004 2005

2000 72 2001

2002;14(2):154 168

;2003;15(4):388 400

2001;11(1):5669

National Standards Institute(ANSI). Control of Workrelated Cumulative Trauma Disorders, Part 1, UpperExtremities (working draft). ANSI N 365, ANSI; 1996.

Fine LJ, Goldestein SA. Ergonomics consideration inhand and wrist tendonitis. Hand Surg 1987;12:830 837

Bernacki EJ, Walter SP. Personnel and Occupationalfactors associated with carpal tunnel syndrome. J Occup Med1981;23:255-258

American

Armstrong T,

Cannon LJ,

182

MCT, Knipschild PG, Kester ADM, Thijs CT, BoekkooiPF, Spaans F. Carpal tunnel syndrome: prevalence in the generalpopulation. J Clin Epidemiol 1992;45:373 374

McAtamney L. Rapid Entire Body Assessment(REBA).Applied Ergonomics 2000;31(2):201 205

Anisworth B, Hartman T, Leon A. A simultaneousevaluation of ten commonly used physical activityquestionnaire. Medicine and Science in Sports and Exercise.1993;25:81 91

Kansi P, and Kuorinka I. Correcting working postures inindustry - A practical method for analysis. Applied Ergonomics1977;8:199 201

Wibom RL, Voss M, Hedstrom LD, Berqvist UO. Workwith video display terminals among office employee: I.subjective symptoms and discomfort. Scand J Work EnvironHealth 1985;11(6):457 466

Cauley J, Kinsey C, Corbett W, Robertson R, Black-Sandler R. The epidemiology of physical activity in children,college students, middle-aged men, menopausal females andmonkeys. J Chr Disea. 1982;35:787 795.

Jacobs D, DeBacker G, Taylor H. Relationship of physicalcharacteristics and life habits to treadmill exercise capacity.Amer J Epidemio. 1981;113:653 660

P. A practical method for the assessment of work-related musculoskeletal risks - quick exposure check(QEC),Proceedings of the Human Factors and Ergonomics Society42nd Annual Meeting, 1998;2:1351 1355

De Krom

Hignett S.,

Jacobs D,

Karhu O,

Knava BG,

LaPorte R,

Leon A,

Li G, Buckle

Current techniques for assessing physical exposureto work-related musculoskeletal risks, with emphasis onposture-based methods. Ergonomics 1999;42(5):674-695

Corlett E. RULA : a survey method for theinvestigation of work-related upper limb disorders. AppliedErgonomics 1993;24(2):91 99

Vierkant RA, DeStefano F, Layde PM. Risk factorsfor carpal tunnel syndrome in a general population. OccupEnviron Med 1997;54:734 740

Safety and Health Administration(OSHA).Ergonomic Program; Final Rule. 29 CFR Part 1910, FedralRegister Vol. 65, No. 220, OSHA; 2000.

W, Annika H. Validity of a self-administeredquestionnaire for assessing physical work loads in a generalpopulation. J Occup Environ Med. 2002; 44: 724 735

Fine LJ, Armstrong TJ. Carpal tunnel syndrome:Causes and a preventive strategy. Semin Occup Med1986a;1:213 221

Fine LJ, Armstrong TJ. Hand and wrist cumulativetrauma disorders in industry. Br J Ind Med 1986b;43:779 844

Harrison RJ, Barnhart S. Work related cumulativetrauma disorders of the upper extremity. JAMA1992;267(6):838 842

Mathiassen SE. Assessment of physical load inepidemiologic studies: concepts, issues, and operationalconsiderations, Ergonomics 1994;37:979 88

Silverstein BA,

Rempel DM,

Winkel J.

Li G, Buckle P.

McAtamney L,

Nordstrom DL,

Occupational

Ola L, Christina

Silverstein BA,