Applied Ergonomics 32 (2001) 517524

Assessment of work postures and movements using a video-based observation method and direct technical measurements
( B. Juul-Kristensena,*, G.-A. Hanssonb, N. Fallentina, J.H. Andersenc, C. Ekdahld
a

! Department of Physiology, National Institute of Occupational Health, Lers Parkalle 105, DK-2100 Copenhagen , Denmark b Department of Occupational and Environmental Medicine, Lund University Hospital, SE-221 85 Lund, Sweden c Department of Occupational Medicine, Herning Hospital, DK-7400 Herning, Denmark d Department of Physical Therapy, Lund University, SE-220 05 Lund, Sweden Received 13 March 2000; accepted 26 January 2001

Abstract The aim was to study postures and movements during repetitive work using video-based observations and direct technical measurements (inclinometers and goniometers). A total of 21 healthy women from a poultry processing plant volunteered. Neck exion >208 was registered during 92% of the recorded time with the observation method, while the corresponding value measured with the inclinometer was 65%. Dierent reference positions and dierent measured variables apparently contributed to the dierences between the methods. Mean wrist position was measured to be 08 in exionextension and 198 in ulnar deviation. Dierences between the methods in the registered hand positions were small. The number of repetitive movements/minute and mean power frequency (MPF) of the electrogoniometer data was signicantly related, showing both variables to be relevant measures of repetitiveness. In conclusion, the observation method and the technical measurements supplemented each other well. A reduction in class categories was suggested for future observation methods. # 2001 Elsevier Science Ltd. All rights reserved.
Keywords: Observation method; Inclinometer; Goniometer; Repetitive work

1. Introduction Observation methods have frequently been used to estimate work postures and work movements in studies of work related musculoskeletal disorders (WMSD). In comparison with direct measurements the observations have been reported to combine a relative low cost, with a large capacity, versatility and generality, and an acceptable precision (Winkel and Mathiassen, 1994; van der Beek and Frings-Dresen, 1998). The application of observation methods for assessing physical exposure depends on their reliability and validity. The internal validity of the observation methods, i.e. the ability to measure what is intended has been estimated with reference to opto-electronic systems and inclinometers (Kilbom, 1994a). The majority of the studies have focused on back postures with limited information on the upper extremity postures and movements (Baty et al., 1986; Burdorf et al., 1992; de Looze et al., 1994; Ericson et al., 1993; Keyserling, 1986). A few studies
*Corresponding author. Tel.: +45-39-16-52-00; fax: +45-3916-52-01. E-mail address: bjk@ami.dk (B. Juul-Kristensen).

have validated neck positions with opto-electronic systems or observations made from still pictures as references (Leskinen et al., 1997; Fransson-Hall et al., 1995). In the PRIM study (Project on Research and Intervention in Monotonous work), a 4-year prospective study of exposure and outcome of WMSDs in neck and upper limbs, the exposure was assessed by a video-based observation method entailing work postures and movements (Andersen et al., 2001; Fallentin et al., 2001). At the same time development of electronics and computers has made direct measurements feasible for eld studies ( (Hansson et al., 1996; Akesson et al., 1997). The aim of this study was to compare postures and movements in repetitive work in a poultry processing plant using the PRIM observation method and direct technical measurements (inclinometers and electrogoniometers). 2. Material and methods 2.1. Subjects A total of 21 healthy women with no major symptoms volunteered for the study. Their mean age was 39.5 years

0003-6870/01/$ - see front matter # 2001 Elsevier Science Ltd. All rights reserved. PII: S 0 0 0 3 - 6 8 7 0 ( 0 1 ) 0 0 0 1 7 - 5

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(range: 2055 years). Their mean seniority within poultry processing work was 5.3 years (range: 0.313.0 years). A total of 11 women worked with manual deboning consisting of cutting incisions along the chicken chest and twisting the meat, and 10 women worked with packing which included manual handling and weighing of chicken thighs and wings in plastic baskets, bags or cardboard boxes, and lifting these onto/ from the assembly lines. No dierences were found between the groups with respect to age and seniority. All 21 women gave their informed consent before participating in the study. The study was approved by the local ethical committee. 2.2. Procedures Each subject was video recorded at the workplace for about 20 min (5 min in each of the four dierent work planes at the dominant arm/hand: the exionextension plane of the neck and arm, the adductionabduction plane of the arms, and a close-up of the hand for both exionextension and deviation). Simultaneous with the video recordings, postures and movements of the head, the upper back, the upper arms and the wrists were measured with inclinometers and electrogoniometers (Fig. 1). The mean recording time during the whole registration period was 55 min. The same period of registration was used for comparison of methods. 2.3. Video-based observations Cycle time, number of exertions (Colombini et al., 1999), number of repetitive movements and postures of the neck, dominant upper arm and hand were used to describe the physical exposure (Fallentin et al., 2001). An observer registered the transitions of the relevant body part from one predened class to another, while a

computer-based program registered the duration within each class and provided statistics regarding duration in percentage of the observed time. Each body part was analysed separately from the video recording. Interobserver reliability of the observation method was tested to be excellent (ri > 0:75) or fair to good (0:45ri 50:75) for 87% of the tested variables (Fallentin et al., 2001). The observed categories are listed in Table 4. Neck exion was dened as the angle between an imaginary line from the centre of the ear to 3 cm in front of the seventh cervical spine (C7) and the line of gravity, and was categorised as either 5208 or >208 (Kilbom et al., 1986b). Furthermore head inclination, i.e. deviation from the neutral posture or horizontal neutral line of gaze (dened by an angle of 718 through the eye edge and the ear centre and the line of gravity) was categorised as either 0258, 25858 or >858 (ISO 11226 Ergonomics, 1995). Upper arm posture was dened as the angle between a line through the midline of the upper arm through the estimated centre of caput humeri and the line of gravity (the arms hanging relaxed along the side of the body), and was categorised as either arm extension (>08) or arm exion (0308, 30608 or >608), and arm abduction (5308, 30608 or >608) (Kilbom et al., 1986b). The exionextension position of the hand was dened as the angle between the midline of the forearm (semipronated) and the metacarpal bones, and was categorised as either neutral (158 exion158 extension), non-neutral (15458 exion or extension), or extreme (>458 exion or extension). The deviation position of the hand was dened as the angle between the midline of the forearm (pronated) and the third metacarpal bone. Deviation was categorised as either neutral (108 ulnar deviation-58 radial deviation), non-neutral (10208 ulnar deviation or 5158 radial deviation) or extreme (>208 ulnar deviation or >158 radial deviation). The number of repetitive movements/minute was counted for the hands, according to operationally dened movements (Fallentin et al., 2001), as additionally used in MTMsystems (Barnes, 1980). Work cycle time was dened as the time from where one work task has begun until the next work task began, and the number of exertions was dened as the number of technical actions with the dominant hand within a work cycle calculated per minute. 2.4. Technical measurements Triaxial accelerometers were used as inclinometers for recording the forward and sideways bending of the head and the upper back, as well as the upper arm elevation (regardless of direction) in relation to the line of gravity (Hansson et al., 2001). Data were sampled using loggers (sampling frequency 20 Hz). The inclinometers were xed with double-sided adhesive tape to the frontal part

Fig. 1. A female performing manual deboning at the poultry processing plant equipped with the technical equipment used (i.e. inclinometer at the head and goniometers at the hands).

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of the forehead (head), C7 (upper back), and for the left and right upper arm at the origin of m. deltoid (superior edge of the inclinometer) and at a line from acromion and the lateral epicondyle (posterior edge of the inclinometer). Reference positions of each subject for the head and the upper back were recorded in an upright standing position with the eyes looking at a point at eye height and when sitting with the upper part of the body bent steeply forward. For the arms the reference position was recorded when holding a 2 kg dumbbell with the arms hanging relaxed towards the ground along the backside of a chair back support. Before application the inclinometers were calibrated in the X, Y and Z direction against the line of gravity. The reliability/precision of the inclinometers was tested to be % 18 in static positions (Hansson et al., 2001). Biaxial electrogoniometers (XM65, Biometrics Ltd., Gwent, UK) were used for recording of the exion extension and deviation angles of the right and left wrists. The sampling frequency was 20 Hz. Each goniometer was attached to the dorsal face of the hand at the third metacarpal bone, and additionally at the dorsal side of the full pronated forearm at the distal part of the forearm. Reference position (standing with the arms hanging relaxed along the side of the body) and maximal mobility tests for each hand were recorded (Hansson et al., 1996). The reliability/precision of the goniometer has been estimated to 1.58 as a mean measured over 908 from the neutral position, with decreasing precision in movements over 608 from neutral position (Biometrics Ltd, 1998). The crosstalk of the goniometers (the fraction of actual deviation angle that will be recorded as exion due to forearm rotation and vice versa) had been tested to be 8% in neutral position, 77% in extreme supination and 32% in extreme pronation (Hansson et al., 1996, 2001).

2.5. Statistics and analyses Analyses of inclinometer and goniometer data were performed with PC-based programmes (Department of Occupational Medicine, Lund University Hospital, Lund). Positions and angular velocities were calculated from inclinometer and goniometer data, and supplemented with calculations of acceleration, mean power frequency value (MPF) and duration with an angular velocity 518/s for >0.5 s for the goniometer data (Hansson et al., 1996). Descriptive statistics were used. A test for normality was performed for selection of the appropriate analytic statistics. Paired t-test/Wilcoxon signed ranks test were used to describe the signicance of the dierence between the dominant and non-dominant arm and hand. Non-paired t-test/Mann-Whitney U-test was used to describe dierences between the work tasks. In all analyses dierences were accepted as signicant at p-values less than 0.05. Linear regression analysis was used primarily to test the MPF as a predictor of the observed number of repetitive hand movements/min.

3. Results Observations of all 21 subjects were performed in all planes except for the hand of one person, where the video recordings were not satisfactory. Due to technical problems measurements from three inclinometers on the head, one inclinometer on the dominant arm and one goniometer on the dominant hand were excluded from the analyses. In general, none of the methods revealed signicant dierences between the work tasks with respect to work postures (Tables 13). However, in acceleration of the

Table 1 Inclinometer registrations of positions and movements for head, upper back, dominant (Dom) and non-dominant (NDom) arm during work tasks at a poultry processing plant. Registrations during 55 min, means (SD) are shown. Positive values denote forward exion and lateral exion to the right side Head Flex/ext n 18 Position Distribution (perc;8) 10th 8 (7) 50th 22 (5) 90th 31 (5) Movements Distribution (perc; 8/s) 50th 19 (3) 90th 54 (9) Latex Upper back Flex/ex n 20 Latex Dom.arm Elev n 20 NDom.arm Elev n 21

9 (4) 1 (4) 7 (4)

3 (5) 8 (5) 16 (4)

10 (4) 2 (4) 5 (4)

19 (5) 28 (5) 42 (7)

17 (5) 26 (7) 41 (9)

22 (4) 67 (11)

16 (5) 49 (14)

16 (5) 49 (12)

32 (11) 98 (31)

35 (13) 110 (43)

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Table 2 Goniometer registrations of positions and movements for the dominant (Dom) and non-dominant (NDom) hands during dierent work tasks at a poultry processing plant. Registrations during 55 min, mean (SD) are shown. Positive values denote palmar exion and ulnar deviation Flexion Dom. hand (n 20) Position Distribution (perc;8) 10th 50th 90th NDom. hand (n 21) Deviation Dom. hand (n 20) NDom. Hand (n 21)

20 (9)b 0 (9)b 22 (11)

20 (10) 1 (11) 24 (10)

5 (15)a 18 (15)a 34 (14)a

10 (12)a 5 (14)a 17 (14)a

Movements Velocities-below 18/s (% of time) mean 0.17 (0.33) Velocity (perc; 8/s) 50th 90th mean

0.23 (0.45)

0.39 (0.66)

0.33 (0.59)

38 (10) 130 (28) 56 (12)

38 (13) 137 (31) 58 (14)

23 (7) 76 (22) 34 (10)

22 (9)b 79 (24) 34 (11)b

Acceleration (perc; 8/s2) 50th 381 (137) 90th 1443 (425)b mean 609 (194)b Repetitiveness (Hz) MPF
a b

381 (162)b 1536 (487)b 637 (208)b

215 (86) 789 (291)b 346 (132)b

218 (99)b 890 (340) 375 (138)b

0.58 (0.13)

0.60 (0.13)

0.55 (0.13)

0.61 (0.15)

Signicant dierence between the dominant and non-dominant hand (p50:05). Signicant dierence between the dierent work tasks of manual deboning and packing (p50:05).

Table 3 Variables related to the work organisation assessed from the observation method. Values are presented for the dominant hand during the period of observation as median (interquartile range Q1; Q3) Observation data Manual deboning median (Q1;Q3) (n 11) 3.4 100.0 35.7 25.0 (2.9; 5.8)a (87.0; 100.0) (31.0; 41.4) (20.0; 29.0) Packing median (Q1; Q3) (n 9) 14.3 100.0 31.9 28.5 (7.2; 17.5)a (100.0; 100.0) (27.7; 38.4) (22.0; 42.0) All median (Q1; Q3)

A. Time variability (1) Cycle time (s) (2) Dur.ex (%) (3) No ex/min (4) Repetitive movements/min hand
a

5.8 100.0 32.5 25.0

(3.0; 14.3) (100.0; 100.0) (29.4; 40.5) (21.0; 32.5)

Signicant dierence between the two work tasks (p50:05).

hand, signicant dierences between the work tasks were seen, showing packing to have the highest acceleration (mean and 90th percentile) seen in Table 2. The observation method found signicant dierences in variables related to the work organisation (cycle time), which showed manual deboning to have a signicantly shorter cycle time but a tendency (p 0:08) of a higher number of repetitive hand movements/minute in packing (Table 3). As work tasks were mostly done with both arms and hands performing the same action and almost no

dierences were seen between the dominant and the non-dominant side. 3.1. Posture registrations The mean duration of neck exion >208 was 92% in the observation method and 65% in the inclinometer registration. This dierence could partly be explained by dierent reference positions of the neck/head in the two methods (observation method: anatomical position, ear centre and 3 cm in front of C7 on the line of gravity)

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Table 4 Dierences between the observation method and the direct measurements in relation to reference positions and measured variables. (The observed categories are shown in italics) Observation method Neck (0208) Reference position Measured variables Arm (0308, 30608, >608) Reference position Measured variables Hand Reference position Measured variables Direct measurements (inclinometer/goniometer)

Anatomical neck exion

Functional comb. neck+head exion

Functional exionextension/abductionadduction

Anatomical elevation

Anatomical no dierences

Functional no dierences

(inclinometer: functional position, standing relaxed, the eyes looking straight ahead at eye height). In Table 4 an overview of part of the dierences between the methods are shown. When adjusting for the dierent reference positions, estimated to be about 58 in a pilot study, the dierence between the methods decreased from 27% to 13%. In Table 1 inclinometer registrations are shown for the head, the upper back and the arms during the whole registration period (55 min). A strong correlation was found between the observed neck exion 0208 and the observed head inclination 0258 (adj. R2 0:55), showing that for some part of the time, neck exion was performed both as a head inclination and a neck exion. Mean neck exion (50th percentile both tasks) was measured with the inclinometer to be 228. The mean duration (% time) for arm positions 30608 was 11% and 3% in the observation method (exion and abduction period) and 39% and 45% in the inclinometer registrations. The smallest dierence between the methods, 0.51.0%, was seen with arm elevation above 608. Again dierent reference positions as shown in Table 4 were used in the two methods (observation method: the arm hanging relaxed along the side of the body) (arm inclinometer: the arm hanging along the line of gravity with a 2 kg dumbbell). When adjusting for the dierent reference positions estimated to be about 108 the dierence between the methods decreased from 29% to about 4% in exion and from 42% to 12% in abduction. The mean angle (50th percentile both tasks) of arm elevation, dominant arm, was measured with the inclinometer to be 288 for exion, 298 for abduction and for both periods 298. No signicant dierence was seen between the dominant and non-dominant arm. In general, the dierences between the methods were small concerning wrist positions, especially in deviation (Table 5), but the methods incorporated dierent reference positions. The goniometer measured a func-

tional position (the arms hanging relaxed along the side of the body), whereas the observation method measured an anatomical 0-point position (straight wrist and ngers, third nger in line with midline of the forearm). In a pilot study, the dierence between the reference positions was estimated to be 208 in exionextension and about 78 in ulnar deviation. An example is presented in Table 5, where the adjustment of the reference positions, reduced the dierences. When adding the two categories of neutral exionextension and nonneutral extension to one common category the mean dierence (+17%, 18%) was almost eliminated. The mean 50th percentile (both tasks) was measured with the goniometer to be 08 in palmar exion and 198 in ulnar deviation. Except for the positions of deviation no signicant dierence was seen between the dominant and non-dominant hand. In Table 2 goniometer registrations of positions, velocities and accelerations are shown for the hands during the whole registration period. 3.2. Movement registrations Signicant relationships (p 0:03 and 0.001) were seen between number of repetitive hand movements/min estimated in the observation method and MPF of the goniometer data, where adjusted R2 -values were 0.18 and 0.44 (exion and deviation) and in the combined measure of MPF (exion and deviation) (p 0:001) adjusted R2 was 0.44. Furthermore signicant relationships (p 0:01) were found between the two observed variables, number of repetitive movements/min and number of exertions/min (adj. R2 0:22).

4. Discussion In general, the physical work load in manual deboning and packing was high (Tables 14), and furthermore both arms and hands were engaged in

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Table 5 Goniometer registrations and observation data of duration spent in various wrist positions of the dominant hand, during work tasks at a poultry processing plant (n 19). Percentage of time, mean (SD and SEM) are shown. Goncorr=corrected goniometer registrations for dierent reference positions (exionextension=208 and deviation=78) Method Position (% time) Wrist exion >458 15458 Neutral 158ex-158ext Wrist extension 15458 >458 Wrist ulnar deviation >208 10208 Neutral 108uln-58rad Wrist radial deviation 5158 >158 Gon (SD) Goncorr (SD) Obs (SD) Goncorr obs (SEM)

1.2 (3) 19.7 (15)

0.1 (0) 3.7 (6)

0.0 (0) 8.8 (12)

0.1 (0) 5.2 (3)

58.2 (14)

34.6 (18)

17.6 (19)

17.0 (7)

20.3 (16) 0.5 (1)

53.5 (18) 8.1 (9)

71.0 (24) 2.6 (11)

17.5 (7) 5.5 (3)

53.5 (38) 18.3 (16)

65.9 (35) 14.7 (14)

74.3 (28) 18.1 (19)

8.4 (9) 3.3 (5)

16.2 (17)

12.9 (18)

7.4 (11)

5.5 (4)

7.2 (12) 4.8 (13)

4.8 (11) 1.7 (5)

0.3 (1) 0.0 (0)

4.6 (2) 1.7 (1)

repetitive work. Non-neutral and extreme postures were frequent in both work tasks, mean velocity and acceleration of the hands were above or close to high risk group levels and the number of repetitive movements/min exceeded recommended limits (Andersson et al., 1983; Persson et al., 1985; Marras and Schoenmarklin, 1993; Kilbom, 1994b). A high MPF (0.60 0.64 Hz) was also seen in the present study, exceeding the MPF level of 0.53 Hz which in repetitive laminate work tasks was associated with a high prevalence of wrist/hand symptoms (pain, tenderness), signs (positive pain-provoking tests) and complaints from a questionnaire (Hansson et al., 2000). Additionally, it was close to the MPF level measured in data entry and letter sorting work (MPF=0.68, 0.79), where an increased risk of CTS was seen (Thomsen, 1999). 4.1. Posture registrations In the present study, the dierence between the methods was 27% for neck exion, and 29% and 42% for arm exion/abduction with a small dierence in arm elevations >608. After adjustments for the dierent reference positions used, dierences in neck exion decreased to 13% and to 4% and 12% in arm exion and abduction, respectively. With respect to the hand registrations, the dierences were small in exion and deviation, but after adjustment for the reference positions, the dierences decreased further, mostly below 10%. A lack of precise denitions of neutral

postures of the cervical spine, have previously been reported as one of the explanations for the large dierence between duration of neck exion >208 and >608 in observation methods and direct technical measurements (Leskinen et al., 1997; Fransson-Hall et al., 1995). Further, a mean actual position close to the class limit has been reported to explain part of the dierences (Burdorf et al., 1992; Keyserling, 1986), but this could not be veried in the present study. 4.2. Neck registrations Besides problems with dierent reference positions, the dierences in the registrations could be explained by dierent measured variables (Table 4). In the present study, the head inclinometer located at the forehead registered a combined position of the upper and the lower cervical spine, whereas the observation method assessed neck exion and head inclination separately. Biomechanical criteria and a possibility for comparison with other studies using head inclination as a variable constituted the dominant criteria for dierentiating between the lower and upper part of the neck in the PRIM observation method (Kilbom et al., 1986a; Fransson-Hall et al., 1995; ISO 11226 Ergonomics, 1995). The consequence of these dierent measured variables was illustrated in a pilot study. A simple test with a xed position dened by the observation method to be, for example, 208 of neck exion was performed with the head inclinometer. The inclinometer registered

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a larger exion when the chin was pulled towards the chest (exion in the upper cervical spine) and a smaller exion when the chin was pushed forward (extension of the upper cervical spine). These dierent measured variables could not be corrected for in the present study, and we do not know the extent of this inuence. 4.3. Upper arm registrations The dynamic character of the work has been used as an explanation for dierences between registrations of upper arm positions in observation methods and a video position analyser (Ericson et al., 1993; Keyserling, 1986). In general, a slight tendency of overestimating the low angles and underestimating medium and high angles when observing static shoulder postures was reported in a laboratory study (Genaidy et al., 1993). In the present study, dierent measured variables were incorporated in the methods. The inclinometer measured the arm elevation in the combined plane of exion/abduction, while arm exion and arm abduction were observed separately in the observation method. The measured variables used in the observation method was based on studies reporting a signicantly higher intramusculature pressure in m. supraspinatus during 308 abduction compared to 308 exion, which will restrict the blood supply to the active muscles and impair tissue nutrition with the risk of development of tissue necrosis (Jensen et al., 1995). A drawback of the PRIM observation method though, was that exion and abduction could not be observed during the same period of time, but in repetitive work tasks this was estimated to be a minor problem. Again however, it was dicult to quantify the inuence of these dierent measured variables. 4.4. Hand registrations No studies have previously compared hand observations and electrogoniometer registrations. In the present study dierences in estimated hand postures between the methods were in general small, and a dierent zeropoint (reference position), which can be adjusted for, partly contributed to this dierence. However, the relatively large dierences seen when comparing the class categories of neutral and non-neutral extension, still remained, which probably was due to diculties in the observation method in distinguishing the two closely located classes in high repetitive work. When these class categories were added into one category, the dierences between methods seemed to disappear, which could be relevant to future observation studies of hand postures. A possible crosstalk in the goniometer registrations (Hansson et al., 1996) may further have contributed to the dierences, as the present dominant forearm was

observed to be primarily in a medium to a large pronation. Ratings on repetitiveness of the hand on a scale from 0 to 10 have been reported to be positively related to the mean angular velocity of the hand (8/s) and number of hand exertions/second, and negatively related to % time of recovery (% time below 2.5% MVC of nger exors and extensors) (Latko et al., 1997; Latko, 1997). In the present study, the number of repetitive hand movements per minute was closely related to the MPF-values, indicating both variables to be relevant measures of repetition. In contrast, cycle time was not directly related to the performed wrist movements. Packing which had a formal cycle time 4 times longer than manual deboning, implied higher angular accelerations and a tendency to a higher number of repetitive movements/min. In conclusion, dierent measured variables and reference positions contributed to the dierences between observations and direct technical measurements of neck and arm postures. In general, the observation method is known to be a more crude method with a lower accuracy compared to the more precise direct measurements, especially when the dynamic character of the work task is taken into consideration. It was however, dicult to quantify the size of the dierences because of the dierent reference positions and measured variables. More crude classes were suggested for future observation methods regarding hand positions. In general the two methods supplemented each other well. The direct equipment measured angles, velocities and accelerations, while the observation method registered a number of supplementary variables related to the work organisation. In future studies it may be feasible to use observation methods in major eld studies, as the technical requirements are less than in direct measurements. A large advantage of direct measurements is, however, that it is possible to perform detailed and precise whole day registrations which, especially in jobs with many dierent work tasks, may be required. Registrations of postures and movements must, however, as a general rule, be supplemented with measurements or estimations of other external forces, that inuence the physical load (i.e. arm/wrist support, external loads, speed and accuracy of movements, eccentric or concentric work).

Acknowledgements This study was supported by the Swedish Medical Research Council, the Swedish Council for Work Life Research and the Swedish National Institute for Working Life (including COPE). Skilfull technical assistance . was given by Paul Asterland, Simon Sjolander and Lothy Granqvist.

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