Efficient strategies for collecting posture data using observation and direct measurement

Sammanfattning: Relationships between occupational physical exposures and risks of contracting musculoskeletal disorders are still not well understood; exposure-response relationships are scarce in the musculoskeletal epidemiology literature, and many epidemiological studies, including intervention studies, fail to reach conclusive results. Insufficient exposure assessment has been pointed out as a possible explanation for this deficiency. One important aspect of assessing exposure is the selected measurement strategy; this includes issues related to the necessary number of data required to give sufficient information, and to allocation of measurement efforts, both over time and between subjects in order to achieve precise and accurate exposure estimates. These issues have been discussed mainly in the occupational hygiene literature considering chemical exposures, while the corresponding literature on biomechanical exposure is sparse. The overall aim of the present thesis was to increase knowledge on the relationship between data collection design and the resulting precision and accuracy of biomechanical exposure assessments, represented in this thesis by upper arm postures during work, data which have been shown to be relevant to disorder risk.Four papers are included in the thesis. In papers I and II, non-parametric bootstrapping was used to investigate the statistical efficiency of different strategies for distributing upper arm elevation measurements between and within working days into different numbers of measurement periods of differing durations. Paper I compared the different measurement strategies with respect to the eventual precision of estimated mean exposure level. The results showed that it was more efficient to use a higher number of shorter measurement periods spread across a working day than to use a smaller number for longer uninterrupted measurement periods, in particular if the total sample covered only a small part of the working day. Paper II evaluated sampling strategies for the purpose of determining posture variance components with respect to the accuracy and precision of the eventual variance component estimators. The paper showed that variance component estimators may be both biased and imprecise when based on sampling from small parts of working days, and that errors were larger with continuous sampling periods. The results suggest that larger posture samples than are conventionally used in ergonomics research and practice may be needed to achieve trustworthy estimates of variance components.Papers III and IV focused on method development. Paper III examined procedures for estimating statistical power when testing for a group difference in postures assessed by observation. Power determination was based either on a traditional analytical power analysis or on parametric bootstrapping, both of which accounted for methodological variance introduced by the observers to the exposure data. The study showed that repeated observations of the same video recordings may be an efficient way of increasing the power in an observation-based study, and that observations can be distributed between several observers without loss in power, provided that all observers contribute data to both of the compared groups, and that the statistical analysis model acknowledges observer variability. Paper IV discussed calibration of an inferior exposure assessment method against a superior “golden standard” method, with a particular emphasis on calibration of observed posture data against postures determined by inclinometry. The paper developed equations for bias correction of results obtained using the inferior instrument through calibration, as well as for determining the additional uncertainty of the eventual exposure value introduced through calibration.In conclusion, the results of the present thesis emphasize the importance of carefully selecting a measurement strategy on the basis of statistically well informed decisions. It is common in the literature that postural exposure is assessed from one continuous measurement collected over only a small part of a working day. In paper I, this was shown to be highly inefficient compared to spreading out the corresponding sample time across the entire working day, and the inefficiency was also obvious when assessing variance components, as shown in paper II. The thesis also shows how a well thought-out strategy for observation-based exposure assessment can reduce the effects of measurement error, both for random methodological variance (paper III) and systematic observation errors (bias) (paper IV).