April 2000 Bulletin

AAOS tells OSHA delay action until evidence stronger

The AAOS is urging the Occupational Safety and Health Administration (OSHA) to postpone the proposed ergonomics program standard because the available scientific evidence is not strong enough to justify the proposal.

AAOS shares OSHA’s concern for the health and safety of workers, and "recognizes that there is some relationship of work activity to musculoskeletal injury, but the exact relationship is not clear," said AAOS President Robert D. D’Ambrosia, MD.

In his comment letter on the proposed rule, Dr. D’Ambrosia said, "We take no formal position on the relationship of work to injury beyond what is documented in the literature as reliable evidence. Despite the large volume of data, the quality of the scientific evidence is not strong enough to justify ergonomic standards of this nature and magnitude."

AAOS is asking OSHA to support a national research agenda, collect the necessary scientific information and, if supportive, return with more specific standards later. OSHA also is being asked to consider an incremental approach to implementing standards and to plan limited and controlled on-the-job pilot programs that test aspects of the proposed rule against specific jobs, complaints, musculoskeletal disorders and remedies.

The proposed standards drew so much interest that OSHA had to extend the comment period. The ergonomics issue has been a hot potato for years, fought vigorously by the business community. Three times Congress wrote language into appropriations bills to prevent the agency from preparing ergonomics rules. The most recent restriction expired before Congress could act, and OSHA immediately published its proposal.

"Where’s the proof" has been the crux of arguments by businessmen and others opposed to the standards. There are strongly divergent opinions within the orthopaedic community.

The National Research Council (NRC), responding to a request from Congress, issued a report last year that found a "fundamental relationship between extreme work exposures and musculoskeletal injuries." The report didn’t satisfy critics and the NRC was asked to do a two-year study of musculoskeletal disorders and the workplace.

Ann Mavor, project director, said the current study is more extensive, looking at the epidemiology, basic science and primary and secondary intervention issues. NRC has held five meetings thus far with presentations from business, labor and government.

In the comment letter to OSHA, Dr. D’Ambrosia said AAOS believes there are various factors that make it difficult to determine the direct relationship of an injury to work. For instance, musculoskeletel disorders can occur under a variety of work conditions, but they do not occur in all individuals under the same conditions. Disorders can vary in intensity and frequency among individuals for reasons unrelated to work. They can be caused or exacerbated by activities performed outside of work.

AAOS believes that additional research is needed to clarify the relationship between symptoms, injury, injury reporting and disability on the one hand; and work, individual and social factors on the other. The research should also provide information on the relationship between the degree of different mechanical stressors and the biological response.

AAOS is concerned about the subjective nature of OSHA’s list of specific musculoskeletal disorders and symptoms. The rule confuses various aches and pains with musculoskeletal disorders, said Dr. D’Ambrosia. "The lack of truly objective findings to verify many of these problems can cause errors in diagnoses, which can lead to inappropriate treatments, surgeries and other prescriptions," he warned.

Dr. D’Ambrosia observed that the label of "musculoskeletal disorder" can encourage a "disease mentality" where one need not exist. "There is too much room for error when attaching a complaint, like a pain or tingling or numbness, to a diagnosis," he said.

AAOS also is concerned that the proposed standard says it is the employer or the employer-selected health care provider who determines if the employee’s problem is work-related and requires remedies. OSHA should call on employers to use health care providers who are "highly trained and qualified" and who are "knowledgeable in the assessment and treatment of musculoskeletal disorders to ensure appropriate evaluation, management and follow-up of workers’ musculoskeletal disorders, Dr. D’Ambrosia said.

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