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Safeguard OSH Solutions - Thomson Reuters

Safeguard OSH Solutions - Thomson Reuters

Safeguard Magazine

MSD: Prevention: the evidence

Struggling with musculoskeletal disorders? JODI OAKMAN offers a freely available toolkit which uses researched evidence to prevent MSDs.

Current approaches to prevent MSDs do not take into account some of the important evidence on the causes of this significant workplace problem. The research team I lead have developed an approach to address this issue and improve the prevention of MSDs. Called the APHIRM toolkit – which stands for “A Participative Hazard Identification and Risk Management toolkit” – it addresses several gaps in existing MSD prevention, namely:

  • • 
    Hazard focus is too narrow.
  • • 
    Workers not sufficiently involved.
  • • 
    Risks not addressed at source.

Gap 1: Current practices intended to reduce MSD risk typically focus narrowly on a few physical hazards such as heavy lifting and repetitive actions, and fail to address MSD risk from work-related psychosocial hazards (also termed “stressors”). These include how work is organised, job design, and the social context that increases workers’ stress levels – eg excessive working hours, low autonomy and poor supervisor support. Gap 2: MSD risk management is more effective when workers are actively involved in the process. In fact, assessment of psychosocial hazards is not possible without worker participation because many of these hazards are not observable by others. Gap 3: Risk control actions are most effective when they address risk at source, as per the H&S hierarchy of risk control. However, in many instances workplaces rely on strategies such as training in manual handing techniques, which is ineffective in the prevention of MSDs.


The toolkit follows five main steps, as outlined in the illustration. The preliminary stage – Getting Started – is not part of the toolkit cycle but is important in securing support from senior managers to ensure the process is sustainable.

In this step a risk management team (RMT) of supervisors, managers, H&S personnel and workers is formed to lead the process of toolkit implementation throughout the full cycle (approximately 12 months). This RMT is pivotal to the success of the toolkit process.


Workers are sent a link to complete an online survey which covers workplace exposures to physical and psychosocial hazards, and musculoskeletal pain/discomfort. The toolkit software processes this information and generates a list of ten hazards which are related to worker pain and discomfort scores. The RMT receives a print of the hazards and pain scores reported by employees. All data is reported anonymously.


Now the main hazards for people have been identified, the next step is to identify the local workplace factors that cause these hazards. It is vital to get workers’ participation as they have the local knowledge about the issues causing these hazards and so are in a strong position to suggest risk control actions.

Workers are invited to answer a series of online questions about the top ten hazards, and some of them are also invited to participate in a workshop to discuss these hazards. The feedback from workers is used by the RMT to develop actions to address each of the hazards.


Using a pre-populated template generated by toolkit software, the RMT leader completes a summary of workers’ suggestions about how to eliminate or reduce risk from each of the main hazards. Information is provided in the toolkit to assist the RMT with developing the most effective controls – in particular, trying to encourage risk controls that are focused on eliminating or reducing the problem, and not focused on manual handling training, which is known to be ineffective.


RMT leaders brief general managers, including those responsible for financial resources, on the proposed action plan and its rationale. Managers review and prioritise the proposed actions, using toolkit guidance on hierarchy of risk control principles and on the legal requirement to do everything “reasonably practicable” to eliminate or reduce risks to workers’ health and safety.

A plan for implementation of the action plan is developed, including who is responsible for each action and the time frame. An important point is to keep workers informed about what is happening to ensure morale is maintained. Opportunities for worker feedback are provided, as some actions may not be successful and require modification.


This stage overlaps with stage 1. How well procedures were implemented is reviewed using data collected throughout the process, and can be used to avoid future problems. The survey is then run again, results can be compared to the previous year, and this becomes the basis for the next action plan.


APHIRM, which we regularly revise and improve, offers a unique approach that brings together psychosocial and physical hazards to improve prevention of MSDs. To date it is the only toolkit that enables workplaces to undertake a comprehensive approach to MSD risk management and which is based on contemporary research evidence.

Associate Professor Jodi Oakman is head of the Centre for Ergonomics and Human Factors at La Trobe University in Melbourne. She acknowledges the work of Natasha Kinsman and Adjunct Professor Wendy Macdonald.

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