Work 43 (2012) 437–446 437

DOI 10.3233/WOR-2012-1460
IOS Press

An integrative approach for evaluating work

related musculoskeletal disorders
Wricha Mishraa,∗ , De Amitabhaa, R. Iqbala , S. Gangopadhyayb and A.M. Chandrab
a
National Institute of Industrial Engineering, Mumbai, India
b
Department of Physiology, University College of Science, Technology and Agriculture, University of Calcutta,
Kolkata, India

Received 10 May 2010

Accepted 15 February 2012

Abstract. Objectives: To develop a framework for evaluating the work related musculoskeletal disorders (WRMSDs).
Participants: The proposed framework was tested on 15 jewellery manufacturing workers working at Chinchpokhli region in
Mumbai, India and on 15 students studying in a management institute of Mumbai, India.
Methods: The framework has been broken into three phases. Phase 1 – Ergonomic-risk evaluation; Phase 2 – Musculoskeletal
Disorders (MSD) evaluation and Phase 3 – Clinical examination. Ergonomic-risk evaluation determines the relationship between
work relatedness and musculoskeletal disorders. Musculoskeletal Disorders (MSD) evaluation tries to assess the presence of
discomforts/disabilities in different body regions, through subjective evaluation tools. Ergonomic-risk evaluation involved QEC,
PLIBEL and posture analysis by RULA. Musculoskeletal Disorders (MSD) evaluation involved administration of self reported
questionnaires. Clinical examination involved muscle grading by a physiotherapist and back strength measurement.
Results: The framework suggested that ergonomic risk evaluation techniques, self reported body part questionnaires and physical
measurement of physiological/biomechanical transients may have a relationship and can be used for the evaluation of work related
musculoskeletal disorders.
Conclusion: The proposed integrative approach will help in developing stage wise intervention strategies for work related
musculoskeletal disorders.

Keywords: Framework, ergonomic-risk, clinical examination

1. Introduction 14] occupational risk factors are responsible for the

Work-related musculoskeletal disorders (WMSDs)
have been widely acknowledged as a major part of oc-
cupational harm, resulting from the acute and cumula-
tive exposure to physical task demands [8,33,37] and
are the most prevalent cause of lost time injuries and
illnesses in almost every industry and are the costliest
occupational disease [3,33].
Studies have identified that physical [14,41] psy-
chosocial, organizational [5,14,24] and individual [2,
∗ Address for correspondence: Wricha Mishra, National Institute
of Industrial Engineering (NITIE), Vihar Lake, Mumbai – 400 087,
India. Tel.: +91 9769393813; E-mail: m.wricha84@gmail.com.
development of work-related musculoskeletal disor-
ders (WMSDs). Thus, the occurrence of work relat-
ed musculoskeletal disorders are multifactorial in na-
ture [33]. Reviewers and researchers through numer-
ous findings reported that exposure to risk factors for
work-related musculoskeletal disorders (WMSDs) in a
workplace are a complex area. Since the majority of
the studies are epidemiological (mainly retrospective
and cross sectional) in nature, the relationship between
musculoskeletal disorders, ergonomic risk factors and
their physiological pathways are not always well estab-
lished [33,42]. Therefore, future studies must include
various characteristics of tasks, physical and biome-
chanical exposures and identification of physiological
pathways on anatomic structures and tissues [30,37].

1051-9815/12/$27.50  2012 – IOS Press and the authors. All rights reserved
438 W. Mishra et al. / An integrative approach for evaluating work related musculoskeletal disorders
There are many tools available for assessing the im-
pact of individual ergonomic risk factors on the causa-
tion of musculoskeletal disorders, but no single tool is
suitable for all purposes [38]. For example, tools em-
ployed by clinicians are predominantly used for iden-
tifying the pathological conditions. Similarly, occupa-
tional ergonomists use epidemiological tools (mainly
cross sectional and retrospective) to establish the role
of ergonomic risk factors on the development of work
related musculoskeletal disorders. Therefore, differ-
ent groups of practitioners approach the problem dif-
ferently resulting in different management/intervention
protocols which are often found to be inadequate. A
comprehensive framework using multiple tools to cap-
ture different aspects of work place would probably be
better way to assess the work related musculoskeletal
disorders [38].
There are several such frameworks available for di-
agnosing, treatment and management of the work relat-
ed musculoskeletal disorders. Westlander [40] devel-
oped a logic framework to assess occupation specific
musculoskeletal disorders [40]. Shoaf et al. [36] pro-
posed a work system model to evaluate how the com-
plete spectrum of work demands (i.e. physical and men-
tal demands, physical/social/organizational/individual
growth environment conditions) influence human ef-
fort [36]. But the model did not provide the rela-
tionship between risk factors and pathological con-
ditions of musculoskeletal disorders. Cole et al. [9]
proposed a framework for evaluating field interven-
tions that included strategies, activities, objectives and
metrics for outcomes using quantitative and qualita-
tive methods [9]. But the framework was only meant
for computer intense office jobs. Human Tech devel-
oped Risk Priority Management model for diagnos-
ing and management of musculoskeletal disorders pre-
dominantly based on work posture, force applied, fre-
quency and duration of exposure mainly for short du-
ration work activities. However, the intensity of dis-
comforts cannot be effectively evaluated by this mod-
el [www.humantech.com/products/softwares/rpm dat-
ed on 10.9]. 2010. Stock et al. [37] proposed a mod-
el to estimate physical work demands taking into ac-
count the relationship between the results of physician
evaluation and ergonomic risk factors to describe the
work relatedness [37]. However, the model did not in-
clude evaluation methodology for major regions of the
body. In addition, the reliability and validity of these
approaches are not reported.
The evaluation and management of work related
musculoskeletal disorders needs to have a framework
which will provide a) work relatedness b) status of
musculoskeletal health and c) work exposure. Based
on the review of the literature, an attempt was made
to propose an integrative approach for evaluating work
related musculoskeletal disorders. The objective of the
study was to propose an integrative framework for the
evaluation of work related musculoskeletal disorders
and to assess the applicability of the proposed frame-
work on two different groups.
2. The framework
2.1. Formulation of framework
The framework is provided in Fig. 1. It involves three
phases. Phase 1 – Ergonomic risk evaluation, Phase 2 –
MSD evaluation and Phase 3 – Clinical examination.
The framework involves self-assessment question-
naires, observational, and direct methods for assessing
musculoskeletal disorders. Self-assessment question-
naires are reported to be powerful instruments in assess-
ing the outcome of medical management and interven-
tions [21]. Observational methods are most often used
to evaluate physical workload in order to identify haz-
ards at work, monitor the effects of ergonomic changes
and/or clinical advices [38]. Moreover, observational
methods have the advantages of being inexpensive and
practical for use in a wide range of workplaces where
using other methods of observing workers would be
difficult because of the disruption caused. It was also
reported that direct measurement systems can provide
large quantities of highly accurate data on a range of
exposure variables [14].
2.1.1. Phase I – Ergonomic risk evaluation
Phase 1 involved evaluation of ergonomic risk us-
ing subjective evaluation tools. The tools used were
Quick Exposure Check (QEC), Plan for Identifying Av
Belastningsfaktorer (PLIBEL) and Rapid Upper Limb
Assessment (RULA). The positive result of Phase 1
signifies the presence of ergonomic risks.
2.1.1.1. Quick Exposure Check (QEC)
QEC was used for obtaining the views of both the
observers’ and subjects’ regarding posture, working
hours, repetition of work. Levels of ergonomic risks
at neck, shoulder, back and wrist were calculated for
both the groups based on the above factors [6]. Intra-
observer reliabilities have been proven to be ‘fair to
good’ for most of the assessment items [15].
 W. Mishra et al. / An integrative approach for evaluating work related musculoskeletal disorders
Fig. 1. Diagrammatic representation of the framework.
2.1.1.2. Plan for Identifying Av Belastningsfaktorer
(PLIBEL)
PLIBEL was used for determining the relationship
among workplace layout, work relatedness and muscu-
loskeletal risk factors [26]. PLIBEL is a rapid screening
tool of major ergonomic risk factors like awkward pos-
ture, frequency, duration and movements which may
have injurious effect on the musculoskeletal system.
It is designed to link ordinarily checked items in the
workplace assessment of ergonomic hazards to primar-
ily five body regions. Reliability of the instrument has
been found to be moderate [38].
2.1.1.3. RULA (Rapid Upper Limb Assessment)
In the RULA method, positions of individual body
segments are observed and scored, with scores increas-
ing in line with growing deviation from the neutral pos-
ture. The inter-observer reliability was found to be
good [31,38].
Takaal et al. [38] stated that QEC and PLIBEL are
good screening tools to evaluate musculoskeletal risks.
Since observational methods should include the fre-
439
quency and duration of items quantifying exposures –
like external forces or postures – in addition to their
magnitude. Hence, QEC which is a tool for evaluat-
ing the change in exposure to risk for musculoskele-
tal disorders and PLIBEL which measures the impact
of these ergonomic risk factors on the musculoskeletal
system were included in the framework [38]. RULA
survey is a posture-sampling tool used specifically to
examine the level of risk associated with upper limb
disorders of individual workers. Studies have shown
that RULA scores have an association with increased
discomfort [19,31]. So for further conformation on in-
fluence of work load on musculoskeletal discomfort,
RULA was used.
2.1.2. Phase 2 – Musculoskeletal disorders evaluation
Phase 2 involved evaluation of MSD through ques-
tionnaires such as Nordic Musculoskeletal Question-
naire (NMQ), Disability of arm, shoulder and hand
(DASH), Neck Disability Index (NDI), Oswestry Low
Back questionnaire and IKDC subjective knee ques-
tionnaire. The positive response indicates the likelihood
of MSD.
440 W. Mishra et al. / An integrative approach for evaluating work related musculoskeletal disorders
Fig. 2. Results of QEC.
2.1.2.1. Nordic Musculoskeletal Questionnaire (NMQ)
NMQ was used for assessing the presence of muscu-
loskeletal discomforts in different anatomical regions.
It deals with questions related to symptoms (ache, pain,
discomfort) experienced during the previous 12-month
period. Respondents are asked if they have had any
musculoskeletal trouble in the last 12 months and last
7 days which has prevented their normal activity [13,
28].
2.1.2.2. Disability of Arm, Shoulder and Hand (DASH)
The main part of the DASH is a 30-item disability/
symptom scale concerning the patient’s health status
during the preceding week. Each item is rated on a five-
point Likert scale. The DASH also contains two option-
al four-item scales concerning the ability to perform
sports and/or to play a musical instrument (sport/music
component), and the ability to work (work compo-
nent) [22]. The Cronbach alpha coefficient was above
0.9 for the DASH disability/symptoms scale indicating
good internal consistency [4].
2.1.2.3. The Neck Disability Index (NDI)
NDI consists of 10 items referring to various daily
activities (personal care, lifting, driving, work, sleep-
ing, concentration, reading, recreation) and pain (pain
intensity, headache) with 6 possible answers for each
item. The score of each item varies between 0 (no
pain and no functional limitation) and 5 (worst pain
and maximal functional limitation) [35]. The NDI has
been shown to be highly reliable on what is called “test
retest” reliability [39].
2.1.2.4. Oswestry low back questionnaire
The questionnaire consists of 10 items addressing
different aspects of function. Each item is scored from
0 to 5, with higher values representing greater disabili-
ty. Measurements obtained with the modified Oswestry
Disability Questionnaire, were the most reliable and
had sufficient width scale to reliably detect improve-
ment or worsening in most subjects [17].
2.1.2.5. IKDC subjective knee questionnaire
It consists of 18 questions in the domains of symp-
toms, functioning during activity of daily living and
sports, current function of the knee, and participation in
work and sports.The responses to each item are scored
using an ordinal method such that a score of 0 is giv-
en to responses that represent the lowest level of func-
tion or highest level of symptoms. The IKDC subjec-
tive knee questionnaire is a reliable and valid instru-
ment worthy of consideration for use in a broad patient
population [25].
NMQ was incorporated in the framework as it is be-
ing used as a standard screening tool for assessing work
related musculoskeletal disorders [12,28]. DASH is a
tool to evaluate the disability and symptoms in single or
multiple disorders of the upper limbs. It enquires about
the degree of difficulty in performing different physi-
cal activities because of problems related to the arm,
shoulder or hand, the severity of each of the symptoms
of pain, activity-related pain, tingling, weakness and
stiffness, as well as impact of the problem’s on social
activities, work, sleep and self-image [22]. NDI was
used to test self-rated disability in neck [35]. It was
reported that the NDI is the most commonly used self-
 W. Mishra et al. / An integrative approach for evaluating work related musculoskeletal disorders
report measure for neck pain [39]. For assessment of
low back related pain Oswestry Low Back Disability
Questionnaire (Oswestry Disability Index) was used.
Since the questionnaire is considered as the ‘gold stan-
dard’ of low back functional outcome tools so it was
included in the framework [18]. The IKDC Subjective
Knee Evaluation Questionnaire was used for assessing
knee discomforts [1,25].
2.1.3. Phase 3 – Clinical examination
Phase 3 involved physical examination namely pa-
tient history, observation, palpation and manual mus-
cle testing. Patient history implies understanding of
whether patients past is related to any injury or ill-
ness. Observation involves observing the posture and
behaviour of the patient related to sitting and standing.
Palpation is a widely used technique to identify struc-
tures and determine the presence and location of pa-
tient described pain patterns. Manual Muscle Testing
(MMT) is used for testing the performance and evalu-
ation of muscle strength and length along with neuro-
muscular conditions. The key to muscle grading used
was 5 as normal, 4 as good, 3 as fair, 2 as poor, 1 as trace
and 0 as no contraction. Normal implies subject can
overcome a greater amount of resistance than a good
muscle; good implies that the subject can raise the body
part against outside resistance as well as against grav-
ity; fair implies subject can raise the body part against
gravity, poor implies movement with gravity eliminat-
ed but cannot function against gravity; trace implies
that muscle can be felt to tighten but cannot produce
movement and 0 or ‘gone’ represents no contraction
felt [27]. The purpose of this phase is to establish con-
firmatory measures of the indicative musculoskeletal
health status reported in Phase 2. This phase also in-
cluded direct measurement of the strength of most trou-
bled area before and after the work exposure. Further
clinical tests such as nerve conduction study, Clinical
Electromyography and Magnetic Resonance Imaging
were not included in the framework as they need to be
carried out in specialised clinical setting/ laboratory.
3. Application of the framework
3.1. Methods and materials
3.1.1. Selection of participants
Fifteen jewellery manufacturing working at Chinch-
pokhli region in Mumbai, India and on 15 students
studying in an management institute of Mumbai, In-
441
Table 1
Depicting general information about subjects
Parameters Jewellery manufac- Students
turing workers Mean (± SD)
Mean (± SD)
Age (years) 29.2 (± 5.7) 24.09 (± 2.45)
Height (cm) 161.28 (± 5.19) 171.51 (± 5.54)
Weight (kg) 58.29 (± 9.68) 69.72 (± 13.65)
BMI(Kg/m2 ) 22.44 (± 3.75) 23.61 (± 3.97)
dia participated in the study. The study was approved
by Ethics Review Board and signed informed con-
sents were obtained from all the participants. These two
groups were chosen as both of them were involved in
sedentary activities, long duration of exposure and low
physical exertions. The jewellery manufacturing activ-
ity like in any other sedentary assembly jobs require
repetition, awkward static posture, contact stress and
long duration of work exposure [7,23]. Therefore, it
is expected that jewellery manufacturing workers may
suffer from work related musculoskeletal disorders and
studies have shown the presence of musculoskeletal dis-
orders in this group of workers [16]. Recent study has
shown that there is high prevalence of musculoskele-
tal disorders among students [29]. Cooper et al. [11]
showed that younger graduate students are exposed to
similar hours reported by younger professionals [11].
Since younger graduate students are the future work
force. So college students were involved in the study
3.1.2. Collection of demographic data
The age of each subject was recorded. The height and
weight were also recorded with help of anthropome-
ter (Siber Hegner, Switzerland) and human weighing
balance (Avery, India) respectively.
The Body Mass Index was calculated by applying
the following formula:
Body Mass Index (BMI) in kg/m2 = weight in
kg/height in m2 [10,35]
3.1.3. QEC, PLIBEL and RULA
The activities of the jewellery manufacturing work-
ers while carrying out manufacturing and the students
in the class room were recorded with the help of Sony
Handycam DCR PC 109E. The videos were replayed.
The predominant postures were used for QEC, PLIBEL
and RULA.
3.1.4. Self reported questionnaires
NMQ, DASH, NDI, OLBP, and IKDC Subjective
Knee Questionnaire were administered to the partici-
pants. After filling of the questionnaire they were col-
lected back.
442 W. Mishra et al. / An integrative approach for evaluating work related musculoskeletal disorders
Fig. 3. This reveals the susceptible areas of body parts of both jewellery manufacturing workers and students.
3.1.5. Clinical examination
History, observation, palpation and manual muscle
grading, tightness and reflexes, were carried out by a
qualified physiotherapist.
3.1.6. Back strength measurement
Back strength was measured by Back dynamometer
(Takei) in the morning (between 9.30 am and 10.00 am)
before the start of the work and at night (between
9.00 pm and 9.30 pm) after the completion of the work.
Two readings were taken; in-between the measure-
ments 30 seconds rest were given. Highest value was
taken as the back strength for each subject.
4. Results
Results presented in Table 1 indicate that both the
groups were having similar body mass index, the mean
ages were 29.2 and 24.1 yrs for jewellery manufactur-
ing workers and the students respectively.
4.1. Phase 1 – Ergonomic risk evaluation
Results of QEC (Fig. 2) showed that the body regions
prone to ergonomic risk factors were neck, wrist /hand,
back and shoulders. The findings of PLIBEL (Fig. 3)
also showed that low back, neck, shoulder and upper
back and knee were the regions which were prone to
ergonomic risk factors.
Results of posture analysis using RULA are present-
ed in Table 2. This showed that postural risks were high-
er in case of jewellery manufacturing workers. Further
analysis showed that problems were more in neck and
back.
Results presented in Table 2 and Figs 2 and 3 indi-
cated that higher level of ergonomic risks were present
in jewellery manufacturing workers. Neck, shoulder,
hand, back and knee were susceptible to ergonomic
risks.
4.2. Phase 2 – Musculoskeletal disorders evaluation
Nordic Musculoskeletal Questionnaire (Table 3)
showed major area of trouble were neck, right shoul-
der, upper back, low back, right elbow, right hand and
knees for the jewellery manufacturing workers. While
for students the major area of trouble was low back. The
reported troubles were significantly higher for neck,
right shoulders, upper back right elbow, low back and
knees for jewellery manufacturing workers. Frequency
of episodes of low back troubles (Table 4) of jewellery
manufacturing workers showed that about 50% of the
respondents had one or more episodes a week. While for
other body regions such responses were 16.16, 16.77,
4.16 for neck, shoulders and upper back respective-
ly. The responses of the students indicated that they
were experiencing hardly any such episodes. The re-
sults, therefore, revealed that low back was the area of
trouble for the jewellery manufacturing workers.
 W. Mishra et al. / An integrative approach for evaluating work related musculoskeletal disorders 443

Table 2
Representing posture analysis scores
Subjects Score Action level Remarks
Jewellery manufac- 5 3 Investigation and changes are required soon
turing workers
Students 3 2 Investigation and changes may be required

Table 3
Representing percentage of discomforts of various body parts
Body parts Jewellery Students Odds 95% CI significant /not
affected manufacturing workers (% of positive ratio significant
(% of positive response) response)
Neck 7 (46.67) 4 (26.67) 2.406 1.331–4.35 significant
Shoulder r 6 (40) 2 (13.34) 4.331 2.147–8.737 significant
Shoulder l 3 (20) – – – –
Upper back 7 (46.67) 2 (13.34) 5.685 2.83–11.42 significant
Low back 12 (80) 7 (46.67) 4.572 2.44–8.567 significant
Thigh r 1 (6.67) 3 (20) 0.286 0.113–0.721 not significant
Thigh l 1 (6.67) 3 (20) 0.286 0.113–0.721 not significant
Knee r 8 (53.34) 1 (6.67) 15.997 6.647–38.503 significant
Knee l 8 (53.34) 1 (6.67) 15.997 6.647–38.503 significant
Elbow r 6 (40) 1 (6.67) 9.329 3.864–22.527 significant
Elbow l 4 (26.67) 1 (6.67) 0.583 0.163–2.08 not significant
Hand r 6 (40) 3 (20) 0.167 0.055–0.508 not significant
Hand l 4 (26.67) 1 (6.67) 0.583 0.163–2.08 not significant

Table 4
Represents the frequency of episode of trouble once a week from
4.3. Phase 3 – Clinical examination
NMQ for both jewellery manufacturing workers and students
Results (Table 6) of the clinical examination showed
Body parts % of positive % of positive
response in jewellery response in that the major affected area of problem was low back.
manufacturing workers students Thirty three percent of the jewellery manufacturing
Neck 16.16 12.5 workers tested grade 3 i.e. fair grade. Thus, it may be
Shoulders 16.77 – assumed that some loss of strength might have been
Upper Back 4.16 4.16 taken place in low back muscle.
Low back 50 12.5 Table 7 showed the scores of back strength before
and after work. The results showed that strength of
Table 5 back muscles after the work exposure had significantly
Evaluation of questionnaires scores reduced in jewellery manufacturing workers. However,
Questionnaires Levels of Significant /not similar results were not observed for the students. This
significance significant once again established that the problem of back may be
DASH P < 0.05 significant due to work exposure.
NDI P > 0.05 not significant
Oswestry low back P < 0. 05 significant
Knee Questionnaire P < 0.05 significant
5. Discussion

Table 5 presented the results of self assessment ques-
tionnaires of specific body regions. Though, the re-
sults showed that discomforts of the jewellery manu-
facturing workers were more in arm, shoulder and hand
(DASH), low back (Oswestry low back questionnaire)
and knee (knee questionnaire) but the individual scores
showed that the responses for arm, shoulder and hand,
neck and knee were within acceptable zones. However,
33% of the jewellery manufacturing workers indicated
moderate disability for low back.
An effective framework for assessing work related
musculoskeletal disorders must include theoretical con-
structs, combining the physiological, epidemiological,
and biomechanical knowledge, which have their impact
on causation of work related musculoskeletal disorders.
The paper proposed an integrative methodology to as-
certain the relationship of work relatedness with occur-
rence of musculoskeletal disorders. Since the primary
objective of an integrative work related musculoskele-
tal disorders assessment framework is hazard identifi-
444 W. Mishra et al. / An integrative approach for evaluating work related musculoskeletal disorders

Table 6
Depicting odds ratio of muscle grading for both the groups
Muscle grading Odds ratio Confidence interval Remarks
Flexors 15.1667 2.8364 to 81.098 significant
Extensors 0.2549 0.044 to 1.4753 not significant
Lateral flexor right 5.1563 1.2335 to 21.5545 significant
Lateral flexor left 5.1563 1.2335 to 21.5545 significant
Lateral Rotator right 6.4286 1.5169 to 27.2448 significant
Lateral Rotator left 5.1563 1.2335 to 21.5545 significant

Table 7
Depicting back strength scores before and after work between same groups
Groups Morning (kg) Late evening (kg) Levels of Significant/not
significance significant
Jewellery Manu- facturing Workers 105.54 (± 10.10) 96.75 (± (9.38) P < 0.05 significant
Students 119.96 (± 14.48) 118.52 (± 13.36) P > 0.05 not significant

cation and risk quantification so Phase 1 – ergonomic 6. Conclusion

risk evaluation helps in analyzing the root cause of the
disorders. Phase 2 helps in understanding the presence
and severity of the existing WMSDs. In this phase the
impact of ergonomic risk factors on the prone anatom-
ical zones are identified. Further, Phase 3 gives the
actual status of the severity of WMSDs.
The proposed integrative approach will help in de-
veloping stage wise intervention strategies for WMS-
Ds. Positive results of Phase 1 requires ergonomic in-
terventions. Positive result of Phase 2 requires both er-
gonomic intervention and postural modifications along
with muscle conditioning and further clinical examina-
tion. Positive results of Phase 3 require medical inter-
vention along with intervention measures suggested in
Phases 1 and 2.
The framework suggests that ergonomic risk evalua-
tion techniques, self reported body part questionnaires
and physical measurement of physiological/ biome-
chanical transients can be used for the evaluation and
management of work related musculoskeletal disor-
ders.
The applicability of the framework was tested on
jewellery workers and students. The framework re-
vealed that jewellery manufacturing workers were ex-
posed to higher level of work related musculoskeletal
discomforts as compared to the students and the low
back is the major area of trouble.
However, the framework requires testing on larg-
er samples and on varied occupations to establish its
validity and reliability. Clinical examination including
tests such as Nerve Conduction Study, Clinical Elec-
tromyography and Magnetic Resonance Imaging were
not included in the study as they need to be carried out
in specialized clinical setting/ laboratory. Inclusion of
these tests may reveal clear status of musculoskeletal
disorders in the working group.
The study proposed an integrative framework which
is divided into three phases; Phase 1 – Ergonomic Risk
Evaluation, Phase 2 – MSD Evaluation, Phase 3 – Clin-
ical Examination. The framework tries to establish a
relationship among ergonomic risk factors; self report-
ed discomforts and physical measurement of physio-
logical/biomechanical transients. The applicability of
the framework was tested on jewellery manufactur-
ing workers and students which revealed that jewellery
manufacturing workers suffered from more discomforts
as compared to students.
Acknowledgements
We are thankful to National Institute of Industrial
Engineering (NITIE) and TIFAC CORE NITIE for pro-
viding the necessary finance and support for the project.
We are also thankful to the jewellery manufacturing
units and the subjects who voluntarily participated in
the study with their full consent.
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