某高風險部門肌肉骨骼傷害評估及健康促進改善措施研究報告

某事業單位年度全廠主觀式問卷Nordic Musculoskeletal Questionnaire (NMQ)調查結果發現，肌肉骨骼疑似有危害之個案(NMQ≧3)總佔比16%，主要不適症狀包括肢、肩、頸及腰背部，其中一部門員工風險顯著高於其他，且疑似有危害個案(NMQ≧3)約40%，換言之，該部門將近四成員工肌肉骨骼疑似有危害之個案。本研究目的，針對該部門之作業流程、內容以及人員之肌肉骨骼健康情形，進行健康危害鑑別及風險評估，藉以了解危害風險等級，及肌肉骨骼健康情形，並整體規劃為期四個月之健康促進改善計畫，以期降低該部門疑似有危害個案(NMQ≧3)之比率，降低員工肌肉骨骼傷害風險。研究方法首先將作業流程以人因危害簡易評估方式來進行篩選，考量其作業姿勢評估部位多為頸、軀幹以及上肢作業為主，故採用Rapid Upper Limb Assessment(RULA)來評估；人員肌肉骨骼健康部份則以肌肉骨骼痠痛表(NMQ)、社會心理與痠痛相關以Maastricht Upper Extremity Questionnaire (MUEQ)等之主觀式問卷進行調查，同時以客觀式姿勢評估Selective Functional Movement Assessment（SFMA）增加判斷之依據。評估分析後，由物理治療師為該部門整體設計肌肉骨骼改善運動，並指導自行每日施作，同時請員工下載伸展、強化肌力之App自行規劃運動時間、運動內容及提醒功能，該APP會自動記錄運動情況。研究結果顯示經RULA評估風險等級結果為第四級之高風險作業，須採行建議措施進行改善；員工肌肉骨骼健康評估結果，疑似有危害(NMQ≧3)個案佔該部門40%，其中多數為車測組員工，異常部位以背部(60%)居多，依次為脖子(55%)，右肩(50%)等部位，而肌肉骨骼不適症狀部位總數(15個部位)，0-3個部位數(60%)居多，依次為4-6個部位數(25%)、7-9個部位數(11.7%)；客觀肌肉骨骼健康篩檢SFMA結果，主要異常依序為平衡測試(70%)，其次為軀幹前彎(63%)及頸部旋轉60%)，經四個月改善運動計畫介入後，該部門疑似有危害之個案(NMQ≧3)總佔比由40%降至15%；NMQ及肌肉骨骼健康姿勢評估SFMA之成對樣本t檢定結果皆有顯著改善。關於工作姿勢危險的風險評估，RULA並未考慮時間，即使已採取了減少工作時間和使用輔助設備等行政措施，風險等級也沒有顯著改善。本研究健康促進之介入措施有效改善作業人員危害風險，故建議持續執行健康促進計畫強化員工肌肉骨骼健康及耐受力以應付作業之需求，但日後仍應針對現場作業考量使用替代性機械或設備加以改善危害情況。

關鍵字

肌肉骨骼不適；物理治療； RULA ； MUEQ ；肌肉骨骼健康姿勢評估SFMA

並列摘要

The survey results of a factory unit's Nordic Musculoskeletal Questionnaire (NMQ) show that the total number of suspected musculoskeletal disorders cases (NMQ ≧ 3) accounted for 16% of the valid questionnaires where the main areas of discomfort are in the upper limbs, shoulders, neck, and back. One department has a risk significantly higher than the others, as the results show that about 40% of suspected cases (NMQ ≧ 3) are from this particular department. In other words, nearly 40% of the employees in this department are suspected of having musculoskeletal disorders (NMQ ≧ 3). The purpose of this study is to identify, evaluate, and plan a four-month health promotion program to reduce the ratio of the suspected cases (NMQ ≧ 3) and improve the musculoskeletal health of the employees in this particular department. In this study, the research was conducted through a series of assessments and surveys. After a simple observation of their working posture, which consists mostly of upper extremity work, the study chose Rapid Upper Limb Assessment (RULA) as the observation tool to evaluate ergonomic risk factors of the job tasks. The study used subjective questionnaires NMQ and the Maastricht Upper Extremity Questionnaire (MUEQ) to survey employees' musculoskeletal health and psychosocial factors that relate to soreness. At the same time, the study conducted a Selective Functional Movement Assessment (SFMA) to evaluate employees' musculoskeletal health through posture evaluation. After evaluating and analyzing the data, a physiotherapist designed a set of exercises and instructed employees to log their daily exercise through an app that can set the time and reminder, plan their exercise content, and automatically record their progress. According to the research results and corresponding recommendations, personnel assessed to be RULA Level 4 risk level underwent investigation and improvement measures. Assessment results show that 40% of the suspected cases (NMQ ≧ 3) , most personnel are responsible for car testing. The major areas experiencing discomfort are in the back (60%), followed by the neck (55%), and the right shoulder (50%). Of the total number of musculoskeletal discomfort areas (15 areas), most (60%) indicated 0-3 areas, 25% indicated 4-6 areas, and 11.7% indicated 7-9 areas. Objective SFMA results show that 70% of movement dysfunctions lie in the balance test (single leg stand), followed by trunk forward bending (63%), and neck rotation (Right) (60%) (Left) (58%). After four months of intervention, suspected cases (NMQ ≧ 3) in this department reduced from 40% to 15%, and the paired NMQ and SFMA sample t-test results also significantly improved. Regarding the risk assessment of work posture hazards, the RULA does not include time in the considerations, even though administrative measures such as reducing working hours and using assistive devices have been implemented, there was no significant improvement to the risk level. This research demonstrates that a health promotion and intervention program significantly reduced employees' risk hazards. The study recommends continuing the health promotion program to strengthen employees' musculoskeletal health and capability to work. However, alternative machinery or equipment should be considered in the future to lower the risk hazard level further.