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Safety Science 131 (2020) 104932
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Expert panel survey among occupational health and safety professionals in
Denmark for prevention and handling of musculoskeletal disorders at
workplaces
Malene Jagd Svendsen
a,b
, Kathrine Greby Schmidt
a
, Andreas Holtermann
a,b
,
⁎
Charlotte Diana Nørregaard Rasmussen
a,
a
b
T
Musculoskeletal Disorders and Physical Work Demands, National Research Centre for the Working Environment, Lersø Parkallé 105, 2100 Copenhagen Ø, Denmark
Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark
A R TICL E INFO
Keywords:
Musculoskeletal disorders
Occupational health and safety
Guideline
Ergonomics
OHS professional
Professional practice
A BSTR A CT
Occupational health and safety (OHS) professionals have a key role in supporting the health and work ability of
employees, including preventing and handling musculoskeletal disorders (MSDs) at workplaces. MSDs are the
leading cause of work disability, productivity loss and sickness absence in Europe. This may be due to limited
consensus on use of effective OHS practices as facilitation of evidence-based practices increases quality of
provided services. This study explored consensus of OHS professionals’ practices and examined OHS profes-
sionals’ request for development of evidence-based guidelines for prevention and handling of MSDs at work-
places. This was done by 1) field observations and interviews with OHS professionals working with ergonomics
or MSDs at workplaces, 2) development and pilot testing of a panel survey, 3) a three-round expert panel survey
and 4) workshop with OHS stakeholders within the OHS organisations in Denmark. The findings indicate limited
consensus of OHS practices and a request for development of practice- and evidence-based guidelines for pre-
vention and handling of work-related MSDs in Denmark. The study also presents an end user involving process
for increased uptake and implementation of guidelines.
1. Introduction
Musculoskeletal disorders (MSDs) represent a considerable eco-
nomic burden and are the leading cause of work disability, productivity
loss and sickness absence in Europe (Bevan,
2015).
MSDs accounts for
at least half of all absence from work among European workers
(Cammarato,
2007).
It is estimated that the total cost of lost pro-
ductivity attributable to MSDs among people in the working age in EU
are up to 2% of the gross domestic product (Cammarato,
2007).
Pre-
vention and handling of MSDs should therefore be of high priority.
Occupational health and safety (OHS) professionals have a key role
in supporting the health and work ability of employees. The OHS pro-
fessionals’ tasks have the goal of describing, analysing, monitoring,
controlling, curing, and preventing illnesses and hazards related to
work. Depending on the country and context, OHS may be considered a
parallel service provider to the public and private health care sectors
(Halonen,
2017).
In some Western countries, including Denmark, the
effectiveness of OHS activities has been questioned (Andersen,
2018).
However, a recent systematic review indicated that OHS activities such
as the introduction and enforcement of legislation and workplace in-
spections are effective in reducing injuries and improving compliance
with OHS regulation, and it is therefore recommended to strengthen
and improve these OHS activities for improving safety and health at
workplaces (Andersen,
2018).
Nevertheless, the review also found a
major research gap with respect to the effect of OHS regulation tar-
geting psychosocial work environment and MSDs (Andersen,
2018).
Danish OHS professionals perform several different tasks and ac-
tivities in the organizations, including operational, systematizing and
processual tasks (Uhrenholdt
Madsen et al., 2019).
The Danish OHS
professionals are therefore characterized by multidisciplinarity with
professional backgrounds in social, technical, natural and health fields
(Uhrenholdt
Madsen et al., 2019).
This results in a heterogeneous group
of Danish OHS professionals with diversity in approaches and methods
(Uhrenholdt
Madsen et al., 2019).
Consequently, despite general re-
cognition of the importance of evidence-based practice (Hulshof
and
Hoenen, 2007; Hasle et al., 2015),
there is a variation in services pro-
vided by OHS professionals for solving the same challenges. Through
the authors’ work with continued education of OHS professionals
⁎
Corresponding author.
E-mail addresses:
[email protected]
(M.J. Svendsen),
[email protected]
(K.G. Schmidt),
[email protected]
(A. Holtermann),
[email protected]
(C.D.N. Rasmussen).
https://doi.org/10.1016/j.ssci.2020.104932
Received 13 June 2019; Received in revised form 16 June 2020; Accepted 23 July 2020
0925-7535/ © 2020 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY license
(http://creativecommons.org/licenses/BY/4.0/).
 BEU, Alm.del - 2019-20 - Bilag 337: Orientering om resultater fra NFA’s projekt Praksis- og Evidens-baserede anbefalinger i Rådgivning om Muskelskeletbesvær på Ar-bejdspladsen (PERMA)
M.J. Svendsen, et al.
Safety Science 131 (2020) 104932
facilitated by the Danish Association of Occupational Health and Safety
Consultants (the trade association for occupational health and safety
professionals in Denmark) and annual conferences for work environ-
ment, a general request among OHS professionals for evidence-based
guidelines to recognise the most effective and fitting services has be-
come apparent. Facilitating the translation of evidence-based knowl-
edge and methods into systematic OHS practices will improve the
quality of the services provided (Kwak,
2017).
The need of evidence-
based systematic OHS practices is not only apparent among OHS pro-
fessionals, but also among employers of customer companies as they
fund the services (Good
Practice in Occupational Health Services: A
Contribution to Workplace Health, 2002).
One way to improve translation of evidence-based knowledge into
OHS practice is by encouraging participation of end-users in the re-
search process. By creating and sharing evidence-based knowledge that
is meaningful for practitioners, the uptake of guidelines will likely in-
crease (Carpenter,
2012; Bumbarger and Campbell, 2012).
That is why
we initiated a research project with the aim of developing guidelines
targeting OHS professionals for prevention and handling of MSDs at
workplaces based on both evidence and best practice and involved OHS
professionals in the process of deciding the scope of the guidelines.
The aim of this study was therefore to 1) identify OHS activities for
prevention of work-related MSDs and solutions used to solve these, 2)
investigate OHS professionals’ consensus for which solutions to choose
for specific OHS challenges, and 3) examine for which OHS activities
OHS professionals requested practice- and evidence-based guidelines
for preventing and handling MSDs at workplaces.
2. Methods
In this study, a process was conducted to identify and examine
consensus of OHS practices related to MSDs and to explore the need for
developing guidelines for preventing and handling MSDs at workplaces.
This process consisted of 1) field observations and interviews with OHS
professionals working with ergonomics or MSDs at work, 2) develop-
ment and pilot testing of survey, 3) a three-round expert panel survey (a
modified Delphi-survey) and 4) workshop with central stakeholders.
2.1. Identification and recruitment of participants
A purposive sampling strategy was used to recruit participants to
each stage of the study. In collaboration with The Danish Association of
Occupational Health and Safety Consultants, we identified and re-
cruited OHS professionals for the field observations and interviews,
pilot test and expert panel survey. For the field observations and in-
terviews, we aimed to recruit OHS professionals who were highly ex-
perienced (approximately more than 10 years of experience as an OHS
professional). For both the three-round expert panel survey and the
pilot test of this, we aimed to recruit OHS professionals with varying
experience to have the insight from both newly trained and very ex-
perienced OHS professionals. We also aimed to include OHS profes-
sionals from both consultancy businesses in the private sector and
council-run organizations as well as both internally and externally
working OHS professionals. Finally, a group of central stakeholders
within OHS organizations in Denmark (union representatives and OHS
leaders/consultants from large, Danish companies) were identified
based on previously having participated in stakeholder groups or their
occupational position. The group of stakeholders functioned as a non-
scientific reference group throughout the project.
2.2. Field observations and interviews
In order to gain information about the work carried out by OHS
professionals working with preventing and handling MSDs at the
workplaces, field observations were carried out preliminary to the de-
velopment of the questions for the pilot survey and first survey-round.
2
One researcher (MJS) followed two different OHS professionals and
observed their work (e.g. education in patient transfer, instructions in
office ergonomics, and lecture in work environment) (in total four
workplace visits). After the observation, an individual semi-structured
interview with the OHS professional was carried out. In addition to this,
three other OHS professionals not being observed were also interviewed
by two of the researchers (CNR and MJS) and three representatives
from different workplaces, who had been promoted at a national con-
ference for work environment for their outstanding initiatives to pre-
vent work-related MSDs, were interviewed (by MJS). The interviews
with OHS professionals concerned information about the OHS process
and the role as an OHS professional, MSD challenges at workplaces
(type, frequency, and differences between occupational sectors), and
their perceived view of need for guidelines for OHS and MSDs at the
workplace. The interviews with workplace representatives focused on
experiences with OHS professionals, and prevention and handling
work-related MSDs at work.
2.3. Development and pilot-testing of survey
Information from the observations and interviews were used to draft
a questionnaire for the first round of the expert panel survey. To test the
questionnaire, we performed one interview with one highly experi-
enced OHS professional who was given the draft to answer and review.
MJS and CNR revised the questionnaire according to the feedback. To
further test the understanding and the content of the questionnaires and
the feasibility of the procedures for sending out the questionnaire, a
pilot version of the survey was sent to four OHS professionals of whom
three participated. Short telephone interviews with each of the re-
sponders were performed to get feedback on both question phrasing
and procedures to create the final version of the first round of the expert
panel survey and drafts for the second and third round.
2.4. Expert panel surveys
The three-round expert panel survey was conducted as a modified
Delphi survey. The Delphi method is a structured process for gaining
consensus among a diverse group of stakeholders or experts without
needing to physically attend meetings (Ryan,
2001).
Unlike a tradi-
tional Delphi process, we did not inform the panel about the responses
from the previous round, and each round can be considered a separate
survey, but we used the information from each round to develop the
questions for the next round.
The panel survey questions are presented in
Table 1.
An email was
sent to the OHS professionals with a unique link to the survey through
an online survey tool (SurveyXact, Ramboll Management Consulting,
Aarhus, Denmark). The OHS professionals were asked to complete each
round of the survey within a 3-week period. Each survey took on
average 10–15 min to complete. Reminders were emailed to non-
completers after 2 weeks.
2.4.1. Round 1
The aim of round one was to collect overall information about OHS
practices concerning MSDs at the workplaces. The survey consisted of
two parts. First, demographic information was collected (e.g. age, sex,
education, seniority and occupation (private or public sector, internal
or external consultancy)). Second, the survey contained three open-
ended questions concerning OHS activities and ways to handle OHS
activities in the MSD-related work (Table
1).
The qualitative entries
were analysed as described in section 2.6. The themes emerging from
this analysis was used to create the round two-survey.
2.4.2. Round 2
The aim of round two was to quantitatively assess frequency of OHS
activities and solutions that were derived from round one, and to ex-
amine consensus among OHS professionals regarding which solutions
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Table 1
Overview of part two questions in the three-round expert panel survey.
Question no. 1
Round 1
Round 2
Describe various OHS activities related to MSDs at the workplaces that
you have worked with
How often do you as an OHS professional handle the following OHS
activities related to MSDs at the workplaces?
-Patient handling
-Lifting
-Push/pull
-Screen work
-Sedentary work
-Awkward postures
-Repetitive work
-Carrying
-Mental well-being (related to MSD)
Responses: [1 = always, 2 = often, 3 = sometimes, 4 = rarely,
5 = never/almost never.]
To what extent do you think that evidence-based knowledge is missing
for the following OHS activities related to MSDs?
-Screen work
-Awkward postures
-Lifting
-Sedentary work
-Carrying
-Push/pull
-Repetitive work
-Mental well-being related to MSD
-Patient handling
Responses: [1 = to a great extent, 2 = greatly, 3 = somewhat, 4 = to a
low degree 5 = to a very low degree.]
Question no. 2
Describe different methods you use or ways you handle OHS activities
related to MSDs in your work
How often do you use the following solutions to OHS activities related
to MSDs in your work as an OHS professional?
-Physical training and health promotion
-Work postures and working technique
-Technical assistive devices and protective equipment
-Design of the workplace
-Teaching and education
-Risk assessment
-Organizational and/or psychosocial efforts
-Other things
Responses: [1 = always, 2 = often, 3 = sometimes, 4 = rarely,
5 = never/almost never.]
To what extent do you think there is a need of developing practice and
evidence-based guidelines for the following OHS activities related to
MSDs?
-Screen work
-Awkward postures
-Lifting
-Sedentary work
-Carrying
-Push/pull
-Repetitive work
-Mental well-being related to MSD
-Patient handling
Responses: [1 = to a great extent, 2 = greatly, 3 = somewhat, 4 = to
a low degree 5 = to a very low degree.]
Question no. 3
Describe briefly what kind of requests you typically have received from
companies related to MSDs at the workplaces
Enter a priority order from ‘very frequently’ (1) to ‘very rarely’ (7) for how
often you use the following solutions in your work as an OHS professional
to handle the following OHS activities; patient handling, Lifting, Push/
pull, Screen work, Sedentary work, Awkward postures, Repetitive work,
Carrying, Mental well-being.
Solutions:
-Physical training and health promotion
-Work postures and working technique
-Technical assistive devices and protective equipment
-Design of the workplace
-Teaching and education
-Risk assessment
-Organizational and/or psychosocial efforts
Are there any other OHS activities you think it is important to develop
practice and evidence-based guidelines for?
3
Round 3
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Table 2
Demographic details of OHS professionals participating in three-round expert
panel survey.
N
%
Mean
Standard
deviation
Sex
(n = 33)
Women
20 60.6
Men
13 39.4
Age
(n = 33)
20–29
0
0
30–39
4
12.1
40–49
13 39.4
50–59
12 36.4
60–69
4
12.1
Educational background
(n = 33)
Physiotherapist
16 48.5
Occupational therapist
13 39.4
Other
4
12.1
Seniority as an OHS professional (in years)
(n = 33)
0–1
1
3.0
> 1–5
3
9.1
> 5–10
9
27.3
> 10–20
9
37.3
> 20
11 33.3
Total years
15.9
Seniority at current workplace (in years)
(n = 33)
0–1
5
15.2
> 1–5
13 39.4
> 5–10
6
18.2
> 10–20
7
21.2
> 20
2
6.1
Total years
7.8
Private/public company
(n = 33)
Private company
22 66.7
Public company
11 33.3
Internal/external consultant
(n = 33)
Internal
11 33.3
External
22 66.7
Geographical location of work (not exclusive)
(n = 33)
Capital Region of Denmark
14 37.8
Region Zealand
6
16.2
Region of Southern Denmark
10 27.0
Central Denmark Region
10 27.0
North Denmark Region
3
8.1
guidelines should encompass. No a priori cut point for determining
consensus was chosen as the expert panel survey was only one part of
the first phase of deciding the scope of the guidelines. The OHS pro-
fessionals were asked to rate to which extent the thought research-
based knowledge was missing, and to which extent they requested
practice- and evidence-based guidelines. Answer options for both
questions were a 5-point Likert scale from ‘to a great extent’ to ‘to a very
low degree’. Lastly, an open-ended question gave the OHS professionals
to suggest other OHS activities for which they thought it would be
important to develop guidelines.
2.5. Workshop with stakeholders
After the three-round expert panel survey, a workshop with nine
central stakeholders within OHS organizations in Denmark was ar-
ranged. Results from the surveys were presented and discussed. The
stakeholders gave their opinion about which OHS activities the guide-
lines should encompass. Based on survey results and a criterion of not
developing sector specific guidelines, the stakeholders and researchers
in the project group came to an agreement on prioritised OHS activities
by verbal consensus.
10.0
2.6. Data analysis
All qualitative data and open comment text gathered during the
expert panel survey were analysed using a thematic analysis approach
(Braun
and Clarke, 2006).
NVivo 11 (QSR
International, 2015)
was
used for coding and analysis of the qualitative data. Data were analysed
independently by one of the researchers (MJS) to develop and refine the
emerging themes. This was then verified with one of the other re-
searchers (CNR). Quantitative data gathered from the expert panels was
entered into IBM SPSS Statistics for Windows (Version 22; IBM Corp.,
Armonk, NY, USA) for analysis. On completion of survey round two and
three, percentages for individual items were analysed. Criteria used to
define and determine consensus in a Delphi study is subject to inter-
pretation, with studies reporting variations, dependent on the sample
numbers and aim of the research (Hasson
et al., 2000; Keeney et al.,
2006).
In the current study, no a priori cut point for quantitatively
determining consensus was set. Instead, we presented the results at a
workshop with central stakeholders during which verbal consensus was
reached.
3. Results
3.1. Demographics of the OHS professionals
Demographics for the OHS professionals included in the three-round
expert panel survey is presented in
Table 2.
Of the 37 OHS professionals
invited to take part in the survey, 33 participated in at least one round
of the survey (40% men; 60% women). The majority was between 40
and 49 years (39%). The OHS professionals geographically represented
all five regions in Denmark. The majority had an educational back-
ground as either a physiotherapist (49%) or an occupational therapist
(39%). On average, the OHS professionals had 16 years of OHS ex-
perience (range 0–37 years) and had worked eight years (range
0–31 years) at their current workplace. Most of the included OHS
professionals worked in the private sector (67%) and the majority were
employed as external consultants working with OHS at workplaces
where they were not employed (67%).
3.2. Round 1 of the expert panel survey
8.4
to choose for different OHS activities. The survey consisted of two parts.
Part one was the demographic questions, which were only available for
those not having answered the round one-survey. In part two, the OHS
professionals were asked to quantitatively rate how often they were
handling different OHS activities (i.e. patient handling, lifting, push/
pull, screen work, sedentary work, awkward postures, repetitive work,
carrying and mental well-being) related to MSDs at the workplaces.
Next, the OHS professionals were asked to quantitatively rate how often
they were using different solutions (i.e. physical training and health
promotion, work postures and working technique, technical assistive
devices and protective equipment, design of the workplace, teaching
and education, risk assessment, organizational and/or psychosocial
efforts, other things) to OHS activities related to MSDs in their work.
The participants were asked to rate their answers on a 5-point Likert
scale from ‘always’ to ‘never/almost never’. Lastly, the OHS profes-
sionals were asked to prioritize the solutions (listed above) according to
the OHS activities (listed above) from 1 to 7, with 1 being the most
frequently used solution to an OHS activity and 7 being the least used
solution to an OHS activity.
2.4.3. Round 3
The aim of the third round was to gain information about the OHS
professionals’ views on the need to develop guidelines for the different
OHS activities related to MSDs at the workplaces. Furthermore, an aim
of this round was to be able to determine which OHS activities the
4
Of the 33 OHS professionals, 25 (76%) answered the three open-
ended questions in the first round. By analysing the answers from
question number one thematically, nine themes related to OHS activ-
ities related to handling or preventing MSDs at the workplaces (i.e.
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Table 3
Taxonomy of identified OHS activities for prevention or handling of MSDs based on qualitative data from first round of expert panel survey.
OHS activities
Patient handling
How to prevent or handle MSDs for patient handling, e.g.:
Ergonomics for manual patient handling
Instruction in use of assistive devices for patient handling
Assessment and purchase of assistive devices for patient handling
How to prevent or handle MSDs for (heavy) lifting, e.g.:
Technique instructions for manual lifting
Instruction in use of assistive devices for lifting
How to prevent MSDs for push/pulling activities, e.g.:
Technique instructions
Instruction in use of assistive devices
How to prevent or handle MSDs when working with screens (any type), e.g:
Adjustments of screens, desk, chair etc.
How to prevent or handle MSDs when majority of working hours are sedentary, e.g:
Micro breaks with physical activity during working hours
Behaviour change related to minimising sedentary behaviour during working hours and leisure time
How to prevent or handle MSDs when working in awkward postures, e.g.:
Mapping prevalence of awkward postures
Minimising prevalence of awkward postures
Technique instructions for awkward postures
How to prevent or handle MSDs when doing repetitive work, e.g.:
Mapping prevalence of repetitive work
Minimising prevalence of repetitive work
Technique instructions for repetitive work
How to prevent or handle MSDs for carrying, e.g.:
Technique instructions for manual carrying
Instruction in use of assistive devices for carrying
How to prevent or handle MSDs by focusing on psychosocial work environment, e.g:
Organisational and individual well-being
Lifting
Push/pull
Screen work
Sedentary work
Awkward postures
Repetitive work
Carrying
Mental well-being related to MSDs
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Table 4
Results from the question “How often do you use the following solutions to OHS activities related to MSDs in your work as an OHS professional”. Answer choices were
mutually exclusive. Data is presented as %.
Always
Physical training and health promotion
Group-based physical training during working hours
Individual physical training during working hours
Health promotion (preventive) activities arranged by employer during working hours
Health promotion (preventive) activities arranged by employer outside working hours
Health profiling and health checks
Work postures and working techniques
Group-based guidance/instruction regarding manual lifting, push/pull, etc.
Individual guidance/instruction regarding manual lifting, push/pull, etc.
Group-based guidance/instruction regarding appropriate work postures without the use of lifting, push/pull, etc.
Individual guidance/instruction regarding appropriate work postures without the use of lifting, push/pull, etc.
Technical assistive devices and protective equipment
Group-based guidance/instruction regarding personal technical assistive devices to improve work postures and technique
Individual guidance/instruction regarding personal technical assistive devices to improve work postures and technique
Group-based guidance/instruction regarding non-personal technical assistive devices to improve work postures and
technique
Individual guidance/instruction regarding non-personal technical assistive devices to improve work postures and technique
Development of new technical assistive devices
Design of the workplace
Individual design of workplace
Non-individual design of workplace
Teaching and educating
Teaching prevention of MSD and/or ergonomics (in general)
Educating resource persons/ambassadors
Campaigns
Risk assessment
Risk assessment/mapping of ergonomic problems
Organisational and/or psychosocial initiatives
Advice concerning habits, behaviour, culture etc.
Advice concerning mental conditions that may affect MSDs
Advice concerning organisational conditions that may affect MSDs
Often
Sometimes
Rarely
Never/almost never
4
8
0
0
0
4
4
4
8
4
8
8
4
0
4
4
8
0
0
4
8
0
12
40
28
20
4
12
56
48
60
48
52
56
20
24
4
52
40
76
20
20
68
44
32
44
28
24
24
24
28
20
28
24
32
24
20
32
16
36
28
32
8
44
32
28
40
32
28
12
12
28
24
16
8
8
8
4
16
4
32
40
44
12
12
8
28
36
0
4
32
12
16
28
28
48
44
12
12
4
8
4
12
8
16
16
4
12
0
8
12
0
4
4
4
patient handling, lifting, push/pull, screen work, sedentary work,
awkward postures, repetitive work, carrying, and mental well-being)
emerged (Table
3).
The OHS activities identified present the work tasks
of the participating OHS professionals. OHS activities were either spe-
cifically requested by the workplace financing the service or suggested
5
by OHS professionals themselves. In addition, we identified seven
overall methods or solutions to the OHS activities mentioned by the
OHS professionals (i.e. physical training and health promotion, work
postures and working technique, technical assistive devices and pro-
tective equipment, design of the workplace, teaching and education,
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Safety Science 131 (2020) 104932
100
90
80
70
60
%
50
40
30
20
10
0
Patient
handling
Lifting
Push/pull
Screen
work
Sedentary
Awkward
Repetitive
work
postures
work
Carrying
Mental
well-being
Fig. 1.
Results from the question “How often do you as an OHS professional handle the following OHS activities related to MSDs at the workplaces”. The bar chart
shows how many in total who replied ‘always’ or ‘often’. Answer choices were mutually exclusive. Data is presented as %.
risk assessment, and organizational and/or psychosocial initiatives).
Each method or solution represented one to five sub groups as pre-
sented in
Table 4.
The solutions were most often not exclusive, i.e. the
OHS professionals reported to be using several methods in the same
process of an OHS activity.
3.3. Round 2 of the expert panel survey
Twentyfive (76%) OHS professionals responded to the second round
of the survey.
3.3.1. OHS activities the OHS professionals most often encounter
The most common OHS activity for the participating OHS profes-
sionals was ‘screen work’ (68%), followed by ‘awkward postures (64%),
‘lifting’ (60%) and ‘sedentary work’ (60%) (Fig.
1).
The least common
OHS activities were ‘patient handling’ (12%) and ‘mental well-being’
(16%).
3.3.2. Solutions or methods used to handling OHS activities
The most commonly used solution for handling OHS activities was
‘teaching and education’ and ‘risk assessment’, but also solutions related
to ‘technical assistive devices and protective equipment’ and ‘work
postures and working techniques’ were often used. ‘Physical training
and health promotion’ had the highest frequency of never/almost never
being offered by OHS professionals as a solution to OHS activities
(Table
4).
3.3.3. Prioritization of the most frequently used solutions to the OHS
activities
The OHS professionals were using almost all solutions for all OHS
activities although there was great variation between which solution to
prioritise for each OHS activity (Fig.
2).
However, for some OHS ac-
tivities, a relative level of consensus among the OHS professionals
seemed apparent, e.g. ‘physical training and health promotion’ for ‘se-
dentary work’ and ‘patient handling’. Overall, the most commonly used
solutions were ‘risk assessment’ and ‘physical training and health pro-
motion’.
3.4. Round 3 of the expert panel survey
In the final round of the survey, 28 (85%) OHS professionals re-
sponded.
Mental well-being
Carrying
Repetitive work
Awkward postures
Sedentary
work
Screen
work
Push/pull
Lifting
Patient
handling
0%
8
8
8
20
12
4 8
20
16
8
28
52
12
12
44
12
48
16
12
28
4
8
12
12
28
20
20
60%
20
80%
8
8
16
12
36
24
Physical training and
health promotion
Work postures and
working technique
4
Technical assistive
devices and protective
equipment
Design of the workplace
Teaching and educating
Risk assessment
Organisational and/or
psychosocial initiatives
100%
6
12
20
28
12
16
24
32
16
4
4
Fig. 2.
Results from the question “Enter a
priority order from ‘very frequently’ to ‘very
rarely’ for how often you use the following
solutions in your work as an OHS profes-
sional to handle the following OHS activ-
ities”. The bar chart shows how many OHS
professionals who replied ‘very frequently’
for each solution. Answer choices were
mutually exclusive. Data is presented as %.
16
24
20
28
20%
20
4 4 8
40%
 BEU, Alm.del - 2019-20 - Bilag 337: Orientering om resultater fra NFA’s projekt Praksis- og Evidens-baserede anbefalinger i Rådgivning om Muskelskeletbesvær på Ar-bejdspladsen (PERMA)
2230774_0007.png
M.J. Svendsen, et al.
Safety Science 131 (2020) 104932
100
90
80
70
60
%
50
40
30
20
10
0
Screen
work
Awkward
postures
Lifting
Sedentary Carrying Push/pull Repetitive Mental Patient
work
work well-being handling
Fig. 3.
Results from the question “To what extent do you think that evidence-based knowledge is missing for the following OHS activities related to MSDs”. ” The bar
chart shows how many in total who replied ‘To a great extent’ or ‘Greatly’. Answer choices were mutually exclusive. Data is presented as %.
100
90
80
70
60
%
50
40
30
20
10
0
Screen Awkward
work postures
Lifting Sedentary Carrying Push/pull Repetitive Mental Patient
work
work well-being handling
Fig. 4.
Results from the question “To what extent do you think there is a need of developing practice and evidence-based guidelines for the following OHS activities
related to MSD”. The bar chart shows how many in total who replied ‘To a great extent’ or ‘Greatly’. Answer choices were mutually exclusive. Data is presented as %.
3.4.1. Lack of research-based knowledge for OHS activities related to MSDs
at the workplace
Most of the OHS professionals thought that evidence-based knowl-
edge concerning the OHS activity ‘mental well-being related to MSDs’
(64%) was lacking; followed by ‘screen work’ (46%) and ‘sedentary
work’ (40%) (Fig.
3).
The lowest rated OHS activity was ‘patient
handling’ (18%).
(Fig.
4).
No new OHS activities were identified from the responses to
the open-ended question that terminated the survey.
3.5. Workshop with stakeholders
Based on the results shown in
Fig. 4,
consensus among OHS pro-
fessionals on which OHS activity/activities to develop guidelines for
was not apparent. At a workshop with nine central stakeholders within
the OHS organizations in Denmark the following five topics were
prioritised to accommodate most challenges in the different sectors: 1)
screen work, 2) awkward postures, 3) lifting/carrying, 4) push/pull,
and 5) mental well-being related to MSDs.
3.4.2. Need for developing practice and evidence-based guidelines
The OHS professionals thought there was a need for developing
practice and evidence-based guidelines for all the OHS activities:
‘Mental well-being’ (71%), ‘Screen work’ (68%), ‘Sedentary work’
(68%), ‘Carrying’ (54%), ‘Awkward postures’ (50%), ‘Push/pull’ (47%),
‘Lifting’ (46%), ‘Patient handling’ (39%), and ‘Repetitive work’ (39%)
7
 BEU, Alm.del - 2019-20 - Bilag 337: Orientering om resultater fra NFA’s projekt Praksis- og Evidens-baserede anbefalinger i Rådgivning om Muskelskeletbesvær på Ar-bejdspladsen (PERMA)
M.J. Svendsen, et al.
Safety Science 131 (2020) 104932
4. Discussion
The aim of this paper was to describe the initial approach taken to
develop a set of guidelines for preventing and handling work-related
MSDs by including the end-users (OHS professionals) in the process to
explore which OHS activity or activities a guideline should encompass.
Overall, the results revealed that there was great variation in OHS
challenges encountered by the OHS professionals and limited consensus
on OHS practices related to prevention and handling of work-related
MSDs. Finally, the results showed that the OHS professionals thought
there was a general lack of research-based knowledge for prevention
and handling of MSDs and a need for development of a practice- and
evidence-based guideline for this. However, the three-round expert
panel survey did not establish consensus regarding which OHS activity/
activities the guideline should encompass. Instead, verbal consensus
was attained after involvement of central stakeholders.
4.1. Large variation in OHS challenges encountered by the OHS
professionals
Overall we found that there was a great variation in OHS challenges
related to MSDs at the workplaces that the OHS professionals most
often encounter, with some OHS challenges (activities) occurring to a
lesser extent, e.g. ‘patient handling’ (12%) and ‘mental well-being’
(16%). OHS professionals in Denmark are characterised by hetero-
geneity and diversity related to biographies and educational accred-
itations (Uhrenholdt
Madsen et al., 2019),
and the identified OHS ac-
tivities reflect the participating OHS professionals’ daily work tasks and
the sectors and workplaces they work within. The findings also reveal
the large variety of OHS challenges that each OHS professional must
handle. This point to a need for versatility and comprehensive knowl-
edge and skills among OHS professionals to determine effective in-
itiatives for OHS challenges.
4.2. Limited consensus on OHS practices related to prevention and handling
of MSDs at the workplaces
We also found a large variation in the priority of the solutions used
by the OHS professionals to solve the nine identified main OHS chal-
lenges related to MSDs at the workplace. This finding may reflect: 1)
that there is a need for more education/training in effective initiatives
for prevention and handling of work-related MSDs, 2) that each OHS
problem require more than one solution, 3) that the solution is highly
dependent on the OHS professional and/or 4) that the solution is highly
dependent on the specific sector. The first point reflects that there is
currently no official training or education in OHS available at either
the bachelor or a master level in Denmark (Uhrenholdt
Madsen et al.,
2019).
The second point may reflect a need for multi-faceted inter-
ventions for handling the complexity of work-related MSDs (van
der
Beek, 2017),
or that each solution is related to a specific sector. The
third point reflects the differences in the background and education of
the OHS professionals and the fourth point might reflect the industry
and organisational reality (Uhrenholdt
Madsen et al., 2019; Pryor,
2019; Seim et al., 2016).
In addition, these findings of the variation in
the priority of the solutions used by the OHS professionals reveals a gap
in the quality of advice being given to some workplaces. This can be
confirmed in other studies (Pryor,
2019; Pam Pryor, 2019).
This en-
dorses the need for development of guidelines related to specific OHS
challenges.
4.3. Knowledge base for developing guidelines
This study provides an important knowledge base of both need and
content before we develop guidelines for preventing and handling
work-related MSDs. A common problem observed with guidelines is
that they often suffer from shortcomings in the development process,
8
including a lack of transparency of the development groups’ meth-
odologies, and overall failure to use rigorous methodologies in the
development (Scott
and Guyatt, 2011).
In this study, we have been
transparent in the process of gathering the information needed to ex-
plore and reach consensus on OHS practices related to work-related
MSDs and explore the need of developing guidelines for preventing and
handling MSDs at workplaces and have described our methods in a
rigorous way. A significant evidence base underpins the key role of
participation of end-users to support uptake when users are involved in
the design of solutions to address issues related to their work (Burgess-
Limerick, 2018; Hignett et al., 2005).
Thus, our study having the end-
users involved in the initial development process is an important pre-
requisite to improve the use of guideline and succeed in preventing and
handling MSDs at the workplaces.
4.4. Methodological aspects
A major strength of the study is the involvement of end-users with a
primary focus on OHS professionals but also those financing the OHS
services. In addition, the paper’s detailed description of the methodol-
ogies used in the study will contribute to the publications in this field.
The majority of data is gathered directly from a diverse group of 33
OHS professionals participating in the expert panel survey. A first
challenge concerns the representativeness of those recruited for this
survey. The OHS professionals were purposively recruited and thus the
results probably reflect their personal views, experiences, practices,
sectors and education more than a general opinion. However, in one
case, with the question in round three “To what extent do you think
there is a need of developing practice and evidence-based guidelines for
the following OHS activities related to MSDs?”, we do not know whe-
ther the OHS professionals requested the guidelines themselves speci-
fically or expressed a general need on behalf of their colleagues. Our
sampling strategy may also have resulted in an expert panel re-
presenting a selective and motivated group of OHS professionals and
results must be interpreted with this in mind. Unfortunately, we were
not able to compare our population to other OHS professionals as these
data do not exist. A challenge related to the participating OHS profes-
sionals, is the comprehensiveness – or lack of – of the qualitative data
from the first round of the survey, which formed the subsequent rounds.
Only OHS practices mentioned in the survey ended up as possible topics
for the guideline. Because of that, the final taxonomies of OHS activities
and solutions were not exhaustive or comparable. Furthermore, despite
our efforts to describe and exemplify each theme when assessing these
quantitatively in round two and three, each OHS professional may have
had an individual understanding of what each topic entailed in-
dependently from other OHS professionals. We do not know in detail
what each OHS professional think all topics cover. Another challenge is
the language barrier embedded in this study as we have translated the
responds from Danish to English without validating every single term
used as labels for the identified OHS activities and solutions. A last
challenge concerns the small sample size and response rate in the
survey, ranging from 76 to 85%. However, we used the stakeholder
group to validate our findings and make a final decision based on the
information from our expert panel at the workshops.
4.5. Implications
The described development process is a feasible process for gath-
ering important knowledge from practice. This paper has important
implications for future guideline development; it provides valuable
information on how practitioners can be included in the development
process, with the aim of increasing the implementability of the devel-
oped guidelines. In order to enhance the field of guideline development
it is imperative that end-users are included in the development and that
approaches to include end-users are evaluated and described. In addi-
tion, this study has contributed with valuable information from OHS
 BEU, Alm.del - 2019-20 - Bilag 337: Orientering om resultater fra NFA’s projekt Praksis- og Evidens-baserede anbefalinger i Rådgivning om Muskelskeletbesvær på Ar-bejdspladsen (PERMA)
M.J. Svendsen, et al.
Safety Science 131 (2020) 104932
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practice, and the findings can be used to inform the content of guide-
lines for preventing and handling work-related MSDs. We are confident
that this participatory approach can be applied in a wider community
than the Danish context to increase implementability of guidelines for
OHS practices.
5. Conclusion
Overall, the findings of this study showed that there is limited
consensus among a sample of OHS professionals for OHS practices re-
lated to prevention and handling of MSDs at workplaces in Denmark.
Furthermore, the findings indicate that the OHS professionals request
guidelines for preventing and handling work-related MSDs and that the
guidelines need to focus on several OHS challenges. These findings will
be used in the further process towards developing a guideline for
Danish OHS professionals on how to prevent and handle MSDs at the
workplaces. The rigorous methods used to involve end-users in the in-
itial development process are important prerequisites to improve the
uptake and use of guidelines and succeed in preventing and handling
MSDs at the workplaces. The next phases of the development process
will involve a literature study to review evidence of effective inter-
ventions for the chosen OHS activities, workshops with a diverse group
of highly experienced OHS professionals to combine and fill out evi-
dence gaps with best practice, and a feasibility study to test and refine
the guideline. The onward process will continuously involve OHS
professionals, as they are the target group of the finished guideline. Our
goal with this project is to help reducing the prevalence of work-related
MSDs by enhancing the use of evidence-based OHS practices among
OHS professionals. With a thorough description of the participatory
development process we wish to inspire other OHS practice guideline
working groups to heavily include end-users throughout the process. As
previously shown, this should improve uptake of guidelines by OHS
professionals (Carpenter,
2012; Bumbarger and Campbell, 2012).
Funding
This study was funded by the Danish Work Environment Research
fund (number: 35-2015-09 20150067447).
References
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safety and health (OSH) interventions at the workplace. Scand. J. Work Environ.
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