2012rachel NugentPhD

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Ergonomic Analysis of Work Related Musculoskeletal

Title Disorder Risk to Plasterers Working in Ireland
Author(s) Nugent, Rachel
Publication 2012-12-19
Date
Item record http://hdl.handle.net/10379/3404
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Ergonomic Analysis of
Work Related Musculoskeletal Disorder Risk to
Plasterers Working in Ireland
Rachel Nugent, B.Sc., M.App.Sc. (Res)
Submitted for the degree of Doctor of Philosophy
Location: Industrial Engineering,

College of Engineering and Informatics,
National University of Ireland, Galway
Research Supervisor: Mr. Enda F. Fallon, Senior Lecturer in Industrial Engineering

Research Director: Prof. Paul Nolan, Department of Mechanical and Biomedical
Engineering
Research Mentor: Dr. Jim Duggan, Department of Information Technology
Date Submitted: July 2012

Table of Contents
LIST OF FIGURES ............................................................................................................................. VIII
LIST OF TABLES .................................................................................................................................. X
LIST OF EQUATIONS ......................................................................................................................... XI
EXECUTIVE SUMMARY .................................................................................................................... XII
DECLARATION ................................................................................................................................ XIV
PUBLISHED WORK ........................................................................................................................... XV
ACKNOWLEDGEMENTS ................................................................................................................. XVII
LIST OF ABBREVIATIONS............................................................................................................... XVIII
QUOTATION .................................................................................................................................... XX
FOREWORD .................................................................................................................................... XXI
STATEMENT OF CONFIDENTIALITY ................................................................................................ XXII
CHAPTER 1. INTRODUCTION .......................................................................................................... 1
1.1 THE PROBLEM AND ITS SETTING .............................................................................................. 1

1.2 THE IRISH CONSTRUCTION INDUSTRY ....................................................................................... 5
1.3 MOTIVATION BEHIND THE RESEARCH ....................................................................................... 7
1.4 SIGNIFICANCE OF RESEARCH ................................................................................................... 8
1.5 RESEARCH AIM AND OBJECTIVES ........................................................................................... 10
1.6 RESEARCH HYPOTHESIS ....................................................................................................... 11
1.7 EXPECTED CONTRIBUTION TO KNOWLEDGE ............................................................................. 14
1.8 STRUCTURE OF DISSERTATION............................................................................................... 15
CHAPTER 2. WORK RELATED MUSCULOSKELETAL DISORDERS ..................................................... 19
2.1 INTRODUCTION .................................................................................................................. 19

2.2 MUSCULOSKELETAL DISORDERS (MSD).................................................................................. 19
2.3 MUSCULOSKELETAL DISORDER TERMINOLOGY ......................................................................... 20
2.4 MUSCULOSKELETAL DISORDER DEVELOPMENT ......................................................................... 20
2.5 WRMSD RISK FACTORS...................................................................................................... 22
2.6 INDIVIDUAL MSD RISK FACTORS ........................................................................................... 22
2.6.1 The Musculoskeletal System ........................................................................................... 23
2.6.2 Biomechanical Stress/Strain– Musculoskeletal System .................................................. 25
2.6.3 Physiological Support to the Musculoskeletal System .................................................... 26
2.6.4 Physiological Stress/Strain-Cardiovascular System ........................................................ 28
~I~
2.6.5 Psychological Response to Physical Activity ................................................................... 32
2.6.6 Associations between Sensations and WRMSD Development........................................ 33
2.7 WORK RELATED MSD RISK FACTORS ..................................................................................... 33
2.8 INTERVENTION STRATEGIES TO MANAGE WRMSDS ................................................................. 36
2.9 PRIMARY INTERVENTION ...................................................................................................... 36
2.9.1 Occupational Health and Safety Legislation ................................................................... 37
2.9.2 Safety Management Systems ......................................................................................... 39
2.9.3 Design for Safety Concept – Early Intervention to Eliminate Hazards ............................ 40
2.9.4 Inspection and Maintenance Programs .......................................................................... 41
2.9.5 Occupational Health & Safety Training .......................................................................... 42
2.9.6 Safe Systems of Work – Example: Rest Recovery Periods ............................................... 44
2.9.7 Personal Protective Equipment (PPE) ............................................................................. 45
2.10 SECONDARY INTERVENTION .................................................................................................. 46
2.10.1 Health Promotion and Health Surveillance..................................................................... 47
2.10.2 Partaking in Regular Exercise/Activity ............................................................................ 48
2.11 TERTIARY INTERVENTION ..................................................................................................... 49
2.12 WRMSD RISK ASSESSMENT METHODS ................................................................................. 50
2.12.1 Hierarchical Task Analysis – Identify Risk factors ........................................................... 50
2.12.2 Biomechanical Assessment Methods.............................................................................. 51
2.12.3 Physiological Assessment Methods ................................................................................ 58
2.12.4 Psychophysical Assessment Methods ............................................................................. 60
2.13 CONCLUSION ..................................................................................................................... 62
CHAPTER 3. FACTORS INFLUENCING THE PRESENCE OF WRMSD RISK FACTORS .......................... 63
3.1 INTRODUCTION .................................................................................................................. 63

3.2 ACCIDENT TAXONOMIES ...................................................................................................... 63
3.3 COMPLEX INTERACTIONS OF STAKEHOLDERS IN CONSTRUCTION PROJECTS .................................... 68
3.3.1 Lifecycle Phases of a Construction Project ...................................................................... 68
3.3.2 Stakeholders Involved in Construction Projects .............................................................. 72
3.3.3 Decision Making Processes ............................................................................................. 77
3.3.4 Stakeholders and Decision-Making in a Project Lifecycle ............................................... 79
3.4 DECISION OUTCOMES - WORKING PRACTICES IN THE IRISH CONSTRUCTION INDUSTRY..................... 83
3.4.1 Plastering Activity ........................................................................................................... 83
3.4.2 Plastering Working Conditions ....................................................................................... 84
3.4.3 Plasterers Working Postures ........................................................................................... 94
3.5 CONCLUSION ..................................................................................................................... 96
CHAPTER 4. METHODOLOGY 1: RISK ASSESSMENT PROTOCOL .................................................... 99
4.1 INTRODUCTION .................................................................................................................. 99
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4.2 RESEARCH WRMSD RISK ASSESSMENT PROTOCOL .................................................................. 99
4.2.1 Definitions: Ergonomics, Risk Factors (Hazards), and Risk ........................................... 100
4.2.2 Ergonomic Risk Assessment .......................................................................................... 102
4.2.3 Assessment Environments ............................................................................................ 103
4.2.4 Assessment Methods .................................................................................................... 104
4.2.5 Participant Requirements and Selection....................................................................... 109
4.2.6 Documents .................................................................................................................... 112
4.2.7 Planning and Scheduling............................................................................................... 112
4.2.8 Evaluate the Risk .......................................................................................................... 112
4.2.9 Provide Recommendations ........................................................................................... 113
CHAPTER 5. METHODOLOGY 2: PLASTERERS WRMSD RISK ASSESSMENT .................................. 115
5.1 INTRODUCTION ................................................................................................................ 115

5.1.1 Outline of WRMSD Risk Assessment Methodology ...................................................... 115
5.2 ASSESSMENT ENVIRONMENTS............................................................................................. 118
5.2.1 Hierarchical Task Analysis – A Guide to Select Assessment Environments ................... 118
5.2.2 Field Study .................................................................................................................... 118
5.2.3 Laboratory Study .......................................................................................................... 119
5.3 ASSESSMENT METHODS .................................................................................................... 124
5.3.1 VADS Survey – Field Study ............................................................................................ 124
5.3.2 Heart Rate Analysis (HRA) – Laboratory Study ............................................................. 126
5.3.3 Electromyography – Laboratory Study ......................................................................... 127
5.4 SELECTING PARTICIPANTS................................................................................................... 130
5.5 GENERATING DOCUMENTATION .......................................................................................... 131
5.6 PLANNING & SCHEDULING ................................................................................................. 133
5.7 EVALUATE WRMSD RISK .................................................................................................. 133
5.7.1 VADS Data Analysis ...................................................................................................... 134
5.7.2 HRA Data Analysis ........................................................................................................ 137
5.7.3 EMG Data Analysis ....................................................................................................... 140
5.8 SUMMARY WRMSD RISK ASSESSMENT METHODOLOGY ......................................................... 142
CHAPTER 6. RESULTS ................................................................................................................. 145
6.1 INTRODUCTION ................................................................................................................ 145

6.2 HIERARCHICAL TASK ANALYSIS (HTA) .................................................................................. 145
6.3 PARTICIPATION AND RESPONSE RATE ................................................................................... 146
6.3.1 Field Study .................................................................................................................... 147
6.3.2 Laboratory Study .......................................................................................................... 147
6.4 FIELD STUDY RESULTS -VADS ............................................................................................ 150
6.4.1 Introduction .................................................................................................................. 150
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6.4.2 Data Analysis ................................................................................................................ 150
6.4.3 Results Outline .............................................................................................................. 151
6.4.4 Frequency Data............................................................................................................. 151
6.4.5 Descriptive and Graphical Results ................................................................................ 156
6.4.6 Inferential Post-hoc Results .......................................................................................... 169
6.4.7 Results Summary .......................................................................................................... 170
6.5 LABORATORY STUDY RESULTS ............................................................................................. 172
6.5.1 Introduction .................................................................................................................. 172
6.6 WORKSTATION SET-UP IN THE LABORATORY STUDY ................................................................ 173
6.7 HEART RATE ANALYSIS (HRA) - RESULTS .............................................................................. 173
6.7.1 Data Analysis ................................................................................................................ 174
6.7.2 Results Outline .............................................................................................................. 176
6.7.4 Mean Heart Rate Data – Comparison between Assessment Workstations.................. 177
6.7.5 Time Worked in Each HR Zone – Comparison between Assessment Condition
Environments............................................................................................................... 179
6.7.6 RHR – Comparison between Assessment Condition Environments .............................. 182
6.7.7 Recommended Rest Periods – Comparison between Assessment Condition
Environments............................................................................................................... 184
6.7.8 Inferential Results ......................................................................................................... 186
6.7.9 Result Summary ............................................................................................................ 187
6.8 ELECTROMYOGRAPHY (EMG) RESULTS ................................................................................ 189
6.8.1 Data Analysis ................................................................................................................ 189
6.8.2 Results Outline .............................................................................................................. 191
6.8.4 Plastering Surfaces: Wall/Ceiling.................................................................................. 191
6.8.5 Standing Surfaces: Ground/Ground & hop-up/Trestle/Stilts ........................................ 192
6.8.6 Mortarboard Stand Height ........................................................................................... 195
6.8.7 Wet-Plastering Sub-Tasks ............................................................................................. 195
6.8.8 Mix Plaster (HTA 10.1.1) Sub-task ................................................................................ 198
6.8.9 Load Mortarboard (HTA 10.1.2): Using a Low Mortarboard Stand and High
Mortarboard Stand ..................................................................................................... 198
6.8.10 Load Hawk (HTA 10.2.1): Using a Low Mortarboard Stand and a High Mortarboard
Stand ........................................................................................................................... 199
6.8.11 Load Hawk (HTA 10.2.1) Sub-task: Standing Surfaces .................................................. 200
6.8.12 Load Hawk (HTA 10.2.1) Sub-task: Standing on stilts, Using Low and High Mortarboard
Stands .......................................................................................................................... 202
6.8.13 Load Trowel (HTA 10.2.2): Standing on Ground & hop-up/Trestle/Stilts ..................... 202
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6.8.14 Plaster (HTA 10.2.3) Sub-task: Standing on Ground & hop-up/Trestle/Stilts ............... 205
6.8.15 Plaster (HTA 10.2.3) Sub-task: Standing on Ground & hop-up/Trestle/Stilts ............... 207
6.8.16 Inferential Post-hoc Results .......................................................................................... 209
6.8.17 EMG Conclusion ............................................................................................................ 211
CHAPTER 7. DISCUSSION AND RECOMMENDATIONS................................................................. 213
7.1 INTRODUCTION ................................................................................................................ 213

7.2 DISCUSSION OF RESULTS .................................................................................................... 213
7.2.1 Visual Analogue Discomfort Scales (VADS) Survey ....................................................... 213
7.2.2 Heart Rate Analysis ...................................................................................................... 217
7.2.3 Electromyography ........................................................................................................ 220
7.3 CONCLUSION FROM THE RESEARCH: ARE PLASTERERS AT RISK OF DEVELOPING WRMSDS? ........... 226
7.4 PRINCIPAL RECOMMENDATIONS.......................................................................................... 228
7.4.1 Elimination - Task Re-design: Designer/Architect Input ............................................... 229
7.4.2 Engineering & Administrative Control: Suitable Trowels .............................................. 230
7.4.3 Engineering & Administrative Control Suitable Stilts ................................................... 230
7.4.4 Administrative Control: Training .................................................................................. 231
7.4.5 Administrative Control: Work Rest Scheduling ............................................................. 235
7.4.6 Administrative Control: Workstation Organisation ...................................................... 236
7.4.7 Administrative Control: Rotating Between Tasks ......................................................... 237
7.5 FURTHER RECOMMENDATIONS ........................................................................................... 237
7.5.1 Pre-Project Phase.......................................................................................................... 239
7.5.2 Concept Phase .............................................................................................................. 240
7.5.3 Design Phase................................................................................................................. 241
7.5.4 Planning Phase ............................................................................................................. 242
7.5.5 Standing Surfaces ......................................................................................................... 246
7.5.6 Tender Phase ................................................................................................................ 248
7.5.7 Construction Phase ....................................................................................................... 249
7.5.8 Personal Protective Equipment (PPE) ........................................................................... 251
7.6 RECOMMENDATIONS SUMMARY ......................................................................................... 251
CHAPTER 8. RESEARCH CONCLUSION ........................................................................................ 253
8.1 INTRODUCTION ................................................................................................................ 253

8.2 RESEARCH CHALLENGES ..................................................................................................... 253
8.3 ACHIEVING RESEARCH AIMS AND OBJECTIVES ........................................................................ 255
8.4 HYPOTHESIS TESTING ........................................................................................................ 256
8.5 CONTRIBUTION TO KNOWLEDGE ......................................................................................... 257
8.6 LESSONS LEARNED ............................................................................................................ 258
8.7 FUTURE RESEARCH ........................................................................................................... 259
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8.7.1 Expansion of the EMG Study......................................................................................... 259
8.7.2 Research for a Joint Psychophysical and Physiological Field Study WRMSD risk
Assessment .................................................................................................................. 260
8.7.3 Research to Improve Heart Rate Assessment Procedure .............................................. 261
8.7.4 Research to Improve Electromyography Assessments ................................................. 262
8.7.5 Research to Re-Design Plasterers Tools Equipment...................................................... 264
8.7.6 Research to Evaluate the Effectiveness of Neck, Shoulder, and Wrist Supports ........... 265
8.8 IMPLEMENTATION ............................................................................................................ 267
8.9 CONCLUSION ................................................................................................................... 267
REFERENCES ................................................................................................................................... 269
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List of Appendices
APPENDIX I: LEGISLATION & GUIDANCE DOCUMENTS ..................................................................................................... 296
APPENDIX II: GENERAL PRINCIPLES OF PREVENTION ....................................................................................................... 299
APPENDIX III: NATIONAL FRAMEWORK OF QUALIFICATIONS (NFQ)................................................................................... 300
APPENDIX IV: HIERARCHAL TASK ANALYSIS (HTA) CONSTRUCTING A HOUSE ...................................................................... 301
APPENDIX V: HTA DRYWALL FINISHING ACTIVITY .......................................................................................................... 302
APPENDIX VI: HTA WET-PLASTERING FINISHING ACTIVITY FOR INTERNAL AND EXTERNAL SURFACES ....................................... 303
APPENDIX VII: VADS SURVEY DOCUMENTS ................................................................................................................. 304
APPENDIX VIII: DOCUMENTS FOR LABORATORY STUDY ................................................................................................... 312
APPENDIX IX: CHECKLISTS – LABORATORY STUDY WRMSD RISK ASSESSMENT ................................................................... 322
APPENDIX X:: OUTLINE OF THE CONTENTS OF AN OCCUPATIONAL HEALTH & SAFETY MODULE FOR THIRD LEVEL CONSTRUCTION
RELATED ENGINEERING COURSES & THE POTENTIAL LEARNING OUTPUT .................................................................... 328
~ VII ~
List of Figures
FIGURE 1: ANNUAL EMPLOYMENT STATISTICS IN THE IRISH CONSTRUCTION INDUSTRY FROM 1975-2008 ................................... 5
FIGURE 2: TOTAL PRODUCTION IN BUILDING AND CONSTRUCTION SECTOR (2000-2010) ........................................................ 6
FIGURE 3: STRUCTURE OF THESIS.................................................................................................................................. 17
FIGURE 4: POSSIBLE WRMSD SYMPTOM PROGRESSION WHEN EXPOSED TO WRMSD RISK FACTORS ........................................ 22
FIGURE 5: STRUCTURE OF SKELETAL MUSCLE COMPONENTS .............................................................................................. 24
FIGURE 6: OUTLINE OF THE METABOLIC PROCESSES CONVERTING NUTRIENTS TO ENERGY (STORED IN ATP MOLECULES) ............. 27
FIGURE 7: FACTORS THAT CAN CONTRIBUTE TOWARDS THE DEVELOPMENT OF WRMSDS .................................................... 35
FIGURE 8: OPTIMAL EQUILIBRIUM POINT ....................................................................................................................... 39
FIGURE 9: THE DOMINO THEORY ADAPTED FROM HEINRICH (1931) ................................................................................... 64
FIGURE 10: SWISS CHEESE MODEL OF ACCIDENT CAUSATION ............................................................................................ 67
FIGURE 11: MODEL OF ORGANISATION ACCIDENTS.......................................................................................................... 67
FIGURE 12: LIFECYCLE PHASES OF A CONSTRUCTION PROJECT ............................................................................................ 68
FIGURE 13: BASIC DECISION MAKING PROCESS ............................................................................................................... 77
FIGURE 14: FACTORS THAT INFLUENCE THE QUALITY AND QUANTITY OF A STAKEHOLDER’S STORE OF INFORMATION AND
KNOWLEDGE ................................................................................................................................................... 78
FIGURE 15: INDIVIDUAL FACTORS THAT INFLUENCE DECISION OUTCOME ............................................................................. 78
FIGURE 16: DECISION MAKING IN A PROJECT LIFECYCLE.................................................................................................... 80
FIGURE 17: STAKEHOLDERS DECISION MAKING PROCESSES – INFLUENCE PRESENCE OF WRMSD RISK FACTORS ......................... 82
FIGURE 18: PINCH GRIP AND POWER GRIP ..................................................................................................................... 93
FIGURE 19: RESEARCH PROTOCOL TO GUIDE RESEARCHERS WHEN DEVELOPING A METHODOLOGY TO EVALUATE WRMSD RISK
FACTOR EXPOSURE IN A RESEARCH STUDY .......................................................................................................... 103
FIGURE 20: RESEARCH WRMSD RISK ASSESSMENT PROTOCOL ....................................................................................... 114
FIGURE 21: OUTLINE OF THE ASSESSMENT PROCEDURE USED TO EVALUATE WRMSD RISK TO PLASTERERS WORKING IN IRELAND117
FIGURE 22: EXAMPLE OF WORKSTATION LAYOUT LABORATORY STUDY ASSESSMENT: REPRESENT CONDITIONS THAT OCCUR ON
ACTIVE CONSTRUCTION SITES ........................................................................................................................... 121
FIGURE 23: MUSCLES ASSESSED USING EMG ............................................................................................................... 128
FIGURE 24: EXAMPLE OF TOOLS USED BY PLASTERERS WHEN CARRYING OUT THEIR TASKS ON ACTIVE CONSTRUCTION SITES ..... 147
FIGURE 25: WORKING TIMES FOR PLASTERERS –START/END DAY, LENGTH OF WORKDAY/ DURATION OF BREAKS .................... 152
FIGURE 26: DURATION OF TIME PLASTERERS WORKED BEFORE TAKING A BREAK ................................................................ 153
FIGURE 27: PLASTERING SURFACES ............................................................................................................................. 153
FIGURE 28: STANDING SURFACES ............................................................................................................................... 154
FIGURE 29: TASKS CARRIED OUT BY PLASTERERS OVER A FIVE-DAY CONSECUTIVE WORK PERIOD............................................ 155
FIGURE 30: VARIATION IN PERCEIVED DISCOMFORT INTENSITY RECORDED OVER FIVE CONSECUTIVE WORKDAYS....................... 157
FIGURE 31: TEMPORAL PATTERNS OF DISCOMFORT FOR TEN BODY AREAS ......................................................................... 159
FIGURE 32: VARIATION IN DISCOMFORT INTENSITY WHEN MOVING BETWEEN WORK PERIODS AND REST PERIODS .................... 160
FIGURE 33: PATTERN OF INCREASING AND DECREASING LEVELS OF DISCOMFORT INTENSITY .................................................. 161
~ VIII ~
FIGURE 34: AVERAGE INCREASE/DECREASE IN DISCOMFORT INTENSITY LEVEL FOR TEN BODY AREAS BETWEEN TIME EVENTS (WORK
PERIOD/BREAKS) ........................................................................................................................................... 162
FIGURE 35: MEAN INTENSITY OF PERCEIVED DISCOMFORT FOR PLASTERING SURFACES......................................................... 164
FIGURE 36: MEAN INTENSITY OF PERCEIVED DISCOMFORT FOR STANDING SURFACES ........................................................... 166
FIGURE 37: MEAN INTENSITY OF PERCEIVED DISCOMFORT FOR PLASTERING TASKS .............................................................. 168
FIGURE 38: MEAN HEART RATE DATA FOR EACH ASSESSMENT WORKSTATION & TEST PERIOD.............................................. 177
FIGURE 39: PERCENT OF TIME AT WORKING AT MODERATE TO MAXIMUM INTENSITY FOR EACH ASSESSMENT WORKSTATION .... 180
FIGURE 40: DISTRIBUTION OF PERCENT OF TIME IN EACH HEART RATE ZONE...................................................................... 181
FIGURE 41: PERCENT OF TIME WORKING IN ACTIVITY/INTENSITY ZONES............................................................................ 181
FIGURE 42: VARIATION OF MEAN TIME PLASTERERS SPENT IN EACH ACTIVITY ZONE ............................................................ 182
FIGURE 43: MEAN RHR DATA FOR EACH ASSESSMENT WORKSTATION.............................................................................. 183
FIGURE 44: MEAN RRP FOR ASSESSMENT CONDITION ENVIRONMENTS............................................................................. 185
FIGURE 45:%PEAK EMG VALUES WHEN WORKING ON A WALL AND A CEILING .................................................................. 192
FIGURE 46: %PEAK EMG VALUES WHEN STANDING ON DIFFERENT SURFACES ................................................................... 194
FIGURE 47: %PEAK EMG VALUES WHEN LOADING MORTARBOARDS ............................................................................... 195
FIGURE 48: %PEAK EMG VALUES FOR SUB-TASKS OF PLASTERING ACTIVITY –AVERAGE VALUE FOR ALL WORKSTATIONS .......... 197
FIGURE 49: %PEAK EMG VALUES FOR MIX PLASTER (HTA 10.1.1) SUB-TASK .................................................................. 198
FIGURE 50: %PEAK EMG VALUES FOR LOAD MORTARBOARD SUB-TASK – WORKING WITH A LOW STAND AND HIGH STAND ...... 199
FIGURE 51: %PEAK EMG VALUES FOR LOAD HAWK SUB-TASK – WORKING WITH A LOW MORTARBOARD STAND AND HIGH
MORTARBOARD STAND ................................................................................................................................... 199
FIGURE 52: %PEAK EMG VALUES FOR LOAD HAWK SUB-TASK – STANDING ON DIFFERENT SURFACES .................................... 201
FIGURE 53: %PEAK EMG VALUES FOR LOAD HAWK SUB-TASK – STANDING ON STILTS AND USING TWO DIFFERENT MORTARBOARD
STANDS ........................................................................................................................................................ 202
FIGURE 54: %PEAK EMG VALUES FOR LOAD TROWEL SUB-TASK – STANDING ON DIFFERENT SURFACES ................................. 204
FIGURE 55: %PEAK EMG VALUES FOR PLASTER SUB-TASK – STANDING ON DIFFERENT SURFACES.......................................... 206
FIGURE 56: %PEAK EMG VALUES FOR PLASTER SUB-TASK – CARRYING OUT A WET-PLASTERING TASK IN FOUR WORKSTATIONS . 208
FIGURE 57: SUMMARY OF RECOMMENDATIONS TO REDUCE PLASTERERS RISK OF DEVELOPING WRMSDS .............................. 238
FIGURE 58: POLAR HEART RATE MONITOR ‘BRA’ .......................................................................................................... 262
FIGURE 59: HEART RATE ZONE RANGES COLOUR CODED TO REPRESENT EACH ZONE ........................................................... 264
FIGURE 60: THE NECPROTECH NECK SUPPORT SYSTEM................................................................................................... 266
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List of Tables
TABLE 1: HEART RATE ZONES –INTENSITY OF ACTIVITY & RECOMMENDED DURATION ............................................................ 30
TABLE 2: CLASSIFYING WORK INTENSITIES: ADAPTED FROM ÅSTRAND AND RODAHL (1986) .................................................... 32
TABLE 3: SCORES AND ACTION LEVELS FOR RULA AND QEC ............................................................................................. 53
TABLE 4: RISK ASSESSMENT MATRIX .......................................................................................................................... 102
TABLE 5: SELF-REPORTING WRMSD RISK ASSESSMENT METHODS .................................................................................. 106
TABLE 6: DIRECT AND INDIRECT WRMSD RISK ASSESSMENT METHODS ............................................................................ 107
TABLE 7: OBSERVATIONAL WRMSD RISK ASSESSMENT METHODS ................................................................................... 108
TABLE 8: SAMPLE OF RESEARCH PUBLICATIONS TO DEMONSTRATE THE SAMPLE SIZES USED IN RISK ASSESSMENT STUDIES ......... 111
TABLE 9: SUMMARY DETAILS OF THE VARIABLE WORKING CONDITIONS IN EACH ASSESSMENT ENVIRONMENT WORKSTATION ..... 120
TABLE 10: HEART RATE ZONE RANGES ........................................................................................................................ 138
TABLE 11: DEMOGRAPHICS OF PARTICIPATING PLASTERERS ............................................................................................. 148
TABLE 12: VADS WRMSD RISK LEVELS ..................................................................................................................... 156
TABLE 13: WILCOXON SIGNED RANKS TEST– MEAN INTENSITY OF PERCEIVED DISCOMFORT - VARIANCE BETWEEN GROUPS........ 170
TABLE 14: FILES COLLECTED FOR 10 PLASTERERS IN PRE-TEST AND WORKSTATIONS ............................................................ 174
TABLE 15: DISTRIBUTION OF MEAN HEART RATE VALUES FOR TEN PLASTERERS FOR EACH ASSESSMENT WORKSTATION............. 178
TABLE 16: HEART ZONE RANGES WITH CORRESPONDING HEART RATE RANGES, ACTIVITY INTENSITY LEVELS, AND LEVELS OF RISK 179
TABLE 17: DISTRIBUTION OF RHR VALUES FOR TEN PLASTERERS FOR EACH ASSESSMENT WORKSTATION ................................ 184
TABLE 18: DISTRIBUTION OF RRP DURATION FOR TEN PLASTERERS FOR EACH ASSESSMENT WORKSTATION ............................. 186
TABLE 19: ONE -WAY ANOVA POST HOC ANALYSIS – VARIANCE BETWEEN GROUPS ............................................................ 187
TABLE 20: SUMMARY RESULTS FOR HEART RATE ANALYSIS ............................................................................................. 188
TABLE 21: SUB-TASK CARRIED OUT IN EACH ASSESSMENT CONDITION................................................................................ 191
TABLE 22: ONE -WAY ANOVA POST HOC ANALYSIS – VARIANCE BETWEEN GROUPS ............................................................ 210
TABLE 23: EXAMPLE OF MUSCLE ACTIVITY ZONES WITH CORRESPONDING ACTIVITY INTENSITY LEVELS AND A RECOMMENDED
DURATION OF PARTICIPATION .......................................................................................................................... 263
~X~
List of Equations
EQUATION 1: RELATIVE HEART RATE – A MEASURE OF WORKLOAD.................................................................................... 31
EQUATION 2: MURRELL EQUATION TO CALCULATE RESTING TIME...................................................................................... 45
~ XI ~
Executive Summary
As a consequence of the organisational nature of the construction industry, and due to
the dynamic nature of construction activities, construction workers are exposed to Work
Related Musculoskeletal Disorders (WRMSDs) risk factors as an intrinsic part of their daily
activities. Plasterers are one of the trades that experience high prevalence rates of the
disorders when compared with other trades within the industry. Consequently, the quality of
their work is affected. Additionally, due to associated absenteeism and early retirement, and
costs associated with treatment, compensation, and insurance costs, the plasterer, their
employer, and the economy experience a significant financial burden.
Upon developing a research risk assessment protocol, it was used as a guide to
develop an assessment methodology to evaluate if plasterers working in Ireland were at an
increased risk of developing WRMSDs because of their tasks and working conditions.
Psychophysical, physiological, and biomechanical assessment methods were selected based
on their suitability to evaluate WRMSD risk. Visual Analogue Discomfort Scales (VADS)
was used to evaluate psychophysical stress; Heart Rate Analysis (HRA) was used to evaluate
physiological stress, and Electromyography (EMG) was used to evaluate biomechanical
stress..
The VADS survey consisted of 100mm linear scales, a body map and questionnaires.
It was used as an assessment method on active construction sites to measure subjective
qualitative judgments of postural discomfort to determine if plasterers experienced
discomfort over the course of a working day and working week. Further analysis of the
VADS data was carried out to evaluate if the type of work being carried out, and the type of
conditions plasterers worked in, influenced levels of discomfort intensity. Additionally, it
was used to provide a snapshot representation of the type of work being carried out, and the
type of conditions plasterers work in over a five-day work period. The dependent unit of
psychophysical response is intensity of discomfort represented as a measure of millimetres
ranging from 0-100mm. Eighteen plasterers participated in the VADS study.
HRA and EMG were used to evaluate plasterers’ responses when carrying out a
plastering activity in four simulated working environments. Each environment was set up to
represent combinations of independent variables - standing surfaces (e.g. ground, stilts,
trestle, and hop-up), plastering surfaces (e.g. wall and ceiling), plastering tasks (e.g. Mix
Plaster, Load Mortarboard, Load Hawk, Load Trowel and Plaster), and mortarboard stand
heights (e.g. 775mm and 1270mm).
~ XII ~
HRA was used to evaluate and compare each plasterer’s physiological response when
they carried out a wet-plastering task in each of the four assessment workstations. The
dependant variables of physiological response were mean heart rate (bpm), Heart Rate Zone
(HRZ) activity, Relative Heart Rate (RHR) and Recommended Rest Period (RRP).
EMG analysis was used to evaluate muscle activity levels to evaluate the plasterers’
biomechanical response of for each for each sub-task for each variable condition. The
muscles assessed were the right and left sternocleidomastoid muscles in the neck, right and
left trapezius muscles in the shoulder, and the right and left erector spinae muscles in the
back. The dependent variable of biomechanical response was mean/maximum muscle activity
level represented as a percentage of peak muscle activity.
Statistical analysis was carried out to describe details about aspects of the sample
population and compare independent variables with dependent variables. The results indicate
that in most cases independent variables significantly influences change in the dependent
variables and plastering activities and working conditions increase plasterers’ risk of
developing WRMSDs. For example, in the VADS study (psychophysical analysis) it was
found that plasterers experienced an increase in perceived discomfort intensity levels over
five consecutive workdays. A decline in intensity levels was observed after a period of rest
i.e. lunch break or overnight break.
In the HRA study (physiological analysis), plasterers experienced the highest
physiological stress when carrying out a wet-plastering activity on a wall while standing on
the ground and a hop-up, and using a low mortarboard stand. When working on ceiling,
plasterers experienced their lowest physiological stress when standing on stilts and using a
high mortarboard stand.
In the EMG study (biomechanical analysis), activity levels were highest when
plasterers worked on a ceiling when compared with working on a wall. The neck muscles had
the highest activity level when standing on a trestle, whereas the shoulder and back muscles
had the highest activity levels when standing on the ground. The neck, shoulder, and back
muscles had the highest activity levels when tasks were carried out when using the low
mortarboard stand.
The findings from the data analysis were used to provide recommendations for control
interventions to minimise the adverse effects that the plastering task and working conditions
has on the musculoskeletal system and decrease the probability of plasterers developing
WRMSDs.
~ XIII ~
Declaration
I hereby declare that my submission is the result of my own work and as a whole is
not substantially the same as any that I have previously made or am currently making,
whether in published or unpublished form, for a degree, diploma, or similar qualification at
any university or similar institution.
_____________________ Date: ___________

Rachel Nugent
~ XIV ~
Published Work
The following is a list of papers presented and published based on the research carried
out by the author:
Nugent, Rachel; Fallon, Enda, F. (2009) Evaluating musculoskeletal disorder (MSD)

risk to Irish Plasterers using the Quick Exposure Check (QEC) at the 17th World Congress on
Ergonomics organised by the International Ergonomics Association (IEA), and the Chinese
Ergonomics Society (CES) on August 9-14, 2009 in Beijing, China
Nugent, R., Fallon, E.(2009) Analysing MSD risk to Blocklayers when working on
the ground and working on scaffolding using the Visual Analogue Discomfort Scale (VADS),
Proceedings of the Sociedade Portuguesa de Segurança e Higiene Ocupacionais (SPOSHO)
Conference, (Portuguese Society for Occupational Safety and Hygiene), Auditório Nobre,
DPS - Universidade do Minho, Guimarães, Portugal, 5th- 6th February 2009
Nugent, R, Fallon, E.F., and Gill, D. (2008) An ergonomic assessment of blocklaying

task elements using the Quick Exposure Check (QEC). In: AHFE International Conference,
Karwoski, W and Salvendy,G (Eds), Proceedings of the Second International Conference on
Human Factors and Ergonomics jointly with 12th International Conference on Human
Aspects of Advanced Manufacturing (HAAMAHA). 14th -17th July 2008, Caesars Palace, Las
Vegas; USA Publishing AHFE International Conference (ISBN 978-1-60643-712-4)
Nugent, R., Fallon, E. and Hegarty, S., (2007) An ergonomic study of blocklaying, In:
Contemporary Ergonomics, Burst, P. (Ed), Proceedings of the annual Conference of the
Ergonomics Society, 17th-19th April 2007, Nottingham University, UK (ISBN 0415436389)
Poster Sessions
Nugent, Rachel and Fallon, Enda, F. (2008) Analysing task elements of blocklaying,
In: Research Posters-Digest of Abstracts, College of Engineering & Informatics Research
Day. Galway: National University of Ireland, Galway
~ XV ~
Future Publications
Nugent, Rachel and Fallon, Enda, F. (2013) Ergonomic Risk Assessment Protocol to
Evaluate WRMSD Risk to Plasterers - Abstract submitted to the Understanding Small
Enterprises (USE) Conference, 19th-22nd Feb 2013, Massey University, Nelson, New
Zealand, and a Special Issue of the Journal of Safety Science based on USE2013 conference
proceedings papers.
Nugent, Rachel and Fallon, Enda, F., Ergonomic Evaluation of Plastering Activities
in Ireland: Report - To be submitted for the attention of the Construction Workers Health
Trust (CWHT), 130/132 Francis Street, Dublin 2, Ireland. Ergonomic Evaluation of
Plastering Activities in Ireland
Nugent, Rachel and Fallon, Enda, F., Ergonomic Evaluation of Plastering Activities
in Ireland: Summary Report - To be submitted for the attention of the Construction Workers
Health Trust (CWHT), 130/132 Francis Street, Dublin 2, Ireland. Ergonomic Evaluation of
Plastering Activities in Ireland
~ XVI ~
Acknowledgements
This end of this journey has only been reached with the love and support of my family
who I am sure are as pleased as I am that my path is branching off in a new and different
direction. To my husband Michael, my daughters Robyn and Melissa, and my son Jamal,
thank you for your support and for putting up with my blathering and rants when I went
through periods of frustration and elation with the research. I am finally finished! As proud as
you are of me for doing this, I am more than proud of you all for the way in which you helped
me to get here and for being there for me throughout it all.
To my supervisor Mr. Enda Fallon, thank you for giving me this opportunity and the
support to take on this project. The process has provided me with skills that will open many
doors for me.
I want to thank all the staff at University College Hospital Galway who contributed to this
research in their own unique way. To Dr Martina Kelly a special thank you for the availability of
your ear and provision of encouragement and guidance, to Mary and Sharon thank you for always
having an open door, and to William and Boni your technical knowledge is endless.
To my research colleagues past and present in NUIG, Dr Daithi for providing me with
lots of guidance in our many discussions over the last number of years, I followed the red thread!
To Liam and Simrn my journey is at its end and I will miss not being a part of it with you in the
future, and to Catherine, keep going there is light at the end of the tunnel and opportunity awaits.
I would like to thank the Construction Workers Health Trust, Brian Daly, and Michael
Brennan for placing their trust in me and providing me with the opportunity to carry out this
research. I hope it will help in their mission to improve the health and wellbeing of
construction workers in Ireland. Special thanks are also due to Billy Wall of the Plasterers
Union and to all the plasterers who participated in this research.
~ XVII ~
List of Abbreviations
ADP: Adenodiphosphate
ATP: Adenotriphosphate
BER: Building Energy Efficiency
BMR: Basal Metabolic Rate
bpm: Beats Per Minute
CNS: Central Nervous System
CWHT: Construction Workers Health Trust
DfS: Design for Safety
EE: Energy Expenditure
EMG: Electromyography
ETA: Event Tree Analysis
FÁS: Foras Áiseanna Saothair, Training & Employment Authority
FETAC: Further Education and Training Awards Council
FMEA: Failure Modes and Effects Analysis
FTA: Fault Tree Analysis
GO: General Operative
HAZOP: Hazards and Operability Analysis
HRA: Heart Rate Analysis
HFE: Human Factors Engineering
HR: Heart Rate – measured in bpm
HR max : Maximum Heart Rate
HR rest : Resting Heart Rate
HRZ: Heart Rate Zones
HSA: Health and Safety Authority
HTA: Hierarchical Task Analysis
IOSH: Institution of Occupational Safety and Health
MAW: Maximum Acceptable Weight
MEWP: Mobile Elevated Work Platforms
MSD: Musculoskeletal Disorder
MVC: Maximum Voluntary Contraction
NIOSH: National Institute for Occupational Safety and Health
NMQ: Nordic Musculoskeletal Questionnaire
~ XVIII ~
NFQ: National Framework of Qualifications
NUIG: National University of Ireland, Galway
OWAS: Ovako Working Posture Analysing System
PPE: Personal Protective Equipment
PSCS: Project Supervisor for the Construction Stage
PSDP: Project Supervisor for the Design Process
QEC: Quick Exposure Check
REBA: Rapid Entire Body Assessment
RHR: Relative Heart Rate
RRP: Recommended Rest Period
RMS: Root Mean Square
RULA: Rapid Upper Limb Assessment
RWL: Recommended Weight Limit
SENIAM: Surface Electromyography for the Non-Invasive Assessment of Muscles
SCM: Sternocleidomastoid muscle
SMS: Safety Management Systems
TA: Task Analysis
VAS: Visual Analogue Scale
VADS: Visual Analogue Discomfort Scale
VO 2 : Volume of oxygen consumed for an activity (in a given time)
VO 2max : Maximum potential volume of oxygen that a person can consume
WRMSD: Work Related Musculoskeletal Disorder
~ XIX ~
Quotation
Respect your fellow human being, treat them fairly, disagree with them honestly, enjoy
their friendship, explore your thoughts about one another candidly, work together for a
common goal, and help one another achieve it. ~Bill Bradley
~ XX ~
Foreword
The research presented in this thesis was supported by a fellowship from the
Construction Workers Health Trust (CWHT), 130/132 Francis Street, Dublin 2, Ireland.
~ XXI ~
Statement of Confidentiality
Any person who wishes to gain access to this thesis, which includes confidential
information, should seek permission from the Discipline of Mechanical and Biomedical
Engineering.
Please contact:
Mr Enda F. Fallon, Senior Lecturer in Industrial Engineering
Centre for Occupational Health & Safety Engineering and Ergonomics (COHSEE),
College of Engineering and Informatics,
Department of Mechanical and Biomedical Engineering
National University of Ireland Galway,
University Road,
Galway
Tel.: +353 (0)91 522745

E-mail: enda.fallon@nuigalway.ie
~ XXII ~
Chapter 1: Introduction
Chapter 1. Introduction
This introductory chapter provides the rationale behind why the research presented in
this thesis was carried out. The research aims, objectives, research hypothesis, and expected
contribution to knowledge are presented. The final section of the chapter provides an outline
of the thesis structure.
1.1 The Problem and its Setting

It has long been recognised that an association exists between work and the health
(and ill health) of workers. Imhotep (2667 BC - 2648 BC), an architect, engineer and court
physician was the first individual to describe work related injuries and diseases in the Edwin
Smith papyrus unearthed in a tomb at Thebes in 1862 (Breasted, 1930). One such case
documented in the papyrus recounts a work-related low back injury of a worker involved in
the construction of the Great Pyramid approximately 5,000 years ago (Brand and Rauf,
1987). Bernardino Ramazinni (1633-1714), the ‘Father of Occupational Medicine’,
recognised associations between specific injuries and occupations. For example the
occurrence of musculoskeletal injury associated with ergonomic work factors such as posture,
repetition of movements, and manually handling loads (Franco and Fusetti, 2004).
Workplace ill health and injury affects workers ability to work effectively. Workers
may require a period of absence from work to recover. In extreme cases, workers take early
retirement because of the severity of their symptoms. Company profits can decline because of
reduced productivity and product quality, and increased costs attributed to higher staff
turnover and retraining of new staff. Additional costs incurred may include insurance, legal,
medical and compensation costs. The economy incurs a cost to provide support systems to
individuals who are unfit for work on a temporary and long-term basis, e.g. medical treatment
and social welfare benefits. It is contended that for every one euro of direct costs incurred
because of workplace ill health and injury an additional €10 is incurred (Schulte, 2005,
Steenland et al., 2003).
Affected individuals experience a reduction in their income and their quality of life. In
cases where symptoms are severe, individuals and their family’s daily and social lives are
affected (Friedman and Forst, 2009, Côté et al., 2008, Waehrer et al., 2007, Indecon, 2006,
Stattin and Järvholm, 2005, Schneider, 2001, Leigh et al., 1997).
Musculoskeletal Disorders (MSDs) experienced in the general population are
attributable to exposure to normal daily activities (Walker-Bone et al., 2004, Andersson,
~1~
2004, Bassols et al., 1999, Andersson et al., 1993, Magni et al., 1990). However, Work
Related Musculoskeletal Disorders (WRMSDS) occur when work activities or work
conditions significantly contribute to their development, or existing symptoms are
exacerbated because of exposure to work-related factors (Bosch et al., 2011, da Costa and
Vieira, 2010, Solidaki et al., 2010).
WRMSDs are one of the top illnesses and disorders experienced worldwide by
workers in all occupations with prevalence and incidences rates increasing annually. Aside
from the debilitating pain and suffering experienced by a growing population of sufferers, a
significant and increasing financial burden is incurred due to high levels of associated
absenteeism and early retirement (Indecon, 2006).
Leigh (2011) analysed injury and illness records for 2007 from America organisations
such as the Bureau of Labor Statistics (BLS), Center for Disease Control and Prevention
(CDC), and the National Academy of Social Insurance. He estimated that the combined direct
and indirect cost of work-related illness was $250 billion per annum. This equates to a 71%
increase in estimated costs for work-related illness in America when comparing the 2007
study to a similar study carried out in 1992 (Leigh, 2011, Leigh et al., 1997).
A survey carried out in 2005 across 31 countries, including the 27 EU Member States,
estimated that almost 60 million European workers are affected by WRMSDs annually.
When compared with previous data there was an annual increase in the number of workers
affected (EUROFOUND, 2007, Parent-Thirion et al., 2007).
Approximately fifty percent of workplace absenteeism lasting three days or longer is
attributed to WRMSDs. It is estimated that this results in 600 million lost workdays per
annum (Bevan et al., 2009, Solidaki et al., 2010). Costs are estimated to be between 0.5% and
2% of GNP (Solidaki et al., 2010, Punnett and Wegman, 2004). In 2007, 22.8 per cent of
European workers reported that they have experienced muscular pain in their neck, shoulders
and upper limbs (Parent-Thirion et al., 2007). According to Cook et al., (1996) the neck is
ranked in third place after the lower and upper back for prevalence rates of WRMSDs that
result in workers seeking medical treatment and time off work to recover.
A survey conducted by IBEC in 2004 determined that WRMSDs related absenteeism
accounted for 14 million lost workdays each year in Ireland. Costs of work-related accidents
and ill-health are estimated at €3.6 billion, equivalent to 2.5% of GNP per annum (Indecon,
2006). The Irish Central Statistics Office estimates that WRMSDs accounts for 50% of
workplace absenteeism and the direct cost attributed to WRMSDs are estimated to exceed
€750m (Central Statistical Office (CSO), 2004).
~2~
The construction industry is believed to be the oldest industry in the developed and
developing economies. It plays an essential role in the provision of buildings and
infrastructure, contributes to the economy, and is a source of employment for Irish and
international workers. It has however a higher prevalence of injury, ill-health, and fatalities
when compared with other occupational industries (Carter and Smith, 2006, Schulte, 2005).
This is particularly true for WRMSDs, which may be attributed to exposure to risk
factors that are an intrinsic part of the daily activity of construction workers. Brenner and
Ahern’s (2000) review of Irish construction records found the top three causes of absenteeism
were injuries (30%) infectious diseases (25%) and WRMSDs (13%). The top causes of early
retirement were cardiovascular diseases (31%) and WRMSDs (30%). WRMSDs of the
shoulder are common in the construction trades (Buckle and Devereux, 2002, Anton et al.,
2001).
Because of the high levels of absenteeism and early retirement attributed to
WRMSDs, the industry experiences a significant financial burden (Brenner, 2006, Arndt et
al., 2005, Deacon et al., 2005, Anton et al., 2005, Holmström and Engholm, 2003, Centre to
Protect Workers Rights (CPWR), 2002, Goldsheyder et al., 2002, Pinder et al., 2001,
Schneider, 2001, Brenner and Ahern, 2000, Welch et al., 1999, Smallwood, 1997, Holmström
et al., 1995, Luttmann et al., 1991, Jørgensen et al., 1991).
In Ireland, the term plasterer is applied to the people who are responsible for the
application of interior and exterior finishes to walls, ceilings, or partitions of buildings. They
are frequently referred to as drywall operators in other countries. Literature and printed
publications reporting on injury statistics for this trade generally refer to them as drywall
operators (Hess et al., 2010b, Smith et al., 2004, Shaw et al., 2002, Chiou et al., 2000,
Lipscomb et al., 2000b, Pan et al., 2000a, Pan et al., 2000c). They are one of the trades that
report high prevalence rates of WRMSDs mainly affecting the lower back, neck, shoulders,
elbows, wrists, and hands. Injuries include strains, sprains, or tears with the severity of
symptoms ranging from minor to severe (Pan et al., 2009, Reid et al., 2001b, Pinder et al.,
2001, Pan et al., 2000b, Pan et al., 2000c). Drywall installers and carpenters who carry out
finishing activities are ranked in the top four occupations in the construction industry who are
at an increased risk of sustaining an occupational injury (Hsiao and Stanevich, 1996).
According to Smith et al., (2004) drywall installers experience WRMSD symptoms more
frequently and for longer durations than all other construction trade workers. The main causes
of injury for drywall installers and carpenters are overexertion and falls (Schneider, 2001,
Chiou et al., 2000, Lipscomb et al., 2000a). A National Institute for Occupational Safety and
~3~
Health (NIOSH) survey of drywall installers and carpenters found that workers believed their
greatest risk of physical stress was from lifting, carrying, or holding drywall boards (Pan et
al., 2000b, Pan et al., 2000c).
Plasterers with shoulder WRMSDs have a high probability of experiencing pain in
their shoulder and arm when carrying out their tasks. Their ability to extend their arm to its
outer range of movement and the ability to generate maximum force output is reduced. The
plasterer’s capacity to carry out their usual task is affected specifically when working
overhead, and when carrying out repetitive movements. Risk factors include handling heavier
loads, working at or above shoulder height, overhead work, extreme or awkward postures 1,
repetitive movements, static work, forceful exertions, working for prolonged periods and
working without frequent rest breaks (Weon et al., 2010, Ebaugh and Spinelli, 2010, Ratzon
and Jarus, 2009, Miranda et al., 2008, Larsson et al., 2007, Walker-Bone and Cooper, 2005,
Anton et al., 2005, Svendsen et al., 2004, Anton et al., 2001, Hagberg, 1996). Symptoms can
include swelling, inflammation and impingement of the musculoskeletal components, pain
and discomfort, headaches, and referred pain in the jaw (Tempelhof et al., 2010, Keener et
al., 2010, Worland et al., 2003). Examples of shoulder WRMSDs include Rotator Cuff
Tendinitis, bursitis, and impingement syndrome.
Risk factors associated with back injury include manual handling especially heavier
loads. Working at different heights can increase the frequency of bending movements and
increase the degree of angular displacement. Poor workplace layout and organisation can
force workers to sustain awkward postures, and increases the frequency of bending, and
twisting.
Within and between countries, people who carry out finishing activities are referred to
many different titles. Injury and illness statistics are recorded under each different title. In
addition, when recording statistical data, organisations frequently use different methodologies
and terminology when describing the injuries and illnesses. Consequently, statistical
inconsistencies are inevitable and new or existing cases frequently go unreported. It is
therefore impossible to accurately predict the severity of the problem within/between
countries, within/between industry sectors, or within/between demographic populations. It is
believed that the true prevalence and cost of WRMSDs is vastly underestimated (Indecon,
2006, Leigh et al., 1997).
1
e.g. elevated arm posture, shoulder abduction, or flexion of greater than 90°
~4~
1.2 The Irish Construction Industry

The construction industry, after a 14-year period of growth, peaked in 2007 when it
employed approximately 400,000 people, i.e. 14.5% of the working population. It generated a
financial output of €38.5 billion which accounted for 19% of Gross Domestic Product (GDP)
and 23.8% of Gross National Product (GNP) (Kerins et al., 2011).
While all employment sectors are experiencing the effects of an economic downturn,
the construction industry is possibly affected more than most. Construction employment has
declined more than 60% when compared with previous employment levels in 2007. In the
third quarter of 2010, construction accounted for just 6.2 % of the working population
(Kerins et al., 2011, Central Statistics Office (CSO), 2011).
It is estimated that approximately 40% of those currently in receipt of unemployment
benefits were previously employed in the construction industry (Central Statistics Office
(CSO), 2011b). In Figure 1, a graphical representation of the employment trend in the Irish
construction industry between 1975 and 2008 is presented.
,ooo employees
180
160
140
120
100
80
60
40
20
0
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
Figure 1: Annual Employment Statistics in the Irish Construction Industry from 1975-
2008
(Central Statistics Office, 2011b)
In Figure 2, the construction sector’s output statistics from 2000 to 2010 (Central
Statistics Office (CSO), 2011) is presented. As well as a decline in construction output, there
is also a shift in the type of construction output. At its peak, 60% of construction output was
residential construction. Home and business owners have reduced investment in purchasing
new properties. Instead they are investing in their existing properties by financing
renovations, installing renewable energy systems, and building extensions (Central Statistics
~5~
Office (CSO), 2011). Subsequently residential construction has declined by approximately

60% from its previous peak level (Central Statistics Office (CSO), 2009).
140
120 All building and

construction
100
Building
(excluding civil
80 engineering)
Residential
60 building
Non-residential
40 building
20 Civil engineering
0
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Figure 2: Total Production in Building and Construction Sector (2000-2010)

(Central Statistics Office, 2011)
During the ‘Celtic Tiger’ period when Ireland experienced unprecedented and
dramatic economic growth, the Irish Government, local planning authorities and Irish
banking system implemented management decisions that were, in hindsight, unsound and
potentially outside safe or logical practice. The rate of construction output escalated in
conjunction with elevated property prices. Purchasers were provided with excessive loans
that far exceeded their capacity to be repaid. The economic crisis has had a negative impact
on almost every citizen in Ireland with reduced income, increased unemployment levels, and
reduced property prices. The subsequent impact has resulted in widespread negative equity
and an excess of un-purchased properties referred to in the media as ‘ghost estates’ (Kerins et
al., 2011).
It is unlikely that the construction industry will attain the levels of employment or
construction output levels when at its peak in 2007. It cannot be denied that there will always
be a requirement for construction work to sustain the current population, to meet the demands
of future populations, and to encourage international investment into Ireland. Eurostat’s
analysis of births, deaths and migration levels in the European Union project a growth of
Ireland’s population by 53% (up to approximately 6.7 million) from 2008 to 2060
(Giannakouris, 2008). The growth in population will require construction of residential and
~6~
commercial properties and the necessary infrastructural to support the population e.g.
sewerage, water, energy, roads, hospitals, schools etc. The ERSI forecasts that approximately
31,500 houses will be constructed annually between 2012 and 2016. In addition the rate of
construction is expected to increase as the economy recovers (DKM Economic Consultants,
2010).
1.3 Motivation behind the Research

The Construction Workers Health Trust’s (CWHT) is a charitable organisation whose
primary focus is on the health and safety of Irish construction workers. It strives to be
progressive and preventative in its approach. They provide a variety of free health
assessments and promote healthier lifestyles to all construction workers throughout Ireland.
Brenner and Ahern (2000), on behalf of the trust, reviewed absenteeism, and early
retirement records for Irish construction workers to establish if patterns of ill health existed
among Irish construction workers. Analysis of absenteeism and early retirement records
identified WRMDS as a major cause of lost workdays.
The CWHT observed that a large number of research projects and studies evaluating
WRMSDs in the construction industry were carried out in other countries. They examined
exposure to WRMSD risk factors and assessed intervention strategies to reduce associated
risks (Bell and Burnett, 2009, Burton et al., 2005, Gatchel, 2004, Faucett et al., 2002, Linton
and van Tulder, 2001, Hagen et al., 2000, Westgaard and Winkel, 1997, Mathiassen and
Winkel, 1996, Yassi et al., 1995, Greenwood et al., 1990). The research rarely focused on
individual trades in the industry. Even within individual trades, research often focused on a
single aspect of their activity rather than each separate task that the trade worker carries out
over the course of their employment. This is particularly true for the individuals who carry
out finishing activities after structures are erected.
Finishing activities may be categorised into three areas, Flooring,
Drylining/Plasterboard, and Wet-Plastering. Plasterers in Ireland are generally trained in all
three finishing activities, flooring, drywall and plastering (Learning Innovation Unit et al.,
2008). In the flooring process, a wet-plaster/cement mixture is applied to a floor surface and
plasterers create a desired textured finish. In the drywall/plasterboard process, gypsum boards
are measured, cut to shape, and adhesive, nails, or screws used to fix then onto internal
surfaces. Joints between the boards are taped before using a trowel to apply wet-plaster to fill
in joint spaces, nail, and screw depressions. Sufficient quantities and coats of a plaster
mixture is applied to fill the joint space and to ensure a continuous smooth level surface
~7~
without the appearance of seams. This may require sanding of the joints once the plaster mix
has dried.
Wet-plastering is the process in which a trowel is used to apply one, two, or three
coats of a wet-plaster compound onto wall or ceiling surfaces to create a desired smooth or
textured finish. Surfaces can be internal or external and constructed from brick/block, timber,
plasterboard, or a supportive wire mesh.
The task requirements, materials used, work environments, and facilities in Irish
construction can differ significantly to those in other countries. Factors that may influence
these differences can include local weather conditions, building regulations, desired textured
finish, whether the work is being carried out on an internal or external surface, the skills of
the workforce, costs, and noise and fire retardant properties of the materials.
The high prevalence rate of WRMSDs in the construction industry and the lack of
research carried out in the Irish construction industry and specifically on plastering activities
prompted the Trust to fund this research. Their aim was to identify the work practices and
working conditions that increase the probability of plasterers working in Ireland developing
WRMSDs. In addition, they wanted to identify intervention strategies that could reduce the
level of WRMSD risk.
1.4 Significance of Research

Annually, when compared with other employment sectors, the Irish construction
industry reports high incidences of ill health, injury, and specifically WRMSDs (Health and
Safety Authority (HSA), 2012, Health and Safety Authority (HSA), 2011b, Brenner, 2006,
McDonald and Hrymak, 2002b, Centre to Protect Workers Rights (CPWR), 2002, Brenner
and Ahern, 2000). Construction workers and specifically plasterers are exposed to WRMSD
risk factors as an intrinsic part of their daily activities e.g. manual handling, repetitive
movements, and forceful exertions (Cowley and Leggett, 2009, Learning Innovation Unit et
al., 2008, van der Molen et al., 2007, WorkSafe Australia, 2007, Pinder et al., 2001, Reid et
al., 2001a, Wakula and Wimmel, 1999). Consequently, because of their exposure, plasterers
are one of the trades that report high prevalence rates of WRMSDs.
Research has been carried out to evaluate risk in the construction industry (Gangolells
et al., 2010, Gambatese et al., 2008, Dingsdag et al., 2008, Choudhry and Fang, 2008,
Jaselskis et al., 2008, Loosemore and Andonakis, 2007, Deacon et al., 2005, Arndt et al.,
2005, International Congress of Trade Unions (ICTU) and Education and Training Services
Trust Limited (ETST), 2000, Holmström et al., 1995). While many studies generally focus on
~8~
the industry as a whole other studies have evaluated risk to single trades in the industry or
have focused on specific activities carried out by the trade workers (Choi, 2010, Hess et al.,
2010a, van der Molen et al., 2010b, van der Molen et al., 2010a, Vedder and Carey, 2005,
van der Molen et al., 2004b, Vi et al., 2002, de Jong and Vink, 2000, Tariq and John, 2000).
To date, research focusing on finishing activities has primarily taken place in America and
focuses on drywall activities (Hess et al., 2010b, Smith et al., 2004, Lipscomb et al., 2003,
Pan et al., 2000b, Pan et al., 2000c, Chiou et al., 2000, Lipscomb et al., 2000a, Boschman et
al., 2011, van der Molen et al., 2007). No research has taken place that focuses on wet-
plastering activities.
To date, only one ergonomic study has been carried out that focuses on the Irish
construction industry and it evaluates WRMSD risk to blocklayers (Nugent and Fallon,
2009a, Nugent and Fallon, 2009b, Nugent and Fallon, 2008, Nugent et al., 2007). A review of
literature did not identify any studies that evaluate the wet-plastering task. This is the first
study that evaluates WRMSDs associated with the wet-plastering task, and it is the first study
of its kind to take place to evaluate WRMSD risk to plasters working in Ireland.
When assessors have an increased awareness of how WRMSD risk factors are
introduced and how they can contribute to plasterers becoming injured, they have an
increased capacity to prevent their introduction, eliminate them, or reduce associated risk if
they are introduced. A detailed literature review was carried out as part of this research to
ascertain how WRMSD risk factors that plasterers may be exposed to are introduced into the
construction phase of a project. In addition, primary, secondary, and tertiary intervention
strategies to reduce the effect WRMSDs have on workers, employers and the economy were
reviewed. This information was used as a foundation when establishing a detailed hierarchy
of recommendations for control interventions to reduce WRMSD risk exposure for plasterers
working in Ireland.
A research risk assessment protocol was developed and used as a guide to develop an
effective assessment methodology to evaluate WRMSD risk to plasterers working in Ireland.
The protocol was used as a guide to select assessment environments, and suitable assessment
methods to evaluate plasterer WRMSD risk associated with their tasks and working
conditions. Failure to select appropriate assessment environments, methods or a
representative sample population will reduce the meaningfulness of the data obtained in the
study. Similarly, failure to use the same procedure and methodology when assessing each
participant can introduce unwanted and unknown confounding factors that can influence and
invalidate the results.
~9~
An array of techniques were identified in the literature review.(Su et al., 2010, Trask
et al., 2010, Buxi et al., 2010, David et al., 2008, Bao et al., 2006, David, 2005, Konrad,
2005, Brown and Li, 2003, Janz, 2002, Du Toit et al., 2002, Huskisson, 1983, McAtamney
and Nigel Corlett, 1993). Suitable combinations of risk assessment methods can scientifically
demonstrate that a working condition exposes workers to WRMSD risk factors that increase
their probability of developing a disorder.
Statistical analysis of the data from the risk assessments highlight which aspects of
the wet-plastering task, sub-tasks and working conditions increase plasterers’ risk of
developing WRMSDs. This information guides assessors in identifying suitable control
intervention strategies and recommendations to reduce plasterers’ risk of developing
WRMSDs. A reduction in the presence of WRMSD risk factors during the construction phase
and a reduction in plasterers’ exposure to WRMSD risk factors reduce the probability of
plasterers developing the disorder. Plasterers will lead a more productive and pain free life,
and the probability of WRMSD related absenteeism and early retirement would be reduced. It
is proposed that a reduction in the incidence rate of WRMSDs reduce the financial burden
currently experienced by affected individuals, their employer, and the economy because of
high prevalence rates.
The assessment methods selected to evaluate WRMSD risk to plasterers in Ireland
were the Visual Analogue Discomfort Scales (VADS), Heart Rate Analysis (HRA), and
Electromyography (EMG) to evaluate plasterers’ psychophysical, physiological, and
biomechanical stresses when carrying out plastering activities. The assessments were carried
out on active construction sites using the VADS to evaluate plasterers’ carrying out their
normal daily activities. HRA and EMG were used to evaluate plasterers’ interactions in four
simulated working environments. The use of this combination and methods enabled a
detailed analysis to evaluate and compare WRMSD risks between different tasks and sub-
tasks and between different working conditions associated with the wet-plastering task.
1.5 Research Aim and Objectives

The primary aim of this research was to carry out an ergonomic risk assessment to
evaluate plasterer’s exposure to WRMSD hazards in the Irish construction industry. The
secondary aims of the research were as follows:
~ 10 ~
• To determine if plasterers were at increased risk of developing WRMSDs because of

their task, sub-tasks or working conditions
• To identify which aspects of plastering tasks and working conditions increase
plasterers risk of developing WRMSDs
• To generate a hierarchy of control interventions and recommendations to reduce
WRMSD risk to plasterers working in Ireland
The objectives of the study were as follows:
• To obtain knowledge and understanding of plastering tasks, specifically the wet-

plastering task.
• To obtain knowledge and understanding of the development of WRMSDs and identify
strategies to reduce the likelihood of their development
• To ascertain how WRMSD risk factors that plasterers may be exposed to are
introduced into the construction phase of a project.
• To create a research risk assessment protocol to be used as a guide in developing a
suitable risk assessment methodology to evaluate WRMSD risk to plasterers working
in Ireland.
• To identify and select appropriate assessment methods, assessment environments and
a representative sample population of plasterers to enable evaluation of plasterers
exposure to WRMSD risk factors
• To use the data obtained from the WRMSD risk assessment to identify a hierarchy of
suitable control intervention strategies and recommendations to reduce plasterers’ risk
of developing WRMSDs
1.6 Research Hypothesis

A hypothesis is a statement that is assumed to be true. The null hypothesis (H 0 ) refers
to a statement that will be tested and the alternative hypothesis (H 1 ) refers to a statement that
is considered true when the null hypothesis is rejected. A significance level is used as a
criteria to reject (or accept) H 0 e.g. 0.05 (5% level) or 0.01 (1% level) . In hypothesis testing,
the difference between resultant data and the H 0 data is determined and the probability of that
difference occurring is calculated. This probability value is compared to the significance
level. If the probability is less than or equal to the significance level then H 0 is rejected and
~ 11 ~
H 1 is considered to be true. The result is considered to be significantly significant i.e. unlikely

to have occurred by chance. In this study, the significance level used as a criteria to reject (or
accept) H 0 is 0.05 (5%).
The data obtained in this study was analysed to investigate if plasterers working in
Ireland are at risk of developing WRMSDs and highlight which aspects of the plastering task,
sub-tasks and working conditions increase the likelihood of plasterers developing WRMSDs.
Data gathered from the assessments was entered into databases and analysed using the
Statistical Package for the Social Sciences (SPSS) 17.0 for Windows. A descriptive analysis
(e.g. frequency, mean, maximum, and minimum values) of the data was carried out to
describe characteristics about individual populations. Comparative, inferential and correlation
analysis was carried out to determine if independent variables influenced dependent
variables.
The independent variables of interest investigated in this study are the plastering tasks
and working environments that are widespread on Irish construction sites. The dependent
variables of interest investigated in this study are the plasterers’ responses in a given
assessment condition. Their psychophysical, physiological, and biomechanical responses
were measured using assessment tools and techniques i.e. VADs, HRA, and EMG.
Independent variables:
• Plastering work surfaces - wall, ceiling, both wall & ceiling,
• Standing work surfaces - ground, hop-up, trestle, stilts, and combinations of these
surfaces
• Working with a low mortarboard and working with a high mortarboard
• Assessment Condition Environments
• All Plastering Sub-Tasks: Erecting framework and supporting structures, Hanging
drywall boards, Taping and filling, Preparing and mixing plaster, Applying skim
coat, and Applying finishing coat
• Wet-plaster Sub-Tasks: Mix Plaster, Load Mortarboard, Load Hawk, Load Trowel
and Plaster
Dependent variables:
• Perceived discomfort intensity - measured on a 100mm VADs scale, -0mm
represents no perceived discomfort, 100mm represents an extreme level of
perceived discomfort experienced
~ 12 ~
• Heart rate values

o Mean heart rate, Resting heart rate (HR rest ), Maximum heart rate (HR max ) -
measured in beats per minute (bpm)
o Percent of time spent in Heart Rate Zones - a range of heart rate activity
representing a proportion of maximum heart rate capacity – indicates a
measure of intensity for physical activity
o Relative Heart Rate (RHR) - a measure of the cardiovascular strain for an
activity and is calculated using HR rest values.
o Recommended rest periods – minutes of rest per hour of activity
• Muscle activity
o Electrical activity of a contracting muscle for a given assessment condition -
represented as a percentage of the peak electrical activity (measured in
microvolts) level recorded for that muscle over the course of an assessment.
0% indicates no muscle activity, 100% indicates that the muscle is active at
its peak level.
The hypotheses tested in this study were as follows:
Primary Research Hypothesis
• H 0 - Plasters working in Ireland are not at risk of developing WRMSDs

• H 1 - Plasters working in Ireland are at risk of developing WRMSDs
Assessment Method 1: Visual Analogue Discomfort Survey (VADS)
• H 0 – Independent variables have no influence on the level of perceived discomfort

intensity. If p > 0.05 then Null = true – No relationship in the population
• H 1 - Independent variables influences the level of perceived discomfort intensity. If p
< 0.05 then Null ≠ true – Relationship exists in the population
Assessment Method 2: Polar HR monitor - Heart Rate Analysis
• H 0 - Independent variables have no influence on heart rate variables (bpm, Percent of

time spent in Heart Rate Zones, RHR, and Recommended rest periods). If p > 0.05
then Null = true – No relationship in the population
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• H 1 - Independent variables influences heart rate variables ((bpm, Percent of time

spent in Heart Rate Zones, RHR, and Recommended rest periods). If p < 0.05 then
Null ≠ true – Relationship exists in the population
Assessment Method 3: Electromyography (EMG)
• H 0 - Independent variables have no influence no influence on muscle activity levels

(% peak activity). If p > 0.05 then Null = true – No relationship in the population
• H 1 - Independent variables influences muscle activity levels (% peak activity). If p <
0.05 then Null ≠ true – Relationship exists in the population
1.7 Expected Contribution to Knowledge

The ultimate test of any PhD is its originality and how it contributes to knowledge.
Eggleston and Klein (1997), based on publications by Francis (1976) and Phillips (1996, 1992,
1980) identify the following twelve ways in which research can be considered as being
original and how a contribution to knowledge can be achieved:
1. Setting down a major piece of new information in writing for the first time
2. Continuing a previously original piece of work
3. Carrying out original work designed by a senior colleague
4. Providing a single original technique, observation or result in an otherwise
unoriginal but competent piece of research
5. Having many original ideas, methods and interpretations all performed by
others under the direction of the writer
6. Showing originality in testing somebody else’s idea
7. Carrying out something in a country that has previously only been done in
other countries
8. Taking a particular known technique and applying it in a new area
9. Bringing new evidence to bear in an old issue
10. Being cross-disciplinary and using different methodologies
11. Looking at areas that people in the discipline haven’t looked at before
12. Adding to knowledge in a way that hasn’t previously been done before
~ 14 ~
This research contributes to knowledge by:
• Carrying out an ergonomic study to investigate WRMSD risk to plasterers who work
in Ireland – to date no research has been carried out that investigates WRMSD risk to
plasterers who work in Ireland. (Point 1, Point 7, Point 11, Point 12)
• Carrying out an ergonomic study to investigate WRMSD risk associated with wet-
plastering activities, a sub-task of the finishing tasks carried out by plasterers. To date
no research has been identified that specifically investigates WRMSD risk associated
with the wet-plastering task (Point 1, Point 11, Point 12)
• Developing a research risk assessment protocol to use as a guide in developing a
suitable methodology to evaluate WRMSD risk to plasterers. This protocol can
potentially be used as a foundation for researchers in future investigations to evaluate
construction workers exposure to WRMSD risk factors (Point 8)
• Using a unique combination of assessment methods to evaluate WRMSD risk. Many
researchers have used combinations of ergonomic assessment tools to investigate
WRMSD risk in different work environments. However, this is the first study
identified that uses a combination of VADS, HRA and EMG to investigate WRMSD
risk in both an active working environment and in simulated working environments
(Point 10)
• Provide recommendations to reduce the probability of WRMSD development to
plasterers (Point 12)
1.8 Structure of Dissertation

This thesis is comprised of eight chapters. Chapter 1, the introductory chapter, draws
attention to the rationale for initiating a suitable ergonomic evaluation of plasterer’s exposure
to WRMSD hazards. The extent of WRMSD prevalence in the construction industry is
discussed indicating how severe the issue is in terms of its impact to plasterers, construction
companies, and on the economy. Additionally the research aims and objectives, expected
contribution to knowledge and the thesis structure are described.
Chapter 2 and Chapter 3 present the literature review section for this thesis. In
Chapter 2, MSDs and WRMSDs are defined. The risk factors that contribute to their
development are described in order to demonstrate the complex aetiology of the disorders. An
~ 15 ~
outline of intervention strategies that assist in reducing the incident rate of WRMSDs and
limit how they affect workers and their families, employers and the economy are presented.
Finally, a selection of methodologies that are used to evaluate workers exposure to WRMSD
risk factors are described.
In Chapter 3, the findings from a literature review are presented in an attempt to
establish how and why WRMSD risk factors are introduced in to the construction workplace.
The construction industry, the stakeholders involved in construction projects, the construction
project lifecycle, and decision-making influences are described to demonstrate how their
complex interaction can introduce WRMSD risk factors into the construction phase of a
project. The final section of the chapter outlines the systems of work, working conditions,
policies, and procedures that exist in the Irish construction industry.
Chapter 4 and Chapter 5 present the methodology section for this thesis. In Chapter 4,
a WRMSD Research Risk Assessment Protocol is presented to outline recommended
procedural phases to direct researchers when developing a WRMSD risk assessment
methodology.
In Chapter 5, the risk assessment methodology developed using the WRMSD
Research Risk Assessment Protocol is presented. In this chapter, the process used to gather
and analyse the psychophysical, physiological, and biomechanical stresses experienced by
participating plasterers when carrying out their tasks is described.
In Chapter 6, the results from the psychophysical, physiological, and biomechanical
assessments to evaluate the stresses experienced by plasterers when carrying out their tasks is
presented. The results of the Visual Analogue Discomfort Survey (VADS) are addressed
followed by the Heart Rate analysis (HRA) and lastly Electromyography (EMG) analysis.
In Chapter 7, the results and findings from the previous chapters are discussed and
conclusions are draw in terms of the stresses imposed on plasterers. This chapter also
provides recommendations for control interventions to reduce plasterers’ risk of developing
WRMSDs.
In Chapter 8, the final chapter, a summary of this research is presented in terms of the
challenges encountered in the course of this research, achieving aims and objectives, and
contribution of knowledge. Additionally recommendations for future research are presented.
The structure of the thesis chapters is illustrated in Figure 3 below.
~ 16 ~
Chapter 1
Introduction & Rationale for
the Study
Chapter 2
Chapter 3
WRMSDs Definition
Construction Project Lifecycle Literature
WRMSD Risk Factors
Stakeholders Review
Intervention Strategies
Decision Making Outcomes
WRMSD Risk Assessment
Practices in Irish Construction
Methods
Chapter 4 Chapter 5
Research
WRMSD Risk WRMSD Risk Assessment Methodology
Assessment Protocol Methodology
Evaluating
Chapter 6 WRMSD
WRMSD Risk Assessment Results Risk
Chapter 7 Recommendations
Discussion of Results to Reduce
WRMSD
Hierarchy of Recommendations to Reduce Plasterers Risk Risk
of Developing WRMSDs
Chapter 8
Research Conclusion
Contribution to Knowledge
Future research
Figure 3: Structure of Thesis
~ 17 ~
Chapter 2: Work Related Musculoskeletal Disorders
Chapter 2. Work Related Musculoskeletal

Disorders
2.1 Introduction
In this chapter, WRMSDs are defined and the risk factors that contribute to
their development are described. A synopsis of intervention strategies that can assist
in reducing the incident rate of WRMSDs and limit how they affect workers and
their families, employers and the economy are presented in this chapter. Finally, a
selection of methodologies that are used to evaluate workers exposure to WRMSD
risk factors are described.
2.2 Musculoskeletal Disorders (MSD)

Musculoskeletal disorder (MSD) is an umbrella term applied to a broad range
of disorders and injuries (e.g. sprain, strain) of the musculoskeletal system (Boocock
et al., 2009). They occur when the demands of an activity exceeds the capacity or
limitations of the musculoskeletal components (Watkins, 2009, Solomonow, 2009,
Ng, 2002, Buckle and Devereux, 2002). Symptoms of MSDs include numbness,
tingling, aches and pain, localised inflammation, weakness, and/or difficulty in
moving joints, which can significantly reduce the ability to do work or carry out
daily activities (Bosch et al., 2011, Christensen and Knardahl, 2010, Darragh et al.,
2009, Bongers et al., 2006b, Lin et al., 2005, Buckle and Devereux, 2002, Bongers et
al., 2002). MSDs can occur suddenly due to a single incident (e.g. handling a heavy
load or due to a sudden movement (slip/trip/fall)). Alternatively, they develop
gradually over long periods, and are frequently referred to as Cumulative Trauma
Disorders (CTD) or Repetitive Strain Injury (RSI) e.g. tendonitis, bursitis and carpal
tunnel syndrome. As the disorder progresses, individuals experience symptoms on a
more frequent basis, symptom severity increases in intensity, and symptoms are
experienced for longer durations. In the most severe cases, symptoms are
experienced constantly and the individual becomes permanently disabled (Boocock
et al., 2009, Bongers et al., 2006b, Buckle and Devereux, 2002).
The brain interprets situations where physiological limitations have been
exceeded, perceiving varying intensities of sensations that correspond with the
magnitude in which limits have been exceeded. These sensations are signals that
~ 19 ~
internal homeostasis is disrupted and recovery steps are required. Physical sensations
include mild to severe aches, pains and discomfort and perceived sensations of
fatigue and tiredness (Öztürk and Esin, 2011, da Costa and Vieira, 2010, Daraiseh et
al., 2010, Boocock et al., 2009, Buckle and Devereux, 2002, Welch et al., 1999,
Edwardson, 1995, Magni et al., 1990).
2.3 Musculoskeletal Disorder Terminology

An MSD affecting a specific body area with a specific set of symptoms that
has developed because of exposure to specific risk factor(s) is frequently referred to
by different terms/names. Medical professionals may refer to the disorder using a
medical/diagnostic term e.g. tendonitis. Researchers may refer to it by using
epidemiological terms, and nonprofessional terms according to symptoms
experienced, contributing risk factors, or the musculoskeletal component/body
area/joint affected e.g. MSD of the wrist/hand. Lay people often use terms associated
with the activity that potentially contributed to the development of the disorder e.g.
‘trigger finger’ or ‘tennis elbow’. The following is a list of terms that are frequently
used interchangeably with the term MSDs (Boocock et al., 2009):
• Repetitive strain injuries

• Cumulative trauma disorders
• Overuse syndrome
• Regional musculoskeletal disorders
2.4 Musculoskeletal Disorder Development

MSD development has a multi-factorial and complex aetiology. While
exposure to a single risk factor can increase an individual’s likelihood of developing
MSDs, the magnitude of risk increases when a person is exposed to multiple risk
factors. They can develop because of 1) an individual’s susceptibility to develop a
disorder, 2) an individual’s exposure to normal daily circumstances, or 3) they
develop or are exacerbated because of exposure to work circumstances.
Where work is attributed to the causation and/or development of MSDs,
workers are exposed MSD risk factors in their workplace (unsafe acts or unsafe
conditions). The term Work Related Musculoskeletal Disorder (WRMSD) is utilised
~ 20 ~
for disorders that are caused by or are exacerbated because of work (Bongers et al.,
2006a, Bongers et al., 2002, Linton, 2001, Hoogendoorn et al., 2000, Linton, 2000,
Hoogendoorn et al., 1999). However, it is important to note that not everyone
exposed to WRMSD risk factors will develop a disorder. Even those who are
affected may experience a different range and set of symptoms in different parts of
the body for different durations and in different intensities. This indicates that
personal factors influence the probability of the disorders development and
influences workers susceptibility in developing a disorder.
WRMSDs can affect an individual’s ability to perform normal day-to-day
activities and their ability to do work. Severe or prolonged WRMSD symptoms can
result in individuals experiencing depression and decreased levels of motivation,
interest, or ability to partake in activities, which can affect their work, family, and
social lives. Affected individuals may be required to take time off work to enable
recovery. In extreme cases, the severity of symptoms and a reduced capacity to carry
out their work activities, results in workers taking early retirement (Reuben, 2008,
Côté et al., 2008, Brenner and Ahern, 2000).
The term WRMSDs is used in this document as an umbrella term to
represent disorders of the musculoskeletal system that are caused or aggravated by
work. Figure 4 was developed to provide a visual representation of WRMSD
symptom progression.
~ 21 ~
Intensity of WRMSD symptoms
Prolonged
and
frequent
exposure
to
WRMSD
risk factors
Symptoms can be episodic, be of greater

No symptoms are experienced: Due to intensity, last for longer periods, and can require
individual factors &/or proactive time off work to recover. Individuals can have a
prevention strategies implemented complete recovery if appropriate intervention
strategies are implemented
Mild symptoms after period of activity
(overloading)- disappear after period of Symptoms are permanent and severe affecting
rest - may never return, Usually no time ones quality of social and daily activities. May
off work: Treatment prevents involve early retirement from work. Unlikely to
reoccurrence have a full recovery
Figure 4: Possible WRMSD symptom progression when exposed to WRMSD risk

factors
2.5 WRMSD Risk Factors

All persons are at risk of developing MSDs at some stage throughout their
life. This section describes the factors that are associated with their development and
outlines how work contributes to their development.
2.6 Individual MSD Risk Factors

Nature and nurture influences the wellbeing and functionality of an individual
(Cagampang et al., 2011, O'Connell and Hofmann, 2011, Kumanyika, 2008, Fausto-
Sterling, 2008, Williams, 2006, Institute of Medicine of the National Academies,
2006, Plomin and Asbury, 2005, Godfrey et al., 2001). The human body’s tissues and
organs develop, mature, and decline at different rates throughout the lifecycle of the
body i.e. childhood, adolescence, young adulthood, adulthood and old age (Melchor,
2008, Tortora, 2008). Nature (genetics) will pre-dispose individuals, and their
component parts (cells, tissues, and organs) to achieve a potential maximum
capacity. For example, the maximum potential the life expectancy for individual cells
in the human body may be determined by biological programming (DNA). Each cell
has a ‘pre-programmed’ number of potential cellular divisions (generations of
~ 22 ~
reproduction) and therefore a potential life span. Upon achieving its peak potential
the ability to effectively function and reproduce declines.
Nurture affects the human body on a cellular level and influences the
wellbeing (health/ill–health) of an individual throughout their lifetime (Fernández et
al., 2008, Williams, 2006, Guo, 2005, Plomin and Asbury, 2005, Perry, 2002,
Portwood, 2002). For example, mineral deposits and tissue composition influence the
strength and density of bone. Generally, these levels peak at age 35 after which the
levels start to decline between age 39 and 70, influencing their susceptibility to
injury. The magnitude of that peak level can be influenced by diet and exercise. The
rate of decline is slower in individuals who have higher peak levels and who
participate in a healthy lifestyle of diet and exercise. In addition, a genetic
predisposition to diseases such as osteoporosis will influence the rate of mineral
deposition, storage capacity, and the rate of decline. Affected individuals have a
greater risk of stature shrinkage and bone fractures, (Collins and O'Sullivan, 2010,
Fausto-Sterling, 2008, Walker-Bone et al., 2004).
Workers genetics, gender, age, history of previous injury or illness, previous
and current lifestyle, exercise regime, diet, alcohol consumption, use of drugs,
cigarettes and stimulants, and exposures to chemicals, viruses or bacteria will
influence their susceptibility of developing WRMSDs (Yamamoto et al., 2010,
Kausto et al., 2010, Johnston et al., 2009, Karsh, 2006, Feuerstein et al., 2004,
Punnett and Wegman, 2004, Achten and Jeukendrup, 2003, Tanaka et al., 2001,
Hoogendoorn et al., 2000, Hoogendoorn et al., 1999). Obesity, for example is a
condition associated with an unhealthy diet and poor exercise participation. Being
obese contributes to the development of type 2 diabetes and cardiovascular disease.
The excess of body weight can influence a person’s centre of gravity, affect their
‘normal’ gait, increase stress on joints and is associated with the development of
MSDs (Kopelman et al., 2009, Schulte et al., 2007).
2.6.1 The Musculoskeletal System

The human body is comprised of a number of specialised systems that
interactively function to maintain life, repair damaged components, and enable
movement.
The primary function of the musculoskeletal system is to enable movement of
the body. It is comprised of muscles, bones, tendons, ligaments, nerves, blood
~ 23 ~
vessels, and supporting structures. Each component has a unique structure and
composition that will determine its function, and ability to generate/resist forces.
In Figure 5, a graphical representation of the complex organisation of
muscles tendons and bone is presented (Williams et al., 1989). Muscles are complex
layers of bunched fibrous cells that contain microscopic contracting elements,
myofibrils. Muscles are connected to bones by tendons and when they contract, they
‘pull’ the tendons resulting in movement of the bone.
Figure Removed for copyright purposes
Figure 5: Structure of Skeletal Muscle Components

(Williams et al., 1989)
Skeletal muscle is activated after receiving input from the brain via nerve
fibres. At rest the Action Potential (electrical charge) in a muscle is between –70mV
and –90mV. On activation, a cascade of electrical and chemical changes increases
the charge to +40mV and causes the myofibrils (actin and myosin) to ‘slide’ over
each other. The charge returns to its original state after a period of recovery (Green,
1976). Multiples of myofibrils are activated to enable specific movements. The
number of myofibrils activated is proportional to energy demand and force
requirements of a muscle.
~ 24 ~
2.6.2 Biomechanical Stress/Strain– Musculoskeletal System

Biomechanics is a discipline that applies the principles of physics to human
movement to study forces exerted on the human body and the musculoskeletal
system.
Musculoskeletal components are arranged to form joints, and muscles pull or
stabilise bones (levers) about a joint (fulcrum). The organisation and arrangement of
a joint’s components influences its ability to move limbs in one, two, or three
dimension. Additionally, the structure of joints determines the joints biomechanical
properties i.e. ability to generate and resist forces (compression, torsion, shear). All
types of muscle actions result in a production of force (kg/m/s2) or torque (rotation
about a joint). The net force imposed on a joint is the sum of forces exerted on the
joint. These include the joints reaction forces, gravity, body section weight (e.g. arm
when lifting) and the weight of a load (mass, kg) being handled. Addition factors that
can influence the magnitude and directional impact of force (Salvendy, 2012,
Whiting and Zernicke, 2008, DeLisa et al., 2005). For example:
• Distance - e.g. how far a load that is being handled is away from a joint (m)
• Displacement - e.g. the difference between the start point distance and the
end point distance (m)
• Velocity – e.g. the time it takes to move from start to end points (m/s)
• Acceleration – the rate at which velocity changes with respect to time (m/s)
The magnitude of force exerted on a joint can be attributed to a single ‘peak’

loading event. Alternatively, it can be cumulative in nature i.e. in situations where
tasks are carried out on a frequent basis, for long durations or when tasks involve
repetitive movements. Symptoms of fatigue e.g. reduced capacity to generate and/or
sustain force output are experienced in response to increased dose exposure (force
demand). For example, force output declines as a joint deviates from neutral posture
and extends to its outer range of movement i.e. extending to maximum
flexion/extension, adduction/ abduction, or rotation. Postures that reduce force
abilities include bending, twisting, kneeling, squatting, stooping, over-reaching, and
overhead work (Hess et al., 2010a, Reid et al., 2010, Balasubramanian et al., 2009,
Splittstoesser et al., 2007, van der Molen et al., 2007, Garg et al., 2006, Gallagher,
2005, Ariëns et al., 2001, Keyserling, 2000, Pan et al., 2000c, Hermans et al., 1999,
~ 25 ~
Mital et al., 1994, Snook and Ciriello, 1991, Gallagher and Unger, 1990, Ayoub and
Mital, 1989, Keyserling et al., 1988, Garg et al., 1978).
The type of activity being carried out, task demands, rate of work,
characteristics of a load, and work method influences the forces exerted on different
joints and muscles. Each task scenario utilises different muscle groups with varying
degrees of efficiency and exertion levels. For example pushing a load has lower force
requirements than pulling the same load i.e. greater efficiency and lower exertion
requirements (Marras et al., 2009, Smith et al., 2009, Schibye et al., 2001, Bonney et
al., 1999, Kumar, 1995, Ayoub and Mital, 1989). The magnitude of force exerted on
the musculoskeletal system increases in response to
• Increased weight and size of the load (Hess et al., 2010a, Tucker et al., 2009,
Marras et al., 2009, van der Molen et al., 2007, van der Molen et al., 2004b,
Naqvi et al., 2004, Hoogendoorn et al., 1999)
• When the load is handled away from the body’s centre of gravity (Brookham
et al., 2010, Tyler and Karst, 2004, Habes et al., 1985)
• Working below the knees (Splittstoesser et al., 2007, van der Molen et al.,
2004b, Gallagher and Unger, 1990, Gallagher et al., 1988)
• Working at or above shoulder height (Brookham et al., 2010, Ebaugh and
Spinelli, 2010, Ebaugh et al., 2006, van der Molen et al., 2004b)
2.6.3 Physiological Support to the Musculoskeletal System

Energy for muscle activity is generated in a series of metabolic processes in
which oxygen is utilised to transform nutrients from the digestive system and body
tissues (carbohydrate, protein, fat). The energy generated in these metabolic
processes is stored in transfer molecules called Adenosine Triphosphate (ATP) and
then released to active muscles when ATP is hydrolysed to Adenosine Diphosphate
(ADP) (Blond et al., 2011, Kenney et al., 2011, McArdle et al., 2009, Bender, 2002).
Over the course of a physical activity, the volume of nutrients and the volume
of available oxygen become depleted. This results in a change in the metabolic
processes to generate energy and convert ATP-to-ADP. The process becomes less
efficient and generates lower quantities of energy and increases the production of by-
products such as lactic acid and carbon dioxide (CO 2 ) (McArdle et al., 2009, Birch et
~ 26 ~
al., 2005, Spence and Mason, 1992, Åstrand and Rodahl, 1986). A diagrammatic
representation of the metabolic processes of converting nutrients into energy for
active muscles is presented in Figure 6. The image is adapted from (Tortora et al.,
2010, Pocock and Richards, 2004, Bender, 2002).
Figure 6: Outline of the Metabolic Processes Converting Nutrients to Energy

(Stored in ATP Molecules)
(Adapted from Tortora et al., 2010, Pocock and Richards, 2004, Bender 2002)
Oxygen is necessary to maintain body functions, enable growth and repair,

and to enable movement. The demand for oxygen increases during physical activity.
The body’s systems adapt to changes in homeostatic balance (normal healthy
equilibrium range) by initiating action/reaction responses. The cardiovascular system
adapts and fluctuates to meet the changing oxygen and energy demands. Over the
duration of an activity, the intensity level of the activity influences the magnitude
and rate of adaptations. The efficiency to adequately meet oxygen demand and
remove metabolised by-products declines with respect to duration and intensity of
physical activity. Prolonged activity increases the disturbance of the homeostatic
balance in active muscles and in the blood.
The disrupted homeostasis affects nerve conduction and electrochemical
stimulation for muscle contractions. This disruption affects the efficiency of muscles
~ 27 ~
to maintain productivity and induces localised physical fatigue i.e. muscles have a
reduced ability to generate and resist forces (Arabadzhiev et al., 2010). The
individual’s age, level of physical fitness, use of tobacco and caffeinated substances,
the quantity of stored and digested nutrients, their body weight, and environmental
conditions limit the efficiency of the cardiovascular system in prolonged activity.
Further disturbances can occur when individuals have less efficient cardiovascular
systems (due to genetics or illness) to deliver oxygen and nutrients and remove
accumulated by-products (McArdle et al., 2009, Ekelund et al., 2007, Birch et al.,
2005, Westerterp, 2004, Speakman and Selman, 2003, Westerterp-Plantenga, 2003,
Bullough et al., 1995, Pannemans and Westerterp, 1995, Vaughan et al., 1991,
Astrup et al., 1990, Perkins et al., 1989, Åstrand and Rodahl, 1986).
Psychological sensations of fatigue generally precede physiological
sensations of fatigue to stimulate the cessation of an activity and thereby reduce the
probability of physical injury (Coutts et al., 2009, McArdle et al., 2009, Cameron,
1996, Armstrong et al., 1993, Åstrand and Rodahl, 1986).
Localised muscle fatigue indicates physiological and biomechanical stress
and can be a symptom of injury to musculoskeletal components.
2.6.4 Physiological Stress/Strain-Cardiovascular System

Energy Expenditure (EE) is a measure of the amount of energy utilised by a
person to maintain body functions, enable growth and repair, and to enable
movement. The Basal Metabolic Rate (BMR) is the minimum energy requirement
for a body at rest in a comfortable environment. Additional energy is required for
physical activity and the greater the intensity of an activity the greater the demand
for energy (Kenney et al., 2011, McArdle et al., 2009, Wilmore et al., 2008, Bhise,
2008).
Oxygen Consumption (VO 2 ) is a measure of the volume of oxygen
consumed for an activity in a given time. The level of oxygen consumed increases
with duration and intensity of an activity when it peaks and plateaus at its maximum
level. VO 2max is the maximum potential volume of oxygen that a person can
consume. It is a measure of cardiovascular fitness (millimetres per kilogram of
bodyweight per minute (ml/kg/min)) and an indicator of the efficiency in ATP
generation in metabolic processes. The greater the VO 2max the more efficient the
metabolic processes (Wilmore et al., 2008, Plowman and Smith, 2007, Birch et al.,
~ 28 ~
2005, McArdle et al., 2000, Brooks et al., 1996, Åstrand and Rodahl, 1986).
Cardiovascular fitness (VO 2max ) and the ability to utilise oxygen (VO 2 ) can improve
through exercise programs (McArdle et al., 2009, Birch et al., 2005, Åstrand and
Rodahl, 1986). Measuring cardiovascular fitness can involve the use of a treadmill or
cycle ergometer in controlled laboratory settings or using step tests such as the
Harvard step test is used as a sub-maximal test procedure (Bonney and Ireland, 2004,
Bridger, 2008, Neumann et al., 1999).
Heart Rate, measured in beats per minute (bpm), is a sensitive indicator of
the activity level of the cardiovascular system and is a measure of the physiological
response to activity i.e. increases with physical workload to meet oxygen demand in
active muscles.
Resting heart rate (HR rest ) is a baseline measurement of the cardiovascular
system. The average HR rest in adults is 60-90bpm with highly conditioned endurance
athletes recording values as low as 28-40bpm and poorly trained individuals
recording values greater than 100bpm (McArdle et al., 2009, Heyward, 2006,
Dunford et al., 2006, Spence and Mason, 1992).
Maximum heart rate (HR max ) is the maximum potential heart rate achievable
and is dependent on age and physical fitness. One such formula frequently used to
estimate HR max is [220 – age]. Other formulas include [217 − (0.85 × age) ] and
[205.8 − (0.685 × age)] (Benson and Connolly, 2011, Tanaka et al., 2001, Fairbarn et
al., 1994).
HR rest and HR max values are unique to the individual and depend on factors
such as age, gender, physical fitness, psychological factors (e.g. stress or anxiety),
caffeine consumption, and diet. It is also influenced by environmental conditions
such as extremes of temperature and altitude. (Achten and Jeukendrup, 2003, Strath
et al., 2000, Maas et al., 1989)
Heart rate zones are frequently used in exercise programs to promote
cardiovascular health (Benson and Connolly, 2011, Hottenrott, 2007, Janz, 2002,
Burke and Burke, 1998). A zone is a range of heart rate activity represented as a
proportion of an individual’s maximum heart rate capacity (HR max (100%) ). Frequently,
five zone ranges are calculated using 50% HR max , 60% HR max, 70% HR max , 80%
HR max , 85% HR max and 90% HR max. Working within a zone range indicates that an
individual is partaking in a physical activity of a particular intensity level.
~ 29 ~
The cardiovascular system and musculoskeletal system gain benefits when

carrying out physical activities for different durations within each zone. However, as
the heart rate elevates, continuing a physical activity in higher zones increases the
demand for energy, nutrients, and oxygen. In addition, greater volumes of by-
products are generated, and sensations of fatigue are experienced with shorter
periods of activity. Prolonged physical activity in higher zones creates greater
disturbances in homeostasis and increases the risk of potential damage to the
cardiovascular system and musculoskeletal system. The capacity to enable longer
periods of physical activity in higher zones increases when individuals partake in a
regular program of exercise (McArdle et al., 2009, Wilmore et al., 2008, McArdle et
al., 2006, Åstrand and Rodahl, 1986).
Heart rate zone activity data can be used to determine what intensity level of
physical activity a person is partaking in and the time spent working at each intensity
level. An example of five heart rate zones calculated as a percentage of HR max and
indicates a recommended duration for maintaining an activity for each intensity
level/zone are displayed in Table 1 (Polar Electro Oy, 2001).
Table 1: Heart Rate Zones –Intensity of Activity & Recommended Duration

(Polar Electro Oy, 2001)
Intensity Physiological & Psychological Recommended
% HR max
Level Sensations duration
Zone Very easy
50% - 60% Very light 20–40 minutes
1 Little strain
Zone Comfortable & easy
60% - 70% Light 40–80 minutes
2 Low muscle /cardiovascular load
Zone
70% - 80% Moderate Steady controlled fast breathing. 10–40 minutes
3
Zone Causes muscular fatigue and heavy
80% - 90% Hard 2–10 minutes
4 breathing
Zone Very exhausting for breathing and less than 5
90% - 100% Maximum
5 muscles minutes
Relative Heart Rate (RHR) is a measure of cardiovascular strain a person

experiences when partaking in a physical activity and indicates a magnitude of
intensity for the physical activity. Calculated using HR rest values (Equation 1), RHR
enables comparison of cardiovascular strain levels between subjects and between
task conditions (Toupin et al., 2007, Tiwari and Gite, 2006, Kirk and Sullman, 2001,
~ 30 ~
Christensen et al., 2000, Pollock et al., 1998, Shimaoka et al., 1997, Kirk and Parker,
1996).
Equation 1: Relative Heart

Rate – A Measure of
Workload
HRtask is measured during a task activity

HRrest is measured at start of bay before assessments commence
HRmax is calculated from Polar Fitness Test
It is important to note that each person has a unique set of physiological

limitations that can inhibit their individual ability to maintain a physical activity at an
intensity level for a period of time. Researchers have attempted to ascertain a safe
physiological limit suitable for a broader spectrum of workers when partaking in
physical activities. In addition, some have used physiological data in an attempt to
classify the intensity level of physical activity.
• An Average of 110 bpm over 8-hr work shift should not be exceeded (Ayoub
and Mital, 1989, Legg and Pateman, 1985, Brouha, 1967)
• Working at a rate less than 5 kcal/min is considered safe for an 8hour shift
but greater than this requires the worker to take rest breaks to enable recovery
(Wickens et al., 2004, Oglesby et al., 1989, Astrand and Rodahl, 1986)
• Abdelhamid and Everett (2002)measured physiological data for 100
construction workers performing typical construction work and determined
that the average heart rate for the measured construction activities was 108
bpm (±17 bpm).
• Åstrand and Rodahl (1986) recommend between 90-130 bpm as the upper
limit for continuous work. An outline of Åstrand, and Rodahl’s (1986)
classification of physical activity/work intensity data is displayed in Table 2.
• Kilbom (1995) stated that a heart rate of up to 90bpm indicates light
cardiovascular strain, 90-100 bpm as moderate strain, 110-130bpm as heavy
and 150-170bpm as extremely heavy strain for continuous work (similar to
Åstrand, and Rodahl’s classification data (Table 2)
~ 31 ~
Table 2: Classifying work intensities: Adapted from Åstrand and Rodahl (1986)
Mean VO2 Peak VO2 Mean HR Peak HR

Work Intensity
(L/min) (L/min) (bpm) (bpm)
Very Light Work NA Up to 0.5 NA Up to 75
Light Work Up to 0.5 0.5-1.0 Up to 90 75-100
Moderate Work 0.5-1.0 1.0-1.5 90-110 100-125
Heavy Work 1.0-1.5 1.5-2.0 110-130 125-150
Very Heavy Work 1.5-2.0 2.0-2.5 130-150 150-175
Extremely Heavy Work Over 2.0 Over 2.5 150-170 Over 175
2.6.5 Psychological Response to Physical Activity

The human body systems interact in a constant feedback loop via the Central
Nervous System (CNS) in which sensations from the peripheral nerves around the
body are interpreted by the brain to generate an appropriate response. Sensations are
perceived from the five body senses, sight, smell, touch hearing, and taste. Generally,
the sense of interest when partaking in physical activities is the ‘touch’ sensations
received from the musculoskeletal and skin tissues.
When homeostasis is disrupted due to prolonged physical activity, the brain
interprets physiological stimuli from the musculoskeletal and skin tissues as a
psychological sensation of stress e.g. fatigue aches, pain, discomfort, weakness, or
tiredness. Localised aches, pains, and discomfort in muscles and joints may be
attributed to micro tears in muscle fibres due to overuse, over-extension or repetitive
movements (Coburn and Malek, 2011, France, 2010, Walker, 2007b, Voight et al.,
2006, Rybski, 2004). The magnitude of the sensation indicates the degree of
homeostatic disruption or severity of injury and acts as an incitement for individuals
to take a break from activities to enable recovery.
Psychophysics is a discipline that examines relationships between the
psychological perceptions of sensations experienced upon interacting with physical
stimuli (Gescheider, 1985). Researchers have observed a correlation between
perceived psychophysical sensations and physiological changes in heart rate values,
oxygen intake, and respiration frequency (Coutts et al., 2009, Tiwari et al., 2005,
Kumar et al., 2000, Strath et al., 2000, Kumar and Lechelt, 1999, Grant et al., 1999,
Robertson et al., 1990).
~ 32 ~
Psychological Sensations are perceived as sensations such as pain,

discomfort, comfort, happiness, sadness etc. The magnitude of a sensation is unique
to an individual. According to Borg (1990) “sensory organs and conscious
perceptions reveal important disturbances in the environment”. However, individuals
indicate varying thresholds in how they experience or perceive sensations and in the
magnitude of the sensation. In some cases, individuals are said to have a high or low
threshold to sensations e.g. pain. Some will avoid a situation in which they may
experience an unwanted sensation and others will search for situations where they
will experience the sensations. However correlations do exist between perceived
sensations and physiological response such as heart rate data (Coutts et al., 2009,
Borg and Borg, 2002, Borg, 1990, Borg, 1978) and between perceived sensations and
biomechanical activity such as muscle activity measured using EMG (Troiano et al.,
2008, Hummel et al., 2005, Gearhart Jr et al., 2002, Wang et al., 2000).
2.6.6 Associations between Sensations and WRMSD Development

A longitudinal study carried out by Hamberg-Van Reenen et al., (2008)
evaluated if peak and cumulative discomfort could predict future musculoskeletal
pain. The researchers used a localised musculoskeletal discomfort (LMD) scale
based on Borg’ category ratio (CR 10) scale (Borg, 1990) to record localised
musculoskeletal discomfort in 13 body areas focusing on the low-back, the neck, and
the right and left shoulders. The 1789 participants recorded their perceived level of
discomfort six times over a single working day and this information was used as a
baseline reference value. An adapted version of the Nordic Musculoskeletal
Questionnaire was distributed three times in a three year follow-up period to the
participants. They were asked to indicate their symptoms of pain in the previous 12-
month period. The results indicate that peak discomfort was a predictor of future low
back, neck and shoulder pain and cumulative discomfort was a predictor for future
neck and shoulder pain.
2.7 Work Related MSD Risk Factors

Physical risk factors (activities or conditions) that increase the probability of
developing MSDs can occur when partaking in normal daily activities e.g. gardening
or household chores. Physical risk factors can also be present in the workplace and
may be referred to as Work Related Musculoskeletal Disorder (WRMSD) risk
factors. Examples of WRMSD risk factors include manual handling, handling heavy
~ 33 ~
or large loads, prolonged physical activity, high intensity activities, infrequent or

insufficient rest-periods, rapid work-pace, extreme or awkward postures (bending,
twisting, stooping), static postures, repetitive movements, forceful movements,
localized or whole-body vibration, and cold working environment (Hancock, 2012,
Salvendy, 2012, Boocock et al., 2009, Larsson et al., 2007, Bongers et al., 2006a,
Karsh, 2006, Punnett and Wegman, 2004, Aptel et al., 2002, Buckle and Devereux,
2002, Devereux et al., 2002, van der Windt et al., 2000, Hoogendoorn et al., 1999,
Marras and Granata, 1997, Cook et al., 1996, Hagberg, 1981).
The design and layout of a workplace influences the postures of the worker.
Inadequate site layout can result in workers having to handle heavy loads due to a
lack of accessibility for mechanical aids. Obstacles and restricted workspace forces
workers into sustaining awkward or extreme postures. Most construction work takes
place outdoors, exposing workers to the elements and extremes of temperature that
can affect musculoskeletal system efficiency.
The demands of a task influences the body’s movements and the stresses
imposed on the body e.g. manual handling, task intensities, frequency of movements,
force requirements, postures sustained (awkward, extreme or static), use of tools or
equipment (e.g. postures, vibration generating).
Psychosocial risk factors are attributed to an individual’s perception of their
environment and their coping ability to deal with a given situation e.g. the demands
of a task and the workers ability to control or have input into their work (Buckle and
Devereux, 2002). Examples of psychosocial factors include monotonous or repetitive
work, too high/low a workload, lack of support from superiors or colleagues, low
decision input, time pressure and job satisfaction (Bongers et al., 2006a, Buckle and
Devereux, 2002). Psychosocial stress can result in changes of postures and physical
behaviour that increases the biomechanical stress on the musculoskeletal system and
increases the probability of MSD development (Collins and O'Sullivan, 2010, Lee et
al., 2008, Bongers et al., 2002).
Based on the literature review presented in this chapter, Figure 7 was
developed to provide a diagrammatic representation of the factors that potentially
increase the likelihood of workers developing WRMSDs.
~ 34 ~
FACTORS THAT CAN INFLUENCE DECISION

DECISION MAKERS INPUT
MAKING PROCESS
• Finance allocation
• Finances available & desired profit
• Scheduling requirements
margin
• Numbers of employees
• Environmental, Building, and
• Competency level of employees
Occupational Health & Safety
• Materials tools & Equipment selection
legislation, standards & codes of
process
practice
• Tool & equipment designs available
• Desires and requirements for finished
• Properties of materials available
structure e.g. function of use, location,
adjacent structures
• Environmental conditions e.g. Weather
DECISION MAKERS OUTPUT
conditions
• Work organisation policies
• Insurance Requirements
• Working schedules:
• Level of control/input into the decision
• Hours worked per day/week & Overtime
making process
policy
• Stage of project life-cycle at which
• Payment methods i.e. Price work/paid per
individual has input into decision making
hour
process
• Reward and/or penalty schemes
• Individual biases - Influenced by
• Work-Rest schedule
• Personal training/education/
• Recruitment policy i.e. number employed &
knowledge/information Re:
degree of competency
• Personal skills, and experience
• Training program policy i.e. Competency,
• Work related risk factors i.e.
skills, experience
Hazards
• Safety Culture Re: Safety & Risk
• Intervention and control strategies
Management
to reduce risks
• Health promotion & surveillance
• Awareness of new technologies and
• Inspection & maintenance procedures
information
• Management & supervision policy
• Personality, attitude, belief, behaviour,
• Safety management systems
• Motivational Factors
• Materials selection and storage logistics
• Individual desires e.g. Potential
awards, recognitions
• Potential bonus/reward, penalties
imposed e.g. To achieve time/
Consequence of Decision Makers
financial deadlines
Output
Presence of WRMSD Hazards and
Magnitude of Risk
Individual Risk Factors –
Influences probability of Load • Task Demands
developing WRMSDS WRMSDs Characteristics • Physical
• Age, Gender • Increased load requirements
• Socioeconomic status Absenteeism weight/size/ • Manual handling
• Weight, height & BMI Early retirement shape requirements
• Diet & lifestyle factors Reduced • Poor coupling • Grip requirements
• Physical fitness production (hand/handle) • Static work
Financial Loss
• Anthropometrics • Load stability • Repetitive
• Physiological capacity Psychosocial movements
(VO2, HRmax) Requirements • Force
• Biomechanical capacity • Demand/control requirements
(MVC, Joint ROM) • Frequency of
• Psychological capacity Workplace exposure
(Risk perception, • Layout • Duration of
motivation, attitude & • Workspace exposure
behaviour dimensions • Postures
• Working heights sustained
Figure 7: Factors That Can Contribute Towards the Development of WRMSDS

(Diagrammatic Representation based on Chapter Literature Review)
~ 35 ~
2.8 Intervention Strategies to Manage WRMSDs

Intervention strategies to manage WRMSD risk can be classified into three
levels Primary, Secondary, and Tertiary. Primary intervention strategies are usually
introduced to prevent the development of the disorder, secondary intervention
strategies are usually introduced to help reduce the severity of the impact when they
occur, and tertiary intervention can help sufferers to recover in a shorter timeframe
and enable returning to work as early as possible.
2.9 Primary Intervention

Primary intervention strategies include the use of proactive and preventative
measures to eliminate WRMSD risk factors and/or implement controls and
intervention strategies to reduce risk to acceptable levels when a risk factor cannot be
eliminated. The effectiveness of primary intervention strategies, and the quality and
quantity of their implementation is influenced by, and in turn influences the safety
culture in an organisation.
With respect to construction projects, a hazardous activity can be eliminated
early in a project’s lifecycle. For example, architects and designers can design a
structure that minimises plasters exposure to hazardous scenarios. Structures may be
designed in dimensional ranges that will not require plasterers to sustain awkward or
extreme postures, or work on elevated platforms. The selecting of alternative surface
finishes for walls and ceilings can influence the task requirements for plasterers.
Different finishes may enable plasterers to apply a plaster mixture onto surfaces
using ‘power spray’ mechanisms 2. Such power systems will help to reduce the
requirements for plasterers to sustain awkward postures, exert high forces, participate
in repetitive movements, or work on elevated surfaces.
Additional examples of primary intervention strategies to prevent or reduce
the probability of WRMSDs occurrences include:
• Implementing legislation, (Safety Health and Welfare at Work Act, 2005)

• Implementing safety management systems (e.g. OHSAS 18,001)
• Design for Safety Concept
• Providing and monitoring occupational health and safety training
2
http://www.lionindustries.co.uk/sprayplaster.html
~ 36 ~
• Establishing inspection and maintenance programs

• Implementing safe systems of work
2.9.1 Occupational Health and Safety Legislation

European Union directives, 3 with a legal foundation in Article 153 of
the Treaty on the Functioning of the European Union (ex Article 137 TEC), set out
minimum requirements to protect workers with respect to occupational health and
safety. Ireland and member countries 4 throughout the European Union have
subsequently implementation of a broad range of occupational health and safety
legislation. Legislators frequently update the legislation in an attempt to protect the
safety, health, and welfare of workers, define roles and responsibilities, and detail the
duties of care for all persons in the workplace. A list of Irish legislation is presented
in Appendix I.
Although many organisations in various employment sectors successfully
meet their legislative requirements the construction industry are inconsistent in
following suit. This inconsistency is a possible indication of the safety culture that
exists in the construction industry. Poor safety cultures contribute to high levels of
accidents, illness and increasing prevalence rates of WRMSDs. (Arezes and Miguel,
2008, McDonald and Hrymak, 2002a, Glendon and Litherland, 2001, Langford et al.,
2000). Historically, the industry has focused on the safety aspects of accident
prevention. There is significantly less focus on occupational health issues such as
WRMSDs, one of the top contributory causes for work related absenteeism in the
construction industry.
All workers have a duty of care for their own safety, health, and wellbeing
and the safety, health, and wellbeing of all other persons associated with work or a
working environment. The scope of their duties is different and is often based on
their position in an organisation. For Example, Section 8 of the Safety Health and
Welfare at Work Act, 2005 requires that employers/managers/owners have a duty of
care to ‘as far as is reasonably practicable’ ensure that employees are provided with a
safe place of work, safe system of work, safe plant and equipment, and a competent
3
European Framework Directive on Safety and Health at Work (Directive 89/391 EEC) http://eur-
lex.europa.eu/LexUriServ/LexUriServ.do?uri=CONSLEG:1989L0391:20081211:EN:PDF
4
http://eur-lex.europa.eu/LexUriServ/LexUriServ.do?uri=CELEX:71989L0391:EN:NOT#FIELD_IE
~ 37 ~
workforce. In addition, risk assessments must be carried out and measures

implemented to reduce risk to acceptable levels. Workers must be provided with the
necessary training, information, and supervision. Where employers/managers/owners
are not competent to carry out these measures alone, they must employ a competent
person to do so. Failure to meet their legal duties can result in prosecution under the
2005 Act. If convicted they can be fined up to €3m or be sentenced to a term in
prison up to two years.
Health and safety legislation provides direction on generating suitable
documentation to manage occupational health and safety. For example, Safety
Statements, a legally required document required under Section 20 of the 2005 Act is
a written programme outlining an organisation commitment to safeguard the safety,
health, and welfare of workers and visitors who enter their workplace. A core part of
safety statements are risk assessments in which 1) hazards are identified 2) risks are
assessed and 3) controls are implemented to reduce risk to acceptable levels.
In Ireland, the General Application Regulations 2007 provides a hierarchy of
recommendations and interventions to manage occupational health and safety
(Appendix II). Researchers recommend a hierarchy of controls which includes
• Elimination – the hazard is removed completely

• Substitution – replace the hazard with a different option that has a lower level
of risk, NB substitution can result in risk transference i.e. introduce a new risk
into the environment
• Engineering Controls – changes are made to the operating process or
equipment to reduce the level of risk associated with a hazard e.g. adding
guards to a piece of machinery, installing ventilation systems
• Administrative Controls – putting measures into place that will reduce
workers exposure to hazard and reduce the level of risk e.g. job rotation,
manual handling training
• Personal Protective Equipment (PPE) – barriers between user and the hazard
e.g. breathing protection, face and eye protection, hearing protection, hard
hats, clothing, and footwear
~ 38 ~
2.9.2 Safety Management Systems

Safety management systems provide a theoretical framework for
organisations to manage their occupational health and safety and ensure safe
interaction between workers and their work. Ideally it should be a cyclical process in
which hazards, risks, and controls are monitored in a continuous process to ensure an
optimum level of occupational health and safety (British Standards Institution, 2008,
Health and Safety Authority (HSA), 2006b, Health and Safety Executive (HSE),
2003). Failure to identify all work processes, procedures, and activities that occur on
a frequent and infrequent basis may result in hazards being overlooked.
Failure to implement suitable management systems incurs a significant
financial burden on employers and the economy. It may be possible that those who
are responsible for managing construction projects fail to recognise the potential
financial benefit in meeting their legislative requirements and implementing health
and safety management strategies. Behm et al. (2004), after carrying out cost analysis
studies, recognised that increasing prevention and detection costs has a subsequent
decline in costs attributed to quality and safety failures. However, there is a limit to
financial benefits i.e. after the Optimum Equilibrium Point (OEP) the financial input
for prevention and detection will exceed the financial gain associated with reduced
quality and safety failures (Figure 8).
Prevention &
Detection
Costs
Optimal
Cost
Equilibrium
Point
Failure
Costs
Quality / Safety Level
Figure 8: Optimal Equilibrium Point

(Adapted from Behm et al., 2004)
~ 39 ~
2.9.3 Design for Safety Concept – Early Intervention to Eliminate

Hazards
Researchers frequently recommend the implementation of a hierarchy of
controls to reduce risk levels. These include elimination, substitution, engineering
controls, administrative controls and lastly personal protective equipment (PPE)
(Hughes and Ferrett, 2012, ANSI/AIHA Z10 Committee, 2005).
Eliminating or substituting risk factors early in a design processes is generally
considered an efficient method to manage occupational health and safety. It is
generally accepted to be more cost efficient than implementing new systems or
processes to rectify problematic issues at later stages (Gangolells et al., 2010,
Gambatese et al., 2008, Schulte et al., 2008, Behm, 2005, Michael, 2005).
Engineering controls reduces exposure to existing risk factors e.g.
redesigning equipment plant, machinery, or processes (Bongers et al., 2006b,
Gervais, 2003, Health and Safety Authority (HSA), 2005). With respect to
WRMSDs, an engineering control may involve the redesign of a scaffolding system
to reduce the probability of workers sustaining awkward or extreme postures.
Administrative controls focus on working methods, procedures, and work practices.
Introducing systems such as changing work/rest schedules, job rotation, or training in
health and safety techniques can help to reduce a workers ‘dose’ exposure to risk
factors. PPE is equipment or clothing worn by workers to further reduce ‘dose’
exposure.
Researchers recognising the complexity of the construction industry
organisation, and its dynamic nature with respect to working populations and
construction phases established the Design for Safety (DfS) concept. The DfS
concept appreciate the benefits of implementing safety management strategies in
which risk factors are identified, risks are assessed, and controls are implemented to
eliminate risk factors or reduce risk. However the researchers noted that safety
performance in the construction phase is linked with the design phase (Gambatese et
al., 2008, Haslam et al., 2005, Behm, 2005, Hecker and Gambatese, 2004, Amell and
Kumar, 2001, Gambatese and Hinze, 1999). They theorise that costs associated with
accidents and injuries, which occur in the construction phase of a project, will be
reduced when health and safety matters are considered earlier in a project life cycle
i.e. the design phase rather than the construction phase. Each phase involves different
arrangements of personnel separated by temporal locations (Gangolells et al., 2010,
~ 40 ~
Schulte et al., 2008, Bellamy et al., 2008, Gambatese et al., 2008, Gambatese et al.,
2006, Behm, 2005, Michael, 2005, Gambatese and Hinze, 1999).
The effectiveness of DfS and the potential to reduce WRMSD risk in latter
lifecycle phases will be dependent on the decision maker’s quantity and quality of
education, training, knowledge and understanding of risks when making decisions at
the design phase (Bartley et al., 2010, Dingsdag et al., 2008, Loosemore and
Andonakis, 2007, Taylor et al., 2006, Burke et al., 2006, Gervais, 2003, Faucett et
al., 2002, Laukkanen, 1999). Their decision outcome will determine the quality of
any safety management systems and safety performance during the construction
phase. It stands to reason therefore that decision makers who influence the magnitude
of WRMSD risk in any given environment should comprehend and understand the
development process of WRMSDs and the measures required to eliminate or reduce
WRMSD risk. Literature indicates that employees throughout the hierarchy of the
construction industry have a poor level of safety awareness (Mohamed et al., 2009,
Dingsdag et al., 2008, Choudhry and Fang, 2008, Haslam et al., 2005, Tam et al.,
2004, Lingard and Holmes, 2001, Holmes et al., 1999).
2.9.4 Inspection and Maintenance Programs

Almost all activities carried out on construction sites involves the use of
plant, machinery, equipment, and tools. Even when they are in their optimum
condition, the workers using them are at an increased risk of injury. Implementing
measures to reduce risk associated with plant, machinery, equipment, and tools may
be considered as an engineering control. Ideally, an ergonomic purchasing program
should be established before any equipment is purchased to ensure that the
equipment meets appropriate health and safety requirements.
Regular inspection and maintenance will help to maintain them in their
optimum condition and ensure risk associated with their use is minimised. The
persons carrying out the inspections and maintenance should be appropriately
qualified and trained to do so. In addition, any tools and measurement equipment
used in the process should be appropriately calibrated. Maintenance and inspection
details should be documented and updated accordingly to ensure the success of the
program (Hassan and Khan, 2012, Yeddanapudi et al., 2008, Harrington and
McConnell, 1994).
~ 41 ~
2.9.5 Occupational Health & Safety Training

Training is considered a lower level intervention in the hierarchy of controls
(administrative control). However, training and education influences a person’s level
of risk awareness, risk-taking behaviour, and decision-making outcomes. In the
construction industry, a variety of stakeholders makes decisions throughout the
various stages of a project. The capacity to manage occupational health and safety in
the construction phase of a project; the ability to reduce risk to a level that is as low
as is “reasonably practicable” is determined by the cumulative decision output from
all of the stakeholders involved. Education and training of stakeholders involved in
decision-making is fundamental to ensure successful safety and risk management.
In Ireland, stakeholders involved in the decision-making processes in
construction projects include architects, designers, engineers, surveyors, and project
managers. They receive their training in third level construction related training
programs many of which do not contain modules that detail the management of
occupational health and safety. The HSA and IOSH funded research to determine
what percentage of health and safety training is included in third level construction
related courses. Approximately 23 third level institutions who provide various
construction-related courses participated in the survey. The courses included in the
study are classified as undergraduate Levels 7 (Ordinary Bachelors Degree) and
Levels 8 (Honours Bachelor Degree) (Refer to Appendix III). The unpublished report
indicates that on average the courses contained less than two percent of health and
safety training (Healy Kelly Turner & Townsend, 2011). Consequently, many of the
decision makers who participated in these courses do not have the capacity to make
informed decisions to manage occupational health and safety.
In a review of over 200 design offices between 1997-2002, the HSA found
that only 10% of designers had health and safety training. In addition, the majority of
designers were unaware of the “General Principles of Prevention” (See Appendix II)
and had an inadequate understanding of the regulations (Health and Safety Authority,
2003).
In the United Kingdom, the Institution of Occupational Safety and Health
(IOSH) (2000) recommends that health and safety training be integrated with the
core subject matter of relevant degrees and skills training programs in further and
higher education courses.
~ 42 ~
Currently, the management of occupational health and safety in construction

projects is often the responsibility of individuals who have participated in a specific
occupational health and safety training programs e.g. Safety Officers. However, they
usually enter into a project lifecycle at the construction phase of a project. It is less
likely that they are involved or consulted in the decision making process in the
earlier phases of a project when implementing measures to manage occupational
health and safety may be more effective and incur lower costs.
Construction trade workers receive their skills training, safety training, and
education by participating in combinations of on-the job training, apprenticeship
training, and third level courses. Many trade workers, including plasterers receive
their skills training through apprenticeships.
In Ireland, trade apprenticeships are managed by Foras Áiseanna Saothair
(FÁS) and the Irish National Training, and Employment Authority, in co-operation
with the Department of Education and Science, Employers, and Unions. The
plasterer’s apprenticeship is provided in a modular seven-phase format over a period
of four years. It consists of classroom activities, practical work, and on-the-job
training. In addition to plastering skills, the apprentices learn about workplace health
and safety, workplace risk factors and risk control measures.
Successful candidates are awarded an internationally recognised FETAC
Advanced Certification (Level 6) upon completion of all modules and securing a
sufficient grade in paper and practical exams. Qualified apprentices, if they wish, can
partake in Level 7 and Level 8 Degree programs (Further Education and Training
Awards Council (FETAC), 2010). Apprentices must be a minimum of 16 years old
and be employed in a construction related position for the duration of their
apprenticeship.
Accidents continue to happen on construction sites and occupational ill health
in the construction industry continues to be of increasing concern. Inconsistent
quality and quantity of training programs creates a population of workers with
variable levels of risk awareness, behaviour patterns, motivational reasons, and
decision-making potential. The type of training received can influence the style of
safety culture in organisations throughout the construction industry. In turn, the type
of safety culture in an organisation will influence the types of training in which its
workforce will participate.
~ 43 ~
Greater emphasis should be placed on the importance of occupational health

and safety training for all parties who will influence the potential introduction of
WRMSD risk factors (Hopkin, 2012, Hughes and Ferrett, 2010, Mitropoulos and
Cupido, 2009, Charnley, 1998). A lack of understanding or awareness of WRMSD
risk factors increases the probability of hazardous decision-making outcomes
(Hopkin, 2012, Hughes and Ferrett, 2010, National Research Council, 2009, Lambert
et al., 2005). Failure to recognise a hazardous situation decreases the probability of
introducing measures to reduce the level of risk for each risk factor to acceptable
levels. In addition when measures are introduces they may be ineffective in reducing
risk levels sufficiently.
2.9.6 Safe Systems of Work – Example: Rest Recovery Periods

Prolonged exposure to WRMSD risk factors increases the stress levels on the
body’s systems. Symptoms of fatigue are experienced and the ability to perform at
optimum performance levels declines (Knicker et al., 2011). Experiencing fatigue
indicates disruption of the homeostatic balance, and being exposed to WRMSD risk
factors that increase the probability of injury. Physiologically, the body may
experience an elevated heart rate and a reduced ability to generate and sustain force
output. Psychophysically, sensations of tiredness, fatigue, pain, and discomfort may
be experienced.
A period of rest is required to return the body’s systems to their homeostatic
balance. This involves replenishing oxygen stores, normalising heart rate and blood
pressure levels, removal of accumulated by-products, and repair of damaged
components (Dawson et al., 2011, Bosch et al., 2011, Lundberg and Cooper, 2010,
Wilmore et al., 2008, Balci and Aghazadeh, 2004, Brooks et al., 1996, Åstrand and
Rodahl, 1986, Brouha, 1967).
A work scenario without rest periods incurs cumulative and upward only
trends of fatigue intensity. Implementing rest periods (an administrative control) for
workers involved in physical activity interrupts the upwards only trend of fatigue and
stress. Although the overall trend of fatigue intensity in a work/rest scenario is
upwards, the rate of incline generally levels or declines during a period of rest. Over
a day, in which rest breaks are taken, the cumulative fatigue is generally lower than
the cumulative fatigue in a day in which no breaks were taken.
~ 44 ~
If rest periods are infrequent or the duration of rest is insufficient to enable a

full return to homeostasis, there is an increased probability of WRMSD development
(Faucett et al., 2007, Woods et al., 2004, Nussbaum et al., 2001, Byström and
Fransson-Hall, 1994, Baidya and Stevenson, 1988). Fatigue is a precursor and
warning indicator of potential injury. To reduce the probability of injury requires
intervention that decreases the cumulative intensity of fatigue sensations.
Murrell (1965) recognised that a period of rest was required for elevated heart
rate to return to normal values i.e. recovery time. His formula can be used to
calculate a recommended rest period using heart rate data for activities (Equation 2).
Equation 2: Murrell Equation

to Calculate Resting Time
R = resting time (min)

T = total working time (min),
E work = energy expenditure during work,
E rec = Recommended average energy expenditure (kcal/min) – usually 4-5 - approximation
of energy expenditure at rest which is slightly higher than the basal metabolic rate) 1kcal =
4.2kJ
2.9.7 Personal Protective Equipment (PPE)

The construction regulations and the Health and safety Authority guidance
documents outlines and specifies requirements for the selection, maintenance, and
inspection of PPE for construction workers. PPE most frequently used on Irish
construction sites include high-visibility clothing, hard hats, and safety shoes.
Additional PPE is required when workers are considered at risk because of their
work condition or task requirement (Health and Safety Authority (HSA), 2011a,
Health and Safety Authority (HSA), 2010, Health and Safety Authority (HSA), 2007,
Health and Safety Authority (HSA), 2006a). Appropriate PPE should be selected
only after all other intervention strategies have been employed. Examples include
respiratory protection systems (respirators, dust masks), eye protection equipment
(facemasks, goggles, glasses), and fall protection equipment (ropes, harnesses,
lanyards).
In Ireland, employers are responsible for providing PPE and employees when
provided with PPE are required to use it in the manner in which it was intended. It is
allocated to an individual user and it should be carefully selected to ensure that it
will protect users from hazards, be comfortable to wear and not interfere with the
~ 45 ~
users ability to carry out their tasks in a safe manner (Forst et al., 2006). It is
important to note that for some individuals wearing PPE can induce a false sense of
increased protection that promotes an escalation of their risk taking behaviour.
There is an issue surrounding the effectiveness of using some types of PPE.
In the case of back belts, the literature is divided with respect to it beneficial and
harmful impact on users. Some researchers believe that wearing belts can be an
effective method in protecting workers backs (Ammendolia et al., 2005, Burton et
al., 2005). However, the National Institute for Occupational Safety and Health
(NIOSH) review on the use of back belts determined that a lack of scientific
evidence exists on the effectiveness that back belts reduce the risk of back injury. At
times, workers wearing back belts were inclined to handle heavier loads than they
should because they believed that the belt gave them additional protection (National
Institute for Occupational Safety and Health (NIOSH), 2000).
Wrist splints can limit the hand/wrist range of motion (flexion/extension/
deviation) and provides support to injured wrists. However wearing wrist splints may
increase the risk of injuring the shoulder (Mell et al., 2006, Perez-Balke and
Buchholz, 1994). Frequently, particularly on larger construction projects, policies
exist in which all workers must at all times throughout a construction site wear a high
visibility coat/vest, safety shoes/boots, and a hard hat. Wearing hard hats all of the
time can be problematic for some users particularly plasterers. The design of hard
hats can restrict the plasterers head, neck and arm movements when carrying out
tasks over their head.
Users should be appropriately trained to carry out inspections on their PPE at
suitable intervals e.g. before use, weekly. Manufacturer’s guidelines should be
adhered to with respect to maintenance and disposal of PPE.
2.10 Secondary Intervention

Workers develop WRMSDs and if left untreated the symptoms can increase
in severity and potentially result in permanent injury. The earlier symptoms are
recognised and the earlier treatment is received the less severe the injury and the
shorter the recovery time i.e. less pain and suffering, less time off work, less negative
impact on productivity and lower costs. Examples of why a person with a WRMSD
continues to work include:
~ 46 ~
• They fail to recognise that the injury more severe than they perceive it to be,
possible due to a high pain threshold
• Workers continue to work because of peer pressure, fear of reprisal from
management, or fear of loosing a job
• Payment/reward schemes in the workplace motivates the worker to continue
working to achieve targets
2.10.1 Health Promotion and Health Surveillance

Physiological capacity, biomechanical capacity, and mental health are
influenced by age, and lifestyle factors such as diet, exercise, fitness levels, smoking,
and alcohol consumption. Health promotion programs encourage, give advice, and
provide information for healthier lifestyle options e.g. smoking cessation programs.
Implementing health promotion programs can reduce work related absenteeism and
improve worker’s health and wellbeing (Henke et al., 2011, Cancelliere et al., 2011,
Deacon et al., 2005).
Health surveillance programs can be beneficial to employees by improving
the probability that a disease will be detected at an earlier stage when symptoms are
less severe, treatment options are less invasive and recovery time shorter. With
respect to WRMSDs, earlier intervention in recognising symptoms and encouraging
earlier treatment intervention will halt the progression of the disorder and reduce
recovery time. In addition implementing health surveillance programs can generate
prevalence records of disorders and injury details in workplaces. The information can
guide employers in intervention strategies to improve the health and wellbeing of its
workforce.
In Ireland, The Construction Workers Health Trust (CWHT) a national
charity founded in 1994 by the Construction Group of Trade Unions promotes good
health in the Irish Construction Industry. They surveyed construction workers and
established specific health promotion strategies in an attempt to counteract any
problematic lifestyle behaviours. They also provide free health surveillance checks to
construction workers on sites around the country. Although there are no statistics
currently available to demonstrate the effectiveness of their health screening and
health promotion programs, a number of workers have been diagnosed with medical
conditions that were potentially fatal. On one occasion, a worker was removed from
~ 47 ~
the site in an ambulance due to his dangerously elevated blood pressure. Follow up
treatment and appointments are arranged for those who require further investigation
based on the screening results.
2.10.2 Partaking in Regular Exercise/Activity

Exercise and physiology publications outline and describe ways of how to
achieve optimum potential for the human body and the body’s systems (France,
2010, Williamson, 2010, Wilmore et al., 2008, Thelle, 2007, Plowman and Smith,
2007, Bahr and Krosshaug, 2005, Melanson and Freedson, 2001, McArdle et al.,
2000, Pollock et al., 1998, Brooks et al., 1996, Heil et al., 1995).
Sports trainers and consultants develop and recommend specific programs of
exercises and activities. They advise frequent participation to improve general
fitness, increase muscle strength, improve range of movement, improve the
efficiency of the cardiovascular system, and increase overall endurance levels. For
example, strength-training programs can cause biomechanical changes in muscles
increasing the number of myofibrils, the contractile filaments in muscles, and
improve oxygen utilisation in the sub-components of muscle cells (mitochondria)
(Wilmore et al., 2008, LeMura and Duvillard, 2004, McArdle et al., 2000, Åstrand
and Rodahl, 1986).
Regular participation in training and exercise programs improves the body’s
ability to maintain homeostatic balance and reduces recovery time when it becomes
disrupted. Muscles become more efficient in utilising nutrient stores, oxygen demand
is reduced, oxygen utilisation is more efficient, and lower levels of by-products are
generated. Subsequently the ability to perform prolonged physical activities increases
(Holloszy and Coyle, 1984).
An effective exercise session generally involves warm-up and stretching
activities to prepare the body systems for more strenuous activities. Afterwards a
cool down activity is undertaken to allow the body’s systems to recover and
restabilise. The benefits of partaking in regular exercise and the negative affects
associated with infrequent exercise are observed on a daily basis in an array of
sporting events such as athletics, gymnastics, soccer and rugby (Doral et al., 2011,
Hutson and Speed, 2011, Walker, 2007a, Kolt and Snyder-Mackler, 2003, Fentem,
1994). Professional athletes, when injured require a prescribed regimen of treatment
to recover full fitness and return to previous performance levels.
~ 48 ~
For members of the public, exercise and physical activity is an essential part
of healthy living and prolonged life. The variety and frequency of exercise
undertaken will directly influence the quality of ones health and wellbeing. It is
recommended to partake in physical activity on a frequent and regular basis (in
conjunction with a healthy diet) to reduce the probability of developing illnesses and
reduce the severity of symptoms associated with existing diseases. This includes
disorders such as cardiovascular disease, hypertension, stroke, diabetes, osteoporosis,
varieties of cancer, and depression (Durstine et al., 2008, Bleyer et al., 2007, Shils
and Shike, 2006, Frayn et al., 2005, Vainio and Bianchini, 2002, Pollock et al., 1998,
Stellman, 1998). Physical activity, either exercise or work related, when improperly
undertaken with respect to type of exercise and frequency of exercise can contribute
to an individual’s ill health and wellbeing (Williamson, 2010, Taylor and Johnson,
2008, Wilmore et al., 2008, Birch et al., 2005, Woods et al., 2004, Fentem, 1994,
Åstrand and Rodahl, 1986)
2.11 Tertiary Intervention

Many workers who experience WRMSDs require short to long-term absence
from work to enable recovery.
Workplace absenteeism has a negative impact on employees, employers and
on the economy. In addition to pain and suffering, absentee employees can
experience a significant loss of income, their quality of family and social life is
affected (Franche et al., 2005). In addition they may experience stress, decreased
motivation, and depression (Krause et al., 1998). WRMSD sufferers may require
intensive rehabilitation to recover. Research has identified that the longer a person
remains out of work there is less of a likelihood that the person will return to work
(Mirka and Sommerich, 1998)
Examples of a tertiary intervention strategies include Modified Work
Programs (MWP) and Return to Work Programs (RWP). To halt the progression of
the disorders and to enable early return to work involves redesigning the task and
modification of the workstation. These types of intervention strategies may not be
suitable for all work in the construction industry. Trade workers, particularly
plasterers are frequently employed on a temporary contract basis to carry out a
specific task activity. Their contract may be awarded only after a tendering process
~ 49 ~
in which the plasterer provides an outline of how they propose to complete their
activity.
It is essential that a combination of primary, secondary, and tertiary
intervention strategies are implement to manage WRMSDs effectively. In cases
when workers have developed disorders, or in cases when injured workers have
retuned to work failing to implement effective primary intervention strategies will
exacerbate existing disorders and increase the likelihood of the recovered workers
become injured again.
2.12 WRMSD Risk Assessment Methods

Researchers have developed a vast array of analysis tools and methods to
assist in determining a level of risk when evaluating exposure to risk factors. They
are suitable to use in a wide variety of work environments (Cheng et al., 2010b,
Behm, 2005, Haslam et al., 2005, Chi et al., 2005, Gervais, 2003, Abdelhamid and
Everett, 2000).
In this section, a selection of risk assessment methods that are suitable to use
to evaluate exposure to WRMSD risk factors is presented. Each method has the
capacity to evaluate risk factor exposures for different environmental conditions or
for different activities. Some are simple and easy to use, they are inexpensive, and
the assessments take only a short time to be carried out. In contrast, other methods
may be highly complex to use and assessors must have a level of expertise in their
application. Additionally there may be a high cost or a long time requirement
associated with their use or when analysing the data.
2.12.1 Hierarchical Task Analysis – Identify Risk factors

In any environment where there is a potential to cause harm it is necessary to
identify hazards and risk factors that can occur in it and determine who may be
exposed to these hazards and risk factors (Bohle and Quinlan, 2000).
Risk factor identification requires an understanding of the mechanism of how
exposure to a risk factor can result in injury and the probability of injury occurrence
i.e. associated risk. Task Analysis (TA) provides a systematic and comprehensive
description of a task, identifying the tasks, sub-tasks, actions, and activities of a
stakeholder(s) in order to achieve a system goal (Gramopadhye and Thaker, 1998,
Kirwan and Ainsworth, 1993). This method provides information about demands
~ 50 ~
imposed on the worker and identifies tasks, sub-tasks or task element variations that
impose a risk to the stakeholder(s) involved.
Hierarchical Task Analysis (HTA) was developed in response to the need of
analysing complex tasks (Annett, 2004). The systematic method is used to
decompose a system goal or overall job objective into the method required to achieve
the goal or objective. In HTA the goal/objective and the various tasks and sub-tasks
are identified in a top-down hierarchical format in as little or as much detail as
required. A numbered plan represents the sequential, parallel, or simultaneous, tasks
required to achieve the system goal (Asimakopoulos et al., 2011, Phipps et al., 2011,
Lane et al., 2006, Annett, 2004, Gramopadhye and Thaker, 1998).
A careful examination of the interactions between workers, tasks, and
environment is required to enable the identification of all risk factors. Information
about a task should be obtained from a multiple sources to ensure all task details are
gathered (Annett, 2004, Kirwan and Ainsworth, 1993, Hodgkinson and Crawshaw,
1985). Examples include observing workers carrying out their task under usual
working conditions, interviewing persons who are involved in the task, and
reviewing operating manuals.
Many researchers have used HTA in their assessments in a variety of
different environments (Asimakopoulos et al., 2011, Phipps et al., 2011, Doytchev
and Szwillus, 2009, Lane et al., 2006, Annett, 2004, Luttmann et al., 1991,
Hodgkinson and Crawshaw, 1985). Analysts are required to have a level of skill to
enable effective application of the method and reduce the likelihood of errors. The
skills can be acquired reasonably quickly through practice and the method can be
applied to practically any environment or activity. Errors associated with HTA
diminish as the assessors become more experienced (Stanton, 2009, Stanton, 2005,
Annett, 2004, Hodgkinson and Crawshaw, 1985).
2.12.2 Biomechanical Assessment Methods

Biomechanical assessment methods are used to monitor strain exerted on the
musculoskeletal system during a task performance in an assessment environment.
Various postural assessment methods are available to evaluate exposure WRMSD
risk factors. These methods may be categorised into self-reporting, observational
methods, direct methods, and indirect methods (David, 2005, Li and Buckle, 1999b).
~ 51 ~
Observational Methods
In observational analysis, assessors observe workers as they carry out their
activity in real-time working conditions. Alternatively, video recordings or
photographs of subjects working are analysed at a separate time and location. The
methodologies can range from simple inexpensive and easy to administer systems
such as a pen and paper method that can consist of questionnaires and checklists.
Systems that are more complex use scoresheets, body diagrams, and tables to provide
a ‘snapshot’ evaluation of WRMSD risk. Training is usually required for the more
complex systems to ensure the accuracy of the data required, and the application of
the assessment method. Errors that can occur due to intra and inter observer
variability can be minimised with training and experience (David et al., 2008, David
et al., 2005, Li and Buckle, 1999b, Li and Buckle, 1999c).
Generally, observational assessments consider exposure to multiple risk
factors in a given work environment e.g. posture of body areas/joints, repetitive
movements, force application, vibration, weight handled, and distances involved etc.
They are usually non-invasive and do not disrupt or impose additional stress on the
worker. They enable comparisons between different working environments, and
evaluate pre/post intervention conditions (David, 2005, Li and Buckle, 1999b).
Examples of observational methods include:

• Rapid Upper Limb Assessment (RULA) (Bao et al., 2007,
McAtamney and Nigel Corlett, 1993),
• Quick Exposure Check (QEC) (David et al., 2008, David et al., 2005,
Li and Buckle, 2004, Brown and Li, 2003),
• National Institute of Occupational Safety and Health (NIOSH)
equation (Potvin, 1997, Waters et al., 1993, Putz-Anderson et al.,
1991).
When using RULA, observer use body diagrams representing different

postural angle ranges for body areas such as the upper and lower arms, wrists, neck,
and trunk. Each diagram has an assigned score level that increases in magnitude with
respect to an increase in angular displacement. For example a score of one (1) is
allotted when the upper arm posture is between 20o Flexion and 20o extension,
~ 52 ~
whereas a score of four (4) is allotted when the upper arm extends 90o or greater.
After allocating scores for each body area, the assessor uses three tables to generate
RULA risk scores that range from one to seven. One indicates little or no risk and a
score of seven indicates extremely high-risk conditions that require immediate
intervention. The method can be complex and time consuming to use. An angular
measurement tool may be required to ensure the appropriate scoring mechanism is
applied (Bao et al., 2007, McAtamney and Nigel Corlett, 1993).
QEC uses two checklists one to be completed by the observer and the second
to be completed by the worker. The information from both checklists is combined to
generate separate scores for four body areas, the back, neck, shoulder/arm, and
wrist/hand. Calculations are used to reference the scores as a percentages of
maximum potential score for each body area. The resultant scores range from 0% (no
risk) to 100% (extremely high risk). Scores of 40% or lower are considered
acceptable working conditions. Values greater than this indicate increased levels of
risk and provide an indication of intervention recommendation (David et al., 2008,
David et al., 2005, Li and Buckle, 2004, Brown and Li, 2003),. RULA and QEC
scores indicate action levels and corresponding intervention recommendations.
Action level scores and corresponding RULA and QEC scores are displayed in Table
3 (David et al., 2008, David et al., 2005, Brown and Li, 2003).
Table 3: Scores and Action Levels for RULA and QEC
Action level Recommended Action RULA QEC Score
1 Acceptable posture 1 or 2 < 40%
Further investigation needed, changes may

2 3 or 4 40 – 49%
be required
3 Investigation and changes needed soon 5 or 6 50 – 69%
Investigation and changes required

4 7 ≥ 70%
immediately
The National Institute for Occupational Safety and Health (NIOSH) used
psychophysical and biomechanical data to develop a manual-handling risk
assessment equation to calculate Recommended Weight Limits (RWL). It considers
~ 53 ~
the environmental and task conditions such as the workers posture and the distance a
load is from the centre of gravity in repetitive lifting tasks to reduce the risk of injury
to the lower back (National Institute of Occupational Safety and Health (NIOSH),
1997, Waters et al., 1993, Putz-Anderson et al., 1991).
Other observational tools include The Rapid Entire Body Assessment
(REBA) (Choi, 2010, Janowitz et al., 2006, Alison, 2005, Lynn and Sue, 2004,
Hignett and McAtamney, 2000, McAtamney and Nigel Corlett, 1993), the Loading
on the Upper Body Assessment (LUBA) (Kee and Karwowski, 2001), PLIBEL
(Kemmlert, 1995) and OCRA (Occhipinti, 1998).
Computerised observational tools are available to assess dynamic activities.
Markers are positioned on specific sites on the body and tasks are video recorded.
Software is used to generate two/three dimensional representations of human body
movement and to calculate biomechanical stress exerted on joints. The methods are
usually expensive to purchase and require detailed training to ensure accuracy of data
acquisition. Examples include the 2D and 3D Computerized Human Static Strength
Simulation Mode 2D/3DSSPP (Nelson and Hughes, 2009, Marras, 2003, Chaffin,
1997), and the Ovako Working Posture Analysing System (OWAS) (Li and Buckle,
1999a, Scott and Lambe, 1996, Karhu et al., 1977).
Additionally a personal digital assistant (PDA), or computer device could be
used as an alternative to paper and pen data acquisition to record information during
the assessments. PDA systems can be used to record observational data over time.
Assessors use appropriately developed software to create checklists or questionnaires
for data acquisition purposes. Information may be entered using text entry options,
multiple choice options, check boxes, or drop down menus (Janowitz et al., 2006).
Video analysis methods can also be used as an observational tool in real time
analysis, or it can be used at a later stage in a separate location to the work place. For
example, the observational methods such as RULA and QEC can be used when
observing video recording of activities as an alternative to being used at the time a
worker is carrying out their activity.
Using frame-by frame video analysis, trained observers can use the Hand
Activity Level (HAL) scale, based on a 10-point visual-analogue scale originally
proposed by Latko et al. (1997), to determine the degree of hand repetition (Chen et
al., 2012).
~ 54 ~
Software systems are available that enable the synchronisation of video

recordings with other assessment methods which can enable the quantification of
postures or activities for work tasks. For example, video recordings can be
synchronised with data obtained from other data acquisition systems such as
electromyography dataloggers (Anton et al., 2001, Forsman et al., 1999).
Dartt et al., (2009) evaluated the reliability of the Multimedia Video Task
Analysis (MVTA), a program for use in occupational studies to analyse postures and
repetition during work tasks. The study demonstrated good to excellent intra-rater
reliability for the neck, shoulder, and wrist postures. They determined that the use of
MVTA as a video observation tool was a reliable method when analysing exposures
to awkward postures of the upper extremities.
Direct Measurement Methods

Direct measurement methods involves the use of manual and electronic
instruments to measure body postures and joint angles to evaluate the intensity of
strain imposed on the musculoskeletal system (Li and Buckle, 1999b). Examples of
direct measurement instruments include Goniometers, Electrogoniometers, (David,
2005, Tesio et al., 1995) Inclinometers, and Lumbar Motion Monitors (Montgomery
et al., 2011, Caldwell et al., 2003, Gilad et al., 1989).
Goniometers, manual and electronic, consist of two segments separated by a
flexible hinge. The segments are positioned on each side of a joint and the change in
the position of the sensors correlates with angular displacement of the joint. In
addition, goniometers can be used to monitor the frequency of repetitious
movements.
Electromyography (EMG) is a direct measurement method used to study
muscle function by analysing the electrical activity of contracting muscles and
indirectly indicates a level of biomechanical stress(Crary et al., 2006, Soderberg and
Knutson, 2000, Onishi et al., 2000, Seroussi and Pope, 1987, Soderberg and Cook,
1984, Milner-Brown and Stein, 1975).
Needle or surface electrodes are used to detect electrical activity of
underlying muscles. The frequency and amplitude of the EMG data indicates which
muscles are active, the intensity of that activity (internal muscle forces), and the
duration of activity. It is a suitable method to evaluate strain on the musculoskeletal
system, and enable comparisons of strain levels between tasks and sub-task activities
~ 55 ~
under a variety of different working conditions (Konrad, 2005, Jing et al., 2004,
Ankrum, 2000, Hägg et al., 2000).
EMG using surface electrodes is a non-invasive method to monitor muscle
activity and measure postural strain. The hypothesis is that when muscles are active
for prolonged periods and/or exert high intensities of activity they are at a greater
risk of becoming fatigued and injured i.e. increased risk of developing WRMSDs.
The inference is that increased muscle activity has occurred because of exposure to
WRMSD risk factors which increases the force demands exerted on the
musculoskeletal system i.e. the greater the magnitude of muscle activity the greater
the probability of injury (Li and Buckle, 1999b).
The Surface Electromyography for the Non-Invasive Assessment of Muscles
(SENIAM) guidelines provides recommendations for EMG assessments (Kamen and
Gabriel, 2010, Mesin et al., 2009, Hermens et al., 2000, Soderberg and Knutson,
2000, Hermens and Merletti, 1996). A sample of these guidelines includes:
• Electrodes should be composed of a suitable material, be a suitable size and

shape, contain a conductive gel, and have an adhesive surface. This reduces
the likelihood of skin impedance when detecting electrical signals from active
muscles and reduces the likelihood of slippage
• Skin should be appropriately prepared and cleaned of dirt, oil and dead cells
using alcohol wipes. Abrasive gel may also be used to further reduce skin
impedance.
• To ensure electrodes are only detecting the electrical activity from the muscle
of interest and not from adjacent muscles (crosstalk) a physiotherapist or
similarly trained individual should position the electrodes.
Data loggers record activity values for up to eight muscle groups and the
recorded data can be synchronised with video recordings. The synchronised data can
be separated into sub-sections of data to enable comparisons between tasks and sub-
task conditions for each muscle assessed.
Raw EMG data is displayed in a graphical wave format for each muscle in
positive and negative units of microvolts (+/- µV) of electrical activity. The data
requires processing using methods such as Averaging, Integration, and Root Mean
~ 56 ~
Square (RMS) methods. The RMS is a popular and acceptable processing method
considering power output over time to convert the wave into a positive wave format
(Konrad, 2005).
To enable comparisons between individuals, between days, and between
different assessment conditions raw EMG data is converted through a normalisation
process. One such method requires subjects to handle a load or sustain a posture to
generate a Maximum Voluntary Contraction (MVC) for the muscle of interest. EMG
data is then referenced as a percentage of MVC. However, this method can
potentially result in subjects sustaining injury while trying to generate MVC and
untrained individuals may not accurately generate their maximum intensity of
contraction rendering the reference value inaccurate. The Root Mean Square (RMS)
method averages EMG data and expresses it as a percentage of peak EMG data. The
Peak Dynamic normalisation method references EMG data recorded during an
assessment against the peak dynamic value recorded for that assessment. This
method is beneficial in reducing inter individual variability (Hibbs et al., 2011, Vera-
Garcia et al., 2010, Burnett et al., 2007, Burden et al., 2003, Marras et al., 2001,
Ankrum, 2000, Soderberg and Knutson, 2000).
Muscle Selection for EMG

Selecting muscles to analyse in an EMG study requires a level of knowledge
about muscle location and their involvement in movement. Muscles of different sizes
and shapes are organised in layers. Body movement involves sequences of
contractions and relaxation of different muscle sets. Smaller muscle systems are
activated to enable small fine movement. Larger muscle systems are activated to
enable large forceful movements. Movement generally involve primary and
secondary movement muscles to generate forces in one direction, and stabiliser
muscles that generate movement in an opposite direction. Muscle contractions can be
isometric with muscle length remaining the same, or isotonic in which the muscle
shortens and widens (Bhise, 2008, Martini et al., 2000, Wynsberghe et al., 1995,
Williams et al., 1989). When lifting and handling loads the body is in constant
motion that includes combinations of bending, twisting, and exerting high forces on
the musculoskeletal system
Surface EMG is suitable to monitor the activity of larger muscles nearest to
the skin surface. Needle electrodes are preferred when analysing activity levels of
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smaller and deeper lying muscles (Hibbs et al., 2011, Mesin et al., 2009, Hermens et
al., 2000).
2.12.3 Physiological Assessment Methods

Cardiovascular load is a measure of physiological stress and can be assessed
using direct calorimetric methods to measure heat energy (calorific energy
expenditure) released by subjects carrying out an activity in an insulated airtight
chamber. Indirect calorimetric methods measure gas volumes exchanged and use
formulas to convert to energy expenditure for a given activity (Blond et al., 2011,
Kopelman et al., 2009, Novas et al., 2003, Emons et al., 1992, Acheson et al., 1980).
Monitoring gas exchange over the course of an activity is a complicated process that
frequently involves using gas exchange monitoring systems e.g. Douglas Bag. It is
usually carried out in a controlled laboratory environment. These methods are
complex and unsuitable for use in field investigations.
A correlation exists between oxygen consumption (VO 2 ) energy expenditure
(EE) and heart rate values. Heart rate has a linear correlation with oxygen
consumption (VO 2 ) when partaking in moderate to strenuous activities and in
dynamic exercise using large muscle groups (Crouter et al., 2004, Freedson and
Miller, 2000, Åstrand and Rodahl, 1986). The linear relationship becomes less
accurate with increased intensity of activity. Experiencing stress, smoking and
consumption of alcohol or caffeine affects the accuracy of the linear relationship
(Kenney et al., 2011, Wilmore et al., 2008, Birch et al., 2005, McArdle et al., 2000,
Astrand and Rodahl, 1986).
Monitoring heart rate is frequently used in ergonomic assessments. It is used
to evaluate physiological demand of activities and establish safe working conditions
with respect to the capacity of the workers involved (Boschman et al., 2011, Maiti,
2008, van der Molen et al., 2007, Faulkner et al., 2007, Anton et al., 2005, Tiwari et
al., 2005, Abdelhamid and Everett, 2000, Strath et al., 2000, Fairbarn et al., 1994,
Astrand and Rodahl, 1986).
Heart rate monitors are used during training and exercise programs to indicate
the intensity level of activities and to monitor levels of fitness. They are also used in
a variety of environments and activity conditions to record cardiovascular activity,
estimate EE and to determine physical workload (Achten and Jeukendrup, 2003,
Janz, 2002, McArdle et al., 2000). They are simple to use, low cost, and non-
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invasive. Polar™ Heart rate monitors have been shown to be a valid method of
gathering heart rate data with an accuracy of ± 1% (±1 beat/minute) (Laukkanen and
Virtanen, 1998).
As heart rate is unique to an individual and it is influenced by a variety of
conditions, it is important that variables be controlled during assessments. Subjects
should eat a light meal and avoid consuming alcohol, stimulants, caffeinated
substances, and smoking for a minimum of two hours prior to the assessment
(Benson and Connolly, 2011, Hottenrott, 2007).
To enable accurate comparisons between individuals a reference value
(normalised value) should be used to evaluate changes in heart rate and calculate
energy expenditure. HR-VO 2 relationships should be determined for each individual
(Hottenrott, 2007, Achten and Jeukendrup, 2003, Janz, 2002, Strath et al., 2000,
Burke and Burke, 1998). Polar™ Heart rate monitors have a simple and easy to use
fitness test option (Polar Fitness Test™ OwnIndexTM). Based on the subject’s
personal details of gender, age, weight, height, and activity level (ranked Low,
Moderate, High, and Top) the monitor detects changes in the subject’s HR rest and
heart rate variability at rest to establish cardiovascular fitness (VO 2max ).
The most accurate method of determining HR max requires clinical
measurement with individuals exerting maximum effort in a stress test on a treadmill
or bicycle and monitored by a specialist such as a cardiologist. Alternatively, HR max
can be predicted simultaneously when determining VO 2max in the OwnIndex test.
VO 2max and HR max determined from the OwnIndex test (Polar™ Heart rate monitors)
has reasonably high association with data gathered in laboratory examinations
(Karavirta et al., 2008, Hottenrott, 2007, Crouter et al., 2004, Janz, 2002).
Ideally, the Polar Fitness TestTM and recording HR rest should be carried out
upon first waking in the morning when a person is lying down at rest without recent
previous exertion. Alternatively, HR rest can be recorded with the subject lying down
without moving in a quite room without being disturbed. The monitor can then be
used to evaluate HR changes for an assessment condition using their VO 2max value.
To ensure accuracy of data and continuity of results within and between subjects the
Polar Fitness TestTM should be carried in the same testing environment, under the
same conditions, and at the same time of day. For example, subjects should be in a
prone position lying unmoving and undisturbed in a quiet room with a comfortable
temperature for the duration of the test.
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Polar™ Heart rate monitors also have an energy expenditure test, OwnCal
that calculates energy expenditure in kilocalories (kcal). It is calculated based on
body weight, height, age, gender, HR max and HR task .
2.12.4 Psychophysical Assessment Methods
Self Reports
Self-reporting methods such as questionnaires, scales, interviews, and diaries
are used to collect information directly from participants on their subjective
perception and opinion (Li and Buckle, 1999c).
The methods are usually simple and easy to use, and are suitable for use in a
wide variety of working environments. They can be distributed to large sample
populations and gather a snapshot of information or information over a long period.
The accuracy of data gathered can be somewhat affected due to variables in the
population sample i.e. personal biases, comprehension of questions, capacity to
follow instructions and literacy. Data output is not absolutely quantifiable.
Questionnaires and symptom surveys are frequently used in a wide variety of
settings. They are relatively inexpensive methods to obtain a broad spectrum of data,
information, and subjective opinions. (Burgel et al., 2010, Lee et al., 2008, Ramadan
and Ferreira, 2006, Grant et al., 1999, Karasek et al., 1998, Kuorinka et al., 1987).
They can be self administered or used in conjunction with interviews and maintain
participant anonymity. They require careful design and structure to reduce the
probability of input bias (Moule and Hek, 2011, Brace, 2008, Denscombe, 2007,
Saris and Gallhofer, 2007, Sarantakos, 2005, Wendel-Vos et al., 2003, Creswell,
2003). When combined with interviews the volume of data acquisition increases and
the information can assist in identifying areas where intervention strategies are
required. Newly designed or modified questionnaires can be tested and validated
prior to being used in a research study to ensure accuracy of data (Coluci et al., 2009,
Sendir and Acaroglu, 2008, Cramer et al., 2002)
The disadvantages of questionnaires, according to Sarandakos (2005) are that
the response rate is generally low and there is little control over how subjects answer
the questions. In ergonomic evaluations questionnaires such as the standardised
Nordic Musculoskeletal Questionnaire (NMQ) are used to evaluate incidences of
WRMSDs in a population (Christensen and Knardahl, 2010, Solidaki et al., 2010,
Raanaas and Anderson, 2008, Kuorinka et al., 1987).
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A variety of linear scales e.g. Borg (Borg and Borg, 2002, Borg, 1978),
Likert Scale, and the Visual Analogue Scale (VAS) are available to evaluate
perceived sensations. Generally, linear scales are of a fixed length and of uniform
thickness. Verbal markers and/or numerical markers are anchored at opposite ends
that correspond with intensity values e.g. 0/No Pain and 5/Extreme Pain. Subjects
are required to mark the scale to represent the degree of their perceived intensity of
sensation. The linear measurement from the left anchor point (zero sensation) to the
subjects’ mark represents the magnitude of the sensation. The markers are re-labelled
when monitoring other sensations e.g. discomfort.
Scales can be horizontal or vertical and contain different scale ranges (Du
Toit et al., 2002, Grant et al., 1999, Neely et al., 1992). The Borg scale has values
from 1 to 10 to indicate perceived level of effort. VAS generally ranges from zero to
100 to indicate the magnitude of a range of perceived sensations. Additional
numerical or verbal increments at fixed intervals along the scale may also be
included to guide subjects when marking them.
Huskisson (1983) found VASs easy and inexpensive to use, suitable for
monitoring a range of subjective sensations, and that they were used in variety of
social and behavioural environment to estimate exertion, pain, and discomfort. VASs
which measure discomfort in body areas are frequently used in a variety of working
environment assessments to evaluate WRMSD risk factor exposure. These are
referred to as Visual Analogue Discomfort Scales (VADS) (Beling, 2009, Nugent
and Fallon, 2009b, Cameron, 1996).
Body maps are used to assist subjects in identifying the body areas that
experience symptoms. They are pictorial representations of the human body with
body areas sectioned off and occasionally labelled. It is recommended that body
maps accompany VAS to guide subjects in identifying specific body area locations
(Kuorinka, 1983, Corlett and Bishop, 1976).
Many researchers to evaluate WRMSDs use combinations of questionnaires,
VADS, and a body map. The combined system is found to be reliable and valid in
documenting the intensity of pain and discomfort (Björkstén et al., 1999) and require
a relatively small sample size to demonstrate statistically significant inter-group
differences (Singer and Thode Jr, 1998).
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2.13 Conclusion
In this chapter, definitions for MSDs and WRMSD are provided. The
development of WRMSDs is discussed to demonstrate its complex aetiology and to
establish that many variable factors can potentially contribute towards their
development.
The human body systems are described to demonstrate how they interactively
behave to facilitate physical activity. Homeostasis of the musculoskeletal system and
the cardiovascular system become increasingly disrupted when partaking in physical
activity. The physical sensations associated with the disrupted homeostatic balance
are psychologically perceived as sensations of aches, pain, and discomfort. Increased
biomechanical, physiological, and psychophysical stresses indicate exposure to
WRMSD risk factors and indicate an increased risk of developing the disorders.
A selection of controls and interventions are described to demonstrate the
various approaches and strategies available to potentially reduce the incidence of
WRMSDs. Implementing various combinations of these strategies can help to reduce
the subsequent impact that workers, their families, employers and the economy
experience because of WRMSDs.
Finally, a selection of assessment methodologies used to evaluate WRMSD
risk factor exposure are described.
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Chapter 3: Factors Influencing the Presence of WRMSD Risk Factors
Chapter 3. Factors Influencing the Presence of

WRMSD Risk Factors
3.1 Introduction
In the previous chapter, the complex aetiology of WRMSDs was described
demonstrating that workers who are exposed to WRMSD risk factors are at greater
risk of developing disorders.
In this chapter, the findings from a literature review are examined to identify
how and why WRMSD risk factors are introduced in to the workplace. The
construction industry, the stakeholders involved in construction projects, the
construction project lifecycle, and decision-making influences are described to
demonstrate how their complex interaction can result in WRMSD risk factors being
introduced into the construction phase of a project.
In the final section of this chapter, the work practices and policies that are an
intrinsic part of the Irish construction industry are described to highlight how
WRMSD risk factors may be introduced into the construction phase of a project.
3.2 Accident Taxonomies

The literature review in the previous chapter demonstrated a cause and effect
relationship exists between exposure to WRMSD risk factors and the subsequent
development of WRMSDs.
Researchers recognise that a cause and effect relationship exists between risk
factors and unwanted accident events. They developed a variety of taxonomies in an
attempt to understand the cause/effect relationship, and to identify what risk factors
can contribute to an accident event occurrence. An outline of two accident causation
taxonomies are presented below to demonstrate how risk factors are potentially
introduced into work environment scenarios. An accident may be defined as:
“an unplanned, unexpected, and undesired event or sequence of events that

result in an unwanted and negative outcome such as property damage, injury, or
death” (Reese, 2012, Doytchev and Szwillus, 2009).
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An incident, on the other hand may be defined as a near miss in which a

control or intervention in place prevented a negative outcome or resulted in a
significant reduction in the severity of the potential outcome (Reese, 2012, Doytchev
and Szwillus, 2009).
Researchers recognised that accidents are rarely caused by a single event or
risk factor. Instead they believe that risk factors are introduced as a consequence of a
sequence of events that are usually separated from the accident event by time and
location (Manu et al., 2010, Choudhry and Fang, 2008, Elvik, 2006, Gibb et al.,
2001, Abdelhamid and Everett, 2000, Shappell and Wiegmann, 1997, Rasmussen,
1997, Reason, 1995). Implementing intervention and control strategies earlier in the
sequence should in theory prevent the end-event occurrence or reduce the severity of
the outcome (Gambatese et al., 2008, Bellamy et al., 2008, Cozzani et al., 2007,
Carter and Smith, 2006, Abdelhamid and Everett, 2000, Johansson et al., 1998).
In Heinrich’s (1931) domino theory, the accident event sequence is likened
to a row of five dominos. Each domino represents a person or situation that
contributes to an unwanted and negative outcome. The failure of a preceding domino
affects the next domino in the sequence and so on (Figure 9).
Ancestry and social Unsafe Act/ Injury/

Fault of person Accident
environment Condition Death/Loss
Management Unsafe work
Person
Organisation Attitude skill practice Unwanted
Product
Safety culture knowledge Unsafe working event
Equipment
conditions
Figure 9: The Domino Theory adapted from Heinrich (1931)
Intervention, in which one of the dominos (contributing event) is removed

should in theory prevent the cascade of dominos and therefore prevent the final event
(accident) (Casal, 2007, Shappell and Wiegmann, 1997). Heinrich identifies the
initial contribution as ancestry and social management, which may include factors
such as management organisation and safety culture. The next cause is the fault of a
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person, and the primary preceding causes to the accident event is unsafe acts and/or
unsafe conditions. The latter may be attributed to human factors (human error),
behavioural factors, and the decision making process (Heinrich et al., 1980).
Error (or failure) may be defined as an unintentional or intentional mistake
attributed to one’s poor judgement, lack of awareness, decreased alertness,
insufficient knowledge, personal belief system, or perception of a given situation
(Choudhry and Fang, 2008, Bellamy et al., 2008, Carter and Smith, 2006,
Abdelhamid and Everett, 2000, Reason, 2000, Guldenmund, 2000, Reason, 1995).
An error may be a result in an inappropriate behavioural response or an unsafe
environmental condition response. Many factors can influence the likelihood that a
decision output is an error (Cassar and Craig, 2009, Stanovich and West, 2008, Jonas
et al., 2008, Juliusson et al., 2005, Acevedo and Krueger, 2004, Chinander and
Schweitzer, 2003). Examples include:
• The decision maker’s quantity and quality of knowledge, information,

training and understanding about the subject matter being decided upon
• The decision maker’s previous experience in dealing with the subject matter
being decided upon
• The capacity of a decision maker to make decisions i.e. the level of attention
or awareness of a situation
• Decision maker’s personal biases, motivation, or perception
• The level of importance and emphasis a decision maker places on their
personal work
Potential failures (errors) that can result from a decision outcome include:
• Failure to understand how a decision outcome will influence the magnitude of

risk to self or others particularly when separated by location or time
• Failure to identify potential risk factors in the workplace at all phases of a
projects lifecycle
• Failure to understand the potential risks associated with risk factors in the
workplace
• Failure to identify suitable controls and interventions to reduce risk levels
associated with risk factors
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• Failure of communication or cooperation between stakeholders in transferring

information about risk factors, risks or controls generated from their decision
output
• Failure to consider alternative options e.g. new technology, materials,
mechanised aids, scheduling, and drawings
Reason (1990) likens accident causation to a row of slices of Swiss cheese.

Errors from a preceding event pass through the ‘holes’ in subsequent events creating
a hazardous situation. However, if controls or recovery interventions are in place
(holes are blocked) a risk factor can be eliminated, or the magnitude of risk can be
reduced. He refers to unsafe acts (behaviour) that occur immediately prior to a
negative event as an active failure (error). An unsafe acts (or decision) that results in
unsafe conditions (or unsafe acts) in later events are referred to as a latent failure.
Latent failures occur at a different time or location prior to the unwanted event
(Reason, 2000).
In a decision making process that occurs at an early stage in the lifecycle of a
construction project e.g. at the planning phase, an active error made by decision
makers introduces latent errors into a later phase of a project’s lifecycle.
An adapted diagrammatic representation of Reasons Swiss Cheese Model is
presented in Figure 10. Implementing controls can eliminate a risk factor or reduce
the level of risk in the event that unsafe decisions have occurred. The magnitude of
risk at the end event is determined by the level of success or failure to recognise risk
factors and implement controls.
Schönbeck et al., (2010) adapted Reason’s (1997) model (Figure 11). The
figure descriptively demonstrates that the introduction of latent errors can result in
unsafe acts or conditions, and subsequently introduces risk factors into the
workplace. Inadequate or failure to implement defences or control measures
subsequently results in losses (e.g. WRMSDs).
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WRMSD
Risk
Controls & Intervention Strategies to Eliminate WRMSD Hazards or

Reduce Risk Associated with WRMSD Hazards
Potential WRMSD Risk factors e.g. Outcome from prior decision making
processes leading to Unsafe Acts, Unsafe Conditions
WRMSD Risk reduction
Figure 10: Swiss Cheese Model of Accident Causation

Adapted from Reason (2000)
Figure Removed for copyright purposes
Figure 11: Model of Organisation Accidents

(Schönbeck et al., (2010) Adapted from Reason (1997)
In the aforementioned accident definition, an ‘unwanted and negative

outcome’ is defined as property damage, injury, or death. An example of a ‘negative
and unwanted injury outcome’ can be WRMSDs. While WRMSDs can be the
resultant outcome from a single accident event (slip/trip incident), they often develop
~ 67 ~
over a prolonged period in which workers experience an accumulation of minor

injuries as a consequence being exposed to repeated accident events.
3.3 Complex Interactions of Stakeholders in

Construction Projects
In this section, the lifecycle stages of construction projects are described,
stakeholders involved in projects are identified, and an outline of their
responsibilities are presented. Stakeholders are involved in complex decision making
processes throughout a project’s lifecycle. The factors that influence decision-
making processes are described to demonstrate how complex interactions between
stakeholders throughout a projects lifecycle can potentially introduce WRMSD risk
factors into the construction phase of a project.
3.3.1 Lifecycle Phases of a Construction Project

Construction projects are generally unique once off processes with a specific
objective or outcome i.e. to erect a new building, modify an existing building,
provide infrastructure (road, bridge). All projects however have a similar lifecycle or
series of phases through which a project will evolve. Generally, an owner/client
contacts designers/architects with a proposal for a project. The designer, in
consultation with the client creates a schematic representation of the proposed
project. The project is usually tendered out to potential contractors and construction
companies and the successful candidate manages the construction of the project
(Behm, 2005, Gangolells et al., 2010, Gambatese et al., 2008, Succar, 2009, Bennett,
2012). Each project, and each phase within that project, involves different
combinations of stakeholders, and involves multiple decisions. The five primary
phases of a construction project detailed below are presented Figure 12 (Westland,
2007, Fewings, 2005, Chitkara, 2002, Loosemore, 2003, Woodward, 1997).
Concept Design Planning Tender Construction

Phase Phase Phase Phase Phase
Figure 12: Lifecycle Phases of a Construction Project
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Concept Phase
All construction projects have an ‘owner’ (client) who conceives an idea of a
product with respect to its structural appearance and end-use functionality. During
the concept phase, the client weighs up potential positives and negatives of a
conceptual product. They estimate the potential costs and resource requirements
based on the long-term strategic goals and objectives. Generally, the processes
required to complete a project are identified but the details and persons responsible
are not considered at this early stage. Options are considered, and subsequently
eliminated or selected based on their level of added/negative contribution value,
potential benefits/weaknesses, and financial costs.
At the end of the concept phase, the client(s) have decided upon the goals,
objective, and scope of a finalised project, its appearance and structure, potential
costs involved in achieving the desired goal, and a potential time frame. Before
commencing to the next phase, the client must appoint a competent Project
Supervisor for the Design Process (PSDP).
The purpose of this phase is to collect and understand business requirements,
detail the project plan, and agree upon a high-level statement of work. This phase
identifies the project’s primary objectives, assumptions, constraints, deliverables and
acceptance criteria.
Design Phase
The client(s) transfer their thoughts and ideas settled upon during the concept
phase to a design team. The design team transpose these thoughts and ideas into
schematics and drawings while taking into consideration any applicable safety,
building and environmental requirements.
The PSDP is responsible for managing and overseeing the design phase
usually in consultation with the client. Decisions are finalised at this stage with
respect to the dimensions of the structure and properties of materials (dimensions,
material composition, and aesthetics). Once a planning authority approves plans and
drawings, the project goes through a tendering process.
Tender to Contract Phase

In the tender phase of a project, the project client(s) or their representative,
seeks a general contractor/construction company to manage and complete the
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construction stage of a project. The general contractor may in turn tender elements of
the construction work to sub-contractors.
Contractors are supplied with documents such as designer’s drawings, legal
and building regulation requirements, preferences with respect to occupational health
and safety, and details on finance and scheduling requirements. Potential contractors
develop a tender document for the client outlining how they propose to complete the
construction phase. It will include information such as:
• Scheduling details of activities and workforce participation – a proposed

schedule outline with optional bonuses or penalties if deadlines are/are not
achieved
• Knowledge of legal and planning regulations etc. and the measures that will
be implemented to meet these requirements
• Financial aspects of the construction stage – the tender applicant outlines a
proposed costing of the project detailing construction and construction related
costs and potential profit
• Facility, material, plant and machinery requirements – what is required,
quantities required, suppliers details, unit costs, particulars with respect to
meeting legal and building regulations, and standards and codes of practice.
• Workforce – skills required, numbers required and when they will be required
• Information about previous contracts completed
• Safety and risk management plan
• Quality management plan
• Documentation Management plan
Successful candidates may win the contract based on factors such as having
submitted the lowest bid offer, quality of previous work, their health and safety
record, their record in meeting schedule deadlines or for completing projects within
budget. The criterion used in offering the contract is dependent on the desire of the
client, and possibly the designers.
Before commencing to the next phase, the client must appoint a competent
Project Supervisor for the Construction Stage (PSCS) who is responsible for
managing and overseeing the construction phase.
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Planning Phase
A number of stakeholders are usually involved in the planning phase of a
project, primarily the client, accountants, design engineers, and architects. Each
stakeholder has different roles, responsibilities, training, knowledge, experience, and
personal desires with respect to the project. If the project involves a tender to
contract phase the parties who apply for the tender will also initiate a planning phase.
The planning process is initiated prior to submitting for tender and is finalised when
they win a tender application.
In the planning phase, decisions are made with respect to allocation of
finances and resources. This will directly influence aspects of a project such as
scheduling of activities, the selection of materials tools and equipment, and the
potential workforce who will be involved in the project. The resultant decision
outcome is the cumulative capacity of each stakeholder’s ability to make effective
decisions. It is the quality and quantity of the shared information and knowledge that
will influence the safety performance in later phases. With respect to this project, it is
the stakeholders understanding or lack thereof about WRMSD development and
prevention that will influence the presence of risk factors and the magnitude of risk
during the construction phase.
Construction Phase
The Project Supervisor for the Construction Stage (PSCS) is responsible for
managing and overseeing the construction phase of a project. A single primary
contractor, upon successful application of a tender, manages the construction of a
project. The primary contractor may directly employ a full workforce on a full-time
or part-time basis to complete a project without external employment. Alternatively,
elements of the project are sub-contracted to specialist trade workers who are
employed solely for the duration taken to complete specialised work activities.
Plastering is among the specialist activities that can be sub-contracted. The
primary contractor manages all elements of construction activities throughout the
construction phase whereas sub-contractors are involved for a specific element or
period within of the construction activity e.g. plasterers carry out their activities after
a structure has been erected.
Generally, the top-level stakeholders have made all decisions prior to the
commencement of the construction phase. The unique characteristics of each project
~ 71 ~
and the stakeholders involved will influence the safety management strategies used
by contractors, sub-contractors and throughout the hierarchy of construction workers.
3.3.2 Stakeholders Involved in Construction Projects

There are many stakeholders involved throughout the lifecycle of a
construction project. Under the Safety Health and Welfare legislation and
Construction Regulations each person has specific roles and responsibilities to
implement measures “as far as is reasonably practicable” to ensure the safety of
persons who interact with the construction activities. The core duties impose a duty
of care to provide a safe place of work, safe system of work, safe facilities, plant and
equipment, and a competent workforce. In addition, each stakeholder must be
deemed to be competent. The Safety, Health and Welfare at Work Act 2005 defines a
competent person where :
“Having regard to the task he or she is required to perform and taking

account of the size or hazards (or both of them) of the undertaking or establishment
in which he or she undertakes work, the person possesses sufficient training,
experience and knowledge appropriate to the nature of the work to be undertaken.”
The stakeholder’s duty of care focuses of ensuring the wellbeing of workers

and the public entering a site during the construction phase of a project. Workers
involved in construction projects should be provided with the necessary training,
information, and supervision to ensure the safety of other employees and to
themselves. The following section outlines duties of care for primary stakeholders
involved in a construction project the client, project supervisors, designers, and
contractors.
Client
The Safety, Health, and Welfare at Work (Construction) Regulations, 2006
defines a 'client' as:
“A person for whom a project is carried out, in the course or furtherance of a

trade, business, or undertaking, or who undertakes a project directly in the course or
furtherance of such trade, business, or undertaking”.
The primary role of the client in a project is to:
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• Communicate their ideas to others with respect to their desired outcome of a

completed project
• Outline the processes on how the end-project will be achieved
• Provide financial support to enable completion of the project
The client has a duty of care to ensure the project will meet occupational
health and safety legislation, end-user health and safety (building codes, standards
and legislation), and environmental legislative requirements during the building
process and throughout the lifetime of a structure including maintenance and
demolition. It is a rare occasion when a client has the skill, knowledge, and expertise
to manage all aspects of a building project. Clients are thereby compelled to seek the
appointment of a competent person(s) to accomplish the task. Construction
regulations require the appointments of a PSDP and PSCS at the commencement of
the design phase and construction phase respectively to assume the managerial role
for the project.
Project Supervisor for the Design Stage (PSDP)

Appointed by the client before commencement of the design phase, the
primary role of the PSDP is to manage the health and safety aspects of a project in
design phase of the project. The PSDP must perform a prospective risk assessment of
the lifecycle phases of the proposed project to identify potential risk factors that may
occur due to planning issues, organisational issues, scheduling issues, working
conditions, work environments, maintenance activities, and demolition activities. A
hierarchy of controls based on the general principles of prevention in the Safety,
Health, and Welfare at Work Act 2005 should be used as basis to eliminate or reduce
risks associated with each risk factor.
The PSDP is responsible for communicating the findings and conclusions of
the risk assessment along with recommended control measures to eliminate or reduce
risk level for each identified risk factor to the design team. They initiate the
development of the project safety file, a collection of all the projects safety
documentation. They manage the development of the safety file and on completion
of the project deliver the completed file to the client. In addition, they prepare a
preliminary safety & health plan when construction takes more than 500 person days
or 30 working days or there is a particular risk.
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Generally, a firm of architects, chartered surveyors, consulting engineers or

project managers is appointed as a PSDP. Firms may employ a multi-disciplinary
engineering and specialist team.
Designer/Architect
Designers, under the direction of the client and the PSDP, develop complex
diagrammatic three-dimensional schematic drawings of the desired structure.
Projects of greater complexity require ‘layers’ of drawings to ensure all aspects of
the structure is represented in minute detail.
The layered drawings represent the sequence of construction phases where
each phase must be completed prior to commencing the next phase. Separate
drawings are also used to represent specific structures such as piping, ductwork,
access routes, and sewage systems.
The drawings and diagrams are used to scale and locate the structure.
Management and project supervisors use the diagrams as a basis to establish the
planning and scheduling of activities, determine appropriate numbers of a desired
skilled workforce, determine materials, plant and equipment requirements, and
determine budget requirements. Detailed knowledge is required when transposing
drawings and diagrams into a physical structure to reduce the probability of an
unstable and unsafe structure. The responsibilities of the designer include:
• Applying the general principles of prevention (Safety, Health, and Welfare at

Work Act 2005) to eliminate or reduce risks associated with risk factors in
the design.
• Co-operate and communicate with project supervisors to ensure all parties are
aware of risk factors, risks and controls
• Assist in the development of safety documentation e.g. Safety and Health
Plan or Safety File
Project Supervisor at the Construction Stage (PSCS)

The PSCS is appointed before the construction work begins and remains in
that position until all construction work on the project is completed. They are
responsible for managing and co-coordinating health and safety matters during the
construction stage. They must co-ordinate and cooperate with the PSDP and
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contractors to develop the projects safety file and the safety & health plan. During
the construction phase they must employ measures to ensure the safety health and
welfare of the workforce and any persons who may enter the construction site. This
includes managing contractors and sub-contractors with respect to:
• Risk assessments and risk management

• Training and training document management (SafePass, CSCS,
Accident/Incidents)
• Managing communication and co-operation between parties
• Supervision of construction activities
• Inspection of construction activities and plant and equipment
• Reporting accidents to the Health and Safety Authority
• Monitoring working procedures
• Appoint full time Safety Advisor if there are over 100 employees on site, and
co-ordinate the appointment of a site safety representative where there are
more than 20 persons on site
Contractor
A contractor is any employer whose employees carry out construction work
and includes both main contractors and sub-contractor. The main contractor is the
successful applicant in the tender process and is responsible for the management and
completion of the structure. The main contractor employs sub-contractors. Generally,
sub-contractors, who may be self-employed, are usually trade workers such as
electricians, or plasterers. The duties of the sub-contractors who are employed for the
duration it takes to complete their activity include:
• Coordination and co-operation with the PSCS to manage occupational health

and safety matters
• Provide the PSCS with relevant information for the safety file
• Develop a site specific safety statement and provide a copy for the PSCS and
all employees
• Comply with all site wide safety rules and requirements
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• Ensure all employees are appropriately trained and comply with site wide
safety rules and requirements
• Appoint a safety officer where there are more than 20 on site or 30 employed
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3.3.3 Decision Making Processes

Managing construction projects is a complex issue with input from multiple
stakeholders at each phase in a projects lifecycle. The decision-making process is a
complex mental process and each person has varying abilities to make effective
decisions.
In decision-making, information is input into the brain where it is processed
and referenced against stored information in the brain (Processed and Transformed).
Upon processing the information, options are considered, and a decision outcome is
selected. A schematic diagram representing the decision making process is presented
in Figure 13.
Processing/
Input Output
Transformation
Storage
Feedback
Figure 13: Basic Decision Making Process
Stakeholder’s decisions are influenced by their unique wants and needs with
respect to end-project requirements, phase goals, and personal preferences. Every
decision output from each stakeholder is influenced by the quality and quantity of his
or her information and knowledge (stored information –reference material). This is
acquired through training, education, work history and life experiences; a unique
experience for each person.
Many types of information influence the decisions made by stakeholders.
Examples include legislative requirements, planning requirements, and availability of
technology and equipment. It is the quantity and quality of the individual’s
knowledge and information of appropriate subject matter that influences decision
outcome. In Figure 14, an outline of the factors that potentially influence the quality
and quantity of stored information and knowledge is presented.
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Types of Information Information

Transfer
• Manufacturers/Suppliers/ Training
Manuals etc Education
Stakeholder’s
• Alternative Technology Experience
• Alternative Equipment
• Alternative Materials • Strategy used in

• Qualification Quantity &
• Planning options information
• Skills Quality of
• Legislators/Planning retrieval, storage
• Knowledge Stakeholder’s
Authorities/Legislation/ & management
• Competency Information &
COP/Standards • Sources of
• Awareness Knowledge
• Building Requirements information
• Confidence
• Environmental • Ease of access
• Bias
Requirements • Quantity of
• Occupational Health & information
Safety Requirements • Quality of
• Hazards, Risks, Controls information
Feedback
Figure 14: Factors That Influence the Quality and Quantity of a Stakeholder’s
Store of Information and Knowledge
• Qualifications • Personality
• Skills • Intelligence
• Attitude
• Knowledge • Role & Action,
• Perception
• Competency Responsibility Condition
• Motivation
• Risk awareness • Task Demand or Opinion
• Behaviour
• Confidence • Wants & Needs
• Bias • Level of Control
Feedback
Figure 15: Individual Factors that Influence Decision Outcome
The subsequent decision outcome is dependent on a person’s unique

perspective and personal bias towards information and knowledge, and their capacity
to make a decision. In Figure 15, an outline of individual factors that can potentially
influence the decision outcome is presented.
The decision making process is highly complex and a vast array of factors the
influence the final decision outcome. Each decision output is unique to the
individuals making the decision. Potentially when multiple persons are involved in a
decision making process multiple decision outcomes are possible.
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3.3.4 Stakeholders and Decision-Making in a Project Lifecycle

Workers involved in the construction phase of a project experience WRMSDs
due to their exposure to WRMSD risk factors. Accident causation taxonomies
indicate that preceding factors to an unwanted event contribute to the occurrence of
that unwanted event (WRMSDs).
The earlier phases of a projects lifecycle involves long-term strategic
decision-making to achieve an overall project goal which may take a number of
months or years to achieve (Pinto and Slevin, 2008). In construction, the goal is
usually to erect a completed functional structure within a desired timeframe and
within budget. In this case, strategic decisions are made by the primary stakeholders
of a project at the higher levels in a hierarchy of key stakeholders. They determine
what the key objectives are in a project, and the key factors required to achieve a
project’s objective e.g. structure, resources, finance, selection of upper management
personnel, and tender requirements. The stakeholders likely to be involved in the
project’s strategic planning include the client, PSDP, designer, architects, PSCS,
contractor, and accountants. In the tender process, contractors and sub-contractors
will be involved in their own strategic planning as they enter into a project with
respect to their role and responsibilities for that project. In addition, each phase of a
project involves strategic planning to achieve the phase’s objective.
Tactical decision-making generally involves the stakeholders in the mid-level
of the organisational hierarchy or it occurs within the mid-range of a lifecycle phase
(Pinto and Slevin, 2008). The decisions at this stage relate to shorter-term sub-
objectives/sub-goals of a project i.e. the targets or tasks that are required sequentially
or simultaneously to achieve the projects overall goal. The timeline for tactical
decision-making is generally weeks to months. Decisions may include developing
policies and procedures, determining resource requirements, acquisition of resources,
planning and scheduling, selecting suppliers, material and plant selection, and the
logistical requirements for ordering and storage of purchased items.
Operational decision-making deals with the short-term hourly/daily/weekly
operational aspects of construction activities (Pinto and Slevin, 2008). The
stakeholders involved are generally the middle management, contractors, sub-
contractors, and workers. Decisions may include monitoring and supervision of
construction activities, identifying and rectifying problems, accident and incident
investigation, inspections, documentation management, safety and risk management,
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and the distribution of materials on site. As the project proceeds through its lifecycle
phases the decision making process moves from strategic to tactical to operational.
A timeline diagrammatic representation of the stages in a project lifecycle,
the type of decisions made within each lifecycle phase, and the stakeholders who
potentially input into the decisions within the phases is presented in Figure 16. In
addition, the bodies who potentially influence the decision making process are
represented.
Pre-Concept Concept Design Planning

Tender Phase Construction Phase
Phase Phase Phase Phase
Strategic Decision Making Tactical Decision Making Operational Decision Making
Suppliers Client
Financial Managers
Quality Managers
Planning
Authority PSDP PSCS
Health &
Safety Primary Contractor
Authority
Safety Managers
Subcontractor
Subcontractor Subcontractor
Legislator Subcontractor
Figure 16: Decision Making in a Project Lifecycle
Multiple stakeholder involvement in decision making can potentially increase

the likelihood that WRMSD risk factors will be introduced. The decision outcome
from all stakeholders will determine the magnitude of WRMSD risk during the
construction phase. A diagrammatic representation of the complexity of the decision-
making processes is presented in Figure 17 (next page). In addition to
communication and cooperation between stakeholders, factors that influence multiple
stakeholders decision-making include:
• Individual factors e.g. roles & responsibility, training & qualifications, task
demand, bias and motivation etc.
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• Organisational factors e.g. safety culture, management systems, and resources

available etc.
• Regulators and Suppliers e.g. legislation, available products, training
programs etc.
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Figure 17: Stakeholders Decision Making Processes – Influence Presence of WRMSD Risk Factors
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3.4 Decision Outcomes - Working Practices in the

Irish Construction Industry
Decision making by stakeholders in the earlier stages of a project’s lifecycle
determine systems of work and working conditions, which may be hazardous to the
health of workers or may introduce WRMSD risk factors. This section describes the
different systems of work and working conditions that are an intrinsic part of the
Irish construction industry. An outline of existing work methods policies and
practices are described to demonstrate how WRMSDs risk factors that plasterers may
be exposed to are potentially introduced.
3.4.1 Plastering Activity

The title of plasterer is used in Ireland to apply to individuals who carry out
finishing activities after structures are erected. Finishing activities may be
categorised into three areas, Flooring, Drylining/Plasterboard, and Wet-plastering.
Plasterers in Ireland are generally trained in all three finishing activities but generally
specialise in only one of them. Less skilled plasterers frequently carry out sub-task
elements of a finishing activity e.g. mixing plaster, or preparing surfaces. The
volume of work required, the number of plasterers employed, and the experience or
skill of a plasterer can influence the type of task/sub-task undertaken by plasterers.
In the flooring process, a wet-plaster/cement mixture is applied to a floor
surface and plasterers create a desired textured finish.
In the drywall/plasterboard process, gypsum boards are measured and cut to
shape, before using adhesive, nails, or screws to fix then on to internal surfaces.
Joints between the boards are taped before using a trowel to fill in joint spaces and
nail and screw depressions, and remove excess plaster. Sufficient quantities and coats
of a plaster mixture is applied to fill the joint space and to ensure a continuous
smooth level surface without the appearance of seams. This may require sanding of
the joints once the plaster mix has dried. A single operator may complete the full
process or the task separated into its sub-tasks that are carried out by different
individuals. Plasterers who carry out this process are referred to as drywall handlers,
tapers, and fillers. Because of the size and weight of the boards used, additional
workers usually assist in manoeuvring and holding boards in position while fixing
them onto surfaces. Aids are available to aid lifting, positioning and fixing boards to
ceilings. The drywall/plasterboard process is generally performed to meet
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fireproofing and noise reduction requirements as well as for aesthetic purposes.

Boards can be left unfinished or coat(s) of wet-plaster may be applied.
Wet-plastering is the process of applying one, two, or three coats of a wet-
plaster compound onto wall or ceiling surfaces to create a desired smooth or textured
finish. Surfaces can be internal or external and constructed from brick/block, timber,
plasterboard, or a supportive wire mesh. Once surfaces are prepared, a smooth
cement like mixture is prepared by the plasterer or a plasterer’s assistant. Ratios of
water, sand, cement, and plaster are mixed to a desired consistency. The composition
used is dependent on factors such as the material of the surface being plastered,
whether the structure is internal or external, environmental and weather conditions,
which coat is being applied, desired noise and fireproofing requirements, and the
desired aesthetic appearance. Usually electronic mixers are used but occasionally
plaster may be mixed using a manually powered mixer. The prepared mixture is
loaded onto a mortarboard that usually sits on an elevated surface that can vary in
height depending on the workstation set-up used by the plasterer. Generally, a
mortarboard stand is used on which the mortarboard is placed. The stands vary in
height, may be of fixed height, or can be adjustable. On some sites, plasterers,
instead of using stands, rest mortarboards on blocks, trestles, or barrels.
A trowel or float is used to load the mixture from the mortarboard onto a
hawk and to apply the mixture onto surfaces to create a coat with a desired textured
finish and depth. In a three-coat scenario, the first coat is referred to as a scud coat. It
is a coarse roughly scratched coat applied to support and hold subsequent coats. A
base coat (brown coat) and a finish coat (white coat) are applied in subsequent layers
allowing time to dry between applications. Different techniques are used for each
coat application. For example, plasterers will mix different compositions and
consistencies of plaster mix, sponge or spray additional water onto plastered surfaces
to achieve or maintain a desired viscosity, use different sized trowels, and floats,
adjust arm movements, and apply variables of force.
3.4.2 Plastering Working Conditions

The following pre-determined working conditions which plasterers have little
or no control over are commonly found on construction sites prior to plasterers
commencing their activity.
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Project Variation
Construction projects range from small low budget renovations on private
dwellings to multi-million euro speciality projects. Projects, regardless of size have
similar lifecycle phases. Each type of construction project requires different
management strategies, resources, skill sets, work force, machinery, equipment,
tools, and materials, etc. Subsequently each project has a unique set of risk factors,
risks, and potential accident, injury and illness outcome. Generally, larger projects
are more complex. They require comprehensive management strategies to co-
ordinate the activities of a large multi-skilled workforce to complete a project within
a specified timeframe and within budget.
Construction Employees
The construction industry has a male dominated transient workforce
comprised of blue-collar lower socioeconomic classes (Brenner, 2006). Brenner’s
(2006) lifestyle survey of Irish construction workers found that they have an
unhealthier lifestyle when compared with the general population. Almost 45% of
construction workers were identified as smokers compared to 38% in the general
population.
Almost 45% of construction workers were identified as smokers compared to
38% in the general population. Their diet was found to be too high in fat and too low
in fruit and fibre. Thirty five percent of workers surveyed indicated that they rarely
or never ate breakfast. Over 45% of construction workers were classified as being
overweight, 32% had high blood pressure and 31% had high cholesterol. This type of
diet and lifestyle is associated with a variety of diseases and disorders such as
coronary heart disease, heart problems, and diabetes that increase the probability of
ill-health and early death.
Construction employees work in a diverse range of activities as managers,
administrators, designers, architects, accountants, engineers, trade workers,
construction operatives, and labourers. The variations in the workforce and their
variable level of competency influences the degree of success of a project, and its
safety performance (Harley et al., 2010).
Each person has a unique set of training, skills, and experience. For example,
designers, architects, and project supervisors generally have at least one engineering
degree or appropriate science degree at a minimum level 8 in the National
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Framework of Qualifications (NFQ) (Refer to Appendix III) or an equivalent

professional qualification. They usually have relevant experience in civil
construction, building construction and/or in project management. Frequently, they
are affiliated with accredited organisations upon successful demonstration of their
achievements with respect to qualifications, experience, and a commitment to
Continuing Professional Development (CPD).
Primary contractors are generally employed to manage the construction phase
of a project. Elements of construction activities are frequently contracted to
specialised sub-contractors. Although plasterers may be employed directly by a
primary contractor, they are often self-employed and hired as sub-contractors.
At any given time, a construction site contains batches of employees from a
variety of different sub-contractors. The number of workers employed, and their
level of competence will be influenced by the amount of resources made available by
from the client. Sub-contracted workers are employed on a temporary basis for the
duration it takes to complete their activities. They work independently and each has
their own set of goals, aims, and objectives specifically towards health and safety
management.
Safety Culture
The term “safety culture” is a conceptual term that refers to the set of values,
beliefs, and perceptions held by an organisation, individuals, and groups of workers.
An organisations safety culture influences attitudes and behaviour towards health and
safety matters. It determines what is considered to be acceptable and unacceptable
working conditions, working processes and safety performance. The magnitude of
risk in the workplace, and the level in which health and safety is prioritised, is highly
influenced by an organisations and its safety culture (Village and Ostry, 2010,
Choudhry et al., 2007, Guldenmund, 2000, Cooper, 2000, Hale, 2000).
It is possible that a variety of safety cultures can exist on a single site at any
one time due to the presence of diverse groups of sub-contractors. However, the
culture of a contractor or a sub-contractor may influence (positively or negatively)
the safety culture during the construction phase of a project (Harvey et al., 2001,
Harrison, 1992). The probability of a workplace accident on a site may be
attributable to the weakest safety culture on that site i.e. a sub-contractor who may be
less motivated to incorporate stronger safety culture strategies. Poor cooperation and
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communication between sub-contractors and the primary contractor may be a

contributing factor to construction accidents (Kines et al., 2010, Chen and Wu, 2010,
Cheng et al., 2010a, Manu et al., 2010, Tserng et al., 2009, Waehrer et al., 2007,
Spangenberg et al., 2003).
Working Hours and Payment Strategies

Construction workers are generally employed to work an eight-hour day for
five days. However, their working hours frequently extend beyond this and overtime
is a frequent requirement. In addition, many workers travel long distances to work
extending the duration of their working day.
A variety of payment schemes are in operation for those employed in the
construction industry. Primary contractors and individuals employed in managerial
roles may receive a fixed weekly/monthly salary from the primary contractor.
Penalties or bonuses may be imposed/awarded to top-level management for a
breach/achieving a prearranged financial, scheduling, or safety targets. Trade
workers directly employed by the primary contractor may receive a regular and
frequent basic weekly/monthly wage.
Sub-contractors i.e. plasterers hired by the primary contractor can be paid a
fixed sum based on the volume of work or based on an estimated timescale required
to complete their work. Payment may be calculated on an hourly/daily/weekly basis.
At times, sub-contractors will only receive their full payment when work is
completed. Alternatively, they may receive part-payments at set periods while they
carry out their work. Income for construction workers can be irregular. This may be
due to seasonal fluctuations in construction work, poor weather conditions, or a
decline in the demand for construction. Payment schemes can influence a plasterers
pace of work. They may work beyond their physical capacity to complete a task to
receive a bonus, or to enable moving on to another project.
The terms and conditions of a plasterer’s employment determines their
volume of work, an expected timeline in which to complete their work, working
hours per day/week, overtime requirements, and a quantity of payment.
Workplace Organisation
Logistic decision-making concerning the planning and management of
complex tasks like construction work directly influences the organisation and layout
of a construction site. Construction sites are often organised into separate areas
~ 87 ~
around a site. Locations must be selected for storage areas of plant, machinery,
materials, equipment, etc. Failure to have an adequate supply of these at the right
time and in the correct location can delay the construction process. Vehicle and
pedestrian routes must be created to ensure mobility of workers and materials
throughout the site. Facilities such as power sources, water sources, storage areas,
and welfare facilities are also required. The quantity, quality, and location of all of
the above will directly influence the physical demands exerted on construction
workers.
Storage areas and preparation areas may be located at a distance from the
plastering areas. Within the mixing area, there may be limited or restricted access to
water and power sources. These conditions increase the demand for manual handling
activities. In the plastering area, materials may be positioned at varying heights on
standing surfaces. The location and height of stored materials and equipment can
require workers to sustain awkward postures. This can include over reaching,
working above chest height or frequently bending and twisting. Sustaining these
postures increase compressive and torsion forces on the joints, particularly in the
lower back (Boschman et al., 2011, Marras et al., 1998, Keyserling et al., 1988,
Marras and Granata, 1997).
Construction sites usually have tools, equipment, materials, or debris lying
about. Poor housekeeping or poor workplace organisation introduces slip/trip risk
factors into the workplace increasing the likelihood of accidents.
Material Selection
In the material selection process, materials and suppliers are generally
preselected and the payment, delivery, and storage logistics are organised prior to
plasterers commencing their activity. The weight, size, shape, and storage location of
materials selected influences the manual handling requirement for workers. The
compounds are usually supplied in 25kg bags that must be carried to mixing area
from a storage area. The greater the distance the bag must be carried the greater the
stress a plasterer will experience i.e. increased WRMSD risk.
The properties of plaster compounds influences the volume of water required
to achieve a mixture of a desired consistency. The volume of water added determines
the weight of the mixed plaster. Plasterers or their assistants are required to lift this
load when loading a mortarboard. Additionally, the properties of mixed plaster
~ 88 ~
determine its consistency and drying times. A mixture that dries too quickly reduces
the time in which a plasterer must finish their task. The viscosity and consistency
influences the numberer of movements made and the forces applied by plasterers
when completing a task before the plaster mixture dries to an unworkable
consistency.
Workspace dimensions
The dimensions of the areas in which construction workers carry out their
activities is usually determined by the presence of temporary or permanently erected
structures e.g. pillars, ventilation systems, pipe work etc. Occasionally, as a time or
cost saving measure, temporary structures such as scaffolding systems may be
erected early in the construction process. The fixed dimension work areas and
location of obstacles may result in a workspace being incompatible with the
anthropometric dimensions of its users. Subsequently workers are forced to sustain
extreme or awkward postures when carrying out their activities.
Storing materials and equipment in work areas further restricts workspace
dimensions. For example, poor layout and organisation of materials on scaffolding
systems can often require workers to frequently bend and twist while handling loads.
Elevated Standing Work Surfaces

Many construction projects require the use of a temporary elevated work
surfaces to enable working at heights. Elevated work systems include scaffolding,
Mobile Elevated Work Platforms (MEWP), stilts, trestle and boards, ladders, and
hop-ups. The use of elevated work systems expose users and other construction
workers to a risk of falling from height or being hit by falling objects. In addition,
their presence can limit workers ability to use manual handling aids thereby
increasing stresses a plasterer will experience i.e. increased WRMSD risk.
The finances and resources available influence the type of elevated systems
that are selected and used. The selection process can also be influenced by plasterer’s
personal preference towards using specific standing surfaces. Construction
companies may have preferences for using specific elevated systems and discourage
the use of other systems e.g. stilts. At times plasterers use items found on site as a
temporary raised surface such as boxes, crates barrels, buckets, and concrete blocks.
The range of scaffolding systems available for use in the construction
industry enable the creation of elevated working environments in an array of
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different dimensions and arrangements. Scaffold systems are selected and payment
organised prior to plasterers commencing their activity. When erected, the majority
of scaffolding systems have a fixed three-dimensional workspace, and the ability to
work within the workspace is influenced by a worker’s anthropometric dimensions.
The dimension also influences how workers organise the layout of materials, tools,
and equipment. Erecting and modifying scaffolding disrupts workflow and imposes
time and financial cost. A competent person must be employed to erect and carry out
modifications and the system must pass inspection before it is available for use.
Stilts are perceived as being a convenient and time saving tool when working
on ceilings. While some larger construction companies in Ireland, Canada, and
Australia ban the use of stilts, or advise against their use, they are widely used in
Ireland especially on smaller construction projects.
A wide range of models are available with adjustable height options. They are
usually composed of strong lightweight alloys e.g. aluminium. Users anchor their
foot onto a footplate using straps at the foot, ankle, and calf. Many stilts have spring-
loaded footplates that mimic foot movement. They take only minutes to put on and
remove; they allow users to move freely between locations without stopping work.
The ability to adjust the standing height of stilts enables users to work at an optimum
and comfortable height at all times.
In Ireland, users purchase and pay for their own stilts. Plasterers are not
trained in stilt use, inspection, or maintenance. They are self-trained and often learn
the skill walking along hallways or around the outside of their house. Their
knowledge about stilts i.e. ranges of design, optimum selection process and stilt care
and maintenance is self-taught or learned from other colleagues. Hence plasterers
may be inadequately trained and use poor fitting and unsuitable stilts.
Wearing stilts alters the dimensions of the user’s body, shifts the body’s
centre of gravity, affects gait, and influences the biomechanical stress imposed on
joints. Plasterers frequently handle loads and sustain awkward postures that
exacerbate the stresses on the body e.g. work with the arm extended above their
head, twisting and arched backs, and tilting the head backwards. Balance is affected
when manoeuvring around objects and when carrying objects. Consequently stilt use
may increase the risk of overexertion injuries of the joints, particularly the back,
hips, knees, and legs. Users may overbalance when putting on or removing stilts or
when bending over to pick up objects. The unfamiliar increase in stature when
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wearing stilts can also increase the probability of collisions with overhead objects
e.g. ceiling fittings and doorframes. The height of a person when standing on stilts is
usually lower than the height when standing on scaffolding. While it may be
assumed that a fall from a lower height will result in a less severe injury it is not
always so. Controls such as barrier systems and fall protection mechanisms that are
suitable for use in scaffolding systems are not suitable as an intervention strategy to
reduce risk when using stilts (Cowley and Leggett, 2009, Schneider and Susi, 1994).
The severity of injury sustained in a slip/trip accident increases when wearing
stilts. Carpenters and drywall installers believe that when considering all elevated
work systems there is a greater risk of falling when using stilts as opposed to using
ladders or scaffolding (Pan et al., 2000b). Drywall installers are more likely to
sustain stilt related injuries than any other trade worker is and stilt use may increase
the risk of slip/trip incidences and the probability of knee injuries (Schneider and
Susi, 1994). A review of Washington States workers compensation records for six
years between 1996 to 2002 identified 280 stilt related injury claims totalling
$3.4million in compensation costs and a median 73 lost workdays. Fifty-three
percent of the cases occurred as a result of slip and trip events attributed to poor
housekeeping and poor stilt maintenance (Whitaker, 2006).
A variety of ladders and step units are available as a temporary raised
platform when working above arms reach. Plasterers due to the dynamic nature of
their activity do not usually use ladders.
Plasterers regularly use a hop-up when working on the upper section of walls.
A hop-up is a rigid structure with two steps, one at approximately 270mm and the
second at approximately 500mm. They are often constructed of lightweight material
and weigh approximately 18kg. Plasterers lift and move the hop-up into suitable
positions adjacent to a wall to enable reaching unreachable sections of the wall.
Trestle and board systems can be set up to fill large work areas (full rooms).
This set-up raises the ‘floor height to enable plasterers work on full ceilings.
However, trestles may also be set up in areas around a room e.g. parallel to the walls.
This may require plasterers to move the trestle systems around the room to enable
complete a dull ceiling surface. A system set-up like this may be a preferred method
when plasterers work on the upper section of a wall rather than use a hop-up.
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Occasionally, trestles or scaffolding systems may be partially boarded out.

This can increase the probability that a plasterer will fall when focusing on their task
(ceiling) rather than watching where they are positioning their feet.
In some cases the boards used on trestles or scaffolding systems are worn,
warped, or have dried plaster or cement on the surfaces. The uneven surfaces
increase the likelihood of slip/trip events, or falls.
Scheduling
Scheduling requirements may require plasterers to work alongside other trade
workers and to work in locations where other activities are being carried out.
Plasterers are therefore exposed to additional risk factors that are not a normal part of
the plastering activity. These risk factors may not have been considered in their sub-
contractor’s risk assessment process.
While some sites organise fixed work breaks over the course of a working
day other sites may fail to organise rest breaks, or breaks occur infrequently and for
shorter periods. Because of scheduling and task demands, many plasterers frequently
work for long periods without taking breaks. In the plastering activity, plasterers
must continue to work for the time it takes to complete a task to ensure a consistent
surface finish. When breaks are taken they are often taken infrequently and only for a
short time.
Payment methods, bonus/penalty schemes, and weather conditions can force
or encourage workers to continue working through scheduled breaks. A period of rest
is an essential requirement to enable recovery after physical activity. Failure to take a
sufficient period of rest at suitable intervals increases the stresses imposed on the
human body systems and increases the probability of injury.
Tools and Equipment

Many construction tasks involve the use of tools and equipment. Injuries
associated with their use include electrical shock, vibration related disorders, cuts,
and entrapment. Tools that are not ergonomically designed force workers to sustain
postures that increase the strain on joints. Tools and equipment require regular
inspection and maintenance to maintain their safety and efficiency. The quantity and
quality of maintenance and inspection of tools and equipment can vary dramatically
from user to user and from construction site to construction site.
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Plasterers generally purchase and pay for their own tools and equipment and
accumulate them over their years of employment. They are responsible for their tool
care and maintenance. The main tools used in wet-plastering are trowels, floats, and
hawks. Although there are a wide variety of design options and range of sizes
available for these tools, the design structures are similar. The tools have a fixed base
dimension (length, width, and thickness) and a rigid handle. Trowels and floats have
a rigid and fixed two-pronged handle while hawks have a single pronged handle.
Materials used for the base of a trowel, float and hawk include wood, stainless steel
and toughened plastic compounds. Handles are usually made from wood or a
toughened plastic compounds. Tool designers have attempted to make plasterer’s
tools more ergonomically friendly by using lighter, softer, and more pliable
materials. Modifications of design shape include adding finger grips to reduce force
stress on the hand.
A plasterer’s ability to achieve a desired surface finish is reduced when tools,
specifically a trowel or float is damaged or poorly maintained. Plasterers must
continue to repeat their movements to remove the blemishes created from faulty
tools. Plasterers constantly alter their hand and wrist postures when wet-plastering
because of the rigid handle/base structure of trowels and floats.
The design of hand tools, materials, and equipment will influence the
postures sustained and determine the magnitude and direction of force. For example,
the size, shape, and position of a tool handle influences the type of grip used (Figure
18), the postures sustained, and frequency of movement. The anthropometric
dimensions and physical strength of tool the user influences hand/tool coupling.
Tools designed with rigid sharp edges can inflict greater localised forces than tools
with rounded pliable surfaces.
Figure removed for copyright purposes
Figure 18: Pinch Grip and Power grip
~ 93 ~
Deviated postures, repetitive movements, and increased application of force

increase the probability of joint related disorders (Koppelaar and Wells, 2005, Jung
and Hallbeck, 2005, Kattel et al., 1996, Lewis and Narayan, 1993). Hard rigid and
poorly shaped handles increase the compressive localised point forces on the hand
where poor coupling exists (Jung and Hallbeck, 2005, Lewis and Narayan, 1993).
Vibrating tools can affect the musculoskeletal system particularly the blood vessels
and nerves in prolonged and frequent use (Bao et al., 2006, Devereux et al., 2002,
Buckle and Devereux, 2002, van der Windt et al., 2000).
Psychosocial Control
Construction work is a physically demanding activity with workers
completing tasks and sub-tasks of varying levels of intensity in a constantly changing
work environment. Workers often have little or no control over their working
conditions or their task demands. Scheduling and financial constraints often requires
workers to carry out high intensity tasks for prolonged periods without breaks to
complete their phase of a construction project.
WRMSD risk can increase with excessive task demand expectations i.e.
demands exceed the capacity of the worker, too few plasterers employed with respect
to the volume of work, or unrealistic scheduling. The type of payment method used
or bonus/penalty system employed can encourage workers to continue to work
beyond their physical capacity.
3.4.3 Plasterers Working Postures

Plasterers adopt a wide range of postures when applying plaster onto wall and
ceiling surfaces. The hawk is held in the non-dominant hand and the trowel held in
the dominant hand. The hand/arm/shoulder body area of the side holding the trowel
is generally more visually active than the side holding the hawk.
When mixing plaster a large bucket, up to 50L capacity, is filled with a
desired quantity of water. While plasterers can use a hose to add the water they may
be required to repetitively carry buckets of water weighing 1kg per litre from a water
source to the bucket’s location. The average small bucket capacity is 12L (12kg).
Dry ingredients packaged in 25kg loads are poured into the water. Additional water
and dry ingredients are added until a desired consistency is achieved. The mixed
plaster and bucket is carried from the mixing location to the mortarboard. It is then
hoisted to a height to enable pouring of the mixture onto the mortarboard.
~ 94 ~
Mortarboards may be placed on concrete blocks at a height of approximately

225mm or 450mm above ground level but a stand with a height of 775mm from the
ground surface is a more frequently used option. Plasterers can avail of stands of
different height such as 1270mm or use a height adjustable stand.
The characteristic of a load and the way it is handled influences the
biomechanical stress on the musculoskeletal system (Boschman et al., 2011, Hess et
al., 2010b, van der Molen et al., 2007, Splittstoesser et al., 2007, Anton et al., 2005,
Corlett et al., 1997, Keyserling et al., 1988). Stress increases:
• When handling heavier or larger loads

• When handling unstable or unbalanced loads
• Handling loads away from the body
• Carrying long distances and
• Lifting from lower heights e.g. below knee height
• Lifting at higher heights e.g. at shoulder height
The type of posture sustained in lifting tasks can influence the magnitude of
biomechanical stress imposed on joints, increase physiological demand on the
cardiovascular system, and thereby increase the probability of developing fatigue
(Kothiyal et al., 2008, Splittstoesser et al., 2007, Marras and Granata, 1997,
Gallagher and Unger, 1990, Garg et al., 1978). Garg et al., (1978) estimate that
physiological demand for squat lift is greater than a stoop lift. Van Dieën et al.,
(1999) found a potential benefit of squat lift over a stoop lift in terms of net moments
and compressive forces on the spine in a limited range of lifting tasks. However, a
squat lift had lower shear forces on the spine than the stoop lift. Bent knee postures
induce greater levels of fatigue particularly in the lower back than stooped postures
(Kumar, 1984).
When loading a hawk from a mortarboard plasterers use a trowel to
manipulate the plaster on the mortarboard to ensure an even consistency. The hand
wrist and arm movements are repetitive with the arm positioned in front of the
plasterer. Depending on the height and position of the mortarboard, plasterers may
have to bend and twist when loading the hawk.
~ 95 ~
Large sweeping and repetitive movements are used when loading the hawk
and when applying plaster onto surfaces. The body area is also involved in exerting
force through the trowel to apply the plaster onto surface, spread the plaster, and
smooth the plaster. The body area involved in holding the hawk generally has
smaller and less frequent movements. It must however support the weight of the
hawk and the weight of the plaster mix.
Plasters stand on the ground surface to apply wet-plaster coats onto a full wall
surface (upper and lower section together). On the lower section of a wall plasterers’
squat, stoop, kneel, bend, and stand with their arm movements extending from
approximately chest height down to the ground level. When working on the upper
section of the wall plasterers adopt standing postures with their arm movements
extending from approximately chest height to an extended overhead reaching
posture. When applying plaster on to a ceiling plasterers carry out the activity with
their arm extended over the head.
Force can be exerted on the body as a peak force in a single event or a
cumulative force. The cumulative force exerted on the body increases when
individuals carry out an activity involving repetitive similar body movements such as
bending or twisting. The ‘dose’ of cumulative force loading increases with the
frequency and duration of an activity and repetitive movements.
3.5 Conclusion
In this chapter, the potential contributing factors to the introduction of
WRMSD risk factors are discussed. The work practice in the construction industry
and the plastering activity are described to outline how WRMSDs are potentially
introduced before plasterers commence their activity during the construction phase of
a project.
The systems of work and working conditions described above demonstrate
that WRMSDs risk factors exist in the workplace when plasterers commence their
activity. Plasterers can therefore be exposed to factors that have the potential to
impose physical, biomechanical, and psychosocial stress. Evidence demonstrates that
exposure to similar factors results in higher prevalence rates of WRMSDs, inflict
significant levels of human suffering, cause a decline in productivity levels, incur
high levels of absenteeism and early retirement, and impose a significant financial
burden to employers, employees, and the economy.
~ 96 ~
Appropriate control interventions can be implemented at any stage to

eliminate risk factors or reduce associated risks. The success of implementing
appropriate controls is influence by the ability to determine if plasterers are exposed
to risk factors and in determining if that exposure increases plasterers risk of
developing disorders.
~ 97 ~
Chapter 4: Methodology 1 Risk Assessment Protocol
Chapter 4. Methodology 1: Risk Assessment

Protocol
4.1 Introduction
In this chapter, a research risk assessment protocol developed for the purpose
of this study and used as a guide in developing a suitable risk assessment
methodology is presented.
4.2 Research WRMSD Risk Assessment Protocol

Risk assessments are usually carried out to evaluate exposure to risk factors
to quantify or qualify a level of risk. Hypothesis testing is a means of interpreting the
results obtained in the assessments to determine if the resultant data occurred due to
chance alone or to determine if a specified hypothesis is true. Section 1.6 details the
research hypothesis for this study i.e. the null hypothesis. Hypothesis testing is used
to determine if the null hypothesis can or cannot be rejected. A Type I Error occurs
when statistical analysis incorrectly identifies an association when no association
exists i.e. indicating risk when no risk exists (false positive) (Rothman, 2010, Good
and Hardin, 2012). When considering the hypothesis in this study a Type I Error may
falsely indicate that, a specific sub-task activity increases the likelihood of plasterers
developing WRMSDs.
Alternatively, the output can be a Type II Error, indicating no risk when risk
exists (false negative) (Good and Hardin, 2012, Rothman, 2010, Brown et al., 1989).
When considering the hypothesis in this study, a Type II Error may fail to indicate a
specific sub-task activity that increases the likelihood of plasterers developing
WRMSDs.
The data output from ergonomics studies is directly related to the assessment
methodology used in the studies i.e. environments assessed, participants in the
studies etc (Kothari, 2009, Checkoway et al., 2003, Creswell, 2003, Patton, 1990,
Brown et al., 1989). It is essential that a suitable risk assessment methodology be
used when carrying out assessments to ensure an accurate evaluation of working
environments, populations of interest and activities carried out. Failure to carry out a
risk assessment in an appropriate manner could potentially:
~ 99 ~
• Fail to evaluate environments, tasks, or sub-task activities in which plasterers

participate in as part of their normal working requirements
• Fail to evaluate variable aspects of their normal working requirements. For
example, plasterers apply coats of wet-plaster onto walls and ceilings, or both
a wall and ceiling over the course of their working day. Failure to evaluate
working on a wall will potentially fail to identify it as a high risk (or low risk)
activity
• A study using an inadequate methodology will not generate accurate and
valid results. This may result in incorrectly identifying tasks or working
conditions that increase plasterers’ risk of developing WRMSDS.
Subsequently, recommendations based on these results may not effectively
reduce risk levels
• Determine that plasterers are not at risk of developing WRMSDS because of
their activities when they are at risk
• Determine that plasterers are at risk of developing WRMSDS because of their
activities when they are not at risk
4.2.1 Definitions: Ergonomics, Risk Factors (Hazards), and Risk

Ergonomics is a multi-disciplined field in which the interactions between
workers and their working environment are studied. In its application, work should
be designed around the worker, taking into account their abilities and limitations,
human behaviour, task demands, tools, equipment, and working environments
(Henriksen et al., 2008, Karwowski, 2005, Wickens et al., 2004, Wilson, 2000,
Sanders and McCormick, 1993).
The International Ergonomics Association (IEA) defines ergonomics (or
human factors) as:
“The scientific discipline concerned with the understanding of the

interactions among humans and other elements of a system, and the profession that
applies theoretical principles, data and methods to design in order to optimize
human well being and overall system. Practitioners of ergonomics,
ergonomists, contribute to the planning, design and evaluation of tasks, jobs,
products, organizations, environments and systems in order to make them compatible
with the needs, abilities and limitations of people” (Schlick, 2009)”
~ 100 ~
The British Standards Association (1991) defines a hazard as:
“A situation that could occur during the lifetime of a product, system or plant
that has the potential for human injury, damage to property, damage to the environment,
or economic loss.”
A hazard can be any variable, or combination of variables, that has the

potential to contribute to a negative outcome such as an injury/illness or a financial
loss (British Standards Institution, 2007). Examples of hazards include unsafe
behaviour, unsafe objects, or unsafe conditions. With respect to occupational health
and safety, the term ‘hazard’ is used synonymously with the term ‘risk factor’ (Lopez
and Project, 2006, Wunderlich, 2005). In this study, the term ‘risk factor’ refers to
any variable that contributes to the unwanted development of MSDs, specifically
those that are work related. Risk is defined as:
“the likelihood than a hazard will cause harm, the potential severity of that
harm and considers the number of people who might be exposed to the hazard”
(Safety Health and Welfare at Work Act, 2005).
Matrices are frequently used to provide quantitative measures of risk (Jensen,

2012, Lingard and Rowlinson, 2005). Probability and severity categories are
appointed with a graded scale of alphabetical/numerical values. When considered
together they generate an alphabetical/numerical for the level of risk for a given risk
factor (Probability x Severity = Risk). Scales can contain different amounts of
alphanumerical intensity values. For example, the Health and Safety Executive
(HSE) Risk Matrix uses:
• Five values for Probability: Rare/Remote (1), Unlikely (2), Possible (3),
Likely (4) and Almost Certain (5)
• Five values for Severity: Negligible (1), Minor (2), Moderate (3), Major (4),
and Extreme (5)
• The risk is quantified as Low (1-5), Medium (6-12) and High (15-25
The matrix presented in Table 4 is a slightly modified version of the HSE’s

version (Health and Safety Authority (HSA), 2006a, Health and Safety Executive
~ 101 ~
(HSE), 2003). The same probability and severity scales are used as are the risk
scores. This version categorises risk into five levels instead of the three levels used
by the HSE.
Table 4: Risk Assessment Matrix

(Modified version of the matrix used by the HSE (2006) and the HSE (2003)
SEVERITY
Negligible Minor Moderate Major Extreme
PROBABILITY 1 2 3 4 5
Rare/Remote 1 1 2 3 4 5
Unlikely 2 2 4 6 8 10
Possible 3 3 6 9 12 15
Likely 4 4 8 12 16 20
Almost Certain 5 5 10 15 20 25
Modified Risk Very Low Low Medium High Very High

Level Range 1-2 3-4 5-8 9-12 15-25
HSE Risk Low High Very High

Level Range 1-5 6-12 15-25
4.2.2 Ergonomic Risk Assessment

A risk assessment is a careful examination of a situation to determine if there
is a potential to cause harm. It is a legal requirement to carry out risk assessments in
work environments to ensure the safety, health, and wellbeing of workers and
visitors to the workplace. The three stages of a risk assessment are 1) identifying
hazards, 2) determining the level of risk associated with each hazard and 3)
identifying suitable controls to eliminate the hazard or reduce the level of risk
associated with the hazard. The methodology used when carrying out ergonomic
assessments should be capable of generating meaningful and accurate data. Failure to
do so will increase the probability of generating inaccurate results. Similarly, failure
to use the same procedure and methodology when assessing each participant can
~ 102 ~
introduce unwanted and unknown confounding factors that can influence and
invalidate the results.
An outline of the research risk assessment protocol is presented in Figure 19.
It lists seven phases to direct researchers when developing a risk assessment
procedure in a research study to evaluate WRMSD risk factor exposure. The phases
of the protocol are described below.
1. Select Assessment Environment(s)
2. Select Assessment Methods
3. Select Participants
4. Generate Documentation
5. Plan & Schedule
6. Evaluate the Risk
7. Provide Recommendations
Figure 19: Research Protocol to Guide Researchers when Developing a Methodology

to Evaluate WRMSD Risk Factor Exposure in a Research Study
4.2.3 Assessment Environments

When evaluating exposure to work related risk factors in a research setting,
risk assessments should be carried out in environments that accurately represent
working environments (Sanders and McCormick, 1993). Ideally, assessments should
be carried out in active working environments (on-site setting) to gain an accurate
indication of risk. Simulated working environments (laboratory settings) are used as
an alternative option to on-site assessments in ergonomic studies. In laboratory
settings, tasks and working conditions can be controlled. This enables comparisons
of risk levels between different aspects of tasks and working conditions. Failure to
~ 103 ~
identify all work scenarios and task variable conditions can reduce the probability of
identifying all WRMSD risk factors that plasterers can be exposed to.
A careful examination of work environments and task requirements is
required to determine if workers are exposed to risk factors. Activities carried out in
the workplace require workers to carry out sub-task activities in specific sequences to
achieve a desired objective. Ideally, risk assessments should be carried out in all
possible various combinations of work scenarios in which a worker may be exposed
to WRMSD risk factors.
However, many variables can exist with respect to the demands of the task
and in a working environment at any given time. Section 3.4 (Page 83) outlines a
selection of variable conditions that can exist in the workplace when plasterers carry
out their activities. Construction workers, specifically plasterers, are exposed to
WRMSD risk factors during the later stage of a construction projects lifecycle.
Factors that influence the presence of WRMSDs risk factors include:
• Working in differently size projects with different levels of complexity

• Different management structures and strategies
• Different workforce dynamics,
• Different workplace organisation, policies, and procedures
• Different payment strategies, and working hours
4.2.4 Assessment Methods

Assessors have a wide variety if options available when selecting assessment
methods when carrying out studies to evaluate workers exposure to WRMSD risk
factors (Chen et al., 2012, Trask et al., 2010, Coutts et al., 2009, Schlick, 2009, Li
and Buckle, 1999b). An outline of existing assessment methods used to evaluate
exposure to WRMSDs is presented in Section 2.12 (Page 50).
When selecting methods to use in a risk assessment process, the
characteristics of each assessment method must be considered carefully.
Occasionally, workers may be unwilling to partake in an assessment because they
perceive it as being intrusive or invasive e.g. questionnaires, or electromyography.
Some methods may interfere with a participant’s ability to carry out an activity in
~ 104 ~
their usual manner when carrying out a task in a work environment. In these cases,
simulated working environments may be a preferred assessment environment.
Errors in data gathering can occur in situations where an assessor is
insufficiently trained or is unfamiliar with using an assessment method. It is therefore
necessary that the assessor is appropriately skilled in the use of selected
methodologies. This also includes the data analysis process. Pilot studies or mock
trials help to ensure that researchers are familiar and competent in the assessment and
data analysis process. Making lists of the tools, equipment, and materials that are
required on the day of the assessment will help to ensure they are present at the time
of the assessments.
Using combinations of assessment methods will gather a broader spectrum of
information when evaluating WRMSD risk e.g. biomechanical, physiological, and
psychophysical methods. Using multiple methods provide greater volumes of
information from which to determine risk levels associated with WRMSD risk factor
exposure. The methodology used in ergonomic research studies should be repeatable,
and when repeated should generate similar results and findings.
A synopsis of the methods considered for use in this study and their
corresponding characteristics is presented in Tables 5, 6, and 7. Other methods not
detailed in these tables were omitted from consideration in this study due to financial
constraints, training requirements and availability of the technology during this
research period. Examples of these methods include the use of accelerometers,
gyroscopes, and magnetoresistive sensors (Tao et al., 2012, Chen et al., 2012,
Madeleine et al., 2011, Roetenberg et al., 2005) such as:
• Vicon motion capture analysis system (Roetenberg et al., 2005, Michalski et

al., 2012, Fischer et al., 2012, Al-Khabbaz et al., 2008)
• Microsoft Kinect ™ - provides real-time anatomical landmark position data
in three dimensions (3D) (Clark et al., 2012, Ning and Guo, 2012, Soumitry
and Jochen, 2012)
• Xsens – multiple gyroscope motion sensors (Liu et al., 2012, Martínez-
Ramírez et al., 2011, Zhang and Lockhart, 2009)
~ 105 ~
Table 5: Self-Reporting WRMSD Risk Assessment Methods
Self Reporting Methods
Visual Analogue
Characteristics Interview Questionnaire Diary Body Map
Scales
Information, Information, Intensity of Information on Participant

Data Opinions, Opinions, perceived work and task
Perceptions Perceptions sensations participation Information
Information Intensity of
Demographic & Information
sensation Task demand
Output Task Variables Demographic & NA
perceived Temporal patterns
Task Variables
Temporal patterns
Measure of Risk Indicates exposure to WRMSD risk Factors

Workers Workers
Intra & inter Workers
interpretation interpretation,
Potential Error observer interpretation, NA
Worker & comprehension bias,
variability Worker bias
Assessor bias literacy
Ease of Use Easy Easy Easy Easy Easy
Costs Associated
Low Low-Medium Low NA NA
Gather Data
Costs Associated
Low-Medium Low-Medium Low Low-Medium NA
Data Analysis
Time Required
Medium-High Low-Medium Low-Medium Low NA
Gather Data
Time Required
Medium-High Medium-High Medium-High Medium-High NA
Data Analysis
Larger sample Larger sample sizes Larger sample Larger sample
Sample Size sizes are more are more sizes are more sizes are more NA
representative representative representative representative
Assessment On-site & Off- On-site & Off- On-site & Off- On-site & Off-
site site site site NA
Environment
Require Assessor
Yes No No No No
to be Present
Competency Medium-
Medium-High Medium-High Medium-High Medium-High
Requirement High
Medium-
Valid & Reliable Medium-High Medium-High Medium-High Medium-High
High
~ 106 ~
Table 6: Direct and Indirect WRMSD Risk Assessment Methods
Direct & Indirect Methods

Lumbar Motion EMG Wells et al.,
Heart Rate
Characteristics monitor Marraset 1997 Schuldt et Electro goniometers
Monitoring
al., 1992 al., 1987
Heart Rate
Joint displacement &
variations Muscle activity
Data Upper body motion frequency of
Cardiovascular & intensity
movements
strain
3D trunk posture,
Flexion, Extension,
Heart Rate variation velocity, Muscle activity -
Rotation, Repetitions
Output - response during acceleration- response during
-response during task
task performance response during task task performance
performance
performance
Measure of Risk Yes Yes Yes Yes
Cross-talk, Muscle
Cross-talk, positioning
Potential Error Low Low selection, sensor
sensor slippage
slippage
Ease of Use Low-Medium Medium - Hard Medium - Hard Medium
Costs Associated Low Low-Medium Low-Medium Low-Medium

Gather Data
Costs Associated
Low Low Low Low
Data Analysis
Time Required Low-Medium Low-Medium Low-Medium Low-Medium

Gather Data
Time Required
Low-Medium Low-Medium Low-Medium Low-Medium
Data Analysis
Larger sample sizes Larger sample sizes Larger sample Larger sample sizes
Sample Size are more are more sizes are more are more
representative representative representative representative
On-site – (leads
On-site – (leads may
Assessment may disrupt
On-site, Off-site On-site, Off-site disrupt dynamic
Environment dynamic work),
work), Off-site
Off-site
Require Assessor Yes Yes Yes Yes

to be Present
Competency High High High High
Requirement
Valid & Reliable High High High High
~ 107 ~
Table 7: Observational WRMSD Risk Assessment Methods
Observation Methods
RULA REBA Hignett NIOSH
QEC Li and McAtammey and Waters et
Characteristics HTA Checklist
Buckle, 1999 and Corlett, McAtammey, al. 1981,
1993 2000 1991
2x checklists
Use score Use scores
Evaluates Distances
Pre- diagrams and diagrams and
Task posture, weight,
determined tables tables
Data Requirement force, coupling,
Objectives & Evaluates Categorise body
Hierarchical movement and
Information posture force, postures and
frequency asymmetry
movement force
duration
Task procedure back,
and descriptive shoulder / Upper body Load for
Posture, Force
Output requirements Information arm and limb manual
& Activity
of human and wrist/hand, assessment handling
system and neck
Yes
Yes
Indicates Yes Action Levels Yes
Magnitude of Lifting
Action 1-4, Action Levels
Risk Index
Levels 1-4 RULA Score 0-4
RWL
1-7
Low Worker Low Worker Low

Low Assessor Low Assessor Low Assessor
Potential Error & Assessor & Assessor Assessor
Error Error Error
Error Error Error
Ease of Use Easy Easy Easy Easy Easy Easy
Costs
Associated Low Low Low Low Low Low
Gather Data
Costs
Associated Data Low Low Low Low Low Low
Analysis
Time Required Low Low Low Low Low Low

Gather Data
Time Required
Low Low Low Low Low Low
Data Analysis
Sample Size Larger sample sizes are more representative
Assessment On-site, On-site, On-site, On-site, On-site,

On-site
Environment Off-site Off-site Off-site Off-site Off-site
Require
Yes No Yes Yes Yes Yes
Assessor
Competency
High High High High High High
Requirement
Valid/ Reliable High High High High High High
~ 108 ~
4.2.5 Participant Requirements and Selection

The Declaration of Helsinki, EU Directives, and National Guidelines
provides for ethical considerations when carrying out research using human subjects
(National University of Ireland Galway (NUIG), 2009, European Parliament and the
Council of the European Union, 2001, World Medical Association, 1975).
Criteria should be established outlining the recruitment process when
selecting participants. It should stipulate appropriate requirements for participant
inclusion or exclusion in the study. All appropriate measures should be implemented
to ensure the health and wellbeing of participants, both during and after participating
in the study. Participants should be physically capable and mentally competent to
perform the tasks to be assessed. They should be free from medical conditions,
illness, or injury when participating in the assessments.
Working environments may contain a population of workers with a diverse
range of demographic characteristics e.g. age, gender etc, and different levels of
skills and experience. Participants without the necessary skills and experience will
not carry out activities in the same manner as personnel who have the appropriate
skills and experience. The same may be true for participants who are not comparable
demographically to that in the population of interest.
An appropriate number of subjects should be selected to ensure a
representative sample population. Researchers may also select a separate control
group. This allows researchers to make comparisons between populations e.g. one
group exposed to risk factors and a second group not exposed to risk factors. When
using a control group, it should have similar characteristics i.e. demographics,
number of participants, skills etc. to the sample (test) population group.
Selecting an appropriate sample size may be determined by using statistical
formulae. Alternatively, the sample size may be based on convenience i.e. selected
from an accessible or available population. Conversely, it may be based on the
sample sizes used by researchers in similar studies. A synopsis of research
publications are presented in Table 8 to indicate the sample sizes used by researchers
in previous WRMSD studies. The publications relate to research carried out where
researchers used VADS, EMG, or HRA to evaluate WRMSD risk factor exposure.
Their sample sizes ranged from 1 up to 41. Other researchers may have used sample
sizes greater than this but are not identified in the table. It is important to note that
there is an increase in the inference about a population when making conclusions
~ 109 ~
from larger sized sample populations. Failure to have a representative sample

population may reduce the significance of the data and increase the likelihood of
incurring a type I or type II error.
Under NUIG ethical guidelines it is recommended that potential participants
be fully informed about the purpose of the research, what their role in the study
entails, the methods to be used in gathering data, and any possible risks that may
occur during the study (National University of Ireland Galway (NUIG), 2009).
Participants can be informed verbally through informal interviews or question and
answer sessions. When informed through printed media, it should be written in a
manner that is easily understood and provide sufficient detail about the study.
Selected participants should have the option of not participating in a study.
Additionally, they should have the option to drop out of the study at any time without
fear of repercussions. All personal information should be stored securely to maintain
anonymity and confidentiality.
All participants should sign a consent form to confirm their understanding
and willingness to participate in the study. This should take place before
commencement of the study.
~ 110 ~
Table 8: Sample of Research Publications to Demonstrate the Sample Sizes used in

Risk Assessment Studies
Sample
VADS Electromyography Heart Rate
Size
1 (Naqvi et al., 2004)
4 (Kirk and Sullman, 2001)
(Tiwari and Gite, (Habes et al., 1985)

5
2006)
(Tiwari et al., 2005) (Jakob et al., 2012) (Jakob et al., 2012,

6 Tiwari et al., 2005, Kirk
and Parker, 1996)
(Cho and Kim, 2012, Bosch (van der Molen et al.,

et al., 2011, Schachter et 2007, Li et al., 2007,
8
al., 2010, van der Molen et Lowe et al., 2001)
al., 2007)
(Tucker et al., 2009, (Balasubramanian et al.,

9 Balasubramanian et al., 2009)
2009, Brown et al., 2004)
(van der Molen et (van der Molen et al., (van der Molen et al.,
al., 2004a, 2010b, Shin and Kim, 2010b)
Kuorinka, 1983) 2007, Balci and
10
Aghazadeh, 2004, Kothiyal
and Kayis, 2001, Marras
and Granata, 1997)
11 (McKean and Potvin, 2001)
(Smith et al., 2002) (Splittstoesser et al., 2007, (Gallagher and Unger,

12
Gallagher et al., 1988) 1990)
13 (Falla et al., 2007)
14 (Hess et al., 2010a) (Cabeças and Milho, 2011)
15 (Jonsson et al., 2011)
(Straker et al., (Rempel et al., 2010)

16
1997)
18 (Ulin et al., 1993)
(Viswanathan et al., (Ebaugh and Spinelli,

20 2006, Straker and 2010)
Mekhora, 2000)
(EBARA et al.,
24
2008)
41 (Hess et al., 2010a)
~ 111 ~
4.2.6 Documents
An array of documents is generally required when carrying out risk
assessments or research studies. This includes information documents, instructions,
questionnaires, surveys, and consent forms. Saunders et al., (1993) recommend that
documents are easy to read, and written in a manner that the reader can understand.
Ideally, the readability and meaningfulness of the documents should be tested with
potential test-subjects or other researchers.
4.2.7 Planning and Scheduling

In a research scenario, assessments can involve multiple people, locations
tools, and equipment. In all project management scenarios, it is essential to carefully
plan and schedule events and stages throughout the study. This helps to ensure
efficient management of the assessments. Additionally, it increases the likelihood
that the output from the assessments will be reliable and consistent.
4.2.8 Evaluate the Risk

Upon completing the data analysis of an assessment, the results should be
evaluated to quantify or qualify the level risk for each assessment condition scenario
(tasks and environment).
Risk may be classified as being acceptable, tolerable, or unacceptable.
Acceptable risk is the level of risk where further intervention is deemed unnecessary
e.g., probability is very low or severity of outcome minor.
Tolerable risk indicates that risk exists but no further intervention will be
considered at this time. Cost benefit analysis is often used to determining tolerable
risk levels. The process considers the costs involved in implanting risk reduction
methods and the potential benefits gained from their implementation. When risk
levels are deemed to be As Low As Reasonably Practicable (ALARP), employers
must be capable of demonstrating that the cost required to further reduce risk would
be grossly disproportionate to the benefits gained (Cameron and Raman, 2005).
Unacceptable risk is deemed to be so when the probability of an unwanted
outcome occurring is high and/or the severity of the outcome unacceptable (Smith,
2011, Cameron and Raman, 2005).
When considering the risk assessment matrix presented in Table 4, the Very
Low risk level may be deemed an acceptable risk level. The Low risk level may be
~ 112 ~
deemed a tolerable risk. The Medium, High, and Very High risk levels may be in
deemed unacceptable risk.
The magnitude of risk and whether it is deemed to be acceptable, tolerable, or
unacceptable will influence the selection process for intervention strategies. For
example, if RULA or QEC assessments generated an action level score of one, there
is no risk associated with the assessment scenario (considered acceptable). Therefore,
no intervention is required. However, an action level of four indicates a very high
level of risk. Intervention strategies should ideally be implemented as soon as
possible.
With respect to WRMSDs, due to their complex aetiology, (Refer to Section
2.4 - Section 2.7; Pg. 20-33), it can be difficult to ascertain the probability of a
negative outcome, or to determine how severe the negative outcome will be.
Alternatively, comparisons can be made between the results from one assessment
condition scenario to the results from another assessment condition scenario. This
can identify conditions that have a higher/lower probability of a negative outcome
and/or a less severe outcome.
4.2.9 Provide Recommendations

Section 2.11 (Pg 36-49) details a broad selection of strategies that can be
implemented to reduce workers risk of developing WRMSDS. Ideally, a hierarchy of
intervention strategies should be implemented to eliminate WRMSD risk factors, or
to reduce the level of risk.
A synopsis of the details for each phase of the assessment protocol is
presented in Figure 20. The phases are not carried out independently or in sequential
order. For example, documents may be generated as a part of an assessment tool,
during the planning stage or in the participant selection stage.
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2. Select Assessment Tools & Methods

Options:
1. Select Assessment Environment(s) Psychophysical, Physiological Biomechanical
Observational, Direct/Indirect, Self Reporting
Options: Consider:
A) On-Site - Real time work • Ease of use
B) Laboratory Setting - Simulated work • Assessors training requirements
conditions • Suitability for use in different environments
• Sample size requirements
Consider: • Meaningfulness of data output
• All tasks and sub-tasks • Associated costs
• All work environment conditions • Data analysis requirements
• All task variable conditions – e.g. tools, materials, • Maintenance, inspection, calibration requirements
working heights, load weights etc. • Time requirement
• Test equipment, check maintenance, inspection and calibration
Information: records
Observe workers carrying out tasks, Q&A sessions,
• Ensure all appropriate software is available for data/statistical
analysis
interviews, questionnaires, checklists, review
literature and previous studies Information:
Literature review, Pilot studies, Seek advice from technicians,
suppliers of assessment equipment
3. Select Participants
Options: 4. Generate Documentation
A) Population of Interest
B) Sample Population Options:
C) Control Population A) Recruitment notice
D) Sample Size B) Information Letter
E) Ethical Approval from appropriate body C) Instructions
Consider: D) Questionnaires
• Methods of identifying& informing potential participants E) Checklists
• Selection process - inclusion/exclusion criteria F) Surveys
• Skills & experience G) Consent forms
• Demographics
• Fitness & health Consider:
• Information requirements - purpose of research, role & Readability - visually clearly seen, easily read,
responsibility, methods of assessment, potential risk and legible
• Methods of informing participants – printed media, verbally, Understanding - easy to interpret
Q&A sessions Test document structure & layout with appropriate
• Documentation requirements bodies e.g. test subjects, academic & modify
• Consent accordingly
Information: Information:
Literature review Pilot studies, Observe workers Q&A interviews, Literature review, ethical guidelines, pilot studies,
questionnaires, checklists, ethical guidelines
6. Evaluate the Risk
Options:
A) Pilot study
B) Mock Trials
5. Plan & Schedule C) Equipment and Document Requirement checklists
D) Assessment procedure flow chart/checklist
E) Schedule
ü Schedule Assessments: involve all stakeholders: F) Carry out assessments
- meetings, phone, email G) Upload data
ü Subjects read information letters and Instructions, H) Analyse data
and sign consent forms I) Determine if results indicate a level of risk
J) Identify which aspects of the assessments expose participants to
higher levels of risk
Consider:
Potential problems on assessment day, Alternative options
Figure 20: Research WRMSD Risk Assessment Protocol
~ 114 ~
Chapter 5: Methodology 2: Plasterers WRMSD Risk Assessment
Chapter 5. Methodology 2: Plasterers WRMSD

Risk Assessment
5.1 Introduction
In this chapter, the methodology used to evaluate WRMSD risk to plasterers
working in Ireland, is described.
5.1.1 Outline of WRMSD Risk Assessment Methodology

The assessment protocol was used as a foundation to develop an appropriate
methodology to evaluate WRMSD risk to plasterers working in Ireland. The
methodology process is presented in the same order as the phases of the research risk
assessment protocol presented in the previous chapter. The phases are:
• Select Assessment Environments

• Select Assessment Methods
• Select Participants
• Generate Documentation
• Plan and Schedule
• Evaluate the Risk
• Provide Recommendations
Plastering tasks and working conditions that potentially expose plasterers to

WRMSD risk factors were identified. Two environmental settings were selected in
which to carry out the assessments 1) Field Setting and 2) Laboratory setting.
Assessment methods were selected based on their suitability to monitor
plasterers’ response when carrying out activities in these environments. Pilot studies
and mock trials were carried out to ensure competency in the use of the methods and
their data analysis requirements. Appropriate software was uploaded onto a laptop
for data analysis and statistical analysis purposes. The tools and methods selected for
these assessments were 1) Visual Analogue Discomfort Survey (psychophysical
stress), 2) Heart Rate Analysis (physiological stress), and 3) Electromyography
(biomechanical stress).
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Documentation was generated to inform plasterers about the assessments,

provide instruction, and obtain personal details, task, and working condition
information from the participants. To ensure the safety of plasterers participating in
this study, ethical approval was sought from the NUI Galway Research Ethics
Committee (REC).
The data gathered in the assessments was analysed to evaluate plasterers’ risk
of developing WRMSDS. Recommendations for intervention strategies to reduce
WRMSD risk to plasterers were identified based on the findings of the WRMSD risk
assessment. A diagrammatic representation of the risk assessment process used in
this study is presented in Figure 21.
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Assessment Methodology
1. Assessment
2. Assessment 3 Select 6. Evaluate the Risk
Environment
Methods Participants
Settings Risk Assessment DATA Analysis
Sources
Field Study
• Online
Active site & real- VADS Survey: Directories Completed Measure all VADS VADS
time working VADS Scales/ • Safety Distribute
conditions and Surveys Input VADS & Temporal patterns over working day/week
Body Map/ Officers on surveys by post
usual plastering returned by Questionnaire Data into & influences of: Plastering surface,
Questionnaires Active Sites and by hand
activities post SPSS Standing surface, Task variable conditions
• Plasterers
Union
4. Document Generation
5. Plan & Schedule
Enter plasterers Run Polar Record HR HRA
Laboratory Study Heart Rate Upload
information Fitness Test for each Evaluate and compare physiological
Training centre Monitors data &
Position transmitter VO2, HRMax, work - response for each assessment condition,
Wet-plastering anlyse
& watch HRrest station Zone time & intensity, Recommended rest
Simulated working
period, RHR
conditions Activate flash marker to separate sub-tasks
EMG
Inclusion & EMG & Video
Exclusion Enter plasterers Evaluate and compare muscular activity
Workstation 1 Select suitable Connect Record
Criteria information, Upload for wet-plastering task
Wall, Ground/Hop- muscles for EMG to EMG for
• Experienced Prepare skin, Data & • Compare activity levels sub-tasks
up, Low board assessment Flash each
& Free from Position & Connect Analyse • Mix Plaster
Workstation 2 Contact marker work-
disorders electrodes to data • Load Mortarboard
Ceiling, Trestle & physiotherapist station
logger & Secure • Load Hawk
Boards, Low board for electrode
Representative leads Label all recorded data • Load Trowel
Workstation 3 placement
Sample • Apply plaster
Ceiling, Stilts, Low Add additional For task variable conditions
Upload to
board Record markers as • Plastering a wall/ceiling
Ethical EMG
Workstation 4 Synchronise
Approval each software per required to • When standing on ground & hop-up/
Ceiling, Stilts, High Video Cameras assessment with EMG separate sub-
subject/ Trestle & boards/stilts
board tasks • Using High/Low mortarboard stand
condition
Figure 21: Outline of the Assessment Procedure used to Evaluate WRMSD Risk to Plasterers Working in Ireland
~ 117 ~
Chapter 5: Assessment Methodology
5.2 Assessment Environments

Hierarchical Task Analysis (HTA) was used to identify and categorise
plastering tasks and sub-tasks in a hierarchical and sequential fashion. Analysing the
task processes enabled the detection of situations where variations occur within the
processes. Identifying variations in task process enables the detection of potential
WRMSD risk factors. This information was used to select appropriate assessment
environments and working conditions for this study
Two assessment environments were used in this study to evaluate WRMSD
risk to Plasterers working in Ireland 1) field study on active construction sites and 2)
a laboratory study in which workstations were set up to represent working conditions
that are observed on active construction sites.
5.2.1 Hierarchical Task Analysis – A Guide to Select Assessment

Environments
Plasterers were observed as they carried out their daily activities on active
construction sites to identify the task requirements and task variables of the
plastering activity. Informal interviews, and question and answer sessions took place
between the researcher and plasterers to acquire additional information about
plastering tasks and working conditions.
5.2.2 Field Study

Eighteen plasterers were assessed when carrying out their normal daily
activities on active construction sites. The HTA diagrams presented in Appendix IV,
V, and VI represent a large selection of the plasterer’s tasks that were assessed in the
field study setting. Appendix IV represents the sequential tasks carried out when
building a house (HTA 10.0 and HTA 11.0). The HTA in Appendix V represents an
example of the drywall and wet-plastering activities that plasterers carry out on a
daily basis. Finally, the HTA presented in Appendix VI represents the sub-task
activities for wet-plastering tasks.
The assessment also assessed the plasterers’ working hours and rest break
patterns. Additionally the variations that occur in plasterers working environments
were assessed, specifically:
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• Working on different plastering surfaces: ceiling, wall or worked on both a

ceiling and a wall
• Standing on different standing surfaces that included the ground, trestle &
boards, scaffolding, stilts, a hop-up or combinations of these surfaces
• Using mortarboard stands of different heights
5.2.3 Laboratory Study

Field studies carried out in working environments provide a more reflective
picture of workers physiological, psychophysical, and biomechanical responses when
carrying out their usual tasks under normal working conditions. However, carrying
out risk assessments on active sites may mean that some combinations of working
conditions will not be included in a study. In an attempt to represent as many
different combinations of work conditions as possible, it was deemed necessary to
carry out risk assessments in a Laboratory Study setting. Laboratory studies are
usually considered ethically preferable to field studies because risk factors can be
easier to control.
When carrying out a wet-plastering activity it was noted that the sub-tasks
plasterers appeared to spend the greatest amount of time carrying out were cyclical in
nature. The sub-tasks of interest, highlighted yellow in Appendix V are
• Sub-task 10.1.1 Mix Plaster

• Sub-task 10.1.2 Load Mortarboard
• Sub-task 10.2.1 Load Hawk
• Sub-task 10.2.2 Load Trowel
• Sub-task 10.2.3 Plaster
A training centre normally used to train apprentice plasterers was selected for
the laboratory study setting. The area was sub-divided into separate workstations
consisting of three walls measuring approximately 2500mm high and 2500mm wide
and also a ceiling (2500mm x 2500mm).
Four workstations were set up in preparation for the assessments to represent
conditions that normally occur on active construction sites. The variable conditions
within each workstation are presented in Table 9. Photographs demonstrating the
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layout of the four workstations are presented in Figure 22. The simulated working
conditions in each workstation correspond to a combination of working condition
scenarios.
1. Plastering a wall while standing on the ground and a hop-up and using a low
mortarboard stand
2. Plastering a ceiling while standing on a trestle & board system and using a
low mortarboard stand
3. Plastering a ceiling while standing on a stilts and using a low mortarboard
stand
4. Plastering a ceiling while standing on a stilts and using a high mortarboard
stand
Ten plasterers were assessed carrying out a wet-plastering task in each

workstation corresponding to sub-task 2.0 in the HTA presented in Appendix VI.
The specific sub-tasks evaluated were Mix Plaster (HTA 10.1.1), Load Mortarboard
(HTA 10.1.2), Load Hawk (HTA 10.2.1), Load Trowel (HTA 10.2.2), and Apply
Plaster (HTA 10.2.3). These correspond to the sub-tasks 10.1.1, 10.1.2, 10.2.1, and
10.2.2, and 10.2.3 highlighted in the HTA presented in Appendix V.
Table 9: Summary Details of the Variable Working Conditions in Each

Assessment Environment Workstation
Assessment Conditions
Workstation Workstation Workstation Workstation
1 2 3 4
Standing Work Ground & Trestle &
Stilts Stilts
Surface Hop-up boards
Mortarboard stand Low Low Low High
height (775mm) (775mm) (775mm) (1270mm)
Plastering Work
Wall Ceiling Ceiling Ceiling
Surface
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Workstation 1 Workstation 2
Plastering a wall while standing on the Plastering a ceiling while standing on a trestle
ground and a hop-up and using a low & board system and using a low mortarboard
mortarboards stand stand
Plastering a ceiling while standing on a Plastering a ceiling while standing on a stilts
stilts and using a low mortarboard stand and using a high mortarboard stand
Figure 22: Example of Workstation Layout Laboratory Study Assessment:

Represent Conditions That Occur on Active Construction Sites
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In Assessment Condition 1, plasterers were required to apply wet-plaster to

a wall surface (2500mm x 2500mm). The plaster was applied to the full surface of
the wall from ground height up to where the wall and ceiling met, approximately
250mm-300mm above the plasterer’s head height. While carrying out their task
plasterers alternated between standing on the ground and standing on a hop-up 5. The
hop-up was moved into position as desired by the plasterer when they needed to
reach a wall surface that was beyond their reach. A mortarboard stand 775mm high
was positioned at one end of the wall at a distance of 450mm from the wall of the
workstation.
a ceiling surface 2500mm from the ground. The plaster was applied to the full
surface of a ceiling (2500mm x 2500mm). Plasterers extended their arm
approximately 250mm-300mm above their head height during the task. While
carrying out their task plasterers stood on a raised work surface erected using solid
wooden planks on top of trestles. The upper surface of the boards was 480mm from
the ground. A mortarboard stand 775mm high was positioned on the ground at one
end of the trestle and board system. The distance between the upper side of the
standing surface and the upper side of the mortarboard was 295mm.
a ceiling surface 2500mm from the ground. The plaster was applied to the full
surface of a ceiling (2500mm x 2500mm). Plasterers extended their arm
approximately 250mm-300mm above their head height during the task. While
carrying out their task, plasterers used stilts as an elevated standing surface.
Plasterers adjusted their stilts to a height level corresponding to their perceived
comfortable elevation. The height of the stilts from the ground ranged from 510mm
to 610mm (mean 583mm). A mortarboard stand 775mm high was positioned on the
ground at one end of the trestle and board system. It was positioned at a distance of
450mm from the wall of the workstation. The distance between the upper side of the
stilts and the upper side of the mortarboard ranged between 165mm to 265mm (mean
192mm).
5
The hop-up used in the study is a rigid structure with two steps, one at 270mm and the
second at 500mm and weighed 18kg.
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In Assessment Condition 4, the conditions were identical to those in

Assessment Condition 3 with one exception. The mortarboard stand used was
1270mm high instead of 775mm high. The distance between the upper side of the
stilts and the upper side of the mortarboard ranged between 660mm to 760mm (mean
687mm).
A separate room in the training centre was made available as a preparation
area and for equipment storage for the duration of the assessments. The preparation
area enabled subjects’ privacy when preparing for the assessments, provided a quite
area for pre-assessments, and provided a secure location for equipment set-up and
data up-loading. The laptop, equipment, and paperwork were set up in one area of the
room and a second area set up with a folding bed on which subjects could lie quietly
when carrying out pre-assessment physiological tests.
One plasterer was assessed per day in the Laboratory Study. Plasterers had a
period of rest after completing their assessment task in each workstation while the
data was up-loaded onto a laptop and the equipment prepared for the next assessment
condition.
At the time of the assessments, drywall boards had been fixed to the walls
and ceiling surfaces. The joints had been taped, filled and sanded and were ready in
preparation for a skim coat application. Plaster compounds, mixing equipment,
mortarboards and stands were supplied by the training centre and a General
Operative (GO) was made available to provide assistance if required.
Plasterers supplied their own hawk, trowel, brushes, and stilts. They mixed
wet-plaster prior to commencing their activity in each assessment environment. Dry
powder compounds from a 25kg bag were added to water in a large mixing
container. A hose connected to a nearby tap supplied the water. The mixture was
agitated using an electronic mixing device supplied by the apprentice-training centre.
Water and/or powder was added and agitated until a desired consistency was
achieved. Once mixed, plasterers lifted the container to load the plaster onto a
mortarboard stand.
~ 123 ~
5.3 Assessment Methods

An array of risk assessment methods used in WRMSD risk assessments were
identified in a detailed literature review and research study publications. After
carrying out mock trials and pilot studies, three methods were selected based on their
suitability to evaluate psychophysical, physiological, and biomechanical stress.
A Visual Analogue Discomfort Scale (VADS) survey was selected to
evaluate psychophysical stresses, Heart Rate Analysis (HRA) was selected to
evaluate physiological stresses, and Electromyography (EMG) was selected to assess
biomechanical stresses. The VADS survey was used in the Field Study while HRA
and EMG were used in the Laboratory Study.
5.3.1 VADS Survey – Field Study

In the Field Study, plasterers were asked to complete a VADS survey when
carrying out their normal daily activities on active construction sites to evaluate their
subjective qualitative judgments of postural discomfort. VADS surveys provide a
subjective evaluation of psychophysical stresses imposed on the body in relation to
the intensity of perceived discomfort experienced from participating in an activity.
The initial design of the VADS survey was decided after a detailed literature
review. It was pilot tested among researchers in NUIG and with trade workers in the
construction industry. It was subsequently redesigned in accordance with the findings
from the pilot study. A selection of the VADS documents is presented in Appendix
VII. The bound 35-page VADS survey contained:
• A participant’s consent form

• An instruction guide
• General information questionnaire
• Two variations of task requirement questionnaires (two per day for five days)
• A body map with ten body areas shaded in different colours - to assist
plasterers in identifying body areas
• Twenty batches of ten VADS
• Each VADS represents one of 10 body areas being assessed: neck, upper
back, shoulders, mid back, elbows, low back, wrists/hands,
buttocks/hips/thighs, knees, and ankles/feet
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• Each batch of VADS represents a specific time event - before the start of
work (BW), before lunch (BL), after lunch (AL), and at the end of the
working day (EW)) for five consecutive working days starting on Monday
The survey was designed to be visually clearly seen, easily read, and legible,
so that participants could easily interpret the intention of the survey (Brace, 2008,
Rajaraman and Samet, 2005). The document was separated into different coloured
sections. Each coloured section represented a different day (Monday to Friday) to
enable plasterers distinguish between days. Different font styles were used to
distinguish between the different time and day events. The time events were
highlighted in large bold print at the top of each page. The ten body areas were listed
vertically on a single page and a corresponding VADS was positioned adjacent to
each body area name.
The scales used in this survey were 100mm long, anchored at each end with
the left anchor point at 0mm, labelled with No Discomfort, the right anchor point at
100mm, and labelled Extreme Discomfort. Each scale is separated into five intensity
zones at 20mm intervals; light (0-20mm), Moderate (20-40mm), Average (40-60mm)
Hard (60-80mm) and Unbearable (80-100mm). Plasterers were requested to mark a
point along a VADS scale to represent the intensity of their perceived discomfort for
a corresponding body area.
Plasterers were asked to mark a point along a scale to represent the intensity
of perceived discomfort they experience in specified body areas at specified time
events. They were also required to complete two task requirement questionnaires,
one during the plasterer’s lunch break and the second at the end of their workday.
VADS was used to
• Provide a snapshot description about plasterers working times, work

activities, and working conditions over five consecutive workdays
• Test the hypothesis that plastering tasks and working conditions have no
influence on a plasterers level of perceived discomfort intensity
• Determine if plasterers experience discomfort in ten body areas
• Determine if plasterers experience temporal patterns of discomfort intensity
over the working week
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• Determine if working times, work activities, and working conditions

influences patterns of discomfort intensity
5.3.2 Heart Rate Analysis (HRA) – Laboratory Study

In the Laboratory Study, plasterers were assessed while carrying out a wet-
plastering task in four workstations. Each workstation was set up to replicate
working condition scenarios found on active construction sites. A selection of the
documents used in the Laboratory Study is presented in Appendix VIII.
Heart Rate monitoring was used to evaluate physiological stresses when
participating in the assessment activity using a Polar™ S810 Heart Rate Monitor.
Plasterers’ details obtained from the General Questionnaire were entered into the
Heart Rate Monitor. This included their gender, height, weight, date of birth, and
fitness level. The monitor was set to record each heart beat, and record plasterers’
energy expenditure for the duration of the recording period.
A Polar T-61 Transmitter was placed across the participant’s chest against the
skin at the level of the xyphoid process. It was secured in position using an elastic
strap. A watch receiver was placed on their wrist.
Plasterers’ VO 2 , predicted HR max , and HR rest were determined using the
monitors Polar Fitness OwnIndex Test, and HR max -P test. These values were used as
reference values when determining the physiological responses for each assessment
condition scenario.
Plasterers heart rate was monitored for the duration it took them to complete a
wet-plastering task in an assessment environment. Heart rate recording commenced
once the plaster was mixed and before the plaster was poured onto a mortarboard,
and continued for the duration it took plasterers to complete their assessment task.
The heart rate data file recorded in the pre-test, and recorded in each assessment
environment was uploaded via a Polar IR interface to a laptop using software
compatible laptop. Each file was labelled using a corresponding plasterer’s reference
code and assessment condition environment reference code for later data analysis
using Polar precision Performance Software.
Fifty heart rate files containing plasterer’s heart rate details were generated;
10 plasterers assessed in four assessment conditions, and one pre test condition.
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HRA was used to test the hypothesis that carrying out a wet-plastering
activity in an assessment environment setting has no influence on plasterer’s
physiological system.
5.3.3 Electromyography – Laboratory Study

Electromyography (EMG) is used to study muscle function by analysing the
electrical activity of contracting muscles. It was selected to monitor plasterer’s
biomechanical stress when carrying out the assessment activity in a Laboratory
Study. The right and left sternocleidomastoid (SCM), right and left trapezius, and the
right and left erector spinae muscles were selected for assessment purposes (Figure
23).
The SCM was selected because of its involvement in moving and supporting
the head and neck. Individually, the SCM muscles are responsible for flexion and
rotation of the head. Together, they counteract the extensor muscles of the neck to
stabilize the head and are used for neck flexion. To aid respiration, they elevate the
sternoclavicular joint when the head is in a fixed position. Symptoms associated with
strain of the SCM are usually experienced as referred pain in the head, face, jaw, and
sternum (Jull et al., 1999). Fatigue associated with neck flexion muscles is associated
with tension headaches in adolescents (Oksanen et al., 2007).
The trapezius muscle was selected because of its involvement in movements
of the shoulder and arm particularly when the arm is elevated and/or moved away
from the body. Injuries of the shoulder are associated with handling heavy loads,
working at or above shoulder height, overhead work, extreme or awkward postures,
repetitive movements, forceful exertions, and working without frequent rest breaks
(Weon et al., 2010, Ebaugh and Spinelli, 2010, Ratzon and Jarus, 2009, Walker-Bone
and Cooper, 2005, Anton et al., 2005, Anton et al., 2001, Hagberg, 1996). Shoulder
injury symptoms include swelling, pain and discomfort, headaches, and referred pain
in the jaw (Tempelhof et al., 2010, Keener et al., 2010, Worland et al., 2003).
~ 127 ~
Left Sternocleidomastoid (SCM) Right Sternocleidomastoid (SCM)
Left Trapezius Right Trapezius
Left Erector Spinae Right Erector Spinae
Figure 23: Muscles assessed using EMG
The erector spinae muscle was selected because of its involvement in moving
and supporting the back. The muscles are the primary stabilisers for the spine and
assist in maintaining erect posture. It stabilises the spine when lifting objects and
when sustaining a wide range of postural movements such as flexion, sideways
bending, and twisting (Keyserling, 2000).
An 8-channel muscle tester ME3000P8 data logger unit (Mega electronics
Ltd, Kuopio, Finland) weighing approximately 0.5 kg was used to record muscle
activity levels. Six channels (1 to 6) were used in this study, one channel being used
for each muscle determined appropriate to evaluate in this study. The frequency-
sampling rate was set at 1000Hz and data was recorded in a continuous saving
format and filtered using a band pass filter (10-500 Hz).
A qualified physiotherapist, following SENIAM guidelines, prepared the skin
and positioned electrodes on the surface over the body of the muscles being assessed.
A set of three electrodes were used for each muscle being assessed. Two pre-gelled
bipolar Silver/Silver Chloride (Ag/AgCl) electrodes (1 cm diameter) were positioned
over the body of the muscles positioned approximately 40mm apart. The third
~ 128 ~
electrode was positioned at an adjacent bony point as a grounding reference for each
muscle. The electrodes were allowed to stabilise on the skin for the duration it took
to carry out the heart rate monitoring pre-tests.
Pre-amplification leads were labelled for connection to a specific muscle and
corresponding channel number. Each set of three electrodes were connected to a
corresponding lead and channel socket in the data logger unit (Figure 23). The leads
were taped using medical tape. This helped to reduce the probability of electrode
slippage during the dynamic activity and to reduce the probability of leads interfering
with the plasters ability to carry out their task in a normal manner.
A Cannon FS100 digital video camera was set up in location to enable
recording of plasterers carrying out their tasks in assessment work areas. It was set at
a distance to enable a full view of the plasterer and the workstation in which he was
carrying out his task. Upon completion of the task in an assessment area, the memory
card with the video recording was appropriately labelled. The recorded videos were
stored on a 2GB Kingston Technology Micro SD card.
A flash marker was connected to the data logger unit. It was activated to mark
the commencement and cessation of assessments and mark the start and end of a sub-
task. When activated the marker ‘inserted’ a flash of light in the video and inserted a
corresponding maker onto the EMG signal.
On completion of the assessments, the raw EMG data was uploaded from the
datalogger onto a laptop using MegaWin V2.21 software (Mega Electronics, Kuopio,
Finland). Each file was appropriately labelled to enable the identification of
plasterers and their corresponding assessment condition data. EMG was used to test
the hypothesis that carrying out a wet-plastering activity in an assessment
environment setting has no influence on plasterer’s muscle activity (biomechanical
stress). Recording muscle activity and videoing tasks, commenced before plasterers
were signalled to start the assessment. The flash marker was activated when
plasterers started the task and each time a plasterer moved between sub-task
activities. This enabled synchronisation between the EMG data and the video
recordings. It also helped to separate the data into sub-task activities for a more
detailed analysis. Recording ceased once a full surface (wall or ceiling) was
completely covered with a smooth coat of plaster.
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5.4 Selecting Participants

In 2009, approximately 136,700 workers were employed in the construction
industry in Ireland and the number of plasterers employed estimated at 7,500
(approximately 5% of the construction worker population ) (CSO, 2009). Currently,
approximately 100,000 people are employed in the industry. Assuming that a similar
decline has occurred in the employment status of plasterers, approximately 5,000
plasterers are currently employed in Ireland (CSO, 2012). To ensure that participants
represented the plastering population of Ireland, participants were sourced by:
• Searching through online trade and craft worker directories in which plasterers
were registered
• Contacting Safety Officers employed in construction companies around Ireland
to determine if plasterers were working on their site
• Contacting the General Secretary of the Operative Plasterers & Allied Trades
Society of Ireland to obtain contact details of plasterers who would be willing
to participate in the study
A criterion was established to include or exclude plasterers in the study. For

the field study setting, plasterers were required to be carrying out plastering activities
for five consecutive working days on an active construction site. For the laboratory
study setting, plasterers were required to be competent and experienced in wet-
plastering activities and use stilts on a regular basis in the normal course of their
work. Additionally, they were required to be free from any health related condition,
injury, or WRMSD that may increase their risk when participating in the study.
Approximately 280 plasterers were contacted by telephone. The research
details for the field study setting and laboratory study setting were explained to them
and they were asked to participate in either study. Plasterers were excluded from the
study in situations where they did not meet with the inclusion criterion.
In the field study, 150 plasterers volunteered to participate and were sent the
appropriate VADS survey documents outlined in the next section.
In the laboratory study, 25 plasterers initially volunteered to participate.
However, 15 withdrew from the study prior to commencing the assessments leaving
ten participants (N=10).
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Each prospective participant received an information pack containing the

contact details of this researcher, a letter explaining the procedures, instructions
outlining what they were required to do, and relevant consent forms.
All queries about the research were answered prior to the participants
volunteering in the research on the understanding that they were free to drop out at
any stage. To maintain anonymity, all participants were allocated a reference
number. It was assumed that the participants:
• Were a representative sample of plasterers employed in the Irish construction

industry.
• They carried out their activities during the assessments in a manner similar to
that carried out during a normal working day
• They completed questionnaires/surveys honestly and accurately
To safeguard the health, welfare, and rights of human participants in this

research, ethical approval was sought and granted from the National University of
Ireland Galway (NUIG) Research Ethics Committee. The assessment procedure was
developed in accordance with ethical guidelines to minimise predictable risk to both
the research participants and to the researcher. Participants were not required to carry
out activities outside of their usual duties. Assessments were non-invasive and of no
risk to the participants. They adhered to NUI Galway Ethical Guidelines in
accordance with the declaration of Helsinki as advised by NUI Galway Research
Ethics Committee (2006).
In the Field Study setting, 18 experienced plasterers were assessed carrying
out their usual daily activities on active construction sites over five consecutive
working days (Appendix V).
In the Laboratory Study setting, 10 plasterers were assessed in simulated
working environments representing combinations of working condition scenarios
that occur on active construction sites.
5.5 Generating Documentation

The documents used in this research were submitted together with the ethical
application to The National University of Ireland Galway (NUIG) Research Ethics
Committee. The documents were generated following their recommendations.
~ 131 ~
Examples of the documents are included in the appendices. The documents used
were:
• Information letter outlining the Field Study requirements sent to plasterers

participating in the VADS survey
• Information letter outlining the Laboratory Study requirements sent to
plasterers participating in HRA and EMG analysis of wet-plastering activity
• Instructions outlining how plasterers were required to complete the VADS
survey
• Two types of information gathering questionnaires included in the VADS
survey – for five consecutive workdays one questionnaire to be completed
during a lunch period, the second to be completed at the end of a working day
• Batches of 10 VADS scales – each batch to be completed at a specified time
event (four times a day for five consecutive workdays
• Consent form to participate in the Field Study
• Consent form to participate in the Laboratory Study
• General Information Questionnaire – used to obtain demographic details of
participants in the Laboratory Study
Checklists were generated to minimise errors when carrying out the

Laboratory Study assessment. These were
• Equipment checklist
• Assessment sequence & estimated timing checklist
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5.6 Planning & Scheduling

The planning requirements for the Filed Study involved the development,
printing, distribution, and collection of the VADS surveys. They were designed,
printed, and bound using facilities in the National University of Ireland Galway
(NUIG). The bound surveys were distributed to plasterers by mail and when
completed they were returned to this researcher in a stamped self-addressed envelop.
A selection of the VADS documents used in the Field Study is presented in
Appendix VII.
For the Laboratory Study, participating plasterers, a physiotherapist, and
management of the training centre were contacted by telephone to organise an
assessment schedule to accommodate all parties. The assessments were scheduled
over a period of three weeks to accommodate all participants involved in the study
In the week prior to commencing the assessments, participant plasterers were
contacted to confirm their scheduled assessment time. At this time plasterers were
advised to eat a light meal 2-3 hours before commencing their assessment, and to
avoid smoking or drinking coffee prior to and for the duration of their assessment. In
addition, plasterers were asked to arrive in the training centre no later than 8.00am
and they were advised to wear loose fitting clothing on the day of their assessment.
Plasterers were also asked to complete the General Information Questionnaire during
this conversation. A selection of the documents used in the Laboratory Study is
presented in.
When planning and scheduling the Laboratory Study assessments, a checklist
was created to ensure that all equipment, materials, and documentation requirements
were identified and available on the days of the assessments. A second checklist
outlined the sequential risk assessment process to ensure consistency in the risk
assessment procedure for each participating plasterer. These checklists are presented
in Appendix IX.
5.7 Evaluate WRMSD Risk

Data analysis was carried to evaluate if plasterers working in Ireland are at
risk of developing WRMSDS. The data was analysed in descriptive terms to provide
details about populations. Comparisons were made between populations to describe
differences between populations. Finally, statistical analysis was carried out in an
attempt to identify which (if any) task requirements and/or work conditions
~ 133 ~
significantly increase the likelihood of plasters developing WRMSDs. The data

analysis procedure to evaluate WRMSD risk is presented below for each assessment
method.
5.7.1 VADS Data Analysis

Experiencing sensations of discomfort indicates exposure to WRMSD risk
factors. The sensations increase in intensity in response to increased disruption of
homeostatic balance, physiological stress and psychological stress (Öztürk and Esin,
2011, da Costa and Vieira, 2010, Boocock et al., 2009, Buckle and Devereux, 2002,
Welch et al., 1999, Edwardson, 1995). Psychophysical sensations may be attributed
to physical injury such as micro tears in muscle fibres (Coburn et al., 2011, France,
2010, Walker, 2007b, Voight et al., 2006). Experiencing sensations of pain and
discomfort act as an incitement to take a break from activities to enable recovery
(Coutts et al., 2009, McArdle et al., 2009, Cameron, 1996, Åstrand and Rodahl,
1986).
The data collected in the VADS survey reflected temporal patterns of body
area discomfort as recorded by subjects. Analysis of the data was carried out to
determine if plasterers experienced discomfort in ten body areas. The data was
analysed to evaluate if intensity levels were influenced by time, task requirements, or
working conditions. The inference of the results is that increased discomfort intensity
indicates exposure to WRMSD risk factors and an increased likelihood of developing
WRMSDs.
Treatment of Data
A ruler was used to measure from the left anchor point to the subjects’
vertical mark on each scale (one corresponding to each body area and for each time
event). The values and the questionnaire information were entered into Statistical
Package for the Social Sciences (SPSS) 17.0 for data analysis. A total of 3,600 fields
of information were entered into the file, 200 per plasterer. A single variable
represented each body area for each time condition over the five working days with
corresponding details relating to the task carried, plastering surface worked on and
standing surface. Each of the plasterers’ scores was treated independently.
The indices of interest in this study are, frequency data about tasks and
working conditions over a five-day work period, and mean discomfort intensity
represented on a 100mm linear scale over the same period.
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The frequency data (mean, maximum, and minimum values) provides a

‘snapshot’ representation of a plasterer’s daily life when working on an active
construction site. Mean discomfort intensity values were calculated for each body
area for each case to evaluate a quantity of discomfort intensity in ten body areas
over a period of twenty time events in a five-day work period. Time event analysis
determines temporal patterns of discomfort intensity for ten body areas over a
working week. In addition, task and working condition data analysis determines their
influence on the intensity levels of discomfort for ten body areas.
The data was filtered into separate categories with respect to the independent
variables to enable comparative, inferential and correlation analysis to investigate
their influence on the dependent variable (perceived discomfort). The filtered
databases enabled the following analysis:
• Filtered by Time Events: Investigate mean perceived discomfort intensity

for body areas across each working day and working week
• Filtered by plastering surfaces worked upon: Investigate mean perceived
discomfort for body areas for each plastering surface condition – wall,
ceiling, wall & ceiling surfaces in a single work period
• Filtered by standing surfaces worked upon: Investigate mean perceived
discomfort for body areas for each standing surface condition –using a single
standing surface or using multiples of standing surfaces in a single work
period
• Filtered by plastering sub-tasks carried out: Investigate mean perceived
discomfort for body areas for each sub-task activity –wet-plastering sub-tasks
and non wet-plastering sub-tasks in a single work period
On the basis that the parametric assumptions of sample normality and

homogeneity could not be met with the collected data, statistical analysis was
performed using Wilcoxon Signed –Rank test.
The test was performed between mean postural discomfort scores for each
body area for each filtered category: Time of Day, Day of Week, Time Event,
Plastering Surface, Standing Work surface and Plastering Tasks. The results were
deemed to be significant in cases where p ≤ 0.05. The hypotheses tested were:
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• H 0 – Time events have no influence on the level of perceived discomfort

intensity.
• H 0 - Plastering surfaces have no influence on the level of perceived
discomfort intensity.
• H 0 - Standing surfaces have no influence on the level of perceived discomfort
intensity.
• H 0 - Plastering tasks have no influence on the level of perceived discomfort
intensity.
• Time events working day/week

• Standing work surfaces - ground, hop-up, trestle, stilts, and combinations of
these surfaces
• Sub-Tasks: Erecting framework and supporting structures, Hanging drywall
boards, Taping and filling, Preparing and mixing plaster, Applying skim coat,
and Applying finishing coat
• Perceived discomfort intensity - Measured on a 100mm VADs scale, 0mm

represents no perceived discomfort experienced, 100mm represents an
extreme level of perceived discomfort experienced
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5.7.2 HRA Data Analysis

Change in heart rate is a physiological response to the demands exerted on
the body when participating in a physical activity. The rate of change increases
proportionally to the intensity level of an activity to meet the oxygen and nutrient
demands of active muscles. Prolonged elevation of the cardiovascular system
indicates prolonged participation in a high intensity activity and therefore an
increased probability of developing WRMSDs.
Monitoring heart rate is frequently used in ergonomic assessments to evaluate
physiological demand of activities and establish safe working conditions with respect
to the capacity of the workers involved (van der Molen et al., 2007, Tiwari et al.,
2005, Anton et al., 2005, Abdelhamid and Everett, 2000, Astrand and Rodahl, 1986).
Experiencing elevated changes in heart rate indicates exposure to WRMSD risk
factors.
To enable comparisons between plasterers and between task assessment
conditions, the data recorded for a plasterer in test scenarios was referenced against
corresponding HR max and HR rest values. The results for each subject were entered
into an excel spreadsheet and formulas were applied to calculate:
• Mean heart rate activity

• Percent of time working in Heart Rate Zones (HRZ) – indicates the
proportion of time (as a percent of total time) plasterers’ spend working at a
specified intensity level.
• Relative Heart Rate (RHR) - a measure of cardiovascular strain for an activity
and is calculated using HR rest values.
• Recommended Rest Periods – minutes of rest per hour of activity
Heart rate zone activity can be used to determine the intensity level of
physical activity a person is partaking in. Zone ranges were calculated based on an
individuals HR rest and HR max values. Each zone corresponds with heart rate values
between HR rest and 50%, 60%, 70%, and 85% of their HR max values. When heart rate
values fall within these zone ranges, it indicates that a person is partaking in an
activity of a specified intensity. The zone ranges are presented in Table 10. Working
in higher zones for longer periods induces physiological strain. This results in a
~ 137 ~
reduced capacity to meet the oxygen and nutrient demand of active muscle groups
and leads to localised and whole body fatigue.
HR zones were calculated for each plasterer using their HR rest and HR max
values obtained in the pre-test setting. The percent of time spent working in each
zone was calculated for each assessment scenario. This information indicates the
percent of time a plasterer spent working at each intensity level when carrying out a
wet-plastering activity
Table 10: Heart Rate Zone Ranges
HR ZONES
1 2 3 4 5
Very light Light Moderate Hard Maximum

HR rest – 50% 51%-60% 61%-70% 71%-85% 85%-
HR max HR max HR max HR max HRmax
Relative Heart Rate (RHR) is a measure of cardiovascular strain a person

experiences when partaking in a physical activity. RHR enables comparison of
cardiovascular strain levels between subjects and between task conditions. Using
Equation 1, and plasterers’ HR rest and HR max values, RHR was calculated for each
plasterer for each of the four assessment scenarios.

Workload

When the demands of an activity exceed the capacity of a worker, they

experience perceived and physical sensations of fatigue. A period of rest is required
to enable recovery. Infrequent breaks, or too short of a break, increases the likelihood
of WRMSD development. Using Murrells Equation (Equation 2), and plasterers
HR rest and HR max values, Recommended Rest Periods (RRP) were calculated for
each plasterer for each of the four assessment scenarios.
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4.2kJ
The calculated data was transferred into Statistical Package for the Social
Sciences (SPSS) 17.0 for Windows for data analysis. The data was filtered into
separate categories with respect to the independent variables to enable comparative,
inferential and correlation analysis to investigate their influence on the dependent
variables. One-way ANOVA inferential tests and relevant post-hoc multiple
comparison analysis (Tukey) was carried out to determine if independent variables
have a significant influence on the dependent variables. This type of analysis was
conducted to evaluate the relationship between heart rate activity and assessment
workstation environments i.e. the differences in assessment workstations (plastering
surface, standing surface, and mortarboard stand height).
• Wet-plastering a wall while standing on the ground and a hop-up and using a
low mortarboards stand
• Wet-plastering a ceiling while standing on a trestle & board system and using
a low mortarboard stand
• Wet-plastering a ceiling while standing on a stilts and using a low
mortarboard stand
• Wet-plastering a ceiling while standing on a stilts and using a high
mortarboard stand
• Mean heart rate, Resting heart rate (HR rest ), Maximum heart rate (HR max ) -
measured in beats per minute (bpm)
• Percent of time spent in Heart Rate Zones - a range of heart rate activity
representing a proportion of maximum heart rate capacity – indicates a
measure of intensity for physical activity
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• Relative Heart Rate (RHR) - a measure of the cardiovascular strain for an

activity and is calculated using HR rest values.
• Recommended rest periods – minutes of rest per hour of activity
5.7.3 EMG Data Analysis

Electromyography (EMG) was used to study muscle function by analysing
the electrical activity of contracting muscles. The hypothesis is that when muscles
are active for prolonged periods and/or exert high intensities of activity, they are at a
greater risk of becoming fatigued and injured. The inference is that increased muscle
activity has occurred because of exposure to WRMSD risk factors. This exposure
increases the force demands exerted on the musculoskeletal system i.e. the greater
the magnitude of muscle activity the greater the probability of injury.
The frequency and amplitude of the EMG data indicates which muscles are
active, the intensity of that activity (internal muscle forces), and the duration of
activity. It is a suitable method to evaluate strain on the musculoskeletal system.
Additionally, EMG enables comparisons of strain levels between tasks and sub-task
activities under a variety of different working conditions (Konrad, 2005, Ankrum,
2000, Hägg et al., 2000).
To enable comparisons between plasterers, task assessment conditions, and
sub-tasks of the plastering activity, the EMG data was processed and normalised.
The RMS option in the MegaWin V2.21 software was used to process and rectify the
raw EMG data.
Corresponding EMG signals and video recordings were synchronised.
Additional markers were inserted where required, to enable the division of the wet-
plastering task into its sub-task conditions. Mean EMG values were calculated for
each muscle, plasterer, assessment condition environment, and sub-task condition.
Forty synchronised and marked files were saved. Each corresponded with a
plasterer and an assessment condition environment (10 plasterers, four
environments). The files were saved as ASCII text files and resaved as Microsoft
Excel files. The data was separated and grouped into sub-tasks of interest and
assessment condition variable.
Plasterers’ muscle activity levels varied in response to the demands of their
activity when participating in the assessments. The maximum EMG values (peak
dynamic value) were considered as being a muscles maximum capacity. Mean EMG
~ 140 ~
values for assessment conditions were referenced against corresponding peak EMG
values to generate an activity level for muscles for assessment conditions. This value
represents activity level as a percentage of peak activity (% peak EMG). The
intensity of muscle activity is quantified in an incremental scale consisting of 100
units ranging from 0% (NO Activity) to 100% (MAXIMUM activity). This enabled
comparison of muscle activity levels for each assessment condition scenario.
The calculated data was transferred into the Statistical Package for the Social
Sciences (SPSS) 17.0 for Windows for data analysis. The data was filtered into
separate categories with respect to the independent variables to enable comparative,
inferential and correlation analysis to investigate their influence on the dependent
variable (muscle activity). One-way ANOVA inferential tests and relevant post-hoc
multiple comparison analysis (Tukey) was carried out to determine if independent
variables have a significant influence on dependent variables. This type of analysis
was conducted to evaluate the relationship between muscle activity and assessment
surface, standing surface, and mortarboard stand height).
• Standing work surfaces – ground & hop-up, trestle, stilts,
• Working with a low mortarboard stand and working with a high mortarboard
stand
• Assessment Condition Environments
• Wet-plaster Sub-Tasks: Mix Plaster (HTA 10.1.1), Load Mortarboard (HTA
10.1.2), Load Hawk (HTA 10.2.1), Load Trowel (HTA 10.2.2) and Plaster
(HTA 10.2.3)
• Muscle activity - represented as a percentage of the peak electrical activity
level recorded for that muscle over the course of an assessment. 0% indicates
no muscle activity, 100% indicates that the muscle is active at its peak level.
~ 141 ~
5.8 Summary WRMSD Risk Assessment

Methodology
The Research Risk Assessment Protocol outlined in Chapter 4 was used as a
guide to develop an appropriate risk assessment methodology to evaluate WRMSD
risk to plasterers working in Ireland. Two environmental settings were selected in
which to carry out the assessments 1) Field Setting and 2) Laboratory setting. VADS
was selected to evaluate psychophysical stress, HRA was selected to evaluate
physiological stress, and EMG was selected to evaluate biomechanical stress.
Plasterers were sourced from a number of different sources. Upon establishing a
suitable criteria to include and exclude plasterers in the study, plasterers were
contacted and asked to participate. Ethical approval was sought and granted to ensure
the safety of participants. Documentation was generated in accordance with ethical
guidelines to inform participants about the study, and to obtain information about the
participants. A suitable assessment schedule and procedure was established to
accommodate all parties and to ensure consistency in the data gathering stage of the
WRMSD risk assessment. Data was analysed to evaluate if plasterers working in
Ireland were at risk of developing WRMSDs and to establish which aspects of their
work requirements and working conditions increased the level of risk. The findings
from the risk assessment process were used to identify recommended interventions to
reduce risk.
• Assessment Setting: two environmental settings were selected in which to

carry out the assessments:
o Field Setting – plasterers carried out their usual daily activities on
active construction sites over five days
o Laboratory setting with four workstations – plasterers carried out a
wet-plastering task in each assessment workstation in which they
applied a complete coat of plaster onto a wall/ceiling surface.
• Threes methods were selected for these assessments
o Visual Analogue Discomfort Survey (psychophysical stress),
o Heart Rate Analysis (physiological stress),
o Electromyography (biomechanical stress).
• Participants in the Study
~ 142 ~
o Field Study: 18 experienced plasterers participated in the field study

and were assessed using the Visual Analogue Discomfort Survey
o Laboratory Study: Ten experienced plasterers who regularly use stilts
as part of their work participated in the laboratory study. The
plasterers physiological stress and biomechanical stress was
monitored using Heart Rate Analysis and Electromyography for each
assessment workstation
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Chapter 6: Assessment Results – WRMSD Risk to Plasterers Working in Ireland
Chapter 6. Results
6.1 Introduction
In this chapter, the results from risk assessments carried out to evaluate
WRMSD to plasterers working in Ireland are presented.
Prior to commencing the ergonomic risk assessment process, plasterers were
observed while they carried out their usual activities on active construction sites.
Hierarchical Task Analysis (HTA) diagrams were created to represent a variety of
plasterers finishing activities.
The risk assessments were carried out in two environmental settings. In the
Field Study, plasterers carried out their usual daily activities on active construction
sites. In the Laboratory Study setting, plasterers carried out a wet-plastering task in
four workstations. Each workstation was set up to simulate working conditions that
occur daily on active construction sites.
The VADS survey was selected to assess psychophysical stress and was used
in the Field Study. HRA was used to assess physiological stress, and EMG was used
to evaluate biomechanical stress in the Laboratory Study. The VADS results are
presented first, the HRA results and finally the EMG results are presented.
6.2 Hierarchical Task Analysis (HTA)

HTA was used to diagrammatically represent the different tasks and sub-tasks
plasterers carry out on a daily basis. Furthermore, it was used as a guide to identify
the variations that can occur as plasterers out their work. The main variations that
were identified included changes between different standing surfaces, between
plastering surfaces, between mortarboards stand heights, and between different sub-
task activities.
Plasterers were observed carrying out the same task or sub-task in the same
working conditions over a working day and continued in the same manner for
consecutive working days. However, they were also observed rotating between
different tasks or sub-tasks and between different working conditions throughout a
single working day. Similarly, their tasks, sub-tasks and working conditions could
vary from day to day.
~ 145 ~
Examples of variations that occurred in their working environment include

plasterers working on a ceiling or a wall, or both a wall and ceiling. When working
on a wall, plasterers worked on either internal or external walls.
Similarly, plasterers used a variety of different standing surfaces: the ground,
hop-up, trestle, stilts, and scaffolding. In a single working day, plasterers worked on
the ground or on a single elevated platform throughout the day. Alternatively,
plasterers rotated between the ground, and/or between different elevated platforms.
Occasionally, plasterers may work on the same standing surface or combination of
standing surfaces for many consecutive workdays.
Plasterers rotated between the many sub-task activities identified in the HTA
diagrams in Appendix V and Appendix VII. They worked on a single sub-task or
multiples of sub-tasks over the course of a working day and/or over the course of a
working week.
Observing plasterers while they carried out their work revealed that plasterers
were carrying out tasks in environments that exposed them to WRMSD risk factors.
For example, when mixing plaster and when carrying out drywall activities,
plasterers repeatedly manually handled heavy and/or large loads. Plasterers
frequently worked under pressure, particularly when applying plasterer to surfaces to
complete the task before the mixture dried to an unworkable consistency. They
frequently and repeatedly exerted forceful movements and sustained awkward
postures. When working on walls they were observed bending, twisting, kneeling,
and stooping, specifically when working on the lower portion of a wall. When
working on ceilings their arm was frequently extended above their head and their
head was flexed to enable viewing the ceiling.
The information obtained from the HTA process established the variable
conditions in which plasterers carry out their tasks and sub-tasks, which have the
potential to be WRMSD risk factors. This information was used as a guide when
establishing the WRMSD risk assessment process to ensure an accurate evaluation of
WRMSD risk to plasterers working in Ireland.
6.3 Participation and Response Rate

The plasterers assessed in this study represent the plastering population in
Ireland. They were sourced through online trade and craft worker directories in
which plasterers were registered, through Safety Officers employed in construction
~ 146 ~
companies around Ireland, and through the Operative Plasterers & Allied Trades
Society of Ireland.
In the Field Study, plasterers were excluded in cases where they were not
carrying out plastering activities for five consecutive working days. In the
Laboratory Study, plasterers were excluded from the study if they were not
experienced in carrying out a wet-plastering task. They were also excluded if they
did not use stilts as a regular part of their working activity.
6.3.1 Field Study

One hundred and twenty five bound surveys and stamped self-addressed
envelopes were sent by mail to eligible plasterers who volunteered to participate.
Completed surveys were returned using the enclosed envelope. Eighteen completed
surveys were returned for analysis, approximately 10% response rate. Although the
participants were requested to provide their demographic details, plasterers did not
complete this section of the VADS survey. No information was gathered about the
tools used by plasterers over the course of the Field Study assessment. An example
of tools that were used by plasterers is presented in Figure 24.
Figure 24: Example of Tools Used By Plasterers When Carrying Out Their Tasks
on Active Construction Sites
6.3.2 Laboratory Study

Thirty-four plasterers were contacted by telephone to participate in the HRA
and EMG Laboratory Study assessment. Twenty-five eligible plasterers initially
volunteered to participate. However, 15 withdrew from the study prior to
commencing the assessments.
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Demographics of Participating Plasterers (n=10)

The mean age of the ten participating plasterers was 38 (Standard Deviation
10), mean height 177 (SD 6) cm and mean weight 85 (SD 9) kg. All participants
were right handed. Forty percent classified their activity level (indication of fitness
level) as High, 30% classified it as Middle, and 30% classified it as Low. Eighty
percent of participants received their plastering training on-site whereas 20%
received their training through an apprenticeship. The average age plasterers
commenced their plastering training was 18 (SD 2).
Table 11: Demographics of Participating Plasterers

Age
Activity Type of
Subject Age Height Weight Handed commenced
Level Training
training
1 59 170 92 Right Low On site 17
2 30 180 83 Right Middle On site 21
4 39 170 72 Right Middle Apprenticeship 18
5 29 181 83 Right High On site 18
9 35 178 89 Right Middle On site 17
10 41 173 81 Right High Apprenticeship 17
Information about Tools Used by Plasterers (N=10) During the Assessment

Plasterers used a trowel (125mm x 355mm) to load a hawk from a
mortarboard and to apply coats of plaster onto surfaces. The hawk measured 330mm
x 300mm, and when loaded with plaster weighed approximately 2kg.
Sixty percent of the trowels used in these assessments had a stainless steel flat
blade with a wooden handle, 30% had a stainless steel flat blade and a durasoft
handle, and 10% had an aluminium flat blade and a durasoft handle.
Sixty percent of the hawks used in these assessments had an aluminium flat
base and a durasoft handle, 30% had an aluminium flat base with a wooden handle,
and 10% had a hawk comprised of a fibreglass material with a wooden handle.
~ 148 ~
Ninety percent of participants used the Durastilt brand of stilts and 10% used
the Marshalltown brand, stilts were purchased on average 4 (SD 2) years and cost an
average of €344 (SD €122). When used as a standing surface, the stilts were
extended to an average height of 583 (SD 44) cm.
~ 149 ~
6.4 Field Study Results -VADS

6.4.1 Introduction
The VADS survey was used to measure subjective qualitative judgments of
postural discomfort. Analysis of the data was carried out to evaluate if time events,
the type of work, carried out, and the type of conditions plasterers worked in,
influenced the levels of discomfort intensity. Additionally, it was used to provide
details of the type of work being carried out, and the type of conditions plasterers
work in.
6.4.2 Data Analysis

The following results will be presented: 1) frequency and graphical data
regarding tasks carried by plasterers and their working conditions (independent
variables), 2) descriptive and graphical statistics of the dependent variable across the
independent variables and 3) inferential analysis of the dependent variable across the
independent variables.
• Time events working day/week

• Standing work surfaces - ground, hop-up, trestle, stilts, and combinations of
these surfaces
• Plastering Tasks: Erecting framework and supporting structures, Hanging
drywall boards, Taping and filling, Preparing and mixing plaster, Applying
skim coat, and Applying finishing coat
Dependent variable:
• Perceived discomfort intensity measured on a 100mm VADs scale, 0mm

represents no perceived discomfort experienced, 100mm represents an
extreme level of perceived discomfort.
~ 150 ~
6.4.3 Results Outline

The VADS results are presented in the following order:
1. Frequency data about participant’s tasks and working conditions

2. Descriptive and graphical statistics of the dependent variable across the
independent variables to evaluate
a. Temporal patterns in discomfort intensity over working day/week
b. Compare discomfort intensity levels when working on different
plastering surfaces
c. Compare discomfort intensity levels when working on different
standing work surfaces
d. Compare discomfort intensity levels when working on different sub-
Tasks
3. Inferential analysis of the dependent variable across the independent variables
6.4.4 Frequency Data
Working Times
Plasterers started their working day between 7:00am and 8:30am. Generally,
the starting times varied over the course of a working week. Sixty-eight percent of
the time, plasterers commenced their working day at 8:00am (68%). Their working
day finished between 4:00pm and 7:00pm. Seventy-three percent of the time
plasterers finished their work at 5:00pm or later (Figure 25, A, and B).
The duration of a working day ranged from 7.5hrs to 10.5hrs. Only 31.6% of
plasterers worked 8.5hrs or less i.e. an eight-hour workday plus 30min lunch break.
In 83% of cases, plasterers took a 30min lunch break. In 4.4% of cases plasterers
worked for the full day without taking a lunch break. Only 7.8% of cases took a
lunch break longer than 30min (Figure 25, C, and D).
In 88.9% of cases, plasterers took a morning break ranging from 15 minutes
(38.9%) to 30 minutes (44.4%). However, in 88.9% of cases, plasterers did not take a
break in the afternoon work period (Figure 25, E, and F).
~ 151 ~
6.10% 2%
1.02% 5.09% 3% 1% 16:00
2.03% 1%
07:00 16:30
07:30 16:40
16.28% 24% 17:00
07:45
17:20
2.03% 08:00 17:30
32%
08:10 1% 17:45
7% 18:00
08:15
18:15
67.45%
08:30 18:30
1%
26% 19:00
2%
(A) Time Start Work (Hr:Min) (B) Time Finish Work (Hr:Min)
6.11% 3.05% 07:30 2.22%
1.02% 1.02%
08:20 4.44% 3.33%
1.02% 5.56%
08:30 1.11%
09:00 0
2.04% 09:05 15
12.22% 29.53% 09:30
20
09:45
10:00 30
13.34% 10:15 45
2.04% 10:30
10:45 60
1.02%
25.56% 11:00 83.33%
2.04%
11:30
(C) Duration of Working Day (Hr:Min) (D) Duration of Lunch Break (Min)
5.56%
5.56%
11.11%
0
44.44% 0
15
10
20
38.89% 15
30
88.89%
5.56%
(E) Duration of Morning Break (Min) (F) Duration of Afternoon Break (Min)
Figure 25: Working Times for Plasterers –Start/End Day, Length of Workday/
Duration of Breaks
~ 152 ~
Plasterers worked between 120 minutes (6%) to 600 minutes (2.17%) before
taking a break. Approximately 15% (+/- 0.65%) of cases worked 180minutes,
270minutes, or 330minutes before taking a break (Figure 26).
2.17
120
5.98 180
14.67 210
15.76 240
7.61 270
5.98 285
9.24 300
7.07
330
14.62
600
Figure 26: Duration of Time Plasterers Worked Before Taking a Break
Plastering Surfaces
Plasterers worked on three different plastering surfaces, a wall, ceiling, and
floor or combinations of these in a given work period. In a given work-period, 44%
of cases worked on a wall, in 18% of cases plasterers worked on a ceiling and in 22%
of cases plasterers worked on both a wall and a ceiling. In 16% of cases plasterers
worked on a floor. In Figure 27, a graphical representation of the percent of cases in
which plasterers worked on different plastering surfaces or combinations of
plastering surfaces is displayed.
16%
Wall
44% Both Wall & Ceiling
18% Ceiling
Floor
22%
Figure 27: Plastering surfaces
~ 153 ~
Standing Surfaces
Plasterers worked on a range of standing work surfaces or combinations of
different surfaces over the course of a working day. In 35% of cases, plasterers stood
on the ground and in 21% of cases, plasterers used stilts as an elevated standing
surface. In Figure 28, a graphical representation of the percent of cases in which
plasterers used standing surfaces or combinations of standing surfaces when working
is displayed.
1% 1% Ground
2% 1%
2% Stilts
3%
Ground & Step-up
4% Trestle & Boards

Step-Up
6% 35%
Ground/Trestle/Step-up
7% Scaffolding
Ground/Scaffold
8% Ground/Scaffold/Trestle/
Scaffolding/Step-up
9% Trestle/Step -up
21%
Ground/Scaffold/Trestle/Step-up
Ground/Scaffold/Step-up
Figure 28: Standing Surfaces
Plastering Tasks
Over the course of a working day and working week, plasterers carried out a
wide range of different activities. A breakdown of the activities carried out by the
plasterers who participated in the VADS survey is displayed in Figure 29.
In this situation, plasterers spent 44% of their time applying a skim coat onto
plastering surfaces, 19% of their time applying a finishing coat, and 12% of their
time carrying out a moulding activity. Almost 7% of their time was spent hanging
drywall using nails, screws, or adhesive.
Ten percent of their time was spent in preparation for wet-plastering activity,
5% preparing and mixing plaster, and 5% taping and filling. Seventy-four percent of
the tasks carried out were associated with wet-plastering activity. These tasks were
~ 154 ~
Apply skim coat, Apply finish coat, Mixing plaster, Apply scratch coat, Apply Scud
coat, Apply Beading, Pointing, and Wall Preparation.
1.62% 1.08% 1.08% 1.08% Apply skim coat

1.08% 0.54% 0.54%
Apply finish coat
1.62%
Moulding
2.16%
Hang Drywall - Screws
4.81% Taping & Filling

Preparing and mixing plaster
4.86%
Apply scratch coat
43.84%
4.86% Apply Scud coat
Floor work
11.89% Erecting Framework

Hang Drwwall - Other
Apply Beading
Pointing
18.92%
Hang Drywall - Nails
Wall Preparation
Figure 29: Tasks carried out by Plasterers over a Five-Day Consecutive Work
Period
~ 155 ~
6.4.5 Descriptive and Graphical Results

Descriptive analysis was carried out to describe characteristics (dependent
variable – discomfort intensity level) in independent variable populations (time
events, plastering surfaces, standing surfaces, and plastering tasks). Comparisons of
the dependent variable values were made across the independent variables to
demonstrate differences between the populations.
The Risk Assessment Matrix in Table 4, pg 102 demonstrates how
probability of a negative outcome and the severity of that outcome are considered
together to determine a level of risk. The cells are colour coded with respect to the
level of risk. The probability and severity levels from the risk assessment matrix are
listed in Table 12. The VADS verbal and numerical markers that indicate five ranges
of discomfort intensity are included in the table to correspond with the five levels of
risk outlined in the risk assessment matrix. The ‘colour codes’, ‘levels of risk’ and
VADS are used to represent a quantity of risk for the VADS results.
Table 12: VADS WRMSD Risk Levels
Level of Risk VADS Verbal and Numerical

Colour Code
Indicators
Probability Severity
Red Very High Risk Extreme Unbearable 80-100mm
Orange High Risk Major Hard 60-80mm
Yellow Medium Risk Moderate Average 40-60mm
Green Low Risk Minor Moderate 20-40mm
Blue Very Low Risk Negligible Light 0-20mm
Temporal Patterns of Discomfort – Time Event Influence on Discomfort Intensity

Comparisons of discomfort intensity levels for each body area were
compared across a working day and a working week to evaluate temporal patterns of
discomfort.
The blue line represents the plasterers average maximum level of discomfort
intensity experienced for each time event (work and rest periods) over the assessment
period. The red line represents the plasterers average mean discomfort values. The
green line represents plasterers average minimum discomfort values. The variation in
~ 156 ~
perceived discomfort intensity for each body area is displayed graphically and
numerically in Figure 30.
The cells highlighted red indicate that at some time over the five-day
assessment period plasterers marked their maximum perceived level of discomfort on
a VADS scale in the 80mm and 100mm zone. This intensity level corresponds to an
unbearable level of discomfort for the specified body areas (Extreme Risk). The body
areas that experienced discomfort levels in this zone are (in descending order) the
knees, ankles/feet, elbows, wrist/hands, low back, upper back, and neck .
Max Mean Min

100
90
80
70
60
50
40
30
20
10
0
Buttocks/
Low Ankles/ Wrists Upper Mid
Knees Shoulders Neck Elbows Hips/
Back Feet /Hands Back Back
Thighs
Min 0 0 0 0 0 0 0 0 0 0
Mean 35 32 30 30 26 26 25 24 21 20
Max 90 96 97 94 73 82 95 78 85 74
Figure 30: Variation in Perceived Discomfort Intensity Recorded over Five

Consecutive Workdays
The cells highlighted orange indicate maximum levels of discomfort

recorded on a VADS scale in the 60mm and 80mm zone corresponding to a hard
level of discomfort for the specified body areas (Major Risk). The body areas that
experienced discomfort levels in this zone are (in descending order) the
buttocks/hips/thighs, mid back, and the shoulders
~ 157 ~
The mean level of discomfort over the five-day assessment period ranged
from 20mm to 35mm. The cells highlighted green indicate the body areas with a
mean perceived discomfort in the moderate intensity zone (20mm-40mm) (Minor
Risk). All body area experienced a mean discomfort intensity level in this zone.
All body areas recorded a minimum level of discomfort of zero at some time
over the five-day assessment period. The cells are shaded blue to represent no
discomfort (Negligible Risk).
Figure 31 (on the following page) provides a graphical representation of the
temporal patterns of discomfort intensity for each body area assessed. The data
represents the average mean discomfort intensity for the ten plasterers. Each graph
represents the mean discomfort intensity for each time event (four times a day for
five consecutive working days for one body area.
In all cases, the intensity of perceived discomfort fluctuated in response to
work and rest periods. Generally, intensity levels increased after a period of work
and decreased after a period of rest. High levels of discomfort indicate that plasterers
were exposed to WRMSD risk factors, and/or plasterers were experiencing localised
fatigue. Decreasing intensity levels of discomfort intensity could indicate that a
period of rest had enabled the plasterer to recover.
It is important to note that in some cases the level of discomfort intensity
increased during a period of rest or decreased during a period of work. A possible
reason for this occurrence may be due to the type of plastering activity carried out, or
it may be because of the working conditions in previous work periods.
The black trend line indicates that the discomfort intensity level increased
over the working week for each body area.
~ 158 ~
Neck Upper Back

35 35
30 30
25 25
20 20
15 15
10 10
5 5
0 0
M BL
M AL
W BL
W AL
T BL
T AL
M BW
W BW
F BL
F AL
T BW
Th BL
Th AL
M EW
W EW
F BW
T EW
Th BW
Th EW
F EW
M BL
M AL
W BL
W AL
M BW
T BL
T AL
W BW
F BL
F AL
T BW
Th BL
Th AL
M EW
W EW
F BW
T EW
Th BW
F EW
Th EW
Shoulders Mid Back
35 35
30 30
25 25
20 20
15 15
10 10
5 5
0
0
Th…
Th…
T BL
T AL
F BL
F AL
T BW
Th BL
Th AL
M BL
M AL
F BW
T EW
W BL
W AL
Th BW
F EW
M BW
Th EW
W BW
M EW
W EW
T BL
T AL
F BL
F AL
Th BL
Th AL
T BW
F BW
M BL
M AL
T EW
W BL
W AL
F EW
M BW
W BW
W EW
M EW
Elbows Low Back
35 35
30 30
25 25
20 20
15 15
10 10
5 5
0 0
T BL
T AL
F BL
F AL
T BW
Th BL
Th AL
M BL
M AL
F BW
T EW
W BL
W AL
Th BW
M BW
F EW
Th EW
W BW
M EW
W EW
M BL
M AL
W BL
W AL
T BL
M BW
T AL
W BW
F BL
F AL
Th BL
T BW
Th AL
M EW
W EW
Th BW
F BW
T EW
F EW
Th EW
Wrists/Hands Buttocks/Hips/Thighs
35 35
30 30
25 25
20 20
15 15
10 10
5 5
0 0
T BL
T AL
F BL
F AL
T BW
Th BL
Th AL
M BL
M AL
F BW
T EW
W BL
W AL
Th BW
M BW
F EW
Th EW
W BW
M EW
W EW
T BL
T AL
F BL
F AL
T BW
Th BL
Th AL
M BL
M AL
F BW
T EW
W BL
W AL
Th BW
F EW
M BW
Th EW
W BW
M EW
W EW
Knees Ankles/Feet
35 35
30 30
25 25
20 20
15 15
10 10
5 5
0 0
M BL
M AL
W BL
W AL
M BW
T BL
T AL
F BL
F AL
W BW
Th BL
Th AL
T BW
M EW
W EW
F BW
Th BW
T EW
Th EW
F EW
M BL
M AL
W BL
W AL
T BL
M BW
T AL
F BL
F AL
W BW
T BW
Th BL
Th AL
M EW
W EW
F BW
T EW
Th BW
F EW
Th EW
Figure 31: Temporal Patterns of Discomfort for Ten Body Areas

MBW- Monday Before Work, MBL- Monday Before Lunch, MAL –Monday After Lunch MEW- Monday End of Work Day
TBW- Tuesday Before Work, TBL- Tuesday Before Lunch, TAL –Tuesday After Lunch TEW- Tuesday End of Work Day
WBW- Wednesday Before Work, WBL- Wednesday Before Lunch, WAL –Wednesday After Lunch WEW- Wednesday End of Work Day
ThBW- Thursday Before Work, ThBL- Thursday Before Lunch, ThAL –Thursday After Lunch ThEW- Thursday End of Work Day
FBW- Friday Before Work, FBL- Friday Before Lunch, FAL –Friday After Lunch FEW- Friday End of Work Day
~ 159 ~
When plasterers moved between working periods, (morning shift and evening
shift) and from resting periods (lunch break and overnight), their level of perceived
discomfort generally increased or decreased after a period of rest or after a period of
work.
Plasterers reported a maximum increase of perceived discomfort intensity that
corresponds to 70mm to 72mm on the VADS scale. This equates to an increase of
discomfort by 3.5 intensity zones e.g. from zero discomfort up to a hard discomfort
intensity.
Plasterers reported a maximum decrease in perceived discomfort intensity
corresponding to -70mm to -90mm on the VADS scale. This equates to a decrease of
discomfort by 3.5 to 4.5 intensity zones e.g. approximate decline from the unbearable
intensity zone down to the light intensity zone. The variation of the increase and
decrease in the intensity of perceived discomfort for each body area assessed is
displayed graphically and numerically in Figure 32.
Mean Min Max

100 Neck 1.03 -73 70
80 Upper
.76 -72 70
Back
60
Shoulders .87 -73 70
40
Mid Back .59 -71 70
20
Elbows .89 -72 70
0
Low
.80 -71 71
-20 Back
-40 Wrists/
.83 -70 70
Hands
-60
Buttocks/
-80 Hips/ .66 -70 71
Thighs
-100
Knees .48 -80 72
Mean Minimum Maximum
Ankles/
1.08 -90 72
Feet
Figure 32: Variation in Discomfort Intensity when moving Between Work Periods
and Rest Periods
~ 160 ~
Figure 33 (below) and Figure 34 (on the following page) provide graphical
representations of the temporal patterns of the increasing and decreasing levels of
discomfort intensity when moving between work and rest periods. Generally, the
greatest decline in intensity levels was observed after plasterers took an overnight
break. A less significant decline was observed after plasterers took a lunch break. As
noted above a lunch break generally lasted up to 60 minutes, whereas an overnight
break was generally longer than 14 hours.
15.00
10.00
5.00
.00
M M M M T T BL T AL T W W W W Th Th Th Th F F BL F AL F
BW BL AL EW BW EW BW BL AL EW BW BL AL EW BW EW
-5.00
-10.00
-15.00
-20.00
-25.00
Neck Upper Back Shoulders

Mid Back Elbows Low Back
Wrists/Hands Buttocks/Hips/Thighs Knees
Ankles/Feet
Figure 33: Pattern of Increasing and Decreasing Levels of Discomfort Intensity
~ 161 ~
Neck Upper Back

15 15
10 10
5 5
0 0
M BL
M AL
W BL
W AL
T BL
T AL
M BW
W BW
F BL
F AL
T BW
Th BL
Th AL
M EW
W EW
F BW
T EW
Th BW
F EW
Th EW
M BL
M AL
W BL
W AL
T BL
T AL
M BW
W BW
F BL
F AL
Th BL
T BW
Th AL
M EW
W EW
F BW
T EW
Th BW
F EW
Th EW
-5 -5
-10 -10
-15 -15
-20 -20
Shoulders Mid Back

15 15
10 10
5 5
0 0
T BL
T AL
F BL
F AL
T BW
Th BL
Th AL
M BL
M AL
F BW
T EW
W BL
W AL
Th BW
F EW
M BW
Th EW
W BW
M EW
W EW
M BL
M AL
W BL
W AL
T BL
M BW
T AL
W BW
F BL
F AL
T BW
Th BL
Th AL
M EW
W EW
F BW
T EW
Th BW
F EW
Th EW
-5 -5
-10 -10
-15 -15
-20 -20
Elbows Low Back

15 15
10 10
5 5
0 0
T BL
T AL
F BL
F AL
Th BL
T BW
Th AL
M BL
M AL
F BW
T EW
W BL
W AL
Th BW
F EW
M BW
W BW
Th EW
M EW
W EW
T BL
T AL
F BL
F AL
T BW
Th BL
Th AL
M BL
M AL
F BW
T EW
W BL
W AL
Th BW
M BW
F EW
Th EW
W BW
M EW
W EW
-5 -5
-10 -10
-15 -15
-20 -20
Wrists/Hands Buttocks/Hips/Thighs
15 15
10 10
5 5
0 0
T BL
T AL
F BL
F AL
T BW
Th BL
Th AL
M BL
M AL
F BW
T EW
W BL
W AL
Th BW
M BW
F EW
Th EW
W BW
M EW
W EW
T BL
T AL
F BL
F AL
Th BL
Th AL
T BW
M BL
F BW
M AL
T EW
W BL
W AL
Th BW
F EW
M BW
W BW
Th EW
M EW
W EW
-5 -5
-10 -10
-15 -15
-20 -20
Knees Ankles/Feet
15 15
10 10
5 5
0 0
M BL
M AL
W BL
W AL
T BL
T AL
M BW
W BW
F BL
F AL
T BW
Th BL
Th AL
M EW
W EW
F BW
T EW
Th BW
F EW
Th EW
T AL
T BL
F BL
F AL
Th BL
Th AL
T BW
M BL
Th BW
F BW
M AL
T EW
W BL
W AL
F EW
M BW
W BW
Th EW
W EW
M EW
-5 -5
-10 -10
-15 -15
-20 -20
Figure 34: Average Increase/Decrease in Discomfort Intensity Level for Ten Body
Areas between Time Events (Work Period/Breaks)
MBW- Monday Before Work, MBL- Monday Before Lunch, MAL –Monday After Lunch MEW- Monday End of Work Day
TBW- Tuesday Before Work, TBL- Tuesday Before Lunch, TAL –Tuesday After Lunch TEW- Tuesday End of Work Day
WBW- Wednesday Before Work, WBL- Wednesday Before Lunch, WAL –Wednesday After Lunch WEW- Wednesday End of Work Day
ThBW- Thursday Before Work, ThBL- Thursday Before Lunch, ThAL –Thursday After Lunch ThEW- Thursday End of Work Day
FBW- Friday Before Work, FBL- Friday Before Lunch, FAL –Friday After Lunch FEW- Friday End of Work Day
~ 162 ~
Influence Associated With Plastering Surfaces

In any given work period (morning shift and evening shift) plasterers worked
on different plastering surfaces, primarily the wall, ceiling, floor, or any combination
of these. In Figure 35, a graphical and numerical representation of the mean
discomfort intensity level for each body area for each combination of plastering
surfaces is displayed
The cells highlighted green indicate a plastering surface combination for a
given body area in which the mean intensity of discomfort equates to 40mm-60mm
on a VADS scale i.e. moderate intensity level (Minor Risk). This result indicates that
the body area is at low risk when plasterers work on this plastering surface
combination.
The cells highlighted blue indicate a plastering surface combination for a
given body area in which the mean intensity of discomfort equates to 0mm-20mm on
a VADS scale i.e. average intensity level (Negligible Risk). This result indicates that
the body area is at very low risk when plasterers use this standing surface
combination.
When mean discomfort intensity was calculated for all ten body areas,
plasterers working on floor had the lowest level of discomfort intensity (22.6mm/
moderate intensity/minor risk). This surface is the least frequently worked on.
Working on both a wall and ceiling surface in a single work period recorded a
mean intensity level of 21.8mm. When working on only a wall the mean discomfort
recorded was 22.5mm. The highest mean discomfort was recorded when plasterers
worked on a ceiling (23.3mm).
~ 163 ~
100
90 Mid Back
80 Shoulders
70 Upper Back
60 Low Back
50 Elbows
40 Wrists/ Hands
Neck
30
Buttocks/ Hips/ Thighs
20
Ankles/ Feet
10
Knees
0
Ceiling Wall Both Wall & Ceiling Floor
Mid Upper Low Wrists/ Buttocks/ Hips/

Plastering Surface Shoulders Elbows Neck Ankles/ Feet Knees
Back Back Back Hands Thighs
Ceiling 33 26 28 25 23 21 20 20 18 19
Wall 23 26 25 26 21 24 20 19 23 18
Both Wall &
30 34 25 16 24 17 21 21 12 18
Ceiling
Floor 12 8 3 12 4 2 3 1 5 1
VADS 0mm-20mm VADS 20mm-40mm VADS 40mm-60mm VADS 60mm-80mm VADS 80mm-100mm
Figure 35: Mean Intensity of Perceived Discomfort for Plastering Surfaces
~ 164 ~
Influence Associated with Standing Surfaces

In any given work period (morning shift and evening shift) plasterers used
different combinations of standing work surfaces e.g. ground, stilts, trestle, hop-up,
or any combination of these. A graphical and numerical representation of the mean
discomfort intensity level for each body area for each combination of standing
surfaces is displayed in Figure 36.
The corresponding colour coded results can be compared to the colour coding
in the Risk Assessment Matrix in Table 4, pg 30. The cells highlighted red indicate a
standing surface combination for a given body area in which the mean intensity of
discomfort equates to 80mm-100mm on a VADS scale i.e. unbearable intensity level
(extreme risk).
The cells highlighted orange indicate a standing surface combination for a
on a VADS scale i.e. hard intensity level (major risk).
The cells highlighted yellow indicate a standing surface combination for a
on a VADS scale i.e. average intensity level (moderate risk).
The cells highlighted green indicate a standing surface combination for a
on a VADS scale i.e. moderate intensity level (minor risk).
The cells highlighted blue indicate a standing surface combination for a given
body area in which the mean intensity of discomfort equates to 0mm-20mm on a
VADS scale i.e. average intensity level (negligible risk).
plasterers recorded discomfort levels lower than 20mm when standing on the Ground
& Hop-up, Ground, Ground/Trestle/Hop-up, and Trestle/hop-up. The highest mean
discomfort was recorded when plasterers used a combined standing surface
Ground/Scaffold/Hop-up in a single work period (37.3mm/average intensity/
moderate risk). This is followed by standing on a hop-up (40.2mm), scaffolding
(32.3mm), and scaffolding/hop-up (31.7mm) in a single work period.
~ 165 ~
100
90 Elbows
80
Knees
70
60 Wrists/ Hands
50 Buttocks/ Hips/ Thighs
40
Ankles/ Feet
30
20 Shoulders
10 Low Back
0
Neck
Mid Back
Upper Back
Standing Work Surface Elbows Knees Wrists/ Hands Buttocks/ Hips/ Thighs Ankles/ Feet Shoulders Low Back Neck Mid Back Upper Back
Ground/Scaffold/Hop-up 75 73 72 72 72 56 52 33 34 34
Hop-up 34 45 41 43 47 37 49 41 35 30
Scaffolding 26 35 26 27 39 31 36 37 36 30
Scaffolding/Hop-up 26 56 56 32 31 21 41 37 11 6
Stilts 22 28 21 18 26 33 34 33 33 32
Trestle & Boards 22 30 24 28 40 22 36 21 21 22
Ground/Scaffold/Trestle/Hop-up 35 34 35 14 30 14 14 33 12 32
Ground/Scaffold 23 32 32 26 32 24 19 19 15 12
Ground/Scaffold/Trestle/ 10 39 38 39 20 24 24 19 9 10
Trestle/Hop-up 15 30 25 25 20 14 14 4 19 5
Ground/Trestle/Hop-up 9 37 8 35 38 1 21 0 8 1
Ground 12 12 14 6 10 10 14 8 6 7
Ground & Hop-up 2 16 17 0 1 4 18 16 1 0
Figure 36: Mean Intensity of Perceived Discomfort for Standing Surfaces
~ 166 ~
Influence associated with Plastering Tasks

In any given work period (morning shift and evening shift) plasterers carried
out different plastering tasks e.g. applying plaster coats, preparation and mixing
activities, drywall activities and any combination of these.
A graphical and numerical representation of the mean discomfort intensity
level for each body area for each combination of plastering tasks is displayed in
Figure 37. The corresponding colour coded results can be compared to the colour
coding in the Risk Assessment Matrix in Table 4, pg 30. The cells highlighted red
indicate a standing surface combination for a given body area in which the mean
intensity of discomfort equates to 80mm-100mm on a VADS scale i.e. unbearable
intensity level (extreme risk).
The cells highlighted orange indicate a standing surface combination for a
on a VADS scale i.e. hard intensity level (major risk).
The cells highlighted yellow indicate a standing surface combination for a
on a VADS scale i.e. average intensity level (moderate risk).
The cells highlighted green indicate a standing surface combination for a
on a VADS scale i.e. moderate intensity level (minor risk).
The cells highlighted blue indicate a standing surface combination for a given
body area in which the mean intensity of discomfort equates to 0mm-20mm on a
VADS scale i.e. average intensity level (negligible risk).
plasterers recorded the highest levels of discomfort when applying plaster onto
surfaces; Apply scratch coat at 41.2mm/average intensity/moderate risk, Apply skim
coat at 40.1mm/moderate intensity/moderate risk and Apply skim coat at 29.6mm/
moderate intensity/minor risk. The remaining tasks recorded discomfort levels lower
than 20mm/light intensity/negligible risk.
~ 167 ~
100
90
80
70
60
50
40
30
20
10
0
Apply scratch Apply finish Apply skim coat Floor work Erecting Preparing and Apply Beading Taping & Filling Wall Hang Drywall Apply Scud coat Pointing Moulding
coat coat Framework mixing plaster Preparation
Ankles/ Feet Wrists/ Hands Mid Back Neck Knees Low Back Upper Back Buttocks/ Hips/ Thighs Shoulders Elbows
Type of work carried out over work period Ankles/ Feet Wrists/ Hands Mid Back Neck Knees Low Back Upper Back Buttocks/ Hips/ Thighs Shoulders Elbows
Apply scratch coat 45 44 35 44 36 40 44 45 30 29
Apply finish coat 38 35 28 36 39 26 30 29 24 30
Apply skim coat 25 26 20 20 24 20 22 20 18 19
Floor work 13 40 34 46 0 0 0 0 0 0
Erecting Framework 51 35 36 35 16 0 0 0 15 0
Preparing & mixing plaster 12 21 17 29 18 17 21 12 17 20
Apply Beading 30 29 5 5 42 30 5 5 5 5
Taping & Filling 15 21 15 21 7 17 21 11 13 17
Wall Preparation 9 9 11 10 10 9 9 10 11 9
Hang Drywall 19 26 13 10 9 3 0 8 7 0
Apply Scud coat 17 17 20 0 34 0 0 0 0 0
Pointing 0 0 41 0 16 0 0 0 0 0
Moulding 4 5 1 5 4 1 1 4 1 5
Figure 37: Mean Intensity of Perceived Discomfort for Plastering Tasks
~ 168 ~
6.4.6 Inferential Post-hoc Results

The results are displayed in Table 13. The shaded cells within each row
contain values p≤0.05. This indicates that the intensity of perceived discomfort was
significantly influenced when plasterers moved between corresponding independent
variable conditions. There was no significant influence in the intensity levels of
perceived discomfort when the p value is greater than 0.05 i.e. in the non-shaded
cells.
The hypotheses being tested are
• H 0 – Time events have no influence on the level of perceived discomfort

intensity.
• H 0 - Plastering surfaces have no influence on the level of perceived
discomfort intensity.
• H 0 - Standing surfaces have no influence on the level of perceived discomfort
intensity.
• H 0 - Plastering tasks have no influence on the level of perceived discomfort
intensity.
Plasterers levels of perceived discomfort was significantly influenced in all

ten body areas assessed when plasterers move between different plastering surfaces,
≤
between different standing work surfaces and between different plastering sub (p
0.05).
With the exception of the Elbows and the Buttocks/Hips/Thighs, time events
has a significant impact on plasterers perceived levels of discomfort. This may
indicate that plasterers perceived similar levels of discomfort (high or low levels) in
their elbows and buttocks/hips/thighs when they moved between each time event
~ 169 ~
Table 13: Wilcoxon Signed Ranks Test– Mean Intensity of Perceived Discomfort -
Variance between Groups
Wilcoxon Signed
Ranks Test Asymp. Independent Variable Conditions
Sig. (2-tailed)
Type Of
Time Day DAY Standing Work
Plastering
Body Areas of of & Work Carried Out
Surface
Day Week TIME Surface Over Work
Period
Neck 0.00 0.00 0.00 0.00 0.00 0.00
Upper Back 0.00 0.00 0.00 0.00 0.00 0.00
Shoulders 0.00 0.00 0.04 0.00 0.00 0.00
Mid Back 0.00 0.00 0.00 0.00 0.00 0.00
Elbows 0.00 0.00 0.66 0.00 0.00 0.00
Low Back 0.00 0.00 0.00 0.00 0.00 0.00
Wrists/Hands 0.00 0.00 0.00 0.00 0.00 0.00
Buttocks/Hips/Thighs 0.00 0.00 0.71 0.00 0.00 0.00
Knees 0.00 0.00 0.00 0.00 0.00 0.00
Ankles/Feet 0.00 0.00 0.00 0.00 0.00 0.00
6.4.7 Results Summary

The result from the VADS analysis clearly indicates that all ten body areas
experienced discomfort attributed to their plastering tasks and working environment
conditions. Plasterers reported an unbearable or hard level of intensity in all body
areas at some stage during the week. This level of discomfort indicates that plasterers
were participating in activities, or their working conditions imposed high
psychophysical stress. Psychophysical sensations of discomfort and pain indicate
exposure to WRMSD risk factors. High intensity sensations indicate that
physiological and biomechanical limits have been exceeded and possible micro
injury has occurred in the musculoskeletal system.
Temporal patterns were observed with discomfort intensity increasing over
the working day and over the working week. A decline in intensity levels was
~ 170 ~
observed after a period of rest. This indicates that plasterers experienced a period of
recovery after a period of rest. The magnitude of recovery corresponded with the
duration of a rest break. The greatest level of recovery was observed after an
overnight break when compared to the recovery experienced after a lunch break.
The results from the inferential analysis indicate that the null hypotheses
should be rejected. Time events, plastering surfaces, standing surfaces, and plastering
tasks all influenced changes in the magnitude of perceived discomfort intensity.
~ 171 ~
6.5 Laboratory Study Results

6.5.1 Introduction
In the Laboratory Study, ten plasterers were assessed while they carried out a
wet-plastering task in four workstations. Each workstation was set up to simulate
conditions that occur normally in the workplace on active construction sites. The
simulated working conditions in each workstation correspond to a combination of
working condition scenarios.
The wet-plastering task is the sub-task 10.1 identified in the HTA presented
in Appendix IV. The wet-plastering sub-tasks of interest in this study are highlighted
in Appendix V. These are Mix Plaster (HTA 10.1.1), Load Mortarboard (HTA
10.1.2), Load Hawk (HTA 10.2.1), Load Trowel (HTA 10.2.2), and Plaster (HTA
10.2.3).
Physiological and biomechanical data were obtained simultaneously using
Heart Rate Monitoring and Electromyography (EMG). The data was recorded for the
duration it took plasterers to complete their task in a single workstation. While
plasterers had a period of rest, the data was uploaded onto a software compatible
laptop for later analysis. Plasterers were assessed in all four workstations, with a
period of rest in between.
Heart Rate Analysis (HRA) was used to evaluate and compare plasterers’
physiological response when they carried out a wet-plastering task in each of the four
assessment workstations (independent variables). The units of physiological response
(dependent variables) are mean heart rate (bpm), Heart rate zone activity, Relative
Heart Rate (RHR%) and Recommended Rest Period (RRP).
EMG analysis was used to evaluate and compare muscle activity levels to
assess plasterers’ biomechanical response when they carried out a wet-plastering task
in each of the four assessment workstations. The data was analysed to enable
comparisons of activity levels (independent variables) between sub-tasks and
between variables within the assessment environment (dependent variables). The
muscles assessed using EMG were the right and left sternocleidomastoid muscles in
the neck, right and left trapezius muscles in the shoulder, and the right and left
erector spinae muscles in the back.
The HRA results are presented first, followed by the EMG results.
~ 172 ~
6.6 Workstation Set-up in the Laboratory Study

Each workstation was set up to represent a working condition scenario.
Plasterers were required to apply a wet-plaster coat onto either a wall or a ceiling,
while standing on the ground & hop-up, a trestle, or stilts, and using a low
mortarboard stand or a high mortarboard stand (775mm or 1270mm). Plasterers
mixed plaster and the prepared plaster was loaded onto a mortarboard stand prior to
commencing the wet-plastering task in a workstation. A trowel was used to
manipulate plaster on the mortarboard, load a hawk, and apply plaster on to a
surface. Plasterers supplied their own trowel, hawk, and stilts. When using stilts,
plasterers adjusted the height they deemed comfortable to use in the assessment
environment. Photographs of each workstation taken at the time of the assessment
are presented in Figure 22. The workstations setup enabled:
1. Plastering a wall while standing on the ground and a hop-up and using a low
mortarboard stand
2. Plastering a ceiling while standing on a trestle & board system and using a
low mortarboard stand
3. Plastering a ceiling while standing on a stilts and using a low mortarboard
stand
4. Plastering a ceiling while standing on a stilts and using a high mortarboard
stand
Before commencing the assessment, all queries were answered and plasterers
signed a consent form indicating their understanding of the research, their
willingness to participate, and that they were free from musculoskeletal disorders.
6.7 Heart Rate Analysis (HRA) - Results

Plasterers were fitted with a Polar™ S810 Heart Rate monitor to examine
physiological response during the assessments. The monitor’s Polar Fitness
OwnIndex test and HR max -P test were used to determine plasterers’ HR rest, HR max
and VO 2 values. These files were saved as plasterers’ ‘test’ files.
In the assessments, recording heart rate data commenced once plasterers
completed the Mix Plaster (HTA 10.1.1) sub-task and before they commenced the
~ 173 ~
Load Mortarboard (HTA 10.1.2) sub-task. Recording ceased once a full surface (wall
or ceiling) was completely covered with a smooth coat of plaster. These files were
saved as plasterers ‘Assessment’ files.
The average duration of recordings was 12.32 (3.52) minutes (Range: 8.20
minutes to 20.08 minutes). This may be attributed to the ability and experience of
each plasterer to carry out a wet-plastering. The subjects’ heart rate in bpm was
collected during the study.
Heart rate data was uploaded onto a laptop using a Polar IR interface for later
analysis using Polar Precision Performance Software 3.0. Fifty files were uploaded
for analysis (Table 14).
Table 14: Files Collected For 10 Plasterers in Pre-test and Workstations
Assessment Conditions
Workstation
Workstation Workstation Workstation
1
2 3 4
Ground &
Trestle Stilts Stilts
Plasterer Test Hop-up
Ceiling Ceiling Ceiling
Wall
Low Low High
Low
(775mm) (775mm) (1270mm)
(775mm)
1 X X X X X
2 X X X X X
3 X X X X X
4 X X X X X
5 X X X X X
6 X X X X X
7 X X X X X
8 X X X X X
9 X X X X X
10 X X X X X
Red text – Standing surfaces, Green Text - Plastering Surfaces, Blue Text – Mortarboard
heights
6.7.1 Data Analysis

Assessment files contained a plasterer’s heart rate data recorded while he
completed a wet-plastering task in a single workstation. Test files contained
plasterers HR rest, HR max , VO 2, and energy expenditure values. Each plasterer’s
~ 174 ~
assessment file (carrying out a wet-plastering task in a workstation) was analysed

using the plasterers corresponding test file data.
The indices of interest in this study are mean heart rate, percent of time in
heart rate zones (intensity levels), Relative Heart Rate (RHR), and Recommended
Rest Period (RRP) durations (dependent variables). Heart rate data indicates a
quantity of physiological strain experienced by plasterers when they carried out a
wet-plastering task in an assessment workstation (independent variables).
The following results will be presented: 1) descriptive and graphical statistics
of the dependent variable across the independent variables and 2) inferential analysis
of the dependent variable across the independent variables.
• Workstation 1: Plastering a wall/standing on ground & hop-up/low

mortarboards stand
• Workstation 2: Plastering a ceiling/standing on trestle/low mortarboard stand
• Workstation 3: Plastering a ceiling/standing on stilts/low mortarboard stand
Workstation 4: Plastering a ceiling/standing on stilts/high mortarboard stand
Dependent variables
• Mean heart rate for duration of task - measured in beats per minute (bpm)
• Percent of time spent in Heart Rate Zones (Refer to Section 5.7.2, pg 129)
• Relative Heart Rate (RHR) (Refer to Section 5.7.2, pg 129)
• Recommended rest periods(Refer to Section 5.7.2, pg 129)
One-way ANOVA inferential tests and relevant post-hoc multiple

comparison analysis (Tukey) was carried out to determine if independent variables
have a significant influence on (dependent variables). This type of analysis was
conducted to evaluate the relationship between heart rate activity and assessment
surface, standing surface, and mortarboard stand height). The results are deemed to
be significant in cases when p ≤ 0.05). The hypothesis being tested were:
~ 175 ~
• H 0 – Working in different assessment environments has no influence on heart

rate
• H 0 – Working in different assessment environments has no influence on the
percent of time spent in each heart rate zone (intensity level)
• H 0 – Working in different assessment environments has no influence on RHR
– i.e. there will be no difference between working rate and resting heart rate
• H 0 – Working in different assessment environments will has no influence on
the duration of recommended rest periods

The HRA results are presented in order of
1. Descriptive and graphical statistics of the dependent variables across the
independent variables to evaluate if the conditions in each assessment
workstation influence changes in heart rate values.
In each case, the results are presented in the following order:
a. Mean Heart Rate data

b. Heart Rate Zone data
c. Relative Heart Rate (RHR) data
d. Recommended Rest Period data

Descriptive analysis was carried out to describe characteristics (dependent
variable – heart rate variables) in independent variable populations (assessment
workstations). Comparisons of the dependent variable values were made across the
independent variables to demonstrate differences between the populations.
~ 176 ~
6.7.4 Mean Heart Rate Data – Comparison between Assessment

Workstations
In this section, plasterer’s physiological response is measured in terms of
their mean heart rate data for each assessment workstation in which plasterers carried
out a wet-plastering task.
Plasterers Polar Precision Performance assessment files were exported as text
files and resaved in Microsoft Excel. Mean heart rate values were calculated for each
plasterer for each assessment workstation. Mean heart rate was also calculated for
each plasterers pre-test event. The latter provided a mean HR rest value for each
plaster. Comparisons of the mean heart rate data are displayed graphically to display
the plasterers’ heart rate activity when at rest (resting heart rate) and physiological
response when working in each assessment workstation.
In Figure 38, the average mean heart rate data for the ten plasterers for each
of the four assessment workstations is displayed. The plasterer’s average mean heart
rate increased in response to the intensity of the wet-plastering task demand and the
assessment environment conditions in each workstation.
120
103 104 102
100 93
80 Test
60 WS 1
60
WS2
40 WS3
WS4
20
0
Mean
Figure 38: Mean Heart Rate Data for Each Assessment Workstation & Test Period
The average mean resting heart rate for plasterers at rest was 60 bpm. The
highest average mean heart rate activity level was recorded when plasterers worked
in Workstation 2 (ceiling/trestle/low stand) (104bpm). The average mean heart rate
was marginally lower for Workstation 1 (wall/ground & hop-up/low stand) (103
bpm) and Workstation 3 (ceiling/stilts/low stand) (102 bpm). Plasterers recorded the
~ 177 ~
lowest average mean heart rate activity level when carrying out a wet-plastering task
in Workstation 4 (ceiling/stilts/high-stand) (93bpm).
The mean heart rate values for the ten plasterers assessed for the test
environment and for the four assessment workstations are displayed in Table 15.
Table 15: Distribution of Mean Heart Rate Values for Ten Plasterers for Each
Assessment Workstation
Plasterer Test (HR rest ) WS 1 WS2 WS3 WS4
A 68 103 99 97 89
B 63 108 101 90 88
C 82 113 112 118 105
D 52 97 103 102 91
E 51 97 96 86 72
F 51 117 110 118 95
G 55 105 104 100 92
H 58 111 116 117 104
I 57 93 99 87 94
J 64 85 97 101 99
Mean 60 103 104 102 93
SD 10 10 7 12 9
• Four plasterers recorded their highest mean heart rate values in Workstation 1
(wall/ground & hop-up/low stand). One plasterer recorded their lowest value
in this workstation
• Four plasterers recorded their highest mean heart rate values in Workstation 3
(ceiling/stilts/low stand). No plasterer recorded their lowest value in this
workstation
• Three plasterers recorded their highest mean heart rate values in Workstation
2 (ceiling/trestle/low stand). ). One plasterer recorded their lowest value in
this workstation
• No plasterer recorded their highest mean heart rate values in Workstation 4
(ceiling/stilts/high stand). Eight plasterers recorded their lowest value in this
workstation
~ 178 ~
6.7.5 Time Worked in Each HR Zone – Comparison between

Assessment Condition Environments
In this section, plasterer’s physiological response is measured in terms of the
duration plasterers spent working in each heart rate zone.
Plasterers heart rate zone ranges were determined using their HR rest and
HR max values. The zone range values were entered into the plasterers’ Polar
Precision Performance files and the percent of time spent within each zone range
calculated. The heart rate zone data for all ten plasterers was entered into a Microsoft
Excel file. The mean time spent in each heart rate zone was calculated for each
assessment workstation. The values represent the proportion of time spent in a zone
as a percentage of the total time taken to complete a task (Refer to Section 5.7.2, pg
129).
Each heart rate zone corresponds to a range of heart rate activity. Zone ranges
are unique to an individual and are calculated using their HR max and HR rest . When an
individual’s heart falls within a zone range, it indicates that the person is
participating in an activity of specified intensity. An outline of heart rate zone ranges
corresponding activity intensity levels, and levels of risk are presented in Table 16.
The levels of risk are based on the range values in the risk assessment matrix
presented earlier in this thesis (Table 4, pg 102).
Table 16: Heart Zone Ranges with Corresponding Heart Rate Ranges, Activity
Intensity Levels, and Levels of Risk
Colour Heart Rate Activity

Level of Risk Zones
Code Range Intensity
Red Very High Risk Extreme Zone 5 85%-HR max Maximum
Orange High Risk Major Zone 4 71%-85% Hard
Yellow Medium Risk Moderate Zone 3 61%-70% Moderate
Green Low Risk Minor Zone 2 51%-60% Light
Blue Very Low Risk Negligible Zone 1 HR rest -50% Very Light
A graphical representation of the average duration plasterers spent working in

each zone when carrying out a wet-plastering task averaged for the four assessment
workstations is displayed in Figure 39.
~ 179 ~
• 1.3 % of their time in Zone 5 working at maximum intensity (Extreme Risk)

• 4.11% of their time in Zone 4 working at hard intensity (Major Risk)
• Almost 33% of the time in Zone 3 working at moderate intensity (Moderate
Risk)
• Almost 42% of the time in Zone 2 working at light intensity level (Minor
Risk)
• Slightly over 20% percent of their time is spent in Zone 1 working at very
light intensity levels (Negligible Risk)
Time in HR Zones 1-3 Moderate to Maximum Work Intensity
WS 4
19% WS 1
28%
WS 3
26%
WS 2
27%
Figure 39: Percent of Time at Working at Moderate to Maximum Intensity for

Each Assessment Workstation
The result reflects the proportion of time plasterers worked at moderate to

maximum intensity as a proportion of the total time taken to complete their wet
plastering in each workstation. The maximum duration taken to complete the task
was 21 minutes.
The results indicate that plasterers spent 28% of their time working at
moderate to maximum intensity levels when carrying out a wet-plastering task in
Workstation 1, 27% for Workstation 2, and 26% for Workstation 3. The plasterers
spent the least amount of time working at moderate to maximum intensity levels
when working in Workstation 4. A graphical representation of the mean percent of
time plasterers spent working within HR zones 1-3 is presented in Figure 40.
~ 180 ~
50
45
40
35 Zone 5
30 Zone 4
25
Zone 3
20
15 Zone 2
10 Zone 1
5
0
WS 1 WS 2 WS 3 WS 4
Workstation Zone 5 Zone 4 Zone 3 Zone 2 Zone 1

WS 1 1.72 6.04 34.7 37.8 19.74
WS 2 1.55 1.84 37.96 44.77 13.88
WS 3 1.22 6.66 32.16 40.7 19.26
WS 4 0.71 1.91 26.01 43.1 28.27
Figure 40: Distribution of Percent of Time in Each Heart Rate Zone
Percent of Time Working in Zones

Zone 5 Zone 4 Zone 3 Zone 2 Zone 1 Zone 5 Zone 4 Zone 3 Zone 2 Zone 1
2% 1% 2%
6% 14%
20%
38%
34%
38% 45%
Zone 5 Zone 4 Zone 3 Zone 2 Zone 1 Zone 5 Zone 4 Zone 3 Zone 2 Zone 1
1% 1% 2%
7%
19%
28% 26%
32%
41%
43%
Figure 41: Percent of Time Working in Activity/Intensity Zones
~ 181 ~
In Figure 41, a graphical demonstration of the distribution of mean time spent

working in each zone for each assessment workstation is displayed. In Figure 42, the
mean time each plasterer spent working in each time zone when carrying out a wet-
plastering activity is presented. The image demonstrates the variability of plasterers’
physiological response to the demands of the activity and task environment
conditions.
Time
(Hrs)
Plasterer: 1 2 3 4 5 6 7 8 9 10
Figure 42: Variation of Mean Time Plasterers Spent in Each Activity Zone
Data Generated from Polar Precision Performance Software Assessment Records
6.7.6 RHR – Comparison between Assessment Condition Environments

In this section, plasterers’ physiological response is measured in terms of
their cardiovascular strain (Relative Heart Rate, RHR) for each assessment
workstation. Using the equation below plasterers RHR was calculated for each
assessment workstation. The information used in determining RHR was the
plasterers HR rest HR max, and their mean heart rate value for that assessment
workstation (HR task ). RHR values were calculated for the ten participants for each
assessment workstation.

Workload

~ 182 ~
The RHR data represents a magnitude of cardiovascular activity measured on

a percentage scale of 100 increments. RHR in the test environment, when plasterers
are at rest is 0%. Elevated RHR values indicate how hard a plasterer worked in
assessment environments. In each workstation, the plasterer’s mean RHR increased
in response to the intensity of the task demand and the environmental conditions. In
Figure 43, the average mean RHR data for the ten plasterers for the four assessment
workstations is displayed.
The highest RHR value was recorded when plasterers worked in Workstation
2 (ceiling/trestle/low stand) (35%), followed by Workstation 1 (wall/ground & hop-
up/low stand) (34%) and Workstation 3 (ceiling/stilts/low stand) (33%).Plasterers
recorded the lowest RHR value when carrying out a wet-plastering task in
Workstation 4 (ceiling/stilts/high stand) (27%).
40
34 35
35 33
30 27
25 WS 1
20 WS2
WS3
15
WS4
10
0
Mean
Figure 43: Mean RHR Data for each Assessment Workstation
In Table 17, the RHR values calculated for plasterers for each assessment
workstation is displayed. Four plasterers experienced their highest RHR in
Workstation 1 or in Workstation 3. One plasterer experienced their highest RHR in
Workstation 2 or in Workstation 4. Eight plasterers experienced their lowest RHR
values in Workstation 4 (ceiling/stilts/high stand). One plasterer did not require a
period of rest when carrying out a wet-plastering task in each of the four
workstations.
~ 183 ~
Table 17: Distribution of RHR Values for Ten Plasterers for Each Assessment
Workstation
Plasterer WS 1 WS 2 WS 3 WS 4
A 32 29 27 19
B 35 31 22 20
C 30 31 36 23
D 34 41 29 31
E 33 32 26 16
F 44 42 48 32
G 38 37 33 28
H 38 48 49 37
I 30 34 25 35
J 27 28 32 30
6.7.7 Recommended Rest Periods – Comparison between Assessment

Condition Environments
In this section, plasterer’s physiological response is measured in terms of
recommended rest periods (RRP) for each assessment condition environment. When
energy expenditure exceeds a person’s physiological limit the homeostatic balance
becomes disrupted and the person experiences physiological fatigue. A period of rest
is required to enable recovery.
Plasterers RRP values were calculated for each assessment workstation using
Murrells Equation. The units of interest in the calculations were the time taken to
complete a wet-plastering task in an assessment workstation (T), the average energy
expenditure recorded by the monitor for a task (E task ) and recommended mean
energy expenditure (5kcal) (E rec )


4.2kJ
~ 184 ~
In Figure 44 the mean RRP per hour of wet-plastering activity for the four
workstations is displayed. The RRP in the pre-assessment condition when plasterers
are at rest is zero minutes.
Seven plasterers were found to require a period of rest when working in
Workstation 1 (wall/ground & hop-up/low stand) at an average of 6.15 minutes for
every hour of activity. In Workstation 2, eight plasterers were found to require rest
with at an average of 3.62 minutes for every hour of activity. In Workstation 3, seven
plasterers were found to require rest with at an average of 3.87 minutes for every
hour of activity. In Workstation 4, three plasterers were found to require rest with at
an average of 3.39 minutes for every hour of activity.
WS 1 WS2 WS3 WS4
7.00
6.15
6.00
5.00
3.87
4.00 3.62
3.39
3.00
2.00
1.00
0.00
Mean
Figure 44: Mean RRP for Assessment Condition Environments
In Table 18, the RRP values for the ten plasterers for each assessment
workstation are displayed. Seven plasterers required their longest rest requirement in
Workstation 1 (wall/ ground & hop-up/low stand). One plasterer required their
longest rest requirement in Workstation 2 (ceiling/trestle/low stand) and one in
Workstation 3 (ceiling/stilts/low stand). One plasterer was found not to require a rest
period for any Workstation. No plasterers were found to require their longest rest
requirement in Workstation 4 (ceiling/stilts/high stand).
~ 185 ~
Table 18: Distribution of RRP duration for Ten Plasterers for Each Assessment
Workstation
Plasterer WS 1 WS 2 WS 3 WS 4
A 5.10 1.92 0.00 0.00
B 8.91 3.88 3.09 1.55
C 6.78 2.75 5.51 0.00
D 0.00 2.55 1.45 0.00
E 2.16 0.00 0.00 0.00
F 11.70 8.24 8.04 6.01
G 2.29 3.82 2.14 0.00
H 6.09 2.89 3.37 2.62
I 0.00 0.00 0.00 0.00
J 0.00 2.88 3.51 0.00
6.7.8 Inferential Results

The results are displayed in Table 19. The cells containing values ≤p0.05
indicates situations when plasterers’ physiological response (dependent variables) is
significantly influenced when plasterers moved between different workstations
(independent variables). These cells are shaded grey.
There is no significant influence in the plasterers’ physiological response
when the p < 0.05 i.e. non-shaded cells. The hypotheses being tested is:
• H 0 – Assessment workstations have no influence on plasterers physiological

response:
1. Mean Heart Rate data

2. Heart Rate Zone data
3. Relative Heart Rate (RHR) data
4. Recommended Rest Period data
The physiological responses are significantly influenced when plasterers

moved from the test environment to each of the four assessment workstations
(corresponds with the rows referenced A, B, C, and D).
~ 186 ~
There was a significant influence on plasterers mean heart rate and RHR
values when working in Workstation 4 (ceiling/stilts/low stand) compared to when
they worked on each of the other workstations (corresponds with rows referenced (E,
F, and G).
There was a significant influence on plasterers RRP values when working in
Workstation 4 (ceiling/stilts/low stand) compared to when they worked in
Workstation 1 (wall/ground & hop-up/low stand) and the three other workstations
(Ref E, H, and I).
Table 19: One -way ANOVA post hoc analysis – Variance between Groups
Moving Between Assessment % Time in

Ref Mean HR RHR RRP
Environments HR Zones
A Test Workstation 1 0.00 0.00 0.00 0.00
B Test Workstation 2 0.00 0.00 0.00 0.05
C Test Workstation 3 0.00 0.00 0.00 0.05
D Test Workstation 4 0.00 0.00 0.00 0.05
E Workstation 1 Workstation 4 0.00 1.00 0.00 0.00
F Workstation 2 Workstation 4 0.00 1.00 0.00 0.33
G Workstation 3 Workstation 4 0.00 1.00 0.00 0.27
H Workstation 1 Workstation 2 1.00 1.00 0.99 0.02
I Workstation 1 Workstation 3 0.96 1.00 0.98 0.03
J Workstation 2 Workstation 3 0.84 1.00 0.86 1.00
6.7.9 Result Summary

Plasterers experienced different levels of physiological and cardiovascular
stress when carrying out a wet-plastering activity in different assessment condition
environments. Overall, the results indicate that working in assessment condition
environment 4, imposed the lowest amount of physiological and cardiovascular stress
to plasterers. In this workstation, plasterers worked on a ceiling while standing on
stilts and using a high mortarboard stand.
A summary of the HRA results is presented in Table 20. The red cells
indicate the numbers of cases in which a workstation had the greatest number of
~ 187 ~
plasterers experiencing the highest levels of physiological stress. The red cells also
contain the highest physiological stress values identified in the study (mean heart
rate, zone activity, RHR and RRP). Orange cells are the second highest values then
yellow and lastly blue.
Table 20: Summary Results for Heart Rate Analysis

Workstation Workstation Workstation Workstation
1 2 3 4
#
plasterers 0 plasterers
Mean Heart recorded 4 plasterers 3 plasterers 4 plasterers (lowest for 8
Rate results highest plasterers)
(bpm) value
Plasterers 103bpm (SD 104 bpm (SD 102bpm 93bpm (SD

Average 10) 7) (SD 12) 9)
Heart Rate % of time working at moderate - maximum intensity =

Zone results moderate - extreme risk.
(percent of 42% of the 37% of the 40% of the 29% of the
time) time time time time
#
plasterers
Relative Heart recorded 4 plasterers 1 plasterer 4 plasterers 1 plasterer
Rate (RHR) highest
results value
(percent)
Plasterers
34% 35% 33% 27%
Average
Average 6.15 (SD 3.62 (SD 3.87 (SD 3.39 (SD

Recommended Duration 3.43 2.21 2.21) 2.37)
Rest Period
results
#
(minutes per plasterers
hour of 7 8 7 3
requiring
activity) rest
~ 188 ~
6.8 Electromyography (EMG) Results

EMG was used to examine plasterers’ biomechanical response (muscle activity
levels) during assessments in which plasterers’ carried out a wet-plastering task in four
simulated workstations.
A physiotherapist positioned electrodes on the skin surface above the right and left
sternocleidomastoid (R_SCM, L_SCM,), right and left trapezius (R_Trap, L_Trap), and
right and left erector spinae (R_ES, and L_ES) muscles following SENIAM guidelines
(Kamen and Gabriel, 2010, Mesin et al., 2009, Soderberg and Knutson, 2000).
Leads were used to connect the electrodes to corresponding channels in a
datalogger unit (data storage unit). A flash marker was also connected to the datalogger. A
video camera was set up in the assessment location to record the plasterers as they carried
out their tasks.
Recording muscle activity and videoing tasks, commenced before plasterers were
signalled to start the assessment. The flash marker was activated when plasterers started
the task and each time a plasterer moved between sub-task activities. This enabled
synchronisation between the EMG data and the video recordings. It also helped to separate
the data into sub-task activities for a more detailed analysis. Recording ceased once a full
surface (wall or ceiling) was completely covered with a smooth coat of plaster.
Upon completion of a task in an assessment area, the raw EMG data was uploaded
onto a laptop using MegaWin V2.21 software (Mega Electronics, Kuopio, Finland). Each
file and video memory card was appropriately labelled with a plasterer’s details and
workstation number.
6.8.1 Data Analysis

After plasterers corresponding EMG and videos were synchronised, additional
markers were added as required to enable separation into each sub-task.
The data was exported into a Microsoft file where it was grouped according to the
sub-tasks of interest. The plasterer’s files were duplicated and the data in the duplicated
files was grouped according to the independent variables.
The mean EMG values were calculated for each muscle for each variable. To
determine the magnitude of activity, the mean values were referenced against the peak
EMG values for the corresponding muscles. This generated a percentage of peak muscle
activity level (%Peak EMG) (dependent variable) for each muscle for each sub-task and
for each workstation condition (independent variables)
~ 189 ~
The indices of interest in this study is %Peak EMG which indicates a quantity of
biomechanical strain experienced by plasterers for each independent variables.
The following results will be presented: 1) descriptive and graphical statistics of the
dependent variable across the independent variables and 2) inferential analysis of the
dependent variable across the independent variables.
The assessment conditions variables:
• Plastering surfaces - Wall and Ceiling

• Standing surfaces – Ground & Hop-up, Trestle & Boards, and Stilts
• Mortarboard stand height
The sub-task variables:
• Mix Plaster (HTA 10.1.1)

• Load Mortarboard (HTA 10.1.2)
• Load Hawk (HTA 10.2.1)
• Load Trowel (HTA 10.2.2)
• Plaster (HTA 10.2.3)
Dependent variables
• %Peak EMG value
One-way ANOVA inferential tests and relevant post-hoc multiple comparison

analysis (Tukey) was carried out to determine if independent variables have a significant
influence on (dependent variables). This type of analysis was conducted to evaluate the
relationship between muscle activity levels and assessment workstation environments
(plastering surface, standing surface, mortarboard stand height and sub-tasks). The results
are deemed to be significant in cases when p ≤ 0.05). The hypothesis being tested were:
• H 0 – Working in different assessment environments have no influence on muscle

activity
• H 0 – Plastering surfaces have no influence on muscle activity
• H 0 – Standing surfaces have no influence on muscle activity
• H 0 – Mortarboard stand height has no influence on muscle activity
• H 0 – Wet-plastering sub-tasks have no influence on muscle activity
~ 190 ~

The EMG results are presented in order of
1. Descriptive and graphical statistics of the dependent variables (%Peak EMG
activity levels of the R_SCM, L_SCM, R_Trap, L_Trap, R_ES, and L_ES across
the independent variables to evaluate if the sub-tasks and the conditions in each
assessment workstation influence changes in muscle activity.

Plasterers carried out the sub-tasks Mix Plaster (HTA 10.1.1), Load Mortarboard
(HTA 10.1.2), Load Hawk (HTA 10.2.1), Load Trowel (HTA 10.2.2) and Plaster (HTA
10.2.3) when working on both the wall and ceiling.
The sub-tasks carried out and the conditions in which they were carried out are
presented in Table 21.
Table 21: Sub-task carried out in each Assessment Condition

Plaster Mortarboard
Standing Surface
Surface Height
Sub-Tasks
Ground
Wall Ceiling Ground Stilts Trestle Low High
Hop-up
Mix Plaster
X
(HTA 10.1.1)
Load
Mortarboard X X X
(HTA 10.1.2)
Load Hawk X X X X X X X
Load Trowel
X X X X X
(HTA 10.2.2)
Plaster (HTA
X X X X X
10.2.3)
6.8.4 Plastering Surfaces: Wall/Ceiling

In Figure 45 a graphical representation comparing the mean %Peak EMG activity
levels for plasterers carrying out a wet-plastering task on two different plastering surfaces:
ceiling and wall is displayed.
~ 191 ~
The red bars indicate that the mean %Peak EMG value is higher for the muscle labelled
directly underneath. The R_SCM, L_SCM, and the R_ES had higher activity levels when
working on the ceiling whereas the R_Trap, L_Trap, and L_ES had higher activity levels
when working on the wall.
100
90 82
80 75 74
69 70 69 70 70
70 66 66
60
50 43 42
40
30
20
10
0
wall ceiling wall ceiling wall ceiling wall ceiling wall ceiling wall ceiling
R_SCM L_SCM R_Trap L_Trap R_ES L_ES
Figure 45:%Peak EMG Values when Working on a Wall and a Ceiling
In the following graphical representations for the descriptive results, three graphs
are presented together. The graph on the top represents the neck muscles (R_SCM and
L_SCM), the middle represents the shoulder muscles (R_Trap and L_Trap), and the
bottom represents the back muscles (R_ES and L_ES). For each muscle, the conditions of
interest are organised in descending order of intensity level from left to right. The
conditions recording the highest activity levels are highlighted red.
6.8.5 Standing Surfaces: Ground/Ground & hop-up/Trestle/Stilts

In Figure 46, a graphical representation comparing the mean %Peak EMG activity
levels for plasterers carrying out a wet-plastering task while standing on four different
surfaces (the ground, ground & hop-up, trestle, and stilts) is displayed.
The neck muscles highest level of activity occurred when standing on a trestle
(76% Peak EMG for R_SCM) and when standing on stilts (77% Peak EMG for L_SCM).
The lowest activity level for the neck occurred when standing on stilts (64% Peak EMG for
R_SCM) and when standing on the ground (59% Peak EMG for L_SCM)
~ 192 ~
The shoulder muscles highest level of activity occurred when standing on the
ground & hop-up (86% Peak EMG for R_Trap) and when standing on the ground (76%
Peak EMG for L_Trap). The lowest activity level for the shoulder occurred when standing
on the ground (66% Peak EMG for R_Trap), and when standing on the trestle (39% Peak
EMG for L_Trap).
The back muscles highest level of activity occurred when standing on the ground
(74% Peak EMG for R_ES) and when standing on the ground (78% Peak EMG for L_ES).
The lowest activity level for the back occurred when standing on stilts (68% Peak EMG for
R_ES), and when standing on the trestle (65% Peak EMG for L_ES).
~ 193 ~
100
90
76 77
80 73 72
66 65 64
70 59
60
50
40
30
20
10
0
Trestle Ground& Ground Stilts Stilts Ground& Trestle Ground
hop-up hop-up
RSCM LSCM
Activity Levels for the Neck Muscles: Right Sternocleidomastoid (R_SCM) and Left
Sternocleidomastoid (L_SCM)
100
90 86
76 73 76
80
66
70
60
50 45 44
39
40
30
20
10
0
Ground& Trestle Stilts Ground Ground Ground& Stilts Trestle
hop-up hop-up
RTrap LTrap
Activity Levels for the Shoulder Muscles: Right Trapezius (R_Trap) and Left Trapezius
(L_Trap)
100
90 78
80 74 73 71
70 68 67
70 65
60
50
40
30
20
10
0
Ground Trestle Ground& Stilts Ground Ground& Stilts Trestle
hop-up hop-up
RES LES
Activity Levels for the Back Muscles: Right Erector Spinae (R_ES) and Left Erector Spinae
(L_ ES)
Figure 46: %Peak EMG Values when Standing on Different Surfaces
~ 194 ~
6.8.6 Mortarboard Stand Height

levels for plasterers carrying out a wet-plastering task while using two mortarboard stands
(775mm and 1270mm) is presented.
This section evaluates the influence of mortarboard stand heights with respect to
activity level of muscles (low stand at 775mm, high stand at 1270mm). The results indicate
that all of the muscles exerted their highest level of activity when loading a mortarboard on
a low stand (indicated in red).
The shoulder muscles exert the greatest amount of activity (98% and 93%)
followed by the back muscles (91% and 80%) and lastly the neck muscles (84% and 69%).
The sub-tasks involved when using the stand are Load Mortarboard (HTA 10.1.2) and
Load Hawk (HTA 10.2.1).
100 98
93 91
90 84 85
78 80
80 73
69 70 69 69
70
60
50
40
30
20
10
0
Low High Low High Low High Low High Low High Low High
Figure 47: %Peak EMG Values When Loading Mortarboards
6.8.7 Wet-Plastering Sub-Tasks

levels for the sub-task activities of a wet-plastering task carried out by plasterers. The sub-
tasks are Mix Plaster (HTA 10.1.1), Load Mortarboard (HTA 10.1.2), Load Hawk (HTA
10.2.1), Load Trowel (HTA 10.2.2), and Plaster (HTA 10.2.3) is presented.
~ 195 ~
The neck muscles highest level of activity occurred when loading the mortarboard
(82% Peak EMG for R_SCM) and when plastering (87% Peak EMG for L_SCM). The
lowest activity level for the neck occurred in the Mix Plaster (HTA 10.1.1) sub-task (53%
Peak EMG for R_SCM, and 52% Peak EMG for L_SCM)
The shoulder muscles highest level of activity occurred when plastering (96% Peak
EMG for R_Trap) and when loading the mortarboard (97% Peak EMG for L_Trap). The
lowest activity level for the shoulder occurred in the Mix Plaster (HTA 10.1.1) sub-task
(58% Peak EMG for R_Trap), and the Plaster (HTA 10.2.3) sub-task (39% Peak EMG for
L_Trap).
The back muscles highest level of activity occurred when loading the mortarboard
(83% Peak EMG for R_ES and 90% Peak EMG for L_ES). The lowest activity level for
the back occurred in the Load Trowel (HTA 10.2.2) sub-task (66% Peak EMG for R_ES),
and the Plaster (HTA 10.2.3) sub-task (61% Peak EMG for L_ES).
~ 196 ~
100 87
90 82 79
80 73 70
66 61 61
70
60 53 52
50
40
30
20
10
0
RSCM LSCM
Activity Levels for the Neck Muscles Right Sternocleidomastoid (R_SCM) and Left
96 97
100
90 77 73
80 69
70 62 58
60 45
50 40 39
40
30
20
10
0
RTrap LTrap
Activity Levels for the Shoulder Muscles Right Trapezius (R_Trap) and Left Trapezius (L_Trap)
100 90
90 83
80 73 70 70 72 71 69
66
70 61
60
50
40
30
20
10
0
RES LES
Activity Levels for the Back Muscles Right Erector Spinae (R_ES) and Left Erector Spinae (L_
ES)
Figure 48: %Peak EMG Values for Sub-Tasks of Plastering Activity –Average Value for
All Workstations
~ 197 ~
6.8.8 Mix Plaster (HTA 10.1.1) Sub-task

levels for the Mix Plaster (HTA 10.1.1) sub-task that plasterers carried out while standing
on the ground is presented. When comparing activity levels, the back muscles were the
most active (70% Peak EMG for R_ES and 72% Peak EMG for L_ES) and the neck
muscles were the least active (53% Peak EMG for R_SCM and 52% Peak EMG for
L_SCM).
80
72
69 70
70
58
60
53 52
50
40
30
20
10
0
RSCM LSCM RTrap LTrap RES LES
Figure 49: %Peak EMG Values for Mix Plaster (HTA 10.1.1) Sub-task
6.8.9 Load Mortarboard (HTA 10.1.2): Using a Low Mortarboard Stand and
High Mortarboard Stand
A graphical representation comparing the mean %Peak EMG activity levels for the
Load Mortarboard (HTA 10.1.2) sub-task is presented in Figure 50. Plasterers carried out
this sub-task using a low mortarboard stand (775mm) in Workstations 1, 2, and 3. In
Workstation 4, plasterers used a high mortarboard stand (1270mm). All muscles exerted
their highest activity level when loading the low mortarboards
~ 198 ~
100 98 93 91
90 84 85
78 80
80 70 73
69 69 69
70
60
50
40
30
20
10
0
Figure 50: %Peak EMG Values for Load Mortarboard Sub-task – Working with a Low
Stand and High Stand
6.8.10 Load Hawk (HTA 10.2.1): Using a Low Mortarboard Stand and a High
Mortarboard Stand
levels for the Load Hawk (HTA 10.2.1) sub-task is presented. When carrying out this sub-
task plasterers lifted plaster from a low mortarboard stand (775mm) when standing on the
ground, trestle, and stilts. They also lifted plaster from a high mortarboard stand when
standing on stilts. In all cases, the muscles exerted their highest activity level when loading
the hawk from a low mortarboard stand.
100
90
80 75 73
70 63 63 64 64 65
60 53 55 56
47
50
40 36
30
20
10
0
Figure 51: %Peak EMG Values for Load Hawk Sub-task – Working with a Low
Mortarboard Stand and High Mortarboard Stand
~ 199 ~
6.8.11 Load Hawk (HTA 10.2.1) Sub-task: Standing Surfaces

This section evaluates the influence of standing surfaces on muscle activity levels
when carrying out the Load Hawk (HTA 10.2.1) sub-task. A graphical representation
comparing the mean %Peak EMG activity levels for the Load Hawk (HTA 10.2.1) sub-
task when plasterers stood on different surfaces is presented in Figure 52. When plasterers
carried out the task when standing on the ground, the height of the stand from the standing
surface was 775mm. When standing on a trestle it was 295mm. When standing on stilts, it
was between 165mm to 265mm when working with the low stand, and between 660mm to
760mm when working with the high stand.
The neck muscles exerted their highest level of activity when loading the hawk
when standing on the trestle (66% Peak EMG for R_SCM) and standing on stilts (69%
Peak EMG for L_SCM). The lowest activity level for the neck occurred when standing on
stilts (56% Peak EMG for R_SCM) and when standing on the trestle 53% Peak EMG for
L_SCM).
The shoulder muscles exerted their highest level of activity when standing on the
ground (72% Peak EMG for R_Trap) and when standing on stilts (51% Peak EMG for
L_Trap). The lowest activity level for the shoulder occurred when standing on both other
surfaces (58% Peak EMG for R_Trap), and when standing on the ground (35% Peak EMG
for L_Trap).
The back muscles exerted their highest level of activity when standing on the trestle
(77% Peak EMG for R_ES) and when standing on stilts (76% Peak EMG for L_ES). The
lowest activity level for the back occurred when standing on the ground (66% Peak EMG
for R_ES and 65% Peak EMG for L_ES).
~ 200 ~
100
90
80 69
66 64
70 59
56 53
60
50
40
30
20
10
0
Trestle Ground Stilts Stilts Ground Trestle
RSCM LSCM
100
90
80 72
70 58 58
60 51
50 44
40 35
30
20
10
0
Ground Stilts Trestle Stilts Trestle Ground
RTrap LTrap
Activity Levels for the Shoulder Muscles Right Trapezius (R_Trap) and Left Trapezius
(L_Trap)
100
90
77 76 76
80 70
70 64 66
60
50
40
30
20
10
0
Trestle Stilts Ground Stilts Trestle Ground
RES LES
Activity Levels for the Back Muscles Right Erector Spinae (R_ES) and Left Erector Spinae
(L_ ES)
Figure 52: %Peak EMG Values for Load Hawk Sub-task – Standing on Different
Surfaces
~ 201 ~
6.8.12 Load Hawk (HTA 10.2.1) Sub-task: Standing on stilts, Using Low and
High Mortarboard Stands
Plasterers standing on stilts used two different mortarboard stands (775mm and
1270mm) from which they loaded a hawk.
levels for the Load Hawk (HTA 10.2.1) sub-task when plasterers stood on stilts and used
two different mortarboard stands is presented. The results indicate that all of the muscles
exerted their highest level of activity when loading a hawk from a low stand (indicated in
red).
The back muscles exert the greatest amount of activity (87% Peak EMG for R_ES
and 86% Peak EMG for L_ES ) followed by the neck muscles (58% Peak EMG for
R_SCM and 80% Peak EMG for L_SCM) and lastly the shoulder muscles (60% Peak
EMG for R_Trap and 64% Peak EMG for L_Trap).
100
90 87 86
80
80
70 64 64 65
58 60
60 53
52 52
50
40 36
30
20
10
0
Figure 53: %Peak EMG Values for Load Hawk Sub-task – Standing on Stilts and Using
Two Different Mortarboard Stands
6.8.13 Load Trowel (HTA 10.2.2): Standing on Ground & hop-

up/Trestle/Stilts
Plasterers carried out the Load Trowel (HTA 10.2.2) sub-task when standing on
different surfaces, the ground & hop-up, trestle, and stilts. During the Load Trowel (HTA
10.2.2) sub-task, plasterers were observed using a trowel held in their right hand to scoop
~ 202 ~
plaster from a hawk held in their left hand. On occasion prior to loading a trowel, the
plasterers manipulated the plaster on the hawk to ensure that the plaster remained at an
even consistency. The majority of the Load Trowel (HTA 10.2.2) tasks involved a quick
scooping movement to lift the plaster onto the hawk. The movement continued from
scooping the plaster to the application of the plaster on to the ceiling/wall surface.
Load Trowel (HTA 10.2.2) sub-task when plasterers stood on the ground & hop-up, trestle,
and stilts is presented in Figure 54.
The neck muscles exerted their highest level of activity when standing on a trestle
(75% Peak EMG for R_SCM) and when standing on stilts (80% Peak EMG fro L_SCM).
The lowest activity level for the neck occurred when standing on stilts (60% Peak EMG for
R_SCM) and when standing on the ground &hop-up (67% Peak EMG for L_SCM)
ground & hop-up (82% Peak EMG for R_Trap and 41% Peak EMG for L_Trap). The
lowest activity level for the shoulder occurred when standing on the trestle (74% Peak
EMG for R_Trap), and when standing on stilts (37% Peak EMG for L_Trap).
The back muscles exerted their highest level of activity when standing on a trestle
(74% Peak EMG for R_ES) and when standing on stilts (63% Peak EMG for L_ES). The
lowest activity level for the back occurred when standing on the ground & hop-up (61%
Peak EMG for R_ES), and when standing on a trestle (59% Peak EMG for L_ES).
~ 203 ~
100
90 80
80 75 73
64 67
70 60
60
50
40
30
20
10
0
Trestle Ground& Stilts Stilts Trestle Ground&
hop-up hop-up
RSCM LSCM
100
90 82
80 70 69
70
60
50 41 41 37
40
30
20
10
0
Ground& Trestle Stilts Ground& Stilts Trestle
hop-up hop-up
RTrap LTrap
100
90
80 74 72
70 61 63 60 59
60
50
40
30
20
10
0
Trestle Stilts Ground& Stilts Ground& Trestle
hop-up hop-up
RES LES
ES)
Figure 54: %Peak EMG Values for Load Trowel Sub-task – Standing on Different
Surfaces
~ 204 ~
6.8.14 Plaster (HTA 10.2.3) Sub-task: Standing on Ground & hop-

up/Trestle/Stilts
Plasterers carried out the Plaster (HTA 10.2.3) sub-task when standing on different
surfaces, the ground & hop-up, trestle, and stilts. During the sub-task, plasterers were
observed using a trowel held in their right hand to scoop plaster from a hawk held in their
left hand. The plaster was applied on to a surface (wall/ceiling) using long sweeping
movements. They used force when applying the plaster to the surface, and when creating a
smooth surface finish.
Plaster (HTA 10.2.3) sub-task when plasterers stood on the ground & hop-up, trestle, and
stilts is presented in Figure 55.
The neck muscles exerted their highest level of activity when plastering while
standing on the trestle (86% Peak EMG for R_SCM and 93% Peak EMG for L_SCM). The
lowest activity level for the neck occurred when standing on the ground & hop-up (74%
Peak EMG for R_SCM and 83% Peak EMG for L_SCM).
ground (72% Peak EMG for R_Trap) and when standing on stilts (51% Peak EMG for
L_Trap). The lowest activity level for the shoulder occurred when standing on both other
surfaces (58% Peak EMG for R_Trap), and when standing on the ground (35% Peak EMG
for L_Trap).
The back muscles exerted their highest level of activity when standing on the
ground & hop-up (78% Peak EMG for R_ES and 82% Peak EMG for L_ES). The lowest
activity level for the back occurred when standing on stilts (56% Peak EMG for R_ES and
63% Peak EMG for L_ES).
~ 205 ~
100 93
86 85 83
90 77
80 74
70
60
50
40
30
20
10
0
Trestle Stilts Ground& hop- Trestle Stilts Ground& hop-
up up
RSCM LSCM
100 99 99 92
80
60
42 39 37
40
20
0
Ground& hop- Trestle Stilts Ground& hop- Stilts Trestle
up up
RTrap LTrap
100
78 82
80 68 65 63
56
60
40
20
0
Ground& hop- Trestle Stilts Ground& hop- Trestle Stilts
up up
RES LES
ES)
Figure 55: %Peak EMG Values for Plaster Sub-task – Standing on Different Surfaces
~ 206 ~
6.8.15 Plaster (HTA 10.2.3) Sub-task: Standing on Ground & hop-

up/Trestle/Stilts
Plasterers carried out the wet-plastering task in four assessment workstations. In the
first workstation, they worked on a wall, stood on the ground & hop-up, and used a low
mortarboard stand. In the second, they worked on a ceiling, stood on a trestle, and used a
low mortarboard stand. In the third, they worked on a ceiling, stood on stilts, and used a
low mortarboard stand. In the fourth, they worked on a ceiling, stood on stilts, and used a
high mortarboard stand.
wet-plastering task carried out by plasterers in four workstations is presented in Figure 56.
The neck muscles exerted their highest level of activity when carrying out the wet-
plastering task in Workstation 2 (70% Peak EMG for R_SCM) and in Workstation 1 (72%
Peak EMG for L_SCM). The lowest activity level for the neck occurred when working in
Workstation 3 (60% Peak EMG for R_SCM) and working in Workstation 2 (60% Peak
EMG for L_SCM).
The shoulder muscles exerted their highest level of activity working in Workstation
1 (79% Peak EMG for R_Trap) and working in Workstation 3 (64% Peak EMG for
L_Trap). The lowest activity level for the shoulder occurred when working in Workstation
3 and 4 (67% Peak EMG for R_Trap), and Workstation 2 (56% Peak EMG for L_Trap).
The back muscles exerted their highest level of activity when working in
Workstation 2 (79% Peak EMG for R_ES) and Workstation 3 (78% Peak EMG for L_ES).
The lowest activity level for the back occurred when working in Workstation 4 (62% Peak
EMG for R_ES and 68% Peak EMG for L_ES).
~ 207 ~
100
80 70 69 72
64 67 65
60 60
60
40
20
0
Workstation Workstation Workstation Workstation Workstation Workstation Workstation Workstation
2 1 4 3 1 4 3 2
RSCM LSCM
100
90 79
80 68 67 67
70 64 62
57 56
60
50
40
30
20
10
0
1 2 4 3 3 1 4 2
RTrap LTrap
100
90 79 78
80 73 72 74 71 68
70 62
60
50
40
30
20
10
0
2 3 1 4 3 1 2 4
RES LES
ES)
Figure 56: %Peak EMG Values for Plaster Sub-task – Carrying out a Wet-plastering
Task in Four Workstations
~ 208 ~
6.8.16 Inferential Post-hoc Results

The results are displayed in Table 22. The shaded cells within each row contain
values p≤0.05. This indicates that the plasterers’ muscle activity response (%Peak EMG)
(dependent variables) was significantly influenced when plasterers moved between the
assessment workstations, the wet-plastering sub-tasks, and variable conditions that exit in
the workstations (plastering surfaces, standing surfaces, and mortarboard stand height)
(independent variables). There was no significant influence in the plasterers’ muscle
activity levels when the p value is greater than 0.05 i.e. non-shaded cells. The hypotheses
being tested are
• H 0 – Working in different assessment environments have no influence on muscle

activity
• H 0 – Plastering surfaces have no influence on muscle activity
• H 0 – Standing surfaces have no influence on muscle activity
• H 0 – Mortarboard stand height has no influence on muscle activity
• H 0 – Wet-plastering sub-tasks have no influence on muscle activity
The activity level of the right neck muscle (R_SCM) was significantly influenced
when plasterers moved between working with a low mortarboard stand and a high
mortarboard stand, and when moving between sub-tasks (Mix Plaster (HTA 10.1.1), Load
Mortarboard (HTA 10.1.2), Load Hawk (HTA 10.2.1), Load Trowel (HTA 10.2.2), and
Plaster (HTA 10.2.3)).
The activity level of the left neck muscle (L_SCM) was significantly influenced
when plasterers moved between plastering surfaces (wall/ceiling), between standing
surfaces (ground, ground & hop-up, trestle and stilts), and between sub-tasks. It was also
significantly influenced when plasterers carried out the Load Hawk (HTA 10.2.1) sub-task
when moving between standing surfaces. When standing on stilts the L_SCM was
significantly influenced when loading the hawk when moving between the low and high
mortarboard stands.
The activity level of the right shoulder muscle (R_Trap) was significantly
influenced when plasterers moved between all independent variable conditions.
The activity level of the left shoulder was significantly influenced when plasterers
moved between plastering surfaces, standing surfaces, mortarboard stand heights, and sub-
tasks. The activity level was also significantly influenced when carrying out the Load
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Mortarboard (HTA 10.1.2) sub-task and Load Hawk (HTA 10.2.1) sub-tasks when moving
between mortarboard stands. When standing on stilts the L_Trap was significantly
influenced when loading the hawk when moving between the low and high mortarboard
stands.
With the exception of the Load Trowel (HTA 10.2.2) sub-task and moving between
standing surfaces, the activity level of the right back muscle (R_ES) was significantly
influenced when moving between the independent variable conditions.
The activity level of the left back muscle (L_ES) was significantly influenced when
plasterers moved between plastering surfaces, standing surfaces, mortarboard stand
heights, and sub-tasks. The activity level was also significantly influenced when carrying
out the Load Mortarboard (HTA 10.1.2) sub-task and Load Hawk (HTA 10.2.1) sub-tasks
when moving between mortarboard stands. When standing on stilts the L_ES was
significantly influenced when loading the hawk when moving between the low and high
mortarboard stands.
Table 22: One -way ANOVA post hoc analysis – Variance between Groups
%Peak EMG Activity
For Muscles
Plastering Surface 0.79 0 0 0 0.05 0
Standing Surface 0.2 0 0 0 0.04 0
Mortarboard Stand
0.01 0.58 0.03 0 0 0
Height
Sub-tasks 0 0 0 0 0.03 0
Mix Plaster No Data
Load Mortarboard &
0.19 0.94 0.03 0.02 0.03 0.05
Stand Height
Load Hawk & Stand
0.33 0.36 0.03 0.04 0.03 0.03
Height
Load Hawk & Stand

0.26 0.05 0.05 0.18 0.02 0.18
Surface
Load Hawk/ Stand on
0.58 0.02 0.04 0.04 0.02 0.02
Stilts & Stand Height
Trowel & Stand Surface 0.22 0.12 0.05 0.9 0.33 0.85
Plaster 0.44 0.3 0.05 0.86 0.04 0.1
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6.8.17 EMG Conclusion

The EMG results clearly indicate that the plastering task, its sub-tasks, and
conditions within the assessment workstations influenced the activity level of muscles. In
the Post-hoc analysis, the EMG results clearly demonstrate that the task environment,
standing surface, and sub-task conditions influences the activity level of the muscles
assessed.
It is important to note than insignificance in the statistical analysis findings
indicates that changing between variables does not influence the magnitude of muscle
activity. The muscle activity levels may be of similar intensity for each of the assessment
variable conditions i.e. high level or low level.
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Chapter 7: Discussion, Conclusion, and Recommendations
Chapter 7. Discussion and Recommendations
7.1 Introduction
In this chapter, the results from the risk assessment are discussed. The HTA results
are presented first, the VADS results, the HRA results, and finally the EMG results are
presented.
7.2 Discussion of Results

Hierarchical Task Analysis (HTA) was used to establish the task and sub-tasks
plasterers carry out, and to determine the conditions in which they are carried out. A Visual
Analogue Discomfort Scale Survey (VADS) was used to assess psychophysical stress
when plasterers carried out their tasks in active construction sites (Field Study setting). The
results provide a ‘snapshot’ of details about the tasks and working conditions plasterers
participate in over a five-day working week. In addition, the VADS survey evaluated if
plasterers experienced temporal patterns of perceived discomfort over a working day/week
and determined if work/rest patterns and working conditions influenced perceived
discomfort intensity in ten body areas.
Heart Rate Analysis (HRA) was used to assess physiological stress, and
Electromyography (EMG) was used to evaluate biomechanical stress. HRA and EMG were
used in a Laboratory Study setting in which plasterers carried out a wet-plastering task in
four workstations that simulated real working conditions. Carrying out this study in a field
study environment alone had a high likelihood of omitting sub-tasks or working condition
variables that were represented in the laboratory study setting. The laboratory study
enabled the assessment of working condition scenarios that occur normally on active sites.
Workstations were set up in a manner to accurately represent the workstation set-up
commonly found on active construction sites. The HRA and EMG results indicate
physiological and biomechanical stress associated with the workstations assessed in the
laboratory study. Because the workstations were set-up in a manner to represent real life
workstations, the results from this study should reflect WRMSD risk in active construction
sites.
7.2.1 Visual Analogue Discomfort Scales (VADS) Survey

A Visual Analogue Discomfort Survey (VADS) was used to evaluate
psychophysical stress perceived by plasterers over a five-day work period. The VADS
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survey provided a subjective evaluation of psychophysical stresses imposed on ten body

areas in relation to the intensity of perceived discomfort for plastering activities and
working conditions. The survey also provided a ‘snapshot’ of plastering tasks carried out
and the conditions of the working environment in which they were carried out (Refer to
Chapter 5, Section 5.3.1).
Subjective symptoms of discomfort and pain are indicators that the body has been
exposed to WRMSD risk factors, homeostatic balance has become disrupted, and injury
has occurred. Psychological sensations of fatigue generally precedes physiological
sensations of fatigue to stimulate the cessation of an activity and thereby reduce the
probability of physical injury (Coutts et al., 2009, McArdle et al., 2009, Cameron, 1996,
Armstrong et al., 1993, Åstrand and Rodahl, 1986). Exposure to WRMSD risk factors
imposes cumulative and peak loading on the musculoskeletal system and increases the risk
of WRMSDs. Hamberg-Van Reenen et al., (2008) indicate that peak discomfort is a
predictor of future low back, neck and shoulder pain and cumulative discomfort is a
predictor for future neck and shoulder pain.
Ideally, all body areas should have been reported as experiencing no discomfort.
The findings from the VADS survey demonstrated that plasterers’ perceived discomfort
associated with their tasks and working conditions. Discomfort intensities increased over
the working day and over the working week for all body areas with some degree of
variability between body areas.
≥ 0.05)
The VADS results demonstrate a statistically significant correlation (p
between discomfort intensity and time events for all body areas assessed with the
exception of the mid back (p = 0.07).
Maximum discomfort intensities of ‘unbearable’ intensity of discomfort (80-
100mm on VADS, Very High Risk) were recorded for the knees (97mm 6), ankles/feet
(96mm), elbows (95mm), wrists/hands (94mm), low back (90mm), upper back (85mm)
and neck (82mm). Maximum discomfort intensities of ‘hard’ intensity of discomfort (60-
80mm on VADS, High Risk) were recorded for the buttocks/hips/thighs (78mm), mid-back
6
Perceived discomfort intensity - Measured on a 100mm VADs scale, 0mm represents no
perceived discomfort experienced, 100mm represents an extreme level of perceived discomfort
experienced
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(74mm), and shoulders (73mm). These levels of discomfort may indicate that the areas are
experiencing localised fatigue (excessive accumulation of metabolic by-products, or
depletion of oxygen). Alternatively, it may indicate that the musculoskeletal system that
supports these areas has experienced a peak or cumulative force loading that has resulted in
injury in these areas.
A decline in intensity levels was observed after plasters’ took a break (lunch and
overnight). This indicates that a period of rest enabled recovery to some extent. However,
the rate of the decline in intensity levels was not consistent. On occasion, plasterers
recorded an increased level of discomfort after a rest period. This may be attributed to the
tasks that plasterers’ carried out, and the conditions in which they worked in a previous
work period. Additionally, it may mean that the duration of their break was of insufficient
duration to enable recovery.
Mean values of discomfort intensity represents the average mean level of
discomfort intensity plasterers perceived over the twenty time events (work and rest
periods) in a five day work period for each body area. Mean discomfort intensity values
were recorded for all body areas corresponding to an ‘average’ range of discomfort
intensity (20-40mm on VADS, Medium Risk). The greatest mean intensity was observed
in the low back (35mm) followed by the ankles/feet (32mm), knees (30mm), wrists/hands
(30mm), shoulders (26mm), neck (26mm), elbows (25mm), buttocks/hips/thighs (24mm),
upper back (21mm) and lastly the mid back (20mm).
The variability of discomfort perceived between plasterers may be attributed to
their range of working capacities and/or their task demands or working conditions when
participating in the study.
The VADS results indicate that all of the body areas assessed during the
psychophysical assessments experience peak and cumulative stress and are therefore at risk
of developing WRMSDs (Hamberg-van Reenen et al., 2008). The results correlate with
the findings from previous studies in which plasterers (drywall operators) report high
prevalence rates of WRMSDs affecting the lower back, neck, shoulders, elbows, wrists,
and hands. Injuries include strains, sprains, or tears with the severity of symptoms ranging
from minor to severe (Pan et al., 2009, Reid et al., 2001b, Pinder et al., 2001, Pan et al.,
2000b, Pan et al., 2000c)
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Plasterers experienced both peak and cumulative levels of discomfort in all body
areas assessed. The results demonstrate a statistically significant correlation≥ (p
0.05)
between discomfort intensity levels when plasterers were working on:
• Different plastering surfaces (wall, ceiling, and combination of both wall

and ceiling),
• Different standing surfaces (various combinations of ground, hop-up,
trestle, stilts, and scaffolding)
• Different plastering tasks (preparation tasks, wet-plastering tasks, and
drywall tasks)
When considering plastering surfaces, the highest mean intensity of perceived

discomfort (averaged for all ten body areas) was recorded when plasterers worked on a
ceiling. The lowest level was recorded when plasterers worked on both a wall and ceiling.
When considering standing surfaces, the highest mean intensity of discomfort was
recorded when plasterers stood on a combination of the ground/scaffolding/hop-up in a
single work period. The lowest level of perceived discomfort was recorded when plasterers
stood on the ground and hop-up in a single work period.
When considering plastering sub-tasks, the highest intensity level was recorded
when plasterers carried out wet-plastering tasks, specifically applying a scratch coat of
plaster (first coat), finish coat, and a skim coat (applied after scratch coat) in a single work
period, followed by standing on a hop-up in a single period. The lowest mean intensity of
perceived discomfort was recorded when plasterers carried out moulding sub-task followed
in a single work period.
Limitations of VADS method

Personal bias can influence the accuracy of the data entered in situations when
participants enter details into self-assessment documents without the presence of an
assessor/interviewer. Subjects can over/under estimate the magnitude of their response or
intentionally input inaccurate information. Data accuracy improves with increased sample
sizes and a large sample population is often recommended when using questionnaires. The
response rate is usually smaller for self-assessment methods especially when using a postal
or electronic (email) delivery/return method.
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In this survey, approximately 250 plasterers were asked to participate in the VADS
survey. Less than half of those contacted volunteered to participate. Only 18 completed
surveys were returned for analysis. Plasterers were requested to provide their demographic
details but did not complete this section of the VADS survey. Additionally, no information
was gathered about the tools used by plasterers over the course of the study.
7.2.2 Heart Rate Analysis

Heart Rate Analysis (HRA) was used to evaluate plasterers’ physiological response
when they carried out a wet-plastering task in four assessment workstations (Refer to
Chapter 5, Section 5.5.2).
A Polar™ S810 Heart Rate Monitor, Polar T-61 Transmitter, and watch receiver
were used to record plasterers’ cardiovascular capacity (VO 2 ), predicted HR max , and HR rest
values in a test environment while plasterers rested in a quite environment. They were also
used to record plasterers’ heart rate and energy expenditure while they carried out a wet-
plastering task in four assessment workstations. In each workstation, plasterers worked on
a wall or a ceiling; stood on the ground & hop-up, trestle, or stilts; and used a low
mortarboard stand or a high mortarboard stand.
• Workstation 1: Plastering a wall while standing on the ground and a hop-up and
using a low mortarboard stand
• Workstation 2: Plastering a ceiling while standing on a trestle & board system and
using a low mortarboard stand
• Workstation 3: Plastering a ceiling while standing on a stilts and using a low
mortarboard stand
• Workstation 4: Plastering a ceiling while standing on a stilts and using a high
mortarboard stand
Change in heart rate is a physiological response to the demands exerted on the body
when participating in a physical activity. The rate of change increases proportionally to the
intensity level of an activity to meet the oxygen and nutrient demands of active muscles.
Prolonged elevation of the cardiovascular system indicates prolonged participation in a
high intensity activity and therefore an increased probability of developing WRMSDs.
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The physiological analysis utilised mean heart rate, Heart Rate Zone activity,
Relative Heart Rate (RHR), and Recommended Rest Period to indicate plasterers
physiological response for each workstation (Refer to Chapter 5, Section 5.7.2 for details).
The results demonstrate a statistically significant correlation≥ (p
0.05) between
physiological levels when plasterers were at rest to when they were carrying out a wet-
plastering task. The findings from the HRA demonstrate that plasterers experience higher
levels of physiological stress when working in the workstations. Additionally, plasterers’
physiological activity levels varied when they carried out the wet-plastering task in each
assessment workstation. A summary of the Heart Rate Analysis results is presented in
Table 20.
A statistically significant correlation (p≥ 0.05) of the mean heart rate and RHR
values was observed when plasterers carried out their assessment in Workstation 4 when
compared with working in the other three workstations.
≥ 0.05)
A statistically significant correlation (p of the RRP values was observed
when plasterers carried out their assessment in Workstation 1 when compared with
working in the other three workstations.
There was no statistically significant correlation ≥(p0.05) of the heart rate zone
activity when plasterers carried out their assessments.
Plasterers appear to experience their highest levels of physiological stress when
carrying out their assessment in Workstation 1 (wall/ground & hop-up/low stand). Four
plasterers recorded their highest mean heart rate values when working in this workstation.
The average mean heart rate, 103bpm, was only one beat per minute less than the value
recorded in Workstation 2 in which three plasterers recorded their highest mean heart rate
value. Four plasterers also recorded their highest RHR values in Workstation 1. The
average RHR value, 34%, was only one percent less than the value recorded in
Workstation 2 in which one plasterer recorded their highest RHR value.
Seven plasterers were identified as requiring rest when working in Workstation 1
and Workstation 3. The average recommended rest period for every hour of working in
Workstation 1 was 6.15 minutes (SD 3.43). Although eight plasterers required rest in
Workstation 2, the duration of rest was almost half that required in Workstation 1 (3.62
minutes, SD 2.21)
When considering zone rate activity as an indices of physiological stress, the
greatest response was calculated when plasterers were assessed when they were working in
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Workstation 1. Forty two percent of their time was spent working at moderate to maximum
intensity. The average for all four workstations indicates that when carrying out a wet-
plastering task, plasterers spent almost 39% of their time working at moderate to maximum
intensity levels. In Workstation 4, only 29% of the time was spent working at moderate to
maximum intensity.
When working on a ceiling, the result indicates that the lowest physiological stress
imposed on plasterers occurred when they were standing on stilts and using a high
mortarboard stand in Workstation 4. They recorded the lowest mean heart rate (93 bpm,
SD 9), only one plasterer recorded their highest RHR value, and only three plasterers
required a rest period.
The results demonstrate that a workstations set up influences plasterers
physiological responses. Participating plasterers recorded different levels of heart rate
variation and physiological responses when compared to each other. This may be due to
their different levels of physical fitness, the pace at which they worked, training,
experience, skill, and the work methods used when carrying out their task. These factors
were not analysed in this study.
Individually, plasterers’ physiological responses and the duration taken to complete
a wet-plastering task changed when they moved between workstations. For example,
Plasterer 7 took the shortest time to complete his activities. When carrying out his task, the
majority of his heart rate response remained at very light to moderate intensity levels, i.e.
heart rate values remained lower than 70% of his maximum heart rate capacity. In
comparison, Plasterer 6 took the longest time to complete his activities. He also had the
highest percentage of time spent working in the hard to maximum level of intensity levels
i.e. heart rate values exceeded 71% of his maximum heart rate capacity.
Some plasterers took longer to complete the assessments than others. In some
cases, the demands of the task in a workstation exceeded the capacity of plasterers i.e. they
required a period of rest to recover. In other cases, the demands were well within the
capacity of the plasterer i.e. no rest required. Only one plasterer did not require rest for any
workstation.
The results appear to indicate that working on a wall imposes greater physiological
stress on plasterers than when they worked on a ceiling. The physiological stress recorded
by plasterers when working on a wall may be attributed to the varying postures sustained,
repetitions of movement and force demands when carrying out their task. Due to
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limitations associated with synchronising heart rate monitors with video recordings, it was
not possible to differentiate physiological responses when plasterers worked on the upper
and lower wall sections or when plasterers sustained different postures during the task.
When working on a ceiling, plasterers recorded lower physiological stress when
standing on stilts compared to standing on a trestle. Additionally when they stand on stilts
while working on a ceiling, they recorded lower physiological stress when using a high
mortarboard stand when compared to when they were using a low mortarboard stand.
7.2.3 Electromyography
Electromyography (EMG) was used to indirectly evaluate plasterers’
biomechanical stress when they carried out a wet-plastering task in four assessment
workstations (Refer to Chapter 5, Section 5.3.3). An ME3000P8 data logger unit was used
to record the activity levels of plasterers’ right and left sternocleidomastoid (R_SCM,
L_SCM,), right and left trapezius (R_Trap, L_Trap), and right and left erector spinae
(R_ES, and L_ES) muscles. The data was processed and normalised following SENIAM
guidelines using MegaWin V2.21 software (Kamen and Gabriel, 2010, Mesin et al., 2009,
Soderberg and Knutson, 2000, Hermens and Merletti, 1996).
Changes in muscle activity levels indicate which muscles were active, the intensity
of activity and the duration of activity. Referencing activity levels for an assessment
condition against a reference value enables comparisons between subjects, time events, and
different assessment conditions. One such method requires subjects to generate a
Maximum Voluntary Contraction (MVC) for the muscle of interest. EMG data is then
referenced as a percentage of MVC. However, this method can potentially result in
subjects sustaining injury while trying to generate MVC and untrained individuals may not
accurately generate their maximum intensity of contraction rendering the reference value
inaccurate. The Peak Dynamic normalisation method references EMG data recorded
during an assessment against the peak dynamic value recorded for that assessment (Hibbs
et al., 2011, Vera-Garcia et al., 2010, Burnett et al., 2007, Marras et al., 2001, Ankrum,
2000).
In this study, the Peak Dynamic normalisation method was used to determine
activity levels (%Peak EMG) (dependent variable) for each muscle, sub-task and
workstation condition (independent variables). Changes in muscle activity levels
demonstrate a biomechanical response to the demands exerted on the muscles when
participating in a physical activity. The rate of change increases proportionally to the
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intensity level of an activity. Prolonged activity indicates prolonged participation in a high

intensity activity and therefore an increased probability of developing WRMSDs.
The findings from the EMG analysis demonstrated that different levels of
biomechanical stress were recorded for plasterers when they carried out the wet-plastering
task in each assessment workstation.
The Neck Muscles – Right and Left Sternocleidomastoid Muscles (R_SCM, L_SCM)
The sternocleidomastoid muscles provide support and enable movement of the head
and neck. Working individually they are responsible for flexion and rotation of the head.
When they work together, they counteract the extensor muscles of the neck to stabilise the
head and for neck flexion. The results indicate that plasterer’s neck muscles experience
their greatest biomechanical loading when working on the ceiling, standing on a trestle,
and using a low mortarboard stand.
The right neck muscle (R_RCM) exerts it highest activity levels when working on a
ceiling when compared to working on a wall; standing on a trestle when compared to
standing on the ground & hop-up or stilts; and using a low mortarboard stand when
compared with using a high stand. When considering carrying out a wet-plastering task in
all workstations, the right neck muscle exerts its highest level of activity in Workstation
2; working on a ceiling while standing on a trestle, and using a low mortarboard stand.
The left neck muscle (L_RCM) exerts it highest activity levels when working on a
ceiling, standing on stilts and using a low mortarboard stand. When considering carrying
out a wet-plastering task in all workstations, the left neck muscle exerts its highest level of
activity in Workstation 3; working on a wall while standing on the ground & hop-up, and
using a low mortarboard stand.
When carrying out sub-tasks, the neck muscles recorded their highest
biomechanical stress when plasterers were participating in the Plaster (HTA 10.2.3) sub-
task, particularly when standing on a trestle when compared with standing on the other
surfaces. The next highest level of biomechanical stress was recorded during the Load
Mortarboard (HTA 10.1.2) sub-task. This may be attributed to the contraction of shoulder
muscles during the lifting task. The sternocleidomastoid muscles may have become
increasing active to support shoulder muscles in their movement during the lifting task.
Alternatively, the activity level may have increased to ensure that the head was maintained
in a stable position during the movement.
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When carrying out the Load Hawk (HTA 10.2.1) sub-task, plasterers recorded
their highest level of stress when standing on stilts. This may be attributed to the postures
sustained in during the task. Plasterers had to bend over to complete the sub-task. At the
same time, the head moved into an extension posture and was held in an almost static
posture for the duration of the task. However, there was a significant reduction in stress
levels when plasterers used a high mortarboard stand when carrying out the sub-task while
standing on stilts. Their postures were maintained in more of an upright position when
using a high stand.
Overall, the highest level of biomechanical stress for the neck muscles occurred
when plasterers carried out their assessment in Workstation 1 (wall/ground & hop-up/ low
stand). However, when working on the ceiling the highest level of stress was recorded in
Workstation 2 (ceiling/trestle/low stand). Plasterers recorded their lowest level of
biomechanical stress in the neck muscles when plasterers were assessed in Workstation 4
(ceiling/stilts/high stand).
The EMG results indicate that the neck muscle activity is highest when plasterers
worked on a ceiling while carrying out the Plaster (HTA 10.2.3) sub-task and standing on a
trestle. Their head was hyper-extended with minor rotations to the left and right. When
carrying out the Load Hawk (HTA 10.2.1) sub-task, the degree of head flexion was lower
when plasterers used a high stand when compared with using a low stand. The high levels
of biomechanical stress exerted on the neck indicates that when plasterers carry out a wet-
plastering task, particularly when working on a ceiling, plasterers are at significant risk of
developing WRMSDs of their neck.
The Shoulder Muscles – Right and Left Trapezius Muscles (R_Trap, L_Trap)
The trapezius is involved in movements of the shoulder and arm particularly when
the arm is elevated and/or moved away from the body. The results indicate that plasterers’
experience their greatest biomechanical stress in their shoulder muscles when working on
the wall, standing on the ground, and using a low mortarboard stand.
The right shoulder muscle (R_Trap) exerts it highest activity levels when working
on a wall when compared to working on a ceiling, and using a low mortarboard stand
when compared with using a high stand. The muscle exerts its highest level of activity
when standing on the ground & hop-up. However, when working on a ceiling, the muscle
is more active when standing on a trestle when compared to standing on stilts. When
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considering carrying out a wet-plastering task in all workstations, the right shoulder muscle
exerts its highest level of activity in Workstation 1; working on a wall while standing on
the ground & hop-up, and using a low mortarboard stand.
The left shoulder muscle (L_Trap) exerts it highest activity levels when working on
a wall, and using a low mortarboard stand. The muscle exerts its highest level of activity
when standing on the ground. However, when working on a ceiling, the muscle is more
active when standing on stilts. When considering carrying out a wet-plastering task in all
workstations, the left shoulder muscle exerts its highest level of activity in Workstation 3,
working on a ceiling while standing on stilts, and using a low mortarboard stand.
The right and left shoulder muscles worked at different levels of intensity over the
duration of these assessments. All plasterers were right handed and the muscle activity
pattern reflected this. The right shoulder muscle exerted over 90% Peak EMG activity
when carrying out the Plaster (HTA 10.2.3) sub-task. In contrast, the left shoulder exerted
less than 42% Peak EMG activity. During this task, plasterers repeatedly moved their arm
in large sweeping movements, and applied significant force to create a desired textured
finish. The lowest biomechanical stress was recorded when plasterers carried out the
Plaster (HTA 10.2.3) sub-task while standing on stilts.
Similar patterns of activity intensity variations between the right and left shoulder
muscles were observed while plasterers carried out the Load Hawk (HTA 10.2.1) sub-task.
During this task, plasterers held a hawk in their left hand and a trowel in their right hand.
The trowel was used to manipulate the mortar and scoop plaster onto the hawk, which was
held adjacent to the mortarboard. The results indicate that the right shoulder muscle
recorded higher biomechanical stress than the left shoulder muscle during this sub-task.
Overall, the highest level of biomechanical stress for the shoulder muscles occurred
when plasterers carried out their assessment in Workstation 1 (wall/ground & hop-up/ low
stand. However, when working on the ceiling, the highest level of stress was recorded in
Workstation 3 (ceiling/stilts/low stand). Plasterers recorded their lowest level of
biomechanical stress in the shoulder muscles when assessed in Workstation 4
(ceiling/stilts/high stand).
The EMG results indicate that the shoulder is highly active when plasterers carry
out a wet-plastering task. The task involves manually handling a container to pour mixed
plaster onto a mortarboard, working at heights above the shoulder, overhead work,
sustaining extreme or awkward postures, repetitive movements, and forceful exertions. The
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high levels of biomechanical stress exerted on the shoulders indicate that plasterers, when
carrying out a wet-plastering task, are at significant risk of developing WRMSDs of their
shoulders, particularly in their dominant arm.
The Back Muscles – Right and Left Erector Spinae (R_ES, L_ES)
The erector spinae muscles are involved in moving and supporting the back. They
are the primary stabilisers for the spine when lifting objects or sustaining a wide range of
postural movements such as flexion, sideways bending, and twisting. They also assist in
maintaining erect posture. The results indicate that plasterer’s back muscles experience
their greatest biomechanical stress when working on the wall, standing on the ground, and
using a low mortarboard stand.
The right back muscle (R_ES) exerts it highest activity levels when working on a
ceiling when compared to working on a wall, and using a low mortarboard stand when
compared with using a high stand. The muscle exerts its highest level of activity when
standing on the ground. However, when working on a ceiling, the muscle is more active
when standing on a trestle when compared to standing on stilts. When considering
carrying out a wet-plastering task in all workstations, the right back muscle exerts its
highest level of activity in Workstation 2, working on a ceiling while standing on a trestle,
and using a low mortarboard stand.
The left back muscle (L_ES) exerts it highest activity levels when working on a
wall and using a low mortarboard stand. The muscle exerts its highest level of activity
when standing on the ground. However, when working on a ceiling, the muscle is more
active when standing on stilts when compared to standing on a trestle. When considering
carrying out a wet-plastering task in all workstations, the left back muscle exerts its highest
level of activity in Workstation 3; working on a ceiling while standing on stilts, and using a
low mortarboard stand.
The right and left back muscles worked at similar intensity levels over the duration
of these assessments. The highest biomechanical stress for the back muscles occurred
when plasterers carried out the Load Mortarboard (HTA 10.1.2) sub-task. When carrying
out his task, plasterers, lifted a large container (weighing approximately 20kg in their right
hand), from the mixing area to the mortarboard stand (approximately 2000mm). The
container was rested on the ground briefly before it was lifted using both hands to pour the
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plaster onto the mortarboard. Plasterers held the container under their left arm and used a
trowel to scrape out the remaining plaster onto the mortarboard.
During the Load Hawk (HTA 10.2.1) sub-task, plasterers recorded their highest
levels of stress when standing on stilts. This may be attributed to the postures sustained in
during the task. Plasterers had to bend over with occasional minor twisting of the back to
complete the sub-task. However, there was a significant reduction in stress levels when
plasterers used a high mortarboard stand when carrying out the sub-task while standing on
stilts. Their postures were maintained in more of an upright position when using a high
stand. When using a trestle (480mm height from the ground), plasterers used a mortarboard
stand (775mm) that was positioned on the ground surface. This resulted in a stand height of
295mm. Thus, plasterers were required to sustain postures with a greater degree of bending
when lifting plaster from the board in the Load Hawk sub-task.
Unexpectedly, the back muscles recorded a high level of biomechanical stress when
carrying out the Load Trowel (HTA 10.2.2) sub-task. This may be because the back
muscles were stabilising the back and maintaining posture during this sub-task. During the
sub-task, plasterers used a trowel held in their left hand to manipulate plaster on a hawk in
their left hand. The trowel was then used to scoop the plaster from the hawk and in a
continuous movement; the trowel was moved to apply the plaster onto a surface. This sub-
task took only moments to complete and immediately moved into the Plaster (HTA 10.2.3)
sub-task. It can only be assumed that the high levels of activity of the back muscles at this
stage is because the were in the process of contraction to enable appropriate forces to be
generated to ensure the plaster mix would adhere to a surface. As the upper limbs were
carrying out the sub-task, the back and lower body were moving into position.
When carrying out the Plaster sub-task (HTA 10.2.3), plasterers recorded their
highest level of biomechanical stress in the back muscles when standing on the ground.
When carrying out the same sub-task while working on the ceiling, the highest level of
biomechanical stress in the back muscles was recorded while plasterers were standing on
the trestle.
Overall, the highest level of biomechanical stress for the shoulder muscles occurred
when plasterers carried out their assessment in Workstation 3 (ceiling/stilts/low stand.
Plasterers recorded their lowest level of biomechanical stress in the back muscles when
plasterers were assessed in Workstation 4 (ceiling/stilts/high stand).
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The EMG results clearly demonstrate that muscle activity levels changes when
plasterers work on different surfaces, stand on different surfaces, use mortarboard stands of
different heights, and when they carry out different sub-tasks.
The activity levels when working on either plastering surfaces or when standing on
different surfaces may be attributed to the postures plasterers sustained and their
movements when carrying out a wet-plastering task. When working on a wall, plasterers
were observed standing, bending, stooping, squatting, and kneeling. Their trowel hand
moved from the ground level of the wall up to a height above their head in long sweeping
movements. When working on the upper section of the wall plasterers adopted standing
postures with their arm movements extending from approximately chest height to an
extended overhead reaching posture. When working on a ceiling, plasterers carried out
their activity with their arm extended over their head, with their head tilted backwards.
Limitations of EMG Study

It is important to note that using stilts alters the users gait and imposes stress on
joints, particularly in the lower back, hips, knees, and ankles. In this research, only the
muscles of the neck, shoulder, and back were evaluated using EMG. Plasterers’ lower limb
muscles were not evaluated and plasterers were only assessed for a maximum of 30
minutes. Consequently, this study does not consider WRMSD risk to the lower limbs of
plasterers. Additionally, it did not evaluate WRMSD risk associated with participating in
activities for a prolonged period.
7.3 Conclusion from the Research: Are Plasterers at Risk

of Developing WRMSDs?
The results from the field and laboratory study indicate that plasterers experience
different levels of perceived discomfort in all ten body areas assessed. The type of surfaces
worked upon, the type of standing surface used, and the sub-task activities carried out
influences the intensity levels of perceived discomfort.
Plasterers recorded their highest levels of discomfort (psychophysical stress) in:
• The upper back, mid back neck and knees when working on the ceiling in a
morning or afternoon work period
• The low back, wrists/hands and ankles/feet when working on a wall in a morning or
afternoon work period
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• The shoulders, elbows and buttocks/hips/thighs when working on both a wall and a
ceiling in a morning or afternoon work period
• The upper back, neck, mid back, shoulder and low back when using a single
standing surface in a morning or afternoon work period
• The wrists/hands, knees, elbows, buttocks/hips/thighs and ankles/feet when using
multiple standing surfaces in a morning or afternoon work period
• All ten body areas when carrying out wet plastering sub-tasks in a morning or
afternoon work period
Plasterers recorded their highest levels of physiological stress when carrying out a
wet-plastering task when working on a wall, standing on the ground & hop-up and using a
low mortarboard stand (Workstation 1). When working on a ceiling, plasterers recorded
similarly high level of physiological stress when working in Workstation 2 (standing on a
trestle) and Workstation 3 (standing on stilts). In both workstations, plasterers used a low
mortarboard stand. The results indicate that the lowest physiological stress was recorded in
a workstation set-up similar to that in Workstation 4 (stilts & low stand).
When considering the neck muscles, it was noted that the left and right neck
muscles worked at almost equal intensity levels throughout the assessments. Similarly, the
right and left back muscles recorded almost equal intensity levels throughout the
assessments. However, the right and left shoulder muscles recorded notably different levels
of activity particularly when carrying out the plaster sub-task.
Over all, the activity level of the neck muscles was highest when carrying out the
plaster sub-task when working on the ceiling. The activity level was highest when using
stilts for the left neck muscle and when using a trestle for the right neck muscle.
The left and right shoulder and right and left back muscles recorded their highest
activity levels when working on a wall. When working on a ceiling, the highest activity
levels were recorded for the left shoulder and left back muscles when plasterers were
standing on stilts. In contrast, the highest activity levels were recorded for the right
shoulder and right back muscles when plasterers were standing on a trestle.
When considering the results from the assessments it is clear that plasterers
experience psychophysical, physiological, and biomechanical stress because of their task
and working conditions. The following recommendations are presented to reduce the
likelihood of plasterers developing WRMSDs. The recommendations are presented in two
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sections. Section 7.4 presents principal recommendations arising from the assessment
results from the field and laboratory studies. They relate to the conditions that were
assessed in this study. The principal recommendations proposed are to eliminate the hazard
through task re-design, implement a combination of engineering and administrative
controls such as purchasing, inspection, and maintenance of ergonomically designed
trowels and stilts, and implementation of administrative controls such as work/rest
schedules, task rotation, and training.
Section 7.5 presents further recommendations to aid in reducing WRMSD risk to
plasterers working in Ireland. The literature review presented in Chapter 3 outlines how
WRMSD risk factors plasterers may be exposed do are introduced into the construction
phase of a project. The complexity of the construction industry, the dynamic nature of
construction projects and the involvement of multiple stakeholders were identified as being
contributing factors. It stands to reason that intervention strategies to reduce WRMSD risk
to plasterers must concern and the persons or situations that influence the presence of
WRMSD hazards and the magnitude of associated risk. It is therefore highly recommended
that a hierarchy of control intervention be considered to reduce WRMSD risk to plasterers
working in Ireland. Ideally, controls and interventions should be considered early in a
projects lifecycle.
7.4 Principal Recommendations

Occupational health and safety management in the construction industry requires
committed individuals to understand the benefits of risk management and safety
management. This is especially true for the top management of construction organisation
and for the individuals involved in the decision making process. The decision and planning
phases of all construction projects determines the systems of work used, task demands
imposed, workplace organisation, working procedures used, workplace conditions, and
materials used. Although controls should be implemented at all phases of the construction
project life cycle, emphasis on risk control and risk management should be considered as
early as possible in a construction project’s lifecycle.
Under Irish legislation, all stakeholders whose decision-making will impact on the
demands imposed on the plasterers, have a duty of care to ensure their health and safety. It
is essential that they are all competent and trained, knowledgeable about new technologies
and materials, and understand the impact that their decision-making has on the worker.
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The construction industry is recognised as being slow to implement change.

However, implementing intervention strategies to manage occupational health and safety,
particularly WRMSDs, will increase construction companies’ legislative compliance,
ensure workers health and safety, and reduce associated costs.
The recommendations presented below considers the construction project lifecycle,
the stakeholders involved in construction projects, the Irish health and safety legislative
guidelines, and the Health and Safety Authority (HSA) guidelines.
7.4.1 Elimination - Task Re-design: Designer/Architect Input

Plasterers carry out a wide variety of tasks in the normal course of their daily
activities that impose different levels of physical stress and demands on the workers.
Plasterers have little control over the type of tasks they will be required to carry out as
part of their finishing activities. These will usually be pre-determined by the
designer/architects early in a projects lifecycle. Selecting alternative finishes can
potentially enable plasterers to use different mechanisms to apply coats of plaster onto
walls and ceiling surfaces. Options are currently available on the market that enables
mechanical spraying of plaster and filler mixtures 7. Advertisers claim that these products
are available in a ready mixed format, they are efficient and easy to use, and there is no
waste associated with their use.
From an ergonomic perspective, mechanised spraying plaster on to surfaces can
potentially reduce the stresses imposed on plasterers. The forces and the repetitions of
movement required to achieve smooth finishes should be eliminated. It should be easier
for plasterers to work around objects or reach into recesses with a spray mechanism
especially if fitted with suitable attachments. Plasterers should therefore be capable
accessing areas without the requirement to sustain extreme or awkward postures.
Further recommendations applicable to designers and architects are presented
below in Section 7.4.4 below.
7
http://www.knaufdrywall.co.uk/news/archive/2008/10/24/knauf-drywalls-new-plasters-mixed-ready-for-
the-machine
http://www.knaufdrywall.co.uk/news/archive/2008/10/24/knauf-drywalls-new-plasters-mixed-ready-for-the-
machine
http://www.blastrax.co.uk/paint-coating.php?Spray-Plastering-2
~ 229 ~
7.4.2 Engineering & Administrative Control: Suitable Trowels

EMG results indicate that the activity levels of the dominant shoulder muscles
increases when plasterers partake in the sub-task (HTA: 10.2.3) apply and smooth plaster.
When carrying out this sub-task, plasterers applied force to a trowel and swept the trowel
over the surface to create a smooth textured finish. When trowels are damaged or
improperly cleaned, the plasterers participating in this study reported that they must apply
greater pressure and increase their movements to achieve the desired finish. Additionally,
poorly designed trowels potentially increases the point forces to the hand, and can result in
plasterers having to sustain hand/wrist and arm postures that increase stress on the
musculoskeletal system in the shoulder, arm, wrist, and hand.
It is recommended that trowels be cleaned as soon as plasterers complete a wet-
plastering task to prevent the accumulation of plaster debris on the trowel surface or
handles. They should be inspected prior to use to ensure there are no scratches or dents on
the smooth level under surface. Damaged trowels should be disposed of.
Plasterers should purchase and use ergonomically designed trowels that are
lightweight and well balanced. Handles should be composed of pliable materials and the
dimensions should be suitable to accommodate the anthropometric dimensions of the user.
A study carried out by Vi et al., (2002) using EMG to evaluate muscle activity in the
forearm of masons determined that trowel size influenced the biomechanical stress on
muscles. No study was identified that evaluated the effects of trowel size and
biomechanical stress for plasterers carrying out a wet-plastering task.
7.4.3 Engineering & Administrative Control Suitable Stilts

The results from this study indicate that when working on a ceiling, plasterers
experience lower levels of stress when standing on stilts, particularly when using a high
mortarboard stand. However, issues surround the use of stilts as an option for use as a
standing platform. Plasterers are not trained in their use, inspection, or maintenance.
Participating plasterers report that on occasions once stilts are put on first thing in the
morning they may not be removed until the end of a workday. Over time, if plasterers fail
to regularly clean their stilts, plaster debris accumulates on the stilts and increases their
weight. Foot straps, used to secure stilts to the lower legs, can become damaged over time
due to wear and tear, or because of the corrosive properties of plaster compounds.
Consequently, a plasterer’s risk of falling increases.
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Plasterers’ attention when working on stilts is frequently focused on the ceiling

rather than on the floor. There is an increased probability that plasterers may fall in
environments with poor housekeeping, or in situation when working on uneven ground or
adjacent to fall hazards.
It is recommended that if plasterers select stilts as a standing platform that they
should receive appropriate training in their use, maintenance, and inspection. Plasterers
should be informed about good work practices associated with stilt use and they should be
encouraged to partake in good work practice behaviour. This should include safe
mechanisms when putting on and taking off stilts and removing stilts when taking a break
(morning, lunch, and afternoon). Ideally, plasterers should not use stilts for prolonged
periods of time and they should rotate between different standing surfaces over the course
of a working day.
Providing grants or alternative financial support should be available to plasterers to
enable their selection of stilts with a design that imposes the lowest physiological strain on
their musculoskeletal system.
7.4.4 Administrative Control: Training

Training is a requirement for all stakeholders involved in construction projects.
Ideally, training requirements should be identified before undertaking any activity.
Additionally, throughout a project lifecycle, particularly during the construction phase,
training requirements should be constantly reviewed and updated.
Training programs should be specific to the occupations and tasks being carried out
and they should be provided in a manner that is clearly understood by participants.
Involving employees in the development of training programs will help to ensure that the
programs are occupation specific. Their involvement in developing training programs may
help to improve their willingness to participate and encourage individuals to buy in to the
program benefits. The training requirements are presented in this one section rather than
separating them throughout the lifecycle stages below to reduce incidences of duplication.
• Manufacturers and Designers of Products - Skills and Quality Training:

Manufacturers of plaster mix, and designers of tools equipment and materials should
participate in appropriate skills training. When possible the organisations should
implement quality management systems (e.g. (ISO 9001:2008). Products should be
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manufactured in accordance with appropriate British Standards and European

guidelines.
Rationale: Poorly designed and poorly manufactured products can be hazardous and
expose users to WRMSD risk.
• Specific Training Programs for Decision Makers: Stakeholders involved in decision-
making includes designers, architects, engineers, and supervisors. All third level
construction related courses that these stakeholders participate in should be reviewed
concerning their occupational health and safety content. Each course should have
specific and compulsory modules detailing effective management strategies for
occupational health and safety. An example of the topics that should be included in such
a module and the learning outcomes are displayed in Appendix X.
Rationale: Many stakeholders involved in the decision making process receive their
training through third level programs. Stakeholders who partake in the decision-making
stages early in a construction projects lifecycle have a greater ability to influence health
and safety in the later stages of a project. In a decision making process, workers who
have a deeper understanding of risk factors, risks, and injury development will have a
greater capacity to make an informed decision. Informed decision-making will increase
the probability of successful safety management, reduce the probability of WRMSD
risk factors being introduced into the workplace, and therefore reduce the probability of
workers developing WRMSDs. Stakeholders will have a greater understanding of how
their decisions can potentially introduce latent errors that increase the probability of a
person becoming injured. Implementing safety measures earlier in a project lifecycle
improves productivity and reduces potential financial re-investment if health and safety
intervention is later required.
• Additional Sources of Information: Training programs should provide participants
with details of where and from whom to obtain additional occupational health and
safety information.
Rationale: Training courses have limited content and it may not be possible for
participants to memorise all of the content. Providing participants with the details of
informative and advisory websites, publications, and/or contact details of health and
safety specialists will increase the availability options of information.
Poor decision-making can introduce errors and risk factors that increase the probability
of a person becoming injured. The greater the capacity a stakeholder has to make
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informative decisions i.e. knowledgeable and information the greater the probability of
successful safety management.
• Construction Workers Training: All construction workers, at all levels throughout the
industry should participate in appropriate training programs. The training program
should be specific to each person’s decision-making input requirements.
Rationale: Partaking in training program will enable workers to fulfil their roles and
responsibilities and improve their capacity to carry out their work in a safe and
competent manner. Employers fulfil their legal requirements in employing competent
individuals with sufficient training, experience, and knowledge appropriate to the nature
of the work to be undertaken, (Safety, Health, and Welfare at Work (Construction)
Regulations 2006).
• Occupational Health and Safety Training: In addition to the FAS SafePass program,
all construction workers, at all levels throughout the industry should participate in
detailed construction related occupational health and safety training. Ideally, this should
take place at the time when workers partake in their skills training programs.
Rationale: Appropriate training influences the level of risk awareness, behavioural
patterns, motivational reasons, and decision-making outcomes. It will influence the type
of safety culture in an organisation. An organisations’ safety culture determines what is
deemed acceptable and unacceptable working conditions, working processes, behaviour,
safety performance, and influences the level of risk in the workplace. Employers fulfil
their legal requirements to employees (Safety, Health, and Welfare at Work
(Construction) Regulations 2006).
• Apprentice Training Programs for non-apprentice plasterers: A course should be
developed for plasterers who do not partake in an apprentice-training program.
Rationale: Plasterers who do not participate in an apprentice training program will not
have the same level of health and safety awareness as a plasterer who received their
training through an apprenticeship. Participating in a structured occupational health and
safety course for non-apprentice trained plasterers will improve their risk awareness and
reduce risk-taking behaviour.
• Specific Training Programs for Apprentice Plasterers: The occupational health and
safety module in the plastering apprentice-training program should be reviewed
concerning its content.
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Rationale: Plasterers who are suitably trained have the capacity to 1) recognise
WRMSD risk factor/risks, 2) bring the risk factor/risk to the attention of someone who
has the ability to remove the risk factor or reduce the risk, and/or 3) improve the
working environment or working conditions to remove the risk factor or reduce the risk.
Participating in safety awareness programs can help improve the safety attitude of the
apprentice and reduce the probability of risk taking behaviour. Ideally, sending
confident and competent apprentices with the necessary health and safety skills into the
workplace will reduce the probability of adopting any existing unhealthy habits within
the workforce. Modifications of the plasterers’ apprentice-training program could
include:
• Provide videos, handouts, and statistical data on injury and illness in the
construction industry to provide the apprentice with information on the types of
injuries and illnesses prevalent in the construction industry
• Provide knowledge on ergonomically healthy techniques and technology currently
available and identify advantages and disadvantages of each
• Establish a register for instructors and their qualifications
• Instructor training and skills should be updated on a periodic basis
• Manual handling training should be provided as a core module of plasterers’

apprentice training and be should updated on a regular basis throughout their working
life
Rationale: having appropriate information and knowledge about safe manual handling
practice will reduce the likelihood of carrying out manual handling activities in an
unsafe manner. Subsequently safe handling practice will reduce the likelihood of
workers developing WRMSDs. Employers fulfil their legal requirements to employees
(Safety, Health and Welfare Act 2005, Safety Health and Welfare at Work (General
Application) Regulations, 2007).
• Exercise Module in Apprenticeship: Apprentice training programs should contain a
module(s) that details the importance of health promotion and in the participating of
training programs or sport or exercise programs. Apprentices should also be taught a
selection of simple stretching exercises that should be carried out before commencing
work and periodically throughout the day.
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Rationale: Partaking in exercise strengthens the body’s systems and improves their
efficiency. Stretching exercises prepares the body for physical activity and reduces the
likelihood of injury occurrence. Sending newly qualified trade workers into the industry
with a healthy lifestyle attitude can help to modify the existing unhealthy lifestyle of
construction workers.
A recommended outline for an Occupational Health & Safety module for third level
construction related engineering coursed in presented in Appendix X. A list of potential
learning output benefits from the course is also presented.
7.4.5 Administrative Control: Work Rest Scheduling

Reorganisation of working hours and rest breaks can reduce the magnitude of
stress experienced by workers. Increasing the frequency of breaks specifically adding
extra breaks in addition to a lunch break benefits workers with no decline in productivity
and tends to increase workers performance (Dababneh et al., 2001, Faucett et al., 2007).
Frequent short breaks have a positive effect on fatigue development in the neck and
shoulder region whereas when workers only take a lunch break they do not necessarily
have a significant recovery of perceived fatigue (Bosch et al., 2012, Bosch et al., 2011,
Faucett et al., 2007).
However, the demands of a wet-plastering activity can restrict a plasterer’s ability
to take frequent short breaks. Plasterers must complete their activity until a full wall or
ceiling surface is completed before the plaster mixture dries and to ensure a uniform
textured finish. This may also require a single plasterer to carry out the task.
The results from the VADS section of this study demonstrated that plasterers
worked as long as 11.5-hour workdays. While the majority of plasterers did partake in a
morning break (96%), on 11% of occasions, plasterers did not partake in a lunch break
and on 89% of occasions, plasterers did not partake in an afternoon break.
No information was obtained in this study about the break options available to
plasterers’ i.e. whether the break taking was scheduled or self regulated. Dempsey et al.,
(2010) suggests that workers do not always take the opportunity to rest. This may be due
to motivational factors such as perceived pressure to complete a task within an allotted
timeframe or potential reward mechanisms presented to the worker. Irish construction
workers can be paid on a piecework system i.e. per unit of work completed. This may
motivate workers to continue working through symptoms of fatigue or discomfort to
finish a task in as short a time as possible to receive the financial reward for doing so.
~ 235 ~
Plasterers are at an increased risk of experiencing psychophysical and

physiological sensations of fatigue, or developing WRMSDs when they have infrequent
rest breaks or the break is of insufficient duration to enable recovery. Plasterers tasks,
particularly wet-plastering is time sensitive. Consequently, plasterers may not be able to
take their breaks at set times throughout the day. It is recommended that plasterers be
provided with a suitable work rest schedule:
• Schedule morning, lunch and afternoon breaks with some flexibility to

accommodate the time requirements associated with some plastering activities
• The frequency and duration of breaks should be determined by the task demands
and the ability of the worker, especially when working in the heat.
• Ideally, plasterers should be capable of scheduling their own breaks to
accommodate their task demands. Plasterers should take an afternoon break
• Site managers, contractors should encourage and enable plasterers to take
appropriate rest breaks i.e. morning, lunch and afternoon breaks
7.4.6 Administrative Control: Workstation Organisation

The results from the laboratory study setting clearly demonstrate that plasterers
experience different levels of physiological stress when carrying out a wet-plastering task
indicating a varying level of task demand and magnitude of physiological stress imposed
on the plasterers involved. Organising a workstation is a simple process in which
plasterers can control.
The degree of bending is directly influenced by the height of a mortarboard stand
height. The results indicate that the standing surface and mortarboard stand height that
imposes the lowest stress levels occurs when working on stilts and a high stand i.e.
between 660mm to 760mm. In the workstation setup with the trestle, the difference
between the standing surface and mortarboard was 295mm.
It is recommended that the mortarboard stand is at a height between 660mm to
760mm. However, the height of plasterers can vary dramatically. It is recommended that
mortarboard stands are set at an optimum height for each plasterer, ideally at waist height.
Generally stands are available in a variety of fixed heights and plasterers should select the
appropriate dimension for the standing surface being worked upon. When using a trestle,
~ 236 ~
either the mortarboard stand should be positioned on the trestle. Alternatively, plasterers
should use the high mortarboard stand and position it adjacent to the trestle.
7.4.7 Administrative Control: Rotating Between Tasks

The results from this study demonstrated that each of the body areas and muscles
assessed experienced different levels of stress when working in different working
environments and when carrying out different tasks.
A previous study carried out by Boettcher et al., (2010) using EMG to compare
the activity level of shoulder muscles for different activities determined that shoulder
muscle activity is task specific and changes in activity levels were observed between the
tasks. Job rotation between tasks of different intensity levels decreases and increases
fatigue levels (Horton et al., 2012, Bosch et al., 2012).
Plasterers utilise different muscle groups and sustain different postures when they
carry out different tasks in different environments. Muscles should experience less stress
and therefore less likelihood of becoming fatigues of injured when plasterers rotating
between different tasks and working conditions could potentially
However, plasterers can have little control their daily activity requirements. For
example the type of surface that will be plasterer i.e. a wall or ceiling. The height at which
a plasterer work on a wall, (e.g. floor, knee, waist or chest) which influence the type of
postures sustained such as standing, bending, stooping, squatting, and kneeling. The
postures sustained influence the stresses imposed on the active joints. Situations in which
plasterers have the option of rotating between these different tasks and working conditions
will ensure plasterers will not work for long periods in high demand/stress activities and
subsequently they should develop high levels of fatigue or discomfort (de Looze et al.
2010; Tuinzaad et al. 2008). It is therefore recommended that plasterers be provided with
the option of job rotation when possible.
7.5 Further Recommendations

Reason (1990) theorises that errors and risk factors are introduced in preceding
events (Swiss Cheese accident causation model, Figure 10, pg 64). An adapted version of
Reasons Swiss Cheese Model is presented in Figure 57. The red cells and arrows represent
WRMSD risk factors being introduced into the construction project. The green cells and
arrows represent intervention strategies that can help to eliminate WRMSD risk factors or
reduce associated risk
~ 237 ~
Poor communication and cooperation between all parties involved in managing occupational health and safety - Inadequate training & personal bias – failure to recognise how decision output
influences WRMSD risk - Latent error: decisions made for future event and location, - Active error: Decisions made at a time and location
• Provide • Poor design & • Poor work organisation and
insufficient layout of structure management structure • Poor planning, and scheduling • Physical limitations
Poor material selection & storage • Failure to recognise the
resources for construction • Poor selection of tools, equipment, •
presence of WRMSD hazards • Failure to recognise the early
phase mechanical aids, standing platforms • Insufficient numbers of workers onset of WRMSD symptoms
Infrequent rest breaks • Failure to identify &
• Employs • Failure to implement safety •
implement controls • Failure to take action at early
incompetent Poor selection of management systems • Inadequate maintenance & Inspection onset of WRMSD symptoms
•
programs, • Failure to implement WRMSD
advisors and building material • Unsafe work environmental health prevention strategies • Failure to implement return to
personnel requirements conditions, task demand • Failure to provide adequate supervision work programs
Potential WRMSD Risk factors - Outcome from prior decision making processes: Unsafe Acts, Unsafe Conditions
WRMSD Risk
Controls & Intervention Strategies to Eliminate WRMSD Hazards or Reduce Risk Associated with WRMSD Hazards
Concept Phase Design Phase Planning and Tender Phase Construction Phase
• Knowledge and Develop Implement Manage & Control Follow

Training awareness
understanding of • Policies & Procedures • Policies & Procedures • Policies & Procedures • Policies & Procedures
knowledge and
legislative • Safe System of Work • Safe System of Work • Safe System of Work • Safe System of Work
understanding of:
requirements, • Safety Management System • Safety Management System • Safety Management System • Safety Management System
• Construction
• Select skilled • Inspection Regime • Inspection Regime • Inspection Regime • Inspection Regime
processes, task
qualified & • Documentation Management • Documentation Management • Documentation Management • Documentation Management
demands, physical
competent persons • Purchasing Program for • Purchasing Program for • Purchasing Program for • Purchasing Program for tools,
working conditions
to ensure quality of tools, materials & equipment tools, materials & equipment tools, materials & equipment materials & equipment
etc.
end product and Maintenance Program Maintenance Program Maintenance Program Maintenance Program
• Their potential to
safety throughout Allocation of Resources Allocation of Resources Allocation of Resources Allocation of Resources
cause harm
project life cycle • Employment Strategies • Employment Strategies • Employment Strategies • Employment Strategies
• Potential controls
• Provide sufficient • Training & Skills program • Training & Skills program • Training & Skills program • Training & Skills program
to reduce risk
resources • Safety Culture • Safety Culture • Safety Culture • Safety Culture
WRMSD Risk Factor (Hazard) Control to Reduce WRMSD risk
Figure 57: Summary of Recommendations to Reduce Plasterers Risk of Developing WRMSDs
~ 238 ~
The recommendations are presented following the sequence of a projects

lifecycle and include a pre-project phase. The sequence of recommendations is:
• Pre-Project Phase
• Concept Phase
• Design Phase
• Planning Phase
• Tender Phase
• Construction Phase
7.5.1 Pre-Project Phase

Stakeholders who may influence the presence of WRMSD risk factors,
includes designers and manufacturers of plant, machinery, tools, equipment, and
materials. They are indirectly involved in a project lifecycle. Poorly designed
products can increase the likelihood that users will develop WRMSDs. In a hierarchy
or control intervention strategy the primary objective is to eliminate risk factors, a
task that is best achieved by designers and manufacturers.
Physical Capacity ‘Aptitude Test’

In ergonomics, a worker and the working environments in which their work is
carried out are evaluated as a unit. Assessments evaluate the capacity of the worker
against the demands of their activity/environment. This information enables the
determination of whether the task demand exceeds or is within the capacity of the
worker and establishes a level of risk to the worker.
In many occupations, prospective employees are required to achieve a
preferred score in aptitude tests before becoming employed i.e. they must have a
minimum mental capacity to meet the task demands. Physical work is a major
contributing factor to WRMSDs. The question arises about the possibility of
introducing a comparable physical ‘aptitude’ test for prospective employees to
ensure that they have a minimum physical capacity to meet their task demands.
In addition, when mental ability is necessary for work, employers provide
systems to develop their employee’s mental capacity by promoting participation in
training programs and courses. Employees who partake in physical work activities
~ 239 ~
could also be offered the opportunity to partake in training programs to increase and
improve their physical activity.
The introduction of a physical capacity ‘aptitude’ test can have repercussions
for both employer and employee. A less scrupulous employer could use the
information to employ only young physically fit plasterers and pay little attention to
ensuring a safe working environment. Generally, younger workers, especially males,
are over confident and self-assured. They are more likely to take part in risky
behaviour believing they are invincible and unlikely become injured. They may be
more likely to work beyond their physical capacity in situations when they are
offered financial incentives or posturing in front of colleagues.
WRMSD and MSD International Database

The true prevalence of workplace accidents, ill health, and MSDs is unknown
due to under reporting (Indecon, 2006). Many organisations use different reporting
strategies and terminology. Many cases, for many reasons, frequently go unreported.
Consequently, it is not possible to determine accurate statistics or to make
comparisons between organisations or between different countries
The issue of under reporting may be improved with developing the workplace
safety culture where individuals can observe the benefits that reporting may bring.
Establishing an international and/or state-wide database system to record injury
illness and disorder statistics will assist in determining the true prevalence of
disorders. This can be beneficial in guiding the allocation of appropriate funds and
resources). Definitions for WRMSDs, and other significant details (e.g. uniform
definition for plasterers/drywall operators) should be established.
7.5.2 Concept Phase

• Seek Advice: Clients should seek the advice from the Health and Safety
Authority and other professionals when undertaking a project.
Rationale: Knowledgeable and informed clients will understand their role,
responsibilities, and duty of care
• Provide resources: Sufficient quantities of resources should be provided to
enable hiring a sufficient number of competent workers, who have the physical
and mental capacity to complete their task within an allotted timeframe, and in a
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safe manner. Sufficient resources should also be provided to provide a safe system
of work, safe place of work and safe plant, machinery tools equipment and
materials
Rationale: Insufficient resources can result in understaffing, incompetent poorly
trained workers, unsafe systems of work, unsafe place of work and unsafe plant,
machinery tools equipment and materials. Insufficient resources can result in poor
safety management, work overload, and increase the likelihood of workplace
accidents.
• Hire competent Management and Supervisors
Rationale: Hiring competent management and supervisors who are
knowledgeable about health and safety in construction will increase the likelihood
of effective safety management of construction sites.
• Tendering a Project: The client should consider carefully all applicants in the
tender process before selecting the company who will be responsible for a
project’s construction. The selection process should consider the applicant’s
previous safety records and management strategies and their accidents events
Rationale: Selecting unsuitable applicants can increase the likelihood of poor
safety and risk management, and may result in an increased likelihood of
accidents, illness, and injury occurrences on sites.
7.5.3 Design Phase

• Risk Assessments: Carry out longitudinal site and task specific risk assessments
Rationale: Carrying out site and task specific risk assessments early in a
construction projects lifecycle will highlight potential WRMSD risk factors that
could be introduced in later phases of the lifecycle. Implementing intervention
strategies at an earlier stage will increase the likelihood that risk factors will be
eliminated, or measures will be introduced to reduce risk levels. Additionally, the
costs associated with managing risk in the later stages of a construction project,
which can be significantly higher, will be reduced.
• General Principles of Prevention: Designers and their design team should apply
the General Principles of Prevention and a hierarchy of risk reduction measures
when designing a structure. They should consider the safety and wellbeing of
workers involved in the construction phase
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Rationale: Designers are legally required to consider the General Principles of

Prevention in the Safety Health and Welfare at Work (General Application)
Regulations, 2007.
• Keep up to date with technological advances and design
Rationale: Designers have an increased likelihood of selecting tools, materials
etc. that are least likely to harm workers
• Site Visits: Designers should visit construction sites at various stages during the
construction phase of a project
Rationale: Observing construction workers at work in ‘normal’ working
environments may help to improve designers’ capacity to develop safer working
environments in future projects.
7.5.4 Planning Phase

During the planning phase, all measures should bee considered and
implemented to ensure a
• Safe place of work

• Safe system of work
• Safe plant, machinery, tools, equipment, and materials
• Competent workers
Safe Place of Work
• Establish Safety Management Systems: Implement safety management systems

to manage occupational health and safety, identify hazardous situations, and
eliminate hazards and reduce risk to acceptable levels
Rationale: Establishing a safety management system demonstrates to the
workforce that employee health and safety is a priority to the employer and boosts
the morale of the workforce. Additionally it meets legislative requirements
particularly where safety management systems such as OHSAS 18001 and ISO
14001 are implemented. Some insurance companies offer reductions in premiums
when management systems are implemented
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• Establish Regime for Safety Management: This can include setting a schedule
for regular safety meetings, detailing who will attend meetings, describing roles
and responsibilities of safety personnel, and outlining methods of communicating
health and safety meetings
Rationale: Regular meetings will increase the likelihood that safety issues will be
identified before they become problematic. Attending meetings and regular
communication will help to ensure that all relevant personnel are kept informed
and up-to-date Cooperation and communication between all parties at frequent
intervals aids document generation and document management. Employers and
construction management are legally required to communicate and cooperate to
manage safety and generate documentation (Safety Health and Welfare at Work
(Construction) Regulations, 2006)
• Facilities: Work areas should be carefully planned to ensure workers are supplied
with adequate provision of resources e.g. storage area, water source, hose, power
supply, workspace, lifting aids
Rationale: Poorly designed work areas create unsafe working environments. A
well designed work area with suitable provision of resources can reduce manual
handling requirements and reduce the likelihood plasterers will sustain awkward
or extreme postures. Additionally, there will be an increased likelihood that tasks
will be carried out at optimum working heights i.e. above knee height and below
chest height (preferably waist height)
• Scheduling Requirements: Scheduling the delivery of plant, equipment, and
materials should be carefully considered. Suitable areas for their storage should be
allocated.
Rationale: Storage areas that are too far away increase manual handling
requirements, whereas a storage area too close to the workplace can impose on a
workers workspace. Too large a storage area can also encroach on a workers
workspace restricting workers freedom to move and increasing the likelihood of
slip/trip accidents
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Safe System of Work
• Avoid overtime and workdays longer than an 8-hour day where possible
Rationale: Working for prolonged periods of time increases the likelihood that
plasterers will work beyond their physical capacity and increase the likelihood of
developing WRMSDs
• Supervision Of Work: Ensure adequate provision of supervisors to monitor
workers and ensure they carry out activities in a safe manner and in a safe
working environment
Rationale: Unsafe work conditions and unsafe behaviour increases the likelihood
of accidents and injuries
• Elevated Seating: Plasterers should be provided with an elevated and stable
seating surface for use when putting on and taking off stilts
Rationale: The postures sustained when putting on and taking off stilts can
increase the likelihood of plasterers falling and becoming injured
Safe Plant, Machinery, Tools, Equipment, and Materials
• Ergonomic purchasing program: Employers should establish an ergonomic

purchasing program for plant, tools, and equipment. They should ideally be
designed to match users’ anthropometric dimensions
Rationale: Ergonomically designed plant, tools, and equipment should enable the
user to maintain a posture that imposes the lowest force possible on the
musculoskeletal system. Postures sustained when using the tools should be close
to neutral to minimise the forces exerted on and required by the musculoskeletal
system.
• Establish Inspection and Maintenance Programs: Employers should establish
and maintain a maintenance regime for all tools and equipment. The details
should be documented to ensure the tools and equipment are go through the
maintenance process within appropriate an appropriate period of time
Rationale: Well maintained tools and equipment will be less likely to be
hazardous to users
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Competent and Healthy Workers
• Stakeholders Capacity: Ensure all decision makers are suitably knowledgeable,

trained, educated, and capable of recognising how their decisions can influence
the magnitude of WRMSD risk (positivity or negatively)
Rationale: A safe system of work is a legal requirement under Irish health and
safety legislation. To enable risk reduction requires competency of decision
makers, adequate provision of the necessary resources, and culture to ensure
safety performance.
• Introduce Health Promotion Programs: To promote healthy lifestyles to
construction workers
Rationale: Workplace health promotion is a suitable arena to tackle risk-taking
behaviour, unsafe attitudes, and motivational issues. They provide workers with
the knowledge required to maintain and improve their health and wellbeing.
Examples include healthy eating programs and modification of unhealthy
practices e.g. smoking cessation programs
• Introduce Health Surveillance Programs: To generate a baseline register of
health statistics of the workforce, and periodic monitoring of workers health and
wellbeing
Rationale: Baseline information can be used as a reference when monitoring the
health of the workforce. Health surveillance can be used to guide employers in
selecting and implementing intervention strategies to improve the health of their
workforce. Monitoring workers’ health status on a regular and frequent basis can
help to recognise health issues early, thereby minimising treatment requirements
and absenteeism.
• Inform Workers about WRMSDS: Workers should be trained to recognise early
signs and symptoms of WRMSDs. They should be encouraged to seek treatment
and to report incidences of the disorders
Rationale: Early recognition and intervention halts the progression of WRMSD
symptoms, and reduces associated absenteeism and costs (medical compensation).
van When comparing workers who receive treatment to those who do not receive
treatment van der Weide et al, (1999) demonstrated that workers return to work
earlier when they receive treatment for WRMSD symptoms within 30 days of
their onset, than those left untreated do.
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• Sports & Exercise Programs: Programs should be established and plasterers

should be encouraged to participate in:
1) Sports and/or exercise programs to improve or maintain their physical
fitness.
2) Stretching and warm-up programs before commencing work and
periodically throughout the day
Rationale: Exercise programs and warm-up exercises strengthens the body by
improving fitness, posture, and balance, and can reduce the likelihood of injuries
to muscles, ligaments and other soft tissues.
7.5.5 Standing Surfaces
Standing Surface: Stilts
• Selection: Plasterers should research the available products on the market in

Ireland and online to identify the optimum product before purchasing their stilts
Rationale: Plasterers can spend eight or more hours per day on stilts. The design
of the stilts can help to minimize the stresses imposed on the body
• Adjustment and Fitting: Plasterers should ensure that stilts are appropriately
fitted and adjusted correctly before use
Rationale: Incorrect adjustment can result in plasterers sustaining poor postures.
Plasterers’ balance may also be affected which can increase the likelihood of a fall
• Inspection & Maintenance: As with all tools, and equipment stilts should be
regularly inspected and maintained. Before use, the straps and springs should be
inspected for wear and tear. Damaged components should be replaced and stilts
should be replaced when unfit for use
Rationale: Poorly maintained stilts can increase the risk of falling
• Cleaning: Periodically throughout the day and specifically at the end of a day,
stilts should be thoroughly cleaned of any plaster mixture and debris.
Rationale: Accumulation of plasterer and debris increases the weight of stilts and
subsequently increases the stresses imposed on the body. The plaster mix can
potentially corrode the restraint straps or restrict moving parts.
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• Work Organisation: Plasterers should use a suitable raised seat when putting on
and taking off stilts
Rationale: Plasterers can become unbalanced when putting on stilts thereby
increasing the likelihood of falling and becoming injured
• Breaks: Plasterers should take breaks off the stilts at frequent intervals
throughout the day.
Rationale: Stilts shift the body’s centre of gravity; alter a person’s gait, and
increase stresses on joints in the lower body. The body systems will experience
increasing levels of stress with prolonged use of stilts. The body becomes fatigued
and requires rest to enable recovery. Many plasterers often remain in their stilts
from the start of a workday to the end of the workday even while taking a break or
eating lunch
• Behaviour: Plasterers should not behave in an unsafe manner when on stilts and
should avoid reaching for objects below their knee height at the risk of
overbalancing
Rationale: Unsafe behaviour increases the likelihood of an accident occurrence
• Housekeeping: All workers, particularly plasterers and their assistants, should be
encouraged to maintain good housekeeping and storage on site, particularly when
plasterers are wearing stilts. At set times throughout the day individuals should
inspect and tidy up the work area.
Rationale: Good housekeeping removes slip/trip hazards in the workplace,
reducing the likelihood of accidents occurring
• Training: Plasterers should be suitable trained in the use of stilts, their
inspection, and their maintenance. This training could be introduced as part of the
apprentice-training program, or it can be operated in a separate course such as in a
FAS CSCS scheme.
Rationale: At the end of a course, plasterers should be capable and competent to
carry out their task standing on stilts while maintaining a balanced posture
• Fall Protection Systems: Barriers and guardrails should be positioned in areas
where plasterers wearing stilts are carrying out work adjacent to an elevated work
area. The height of a plasterers stilts should be considered when determining the
heights of barriers and guardrails.
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Rationale: Plasterers are at an elevated height when working on stilts. Working

adjacent to an elevated work area while wearing stilts increases the heights
plasterers can fall
• PPE: The use of a rugby scrumcap may help to protect a plasterer’s head in the
event of a fall.
Rationale: Fall protection systems are often unsuitable for use with stilts and hard
hats can interfere with a plasterers head and neck posture. The scrumcap may help
to protect a plasterers head in the event of a fall
Standing Surface: Trestle
• Workplace Layout: Ideally, when a trestle is used as a standing surface it should

fill as large a space as possible i.e. the full room rather than a section of the room
Rationale: Plasterers, when working on a ceiling, focus their attention on the
ceiling rather than on the standing surface and seldom look where they are
positioning their feet. Too small of a surface will increase the likelihood of a
plasterer falling from the trestle.
• Maintenance: Ensure the boards are flat, even, and sit flush with adjacent boards.
Rational: Poorly maintained or warped boards, increase the likelihood of
plasterers tripping over uneven surfaces
• Fall Protection: Guard rails may be required at the edge of the trestle
Rationale: In cases where plasterers are at risk of falling, a guardrail will help to
reduce the likelihood of a fall occurring
7.5.6 Tender Phase

The recommendations presented in the Planning Phase above are equally
applicable to the Tender Phase of a project. Organisations who submit tender
applications should consider all measures to ensure the health and safety of workers
directly employed by the primary contractor, and the employees of sub-contractors
involved in the project.
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7.5.7 Construction Phase

Plasterers can have little control over their working environment and their
task requirements. However, they have a legal duty of care to protect their own
health. If issues arise in the workplace they should notify appropriate personnel,
inform them and seek corrective actions.
The following are some simple measures that plasterers can implement to
reduce their WRMSD risk
Mix Plaster (HTA, 10.1.1) Sub-task
• Mechanical Aids: When possible, use cement mixers for mixing plaster. Ideally,
locate the mixer adjacent to the mortarboard stand
Rationale: Reduces the frequency plasterers will sustain awkward postures, and
reduces manual handling requirements
• Power Supply: Locate a power supply in close proximity to the mixing area and
at a suitable height for plasterers to reach comfortably
• Water Supply: When possible use a hose to add water to the plaster-mixing
bucket, alternatively relocate the mixing area in closer proximity to a water supply
• Location: Locate the mixing area in a well-ventilated area close to the plastering
area
Rationale: This will reduce the need for manual handling requirements.
Additionally, exposure to potentially harmful dust will be reduced
Load Mortarboard (HTA, 10.1.2) Sub-task
• Location: Mortarboards should be positioned in a location as close to the

plastering activity without interfering with the plasterer’s ability to manoeuvre
about his workstation. Additionally, they should be positioned close to the mixing
area
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• Aids when Loading Mortarboard: Provide a step aid when loading high
mortarboard stands
• Two Person Lifts: Use team lifting when lifting full containers of mixed plaster
Rationale: Reduces manual handling requirements
Load Hawk (HTA, 10.2.1),
• When Using Stilts: Use a high mortarboard stand when wearing stilts. The stand
height in this study was 1270mm. However, the stands height should be adjusted
to match the stilt height
Rationale: The results in this study demonstrate that plasterers when wearing
stilts, experience lower physiological and biomechanical stress levels when using
a high mortarboard stand. Higher stands can reduce the degree of back bending
and reduce the frequency plasterers will sustain awkward postures
• When using Trestles: Low mortarboard stands should be positioned on the
trestle. Alternatively, a suitably high mortarboard stand should be positioned
adjacent to the trestle
• Height Adjustable Mortarboard Stands: Provide height adjustable mortarboard
stands
Rationale: Plasterers can adjust the stand to a suitable working height that will
reduce the frequency and degree of bending sustained by the plasterers
Load Trowel (HTA, 10.2.2), and Plaster (10.2.3)
• Purchase Suitable Tools: Trowels should be ergonomically designed,

lightweight, and well balanced
Rationale: Poorly designed tools force plasterers to sustain awkward or extreme
postures and increase the likelihood of developing WRMSDs
• Tool Selection and Maintenance: Tools should be regularly cleaned, inspected,
and maintained. Damaged tools should be replaced.
~ 250 ~
Rationale: A plasterer’s ability to achieve a desired finish is reduced when tools,

specifically a trowel or float, are damaged or poorly maintained. Damaged tools
increases the force requirements, postures and repetition of movements to achieve
a desired textured finish
7.5.8 Personal Protective Equipment (PPE)

PPE should only be considered as a last resort in the process of reducing risk
to acceptable levels. To avoid injury, construction workers wear Personal Protective
Equipment (PPE) such as hard hats, safety shoes, high visibility jackets, goggles, ear
protection, and gloves. Many construction sites have site wide policies in which all
construction workers, at all times, are required to use a minimum level of PPE. This
includes a hard hat, a high visibility vest and safety shoes. Wearing a hard hat at all
times can be problematic for plasterers, especially when working on a ceiling. The
hat inhibits the plasterers head movements when reaching overhead and bending the
head back.
Splints, Brace & Joint supports

Consider using a splint/joint support to limit the range of joint movement and
support the weight of joints. Supports are available for the back, neck, shoulder
wrists and knees. However, with respect to back supports, researchers are almost
equally divided on benefit of using a back support belt to reduce the probability of
injury. Fifty percent consider them as a suitable preventative intervention whereas
the other fifty percent believe that they can contribute to injury.
7.6 Recommendations Summary

The results indicate that plasterers who work in Ireland are at risk of
developing WRMSDs because of their task demands and working conditions, which
are frequently determined because of decisions made by persons other than by
plasterers (unsafe conditions). Plasterers can also contribute to the presence of
WRMSD risk factors by behaving in an unsafe manner or creating unsafe conditions.
It is proposed that implementing the above recommendations will reduce the
presence of WRMSD risk factors that plasterers will be exposed to. Additionally
when risk factors exist in the workplace, the above measures will reduce associated
~ 251 ~
risk. Subsequently the risk to plasterers working in Ireland developing WRMSDs

will be reduced.
~ 252 ~
Chapter 8: Research Summary
______________________________________________________________
Chapter 8. Research Conclusion
8.1 Introduction
In this chapter, a summary of the challenges faced in this research to Ergonomic
Analysis Work Related Musculoskeletal Disorder Risk to Plasterers Working in Ireland.
In addition, the contribution to knowledge from this research is presented. Finally, an
outline of future research is presented
8.2 Research Challenges

This section highlights challenges that arose when carrying out and Ergonomic
Analysis of Work Related Musculoskeletal Disorder Risk to Plasterers Working in
Ireland. To enable management of these challenges a research risk assessment protocol
was developed to be used as a guide in developing a suitable assessment methodology.
The research risk assessment protocol created for this study, and the subsequent
assessment methodology, was developed after a thorough and detailed literature review
and carrying out mock assessments and pilot studies. The results and findings of the
assessments is the resultant outcome from the methodology used i.e. the selection of the
assessment environments, assessment methods, and participating plasterers. Careful
planning and consideration went into organising this methodology to ensure the results
would be meaningful and accurate.
Phase 1 of the Protocol- Selection of Assessment Environments

During this research, a number of challenges were encountered that delayed the
completion of the work. The decline in construction output and the types of construction
projects being carried out resulted in sites being unavailable for assessment purposes.
Heart Rate Analysis (HRA) is a suitable method to carry out assessments in working
environments. However, due to the unavailability of working sites for the assessments,
HRA was used simultaneously with the Electromyography (EMG) assessment in a
laboratory setting. Ideally, the assessment environments should closely represent working
environments. HRA and EMG were carried out in simulated working environments in
which the conditions represented combinations of working condition scenarios that can
occur on active construction sites. This enabled the capture of working condition
scenarios in the study that may otherwise have been missed if carrying out the
assessments on active sites.
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Phase 2 of the Protocol- Selection of Assessment Methods

The methods selected in this study were deemed to be the most appropriate in
monitoring plasterers psychophysical (VADS), physiological (HRA) and biomechanical
(EMG) responses when participating in the study. Each method provides detailed and
meaningful data when evaluating WRMSD risk. To ensure competency in the use of the
research methods, particularly EMG and its simultaneous use with HRA, pilot studied
and mock assessments were carried out. The VADS survey was delivered and returned by
mail. Contact with participants of this study was by telephone or mail. The lack of face-to
face contact with participants could be a contributing factor to such a low response rate in
this study.
Phase 3 of the Protocol – Select Participants

The greatest challenge faced was the availability of plasterers to participate in
assessments. This was predominantly due to unemployment levels in the construction
industry and a significant decline in construction output. Originally, plasterers were being
sourced through online trade and craft worker directories in which plasterers were
registered and by contacting Safety Officers employed in construction companies around
Ireland to determine if plasterers were working on their site. Insufficient numbers of
plasterers were sourced in this manner. The search for participants was expanded by
contacting the General Secretary of the Operative Plasterers & Allied Trades Society of
Ireland who provided contact details of plasterers registered with the union. Ideally,
larger sample sizes are preferred when carrying out research studies. The sample size in
this study was limited to the plasterers who volunteered to participate.
Phase 4 of the Protocol –Generate Documentation

The documentation requirements were established after reviewing ethical
guideline requirements, and reviewing previous research study publications. The Visual
Analogue Discomfort Scale (VADS) survey had to be designed, tested, modified, printed,
and bound. No major challenges were experienced when generating the documentation
Phase 5 of the Protocol- Planning and Scheduling

Scheduling the assessments in the Laboratory Study required careful planning to
coordinate and match the schedules of all parties’ involved (ten plasterers, a
physiotherapist and the management of a training centre). On two occasions, the
assessments had to be postponed due unforseen circumstances delaying the assessments
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by approximately six months. When the final schedule was organised, five plasterers
dropped out at the last minute and five other plasterers had to be recruited. Subsequently
the assessments took three weeks to complete instead of the originally planned two
weeks.
Phase 5 of the Protocol - Evaluate the risk

Trial assessment data was analysed using compatible assessment software to
ensure the meaningfulness and accuracy of the results generated from the assessment
analysis. In addition, this researcher participated in a three-day Statistical Package for the
Social Sciences (SPSS) 17.0 course, and purchased reference books on statistical analysis
to ensure competency when evaluating the results.
Phase 6 of the Protocol – Providing Recommendations

A literature review was required to identify a hierarchy of strategies that may be
used to eliminate WRMSD risk factors, and reduce risk when they cannot be eliminated.
8.3 Achieving Research Aims and Objectives

The primary aim of this research was achieved by carrying out an ergonomic risk
assessment to evaluate plasterer’s exposure to WRMSD hazards in the Irish construction
industry. The secondary aims of the research were achieved after evaluating the
assessment results:
• It was determined that plasterers are at increased risk of developing WRMSDs

because of their task, sub-tasks or working conditions
• When comparing the risk levels between the variables of working tasks and
working conditions it was determined that some have higher levels of risk than
others
• A hierarchy of control interventions and recommendations to reduce WRMSD
risk to plasterers working in Ireland was generated
The objectives of the study were achieved as follows:
• Knowledge and understanding of plastering tasks, specifically the wet-plastering

task, was acquired to identify the different tasks and sub-tasks plasterers carry out
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on a daily basis. This also included identifying the different conditions in which
plasterers carry out these tasks
• Knowledge and understanding about the development of WRMSDs, and the risk
factors that contribute to their development was acquired to identify the complex
aetiology of the disorders. In addition, strategies that are used to reduce the
likelihood of their development were identified (this information can be used
when selecting recommendations to reduce WRMSD risk)
• An examination of the construction projects lifecycle phases, stakeholders
involved in construction and their decision making outcomes was carried out. This
helped to identify possible causes as to how WRMSD risk factors that plasterers
may be exposed to are potentially introduced into the construction phase of a
project. (This information can be used when selecting recommendations to reduce
WRMSD risk)
• A research risk assessment protocol was developed and used to develop a risk
assessment methodology to evaluate WRMSD risk to plasterers working in
Ireland.
• Assessment methods, assessment environments, and a representative sample
population of plasterers were selected to evaluate plasterers exposure to WRMSD
risk factors
• The data obtained from the WRMSD risk assessment was used to identify a
hierarchy of suitable control intervention strategies and recommendations to
reduce plasterers’ risk of developing WRMSDs
8.4 Hypothesis Testing

Primary Research Hypothesis
• H 0 - Plasters working in Ireland are not at risk of developing WRMSDs
The results indicate that this H 0 hypothesis should be rejected. The conclusion is
that plasterers working in Ireland are at risk of developing WRMSDs.
Assessment Method 1: Visual Analogue Discomfort Survey (VADS)
• H 0 – Independent variables have no influence on the level of perceived discomfort

intensity. If p > 0.05 then Null = true – No relationship in the population
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that plasterers’ psychophysical response is influenced by plastering surfaces, standing
surfaces, and plastering tasks when carrying out their tasks in their working environment.
Assessment Method 2: Polar HR monitor - Heart Rate Analysis
H0 - Independent variables have no influence on heart rate variables (bpm,

Percent of time spent in Heart Rate Zones, RHR, and Recommended rest periods). If p >
0.05 then Null = true – No relationship in the population
that plasterers’ physiological response is influenced when they carry out a wet-plastering
task in different workstations i.e. the working conditions in a workstation influences
physiological response
Assessment Method 3: Electromyography (EMG)
H 0 - Independent variables have no influence no influence on muscle activity

levels (% peak activity). If p > 0.05 then Null = true – No relationship in the population
that plasterers’ biomechanical response is influenced when they carry out a wet-plastering
task in different workstations i.e. the working conditions in a workstation influences
physiological response
8.5 Contribution to Knowledge

Chapter 1, Section 1.7 outlines 12 ways in which a PhD can be deemed to be
original and therefore contribute to knowledge (Eggleston and Klein, 1997, Francis,
1976, Phillips, 1996, Phillips, 1980, Phillips, 1992). This research has met the following:
points:
Point 1: Setting down a major piece of new information in writing for the first time
∗ This thesis is the first publication that details the research carried out and its
subsequent findings and recommendations
Point 7: Carrying out something in a country that has previously only been done in
other countries
∗ This is the first time that plasterers working in Ireland have been assessed
Point 8: Taking a particular known technique and applying it in a new area
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∗ Developed a research risk assessment protocol based on existing risk

assessment processes
Point 10: Being cross-disciplinary and using different methodologies
∗ A combination of psychophysical Visual Analogue Discomfort Scales),
physiological (Heart Rate Analysis) and biomechanical (electromyography)
assessment methods were used in this study
Point 11: Looking at areas that people in the discipline have not looked at before
∗ This is the first time WRMSD risk assessments have been carried out on wet-
plastering tasks
Point 12: Adding to knowledge in a way that has not previously been done before
∗ A hierarchy of recommendations based on the research carried out are provided
to reduce the likelihood of plasterers working Ireland developing WRMSDs
∗ Providing recommendations for training programs to ensure effective decision
making by stakeholders in the construction industry
8.6 Lessons Learned

When considering ergonomic assessments the following should be considered:
• Identify the hazards: Use suitable methodologies to identify all tasks and sub-
tasks that the population of interest potentially participates in over the course of
their normal workday. Informal interviews, observations of workers, and
questionnaires are effective methods to gather detailed information.
• HTA is used to enable diagrammatic representation of the tasks and sub-task
activities required to achieve workers’ overall task requirements. The information
obtained in this manner helps to ensure representative environments are selected
in which to carry out risk assessments. Carrying out the assessments in both a
field study setting and a laboratory study setting enabled the evaluation of a
broader range of task activities and working condition scenarios than if assessing
only one assessment environment
• The literature review carried out for this research highlighted an array of
assessment methods ergonomists use to evaluate WRMSD risk in a broad range of
environments. Three methods were used in this study which enabled an evaluation
of psychophysical, physiological, and biomechanical stress to plasterers. Using
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multiple assessment methods generates a greater quantity of information from

which conclusions can be made. The meaningfulness of the data becomes more
significant when the results from multiples assessment methods used in similar
settings indicate similar findings.
• The Visual Analogue Discomfort Scale Survey (VADS) is a useful assessment
method for use in field studies. Using questionnaires in the survey enabled
gathering detailed information about the participants, their tasks and their working
environments. The questionnaire can be adapted to increase the volume of
information obtained.
The design of the survey i.e. using different coloured pages, different font styles
etc. facilitated plasterers when completing the survey. Using a combination of
Visual Analogue Scales (VAS) and a body map helped plasterers to clarify the
body area regions.
• Heart Rate Analysis (HRA) using the Polar™ Heart rate monitors was a relatively
easy method to use for monitoring heart rate data. The inbuilt test systems and the
ability to input participants data enabled determining physiological information,
specifically HR rest and HR max values. The software used for analysis (Polar
Precision Performance) was user friendly and generated visually representative
graphical and tabular information. It also enabled the storage of multiple records
for 40 assessment recordings.
• Electromyography was probably the most complex method used in this study. A
physiotherapist was required to ensure accurate placement of the electrodes and a
number of mock trials were carried out to ensure competency in its use. However,
a substantial volume of information was generated from the EMG study that
enabled detailed evaluation between multiple variables.
8.7 Future Research

In this section, further research recommendations are presented.
8.7.1 Expansion of the EMG Study

In this research, only the muscles of the neck, shoulder, and back were evaluated
using EMG. Plasterers’ lower limb muscles were not evaluated and plasterers were only
assessed for a maximum of 30 minutes. Consequently, this study does not consider
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WRMSD risk to the lower limbs of plasterers. Additionally, it did not evaluate WRMSD
risk associated with participating in activities for a prolonged period.
The EMG section of this research should be expanded to evaluate the activity of
the lower limb muscles and determine if standing surfaces influences their activity levels.
Ideally, the lower back, hip, thigh, knees, and ankle muscles should be considered.
The study could be carried out in conjunction with a VADS survey. Plasterers
could be assessed while wearing stilts and carry out their activities on active construction
sites. Plasterers EMG values could be recorded for approximately 20 minutes early in the
morning, before lunch, after lunch, and at the end of a working day for five consecutive
days. Comparisons could be made between activity levels over the course of a working
week. The results could be compared with psychophysical data gathered using the VADS
survey.
8.7.2 Research for a Joint Psychophysical and Physiological Field Study

WRMSD risk Assessment
In this research, the VADs survey was used in the Field Study and Heart Rate
Analysis (HRA) used in the Laboratory Study. This methodology could be adapted to
include both methods together in Field Study settings. The heart rate monitor is simple
and easy to use; it is used on a daily basis in a variety of sporting activities. Plasterers and
other trade workers could be trained in its use. The monitor has the capacity to record and
store data for a five day assessment period.
The VADS survey method could remain similar to the design used in this study.
The questionnaires could be customized to gather different data-sets of task and working
environment information based on occupation and working environments of the
participants. The body areas to be assessed can be any body at potential risk of injury. For
five consecutive working days, participants could record heart rate from the time they
commence work and stop recording at the time they cease work. The VADS survey could
be completed in the same manner as the method used in this study.
This type of study should enable a comparative analysis between physiological
stress and psychophysical stress over a working week. The method should be capable of
being used in any working environment and assess WRMSD risk to workers in any
industry or occupation.
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8.7.3 Research to Improve Heart Rate Assessment Procedure

Monitoring heart rate using a Polar™ S810 Heart Rate monitor is a suitable
method to evaluate physiological changes in working environments. However, the
monitor was found to be somewhat limited in this research study. This included:
• Investigating physiological changes in real time settings was not possible. The
data had to be uploaded onto a software compatible computer/laptop and analysed
at a later stage.
• Extreme peaks or dips in the heart beat values were observed when analysing the
data. It was not possible to determine an accurate cause for these changes.
Postural changes or sweating may have temporarily moved the position of the
chest transmitter.
• The heart rate data and video recordings could not be synchronised.
Consequently, it was not possible to correlate the changes in heart rate data to
changes in posture, movements, or tasks being carried out by the plasterers.
It is recommended that manufacturers and ergonomists re-examine the existing

design of heart rate monitors:
• To enable a real-time on-screen analysis of heart rate data the information could
be simultaneously uploaded via a wireless system onto the monitor
• To reduce the likelihood of undesirable movement of transmitters. One such
option currently available from the Polar Heart Rate monitor suppliers is a sports
‘bra 8. The transmitter sits securely in the strap band of the bra to reduce the
likelihood of slippage (Figure 58). This existing design could be modified to meet
the needs of carrying out ergonomic assessments of dynamic activities in which
men are being assessed.
• To enable synchronisation of heart rate data and video recordings. In EMG
analysis, a flash marker can be used to insert a flash of light in to a video
recording and insert a simultaneous ‘mark’ into the EMG recording. This enables
8
http://www.fitsugar.com/Get-Your-Butt-Gear-Polar-Heart-Bra-267229
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the synchronisation of EMG data with video recordings. If the same facility
existed in heart rate monitors this could enable the synchronisation of heart rate
data and video recordings. This system could be used to provide a more detailed
analysis of activities with respect to variations in heart rate data.
• To improve the usefulness of heart rate monitors in evaluating physiological stress
in ergonomic assessments by adding GPS systems and pedometers into the
monitors.
Figure 58: Polar Heart Rate Monitor ‘Bra’
8.7.4 Research to Improve Electromyography Assessments
Determining the Dose of Muscle Activity

In this study, heart rate zone activity (physiological data) was used to determine
the proportion of time plasterers spent working at different intensity levels. Heart rate
zones are calculated using individuals’ resting heart rate and maximum heart rate data.
Each zone range corresponds to an intensity level of physical activity. Carrying out
activities in which the heart rate is in higher zone ranges increases the demands exerted
on the cardiovascular and musculoskeletal systems. Prolonged physical activity in higher
zone ranges creates greater disturbances in homeostasis and increases the risk of potential
damage to the cardiovascular system and musculoskeletal systems.
Generally, the intensity level of a muscle’s activity is represented as a proportion
of the muscles Maximum Voluntary Contraction (MVC), or as used in this study,
proportional to a muscles peak dynamic activity. MVC and peak dynamic activity
represent a muscles maximum capacity (100%), in the same way that maximum heart rate
represents a persons’ maximum heart rate capacity.
At the time of this research, a review of literature did not identify zone ranges for
muscle activity similar to those used for heart rate data. MVC data or peak dynamic data
could potentially be used to compute muscle activity zone ranges similar to the zones
used for heart rate. Zone ranges could be calculated using percentage values of MVC or
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peak dynamic activity (maximum capacity). Each zone range could represent a
proportion of a physical intensity.
Using heart rate zone range data as a guide, a proposed example of muscle
activity zone ranges is presented in Table 23. It is important to note that heart muscle and
skeletal muscle are different physiological tissues with different properties, functions, and
support systems. Further research is required to apportion appropriate muscle zone
regions and to estimate a recommended duration of activity when working in each zone.
Table 23: Example of Muscle Activity Zones with Corresponding Activity Intensity
Levels and a Recommended Duration of Participation
% HR max % MVC Intensity Level Recommended duration

Zone 1 50% - 60% 50% - 60% Very light 20–40 minutes
Zone 2 60% - 70% 60% - 70% Light 40–80 minutes
Zone 3 70% - 80% 70% - 80% Moderate 10–40 minutes
Zone 4 80% - 90% 80% - 90% Hard 2–10 minutes
Zone 5 90% - 100% 90% - 100% Maximum less than 5 minutes
Real time analysis

The EMG and software used in this study required EMG data to be uploaded after
the assessments were completed. The data analysis had to be carried out in a separate
location, and could only take place after the assessments were completed. It was only at
this stage when the patterns of activity could be observed. Using a real-time system such
as the wireless NEXUS-10 biofeedback system 9 can enable simultaneous viewing of the
EMG wave on a screen as a subject carries out their task.
Further research could be carried out to display additional information on a screen
as the data is being recorded, for example, muscle activity levels (%MVC or % Peak).
Additionally, if zone ranges were calculated, the activity levels could be displayed in
colour zones similar to data output from Polar Precision Software. In Figure 59, a screen
shot of colour coded zone ranges generated from a heart rate file is presented.
9
http://www.stens-biofeedback.com/pdf/stens_2010_catalogue.pdf
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Figure 59: Heart Rate Zone Ranges Colour Coded to Represent Each Zone
Postural Assessment
The muscles selected in this study were ‘pairs’ of muscles i.e. the same muscle
was selected in the right and left side of the body (e.g. right trapezius and left trapezius
muscles). When synchronising the EMG data with corresponding videos, patterns of
muscle activity levels were observed in conjunction with plasterers’ postural changes and
task activities being carried out.
Future research is recommended to examine the use of EMG to ‘map’ the activity
patterns of muscle groups for different postures or for different tasks being carried out
(e.g. twisting, handling load in one hand).
8.7.5 Research to Re-Design Plasterers Tools Equipment

Engineers, designers, and manufacturers of plasterers’ tools and equipment should
review the existing designs of trowels to ensure that they are designed ergonomically. Vi
et al., (2002) evaluated trowel size for masonry (blocklaying) activities and demonstrated
that trowel size influences the stresses imposed. A similar study could be carried out to
determine the optimal size and or the design of trowels for plastering tasks and sub-task
to ensure plasterers the least amount of stress possible. Ergonomically designed trowels
and maintaining its smooth surface can help to minimise the stress imposed and thereby
reduce the probability of plasterers developing upper limb WRMSDs.
Engineers, designers, and manufacturers should review the design of plasterer’s
stilts to ensure they are designed ergonomically. Ideally, a multi-disciplined design team
~ 264 ~
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should be involved in the evaluation and re-design process to create stilts that are suitable
for plasterers and other construction workers. The team could be comprised of specialists
such as ergonomists, engineers, medical professionals, rehabilitation specialists, and
prosthetic designers. Plasterers wear stilts for long periods when working on ceilings and
are at risk of falling or being involved in slip/trip events. Wearing stilts affects gait and
increase stresses imposed on the back and the lower limbs. Plasterers report symptoms of
discomfort after prolonged use. Although there are a wide variety of stilts available on the
market, the design of stilts can be improved in order to minimise biomechanical stresses
imposed on the body. Potentially stilts could be designed that augments the
biomechanical properties of the musculoskeletal system. Improved design of stilts will
reduce the likelihood of plasterers becoming injured due to a fall or developing
WRMSDs. Using stilts as an elevated working platform can help to improve productivity
and reduce the time and costs associated with erecting alternative elevated systems (e.g.
scaffolding, and trestle and boards).
Manufacturers of plaster mixtures should review the composition and properties
of plastering mixes and if possible create an alternative product. The existing properties
and composition of plastering compounds influence the task demands of wet-plastering
activities and increase the stresses on the musculoskeletal system. Plasterers have a
limited timeframe to complete the task, must apply increasing levels of force, and
increase their frequency of movements to achieve a desired textured finish. The
compound can be modified to ensure it mixes to a suitable viscosity with a drying time
that requires lower force requirements and frequencies of movement. Plasterers will
experience lower levels of stress and have a lower probability of developing upper limb
WRMSDs
8.7.6 Research to Evaluate the Effectiveness of Neck, Shoulder, and Wrist

Supports
A selection of neck, wrist, and shoulder splints/supports are available, which
manufacturers recommend for use in working environments to reduce the level of stress
on joints.
Manufacturers claim that neck supports work because they bear the weight of the
head and reduces hyperextension of the neck. The stress exerted on the neck, shoulders,
and upper back is reduced and there is a reduced likelihood of injury and pain to these
body areas.
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An online supplier advertises the necprotech 10 neck support system that was
designed and developed in New Zealand. The company say that the Human Performance
Centre in the University of Otago, New Zealand has scientifically tested the product.
They found that wearing the support reduces the stress exerted on the neck muscles by
over 33% and reduces the level of discomfort experienced by users. In New Zealand, Site
Safe, the Occupational Health and Safety Authority for Construction, endorse the product
(Necprotech.com, 2012).
Further research is recommended in the use of neck support systems for
plasterers. The methodology used in this research could be adapted to evaluate plasterers
carrying out a wet-plastering task on ceilings. Comparisons could be made between
situations in which the support is worn to the situations in which the support in not worn.
The images below are taken from the necprotech website to demonstrate the
design of the product and an indication of the working activities that the support can be
worn in Figure 60.
Support systems are also available for the shoulders and the wrists. Further
research should be carried out to determine their effectiveness in reducing stress that
plasterers experience in these body areas when carrying out their tasks.
Figure 60: The Necprotech Neck Support System

(http://www.necprotech.com, 2012)
10
http://www.necprotech.com/default.asp
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8.8 Implementation
Many researchers recognise the importance of implementing intervention
strategies to manage occupational health and safety to reduce occupational risk.
Examples of interventions strategies include implementation through legislative and
judicial management, establishing training programs, implementing different work
practices, reorganisation of the workplace and task demands, providing information about
new technologies, developing behavioural change programs, and motivating change by
positive or negative reward/punishment schemes. (Choi et al., 2011, Driessen et al., 2010,
Gambatese et al., 2008, Schulte et al., 2008, Pinto and Slevin, 2008, Choudhry and Fang,
2008, Health and Safety Authority (HSA), 2006b, Vink et al., 2006, van der Molen et al.,
2004b, Vink et al., 1997).
8.9 Conclusion
In this chapter, a summary of the challenges faced in this research, and how the
research contributed to knowledge were presented.
In addition, further research was recommended based on this researchers
experience and conclusions reached over the duration of this research. A selection of
future research was proposed to potentially increase the effectiveness of the assessment
methods used in this stuffy for the benefit of future WRMSD risk assessments.
Furthermore, recommendations were presented to expand on the ergonomic risk
assessment methodology used in this study to ensure a comprehensive evaluation of
WRMSD risk to plasterers working in Ireland.
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~ 293 ~
Appendices
APPENDICES
~ 295 ~
Appendices
Appendix I: Legislation & Guidance Documents
• Safety, Health and Welfare at Work (Construction) (Amendment) Regulations 2008

(S.I. No. 130 of 2008)
• Safety, Health and Welfare at Work (Construction) (Amendment) (No. 2) Regulations
(S.I. 423 of 2008)
• Safety, Health and Welfare at Work (General Application) Regulations 2007 (S.I. No.
299 of 2007)
• Safety, Health and Welfare at Work (Control of Vibration at Work) Regulations 2006
(S.I. No. 370 of 2006)
• Safety, Health and Welfare Act 2005 (S.I. No. 10 of 2005)
• Safety, Health and Welfare at Work (Construction) Regulations 2006 (S.I. No. 504 of
2006)
• Safety, Health and Welfare at Work (Work at Height) Regulations 2006 (S.I. No. 318
of 2006)
• Safety, Health and Welfare at Work (Control of Noise at Work) Regulations 2006 (S.I.
No. 371 of 2006)
• European Communities (Machinery) Regulations 2008 (S.I. No. 407 of 2008)
Health and Safety Authority Guidance Documentation
• Health and Safety Authority (HSA) (2009) Clients in Construction - Best Practice
Guidance
• Health and Safety Authority (HSA) (2009) Understanding Construction Risk
Assessment
• Health and Safety Authority (HSA) (2008) Lighten the Load for the Construction
Sector
• Health and Safety Authority (HSA) (2008) Code of Practice for Access and Working
Scaffolds
• Health and Safety Authority (HSA) (2008) Use Of Mobile Machinery on Construction
Sites
~ 296 ~
Appendices
• Health and Safety Authority (HSA) (2008) Construction Safety Code of Practice for
Contractors with Three or Less Employees
• Health and Safety Authority (HSA) (2007) Guide to the Safety, Health and Welfare at
(Work General Application) Regulations
• Health and Safety Authority (HSA) (2007) Using Ladders Safely - Information Sheet
• Health and Safety Authority (HSA) (2007) A Guide to Safety in Excavations
• Health and Safety Authority (HSA) (2007) Guide for Clients involved in Construction
Projects
• Health and Safety Authority (HSA) (2007) Safe Use of Work Platform / Trestles -
Information Sheet
• Health and Safety Authority (HSA) (2007) Safety with Asbestos - Information Sheet
• Health and Safety Authority (HSA) (2006) Ergonomics in the Workplace
• Health and Safety Authority (HSA) (2006) Workplace Safety and Health Management
• Health and Safety Authority (HSA) (2006) Summary of Key Duties under the
Procurement, Design and Site Management Requirements of the Safety Health and
Welfare at Work (Construction) Regulations
• Health and Safety Authority (HSA) (2006) Guidelines on the Procurement, Design and
Management Requirements of the Safety health and Welfare at Work (Construction)
Regulations 2006
• Health and Safety Authority (HSA) (2006) Guidelines on Risk Assessments and
Safety Statements
• Health and Safety Authority (HSA) (2006) Workplace Safety and Health Management
• Health and Safety Authority (HSA) (2006) Guidelines on Safety Representatives and
Safety Consultation
• Health and Safety Authority (HSA) (2006) A Short Guide to The Safety, Health and
Welfare At Work Act 2005
• Health and Safety Authority (HSA) (2006) Guide to the Safety, Health and Welfare at
Work Act, 2005
• Health and Safety Authority (HSA) (2005) Guidance on the Management of Manual
Handling in the Workplace
• Health and Safety Authority (HSA) (2004) Improving Safety Behaviour at Work
~ 297 ~
Appendices
Building Regulations
• Building Control (Amendment) Regulations 2009 (S.I. No. 351 of 2009)
• Building Regulations (Part L Amendment) Regulations 2008 (S.I. 259 of 2008)
• European Communities (Energy Performance of Buildings) (Amendment) Regulations
2008 (S.I. 229 of 2008)
• Building Control Act 2007
• European Communities (Energy Performance of Buildings) Regulations (S.I. 666 of
2006
• European Communities (Energy Performance of Buildings) Regulations (SI 872 of
2005)
~ 298 ~
Appendices
Appendix II: General Principles of Prevention
Schedule 3 of the Safety, Health, and Welfare at Work Act 2005
1. The avoidance of risks.
2. The evaluation of unavoidable risks.
3. The combating of risks at source.
4. The adaptation of work to the individual, especially as regards the design of places of work,
the choice of work equipment and the choice of systems of work, with a view, in particular, to
alleviating monotonous work and work at a predetermined work rate and to reducing their
effect on health.
5. The adaptation of the place of work to technical progress.
6. The replacement of dangerous articles, substances or systems of work by safe or less

dangerous or less dangerous articles, substances or systems of work.
7. The giving to collective measure of priority over individual protective measures.
8. The development of an adequate prevention policy in relation to safety, health and welfare
at work, which takes account of technology, organisation of work, working conditions, social
factors and the influence of factors related to the working environment.
9. The giving of appropriate training and instructions to employees.
~ 299 ~
Appendices
Appendix III: National Framework of Qualifications (NFQ)
~ 300 ~
Appendices
0.0 Hierarchical Task Analysis of Constructing a House
6.0 Doors 9.0 Kitchen 10.0 11.0

1.0 2.0 3.0 4.0 5.0 7.0 8.0
& & Internal External
Foundation Floors Ceilings Walls Roofing Electrics Plumbing
Windows Bathrooms Finish Finish
HTA HTA
Plasterer Plasterer
Appendix IV: Hierarchal Task Analysis (HTA) Constructing a House
~ 301 ~
Appendices
0.0 Hierarchical Task Analysis of Plastering Activity - Internal Finishing - Drywall Stages
4.0 Cut Holes for 5.0 Lift, Carry 6.0 Fix 8.0 Conceal 9.0 Sand 10.0 Apply
1.0 Prepare 2.0 Measure 3.0 Cut Drywall 7.0 Conceal
Outlets and Light and Position Drywall to Screw/Nail Surface Wet Plaster
Area the Area to Size Joints
Switches Drywall Wall/Ceiling Holes & Defects Smooth Finish
3.1 Measure 3.2 Mark Sheet 3.3 Score Paper- 3.4 Break Sheet 6.1 Use 6.2 Use 8.1 Mix 8.2 Fill Holes 8.3 Allow
6.3 Use
Using Tape & on Back with Backing with Along Cut in Nails & Screws Plaster and Defects with to Air
Adhesive
T-square Pencil Utility Knife Opposite Direction Hammer & Drill with Water Plaster Mix Dry
7.1 Mix 7.3 Allow

4.1 Use 4.2 Use 4.3 Use High 7.2 Tape
Plaster to Air
Keyhole Utility Speed Rotary Joints
with Water Dry
1.1 Erect Wooden/ Saw Knife Tool/Drill
1.2 Position 1.3 Clean
Steel Frame &
Drywall Wall
Supporting
Fasteners Surface
Structure 7.2.1 Position 7.2.2 Spread 7.2.3 Press 7.2.4 Cover
6.3.1 Daub 6.3.2 Attach 6.3.3 Tap Tape Along Plaster Along Tape Firmly Joint and Tape
Adhesive to Board to Board into Joints each Joint into Plaster with Plaster
Wall Adhesive Position
Plan 0.0: Do 1.0, 2.0, 3.0, 4.0, 5.0, 6.0, 7.0, 8.0, 9.0, 10.0 10.3 Build to
10.1 Prepare 10.2 Apply 10.4 Allow
Plan 1.0: Do 1.1, or 1.2, and then 1.3 2mm Thickness
Plaster Coat to Air Dry
Plan 3.0: Do 3.1, 3.2, 3.3, 3.4 in 1 or 2 coats
Plan 4.0: Do 4.1, or 4.2, or 4.3
Plan 6.0: Do 6.1 or 6.2 or 6.3 10.1.1 Mix Plaster 10.2.1 10.2.2
Plan 6.3: Do 6.3.1, 6.3.2, 6.3.3 10.1.2 Load 10.2.3 Apply and
with Water to a Load Load
Plan 7.0: Do 7.1, 7.2, 7.3 Mortarboard Smooth Plaster
Smooth Consistency Hawk Trowel
Plan 7.2: Do 7.2.1, 7.2.2, 7.2.3, 7.2.4
Plan 8.0: Do 8.1, 8.2, 8.3
Plan 10.0: Do 10.1, 10.2, 10.3, 10.4 10.1.1.2
10.2.3.1 10.2.3.2 10.2.3.3 10.2.3.4 10.2.3.5
Plan 10.1: Do 10.1.1, 10.1.2 10.1.1.1 Agitate Plaster
Apply Remove Re- Apply Re-
Plan 10.1.1: Repeat 10.1.1.1 and 10.1.1.2 Add water to desired
Plaster to Excess apply Water with apply
Plan 10.2: Do 10.2.1, 10.2.2, 10.2.3 Consistency
surface Plaster Trowel Brush/Spray Trowel
Plan 10.2.3: Repeat 10.2.3.1, 10.2.3.2, 10.2.3.3,
10.2.3.4, 10.2.3.5
Appendix V: HTA Drywall Finishing Activity
~ 302 ~
Appendices
0.0 Hierarchical Task Analysis of Finishing Work (Internal & External Wall Surface, Corresponds to HTA 10.0 and HTA 11.0)
1.0 Beading 2.0 Apply Skim Coat 3.0 Apply First Under Coat (Scratch Coat) 4.0 Apply Second Under Coat (Final Coat)
3.1 3.2 3.3 3.4 3.5Allow

1.1 Cut 1.2 Mechanically 1.3 Apply 2.1 2.2 Apply 2.3 2.4 Allow 4.1 4.2 4.3 4.4Allow
Prepare Apply Allow Comb/ coat to
beading to fix beading to render/ Prepare plaster Dampen scud coat Prepare Uniformly Apply coat to
plaster plaster coat to scratch harden &
desired length blockwork plaster mix plaster mix mix surface to dry plaster wet plaster harden &
mix mix set firm coat dry
mix undercoat mix dry
1.3.1 1.3.2 1.3.3 1.3.4

Prepare Apply Smooth Allow 2.2.1 Use
2.2.2 Throw plaster 3.2.1 Use trowel 3.2.2 Use trowel
plaster mix plaster mix coat coat to dry hand scoop to
mix onto surface to lift plaster to apply plaster 4.3.1 Use 4.3.2 Use wood float
lift plaster mix
mix mix onto surface float to lift to apply plaster mix
plaster mix onto surface
1.3.2.1 Use 1.3.2.2 Use wood
float to lift float to apply plaster
plaster mix mix onto surface 2.1.1 Measure 2.1.3 Mix
2.1.2 3.1.1 Measure Proportions:
Proportions: ingredients to 3.1.3 Mix 4.1.1 4.1.3 Mix
Add Cement : [Sand + Plasticiser] 4.1.2
Cement : Sand consistency of 3.1.2 Add ingredients to Measure out ingredients
1.3.1.1 1.3.1.3 Mix water 1:4 Add
1.3.1.2 1 : 2-2.5 thick slurry water desired desired to desired
Measure ingredients to Cement : Lime : Sand water
Add consistency proportions consistency
Proportions: desired 1 : 0.5 : 4-4.5
Water
For plaster mix consistency
Plan 0.0: Do step 1.0 around windows and doors as required, then do 2.0, then 3.0, then 4.0
Plan 1.0: Do step 1.1 then 1.2, then 1.3
Plan 1.3: Do 1.3.1, then 1.3.2, then 1.3.3, Repeat as required until beading is covered in smooth coat of plaster mix, then do 1.3.4.
Plan 1.3.1: Do 1.3.1.1 then 1.3.1.2 then 1.3.1.3, Repeat steps until the desired quantity of plaster mix is prepared
Plan 1.3.2: Do 1.3.2.1 then 1.3.2.
Plan 2.0: Do step 2.1, then 2.2., periodically when doing 2.2 do 2.3 as required to maintain consistency of plaster mix, Repeat steps until wall surface is covered in a scud coat
approximately 3-5mm, then do 2.4
Plan 2.1: Do 2.1.1 then 2.1.2 then 2.1.3, Repeat steps until the desired quantity of plaster mix is prepared
Plan 2.2: Do 2.2.1 then 2.2.2
Plan 3.0: Do step 3.1 then 3.2, continue 3.2 until wall surface is covered in coat approximately 8mm to 12mm thick, or up to 16mm thick for localised areas, then do 3.4 until all
plaster surface is scratched to desired depth, then do 3.5
Plan 3.2: Do 3.2.1 then 3.2.2
Plan 4.0: Do step 4.1 then 4.2 then then 4.3, Repeat steps until wall surface is covered in coat approximately 6mm to 10mm thick, then do 4.4
Plan 4.3: Do 4.3.1 then 4.3..2
Appendix VI: HTA Wet-Plastering Finishing Activity for Internal and External Surfaces
~ 303 ~
Appendices
Appendix VII: VADS Survey Documents
~ 304 ~
Appendices
VADS Research Consent Form
Research Area: “Evaluating musculoskeletal risk to Plasterers in Ireland”

Principal Researcher Ms. Rachel Nugent
Project Supervisor Mr. Enda Fallon
About the researcher

I am conducting research as part of a PhD program in Occupational Safety, Health and
Ergonomics at the National University Ireland Galway (NUIG).
About the Study

This survey is part of a wider research program that assesses musculoskeletal
disorders amongst Plasterers in Ireland. It will be used to obtain information from participants
by means of questionnaires, a body map, and discomfort scales.
Your participation will help to identify if there is an increase in the perceived intensity
of discomfort among Irish Plasterers across the working day and the working week. The
information obtained from this study will also be used to identify if working activity and
working conditions influence plasterer’s perceived discomfort intensity.
Freedom to Withdraw
Your participation in this study is voluntary. You may withdraw from the study at any
time and for any reason
Confidentiality
All person–identifiable data collected in this research will be kept confidential.
If you have read the above information carefully, and understand, and consent to its contents,
please complete and sign the following statement.
Thank you for your help
Participation Consent
I have read this form carefully and would like to participate in the research
Signature: __________________________ Date: ______________
Start Date: ____________________
~ 305 ~
Appendices
General Information
Contact Number: ____________________________________
Contact Email/address ___________________________________
Date of Birth: ____________________________________
Age: ____________________________________
Height: __________________________________cm
Weight: __________________________________kg
Which hand do you use most of the time? ________________
Where did you receive your plastering training? ____________________________
When did you receive your training? Age _______ # year’s ago________
Was this an apprenticeship? Yes No
What plastering qualifications/certificate do you have? __________________________
~ 306 ~
Appendices
VADS Instructions
The Visual Analogue Discomfort Scale (VADS) is a 100mm linear representation of

the intensity of discomfort that you feel. “0” indicates “no discomfort” and “100” indicates
“severe discomfort”. To help you grade your discomfort intensity each scale has the
following discomfort markers – light, moderate, average, hard, and unbearable.
The survey is divided into five sections corresponding to five consecutive working
days (Monday through to Friday) with a different colour representing each day.
Each section is further divided into four time intervals (Before Work, Before Lunch,
After Lunch, and End of Working Day).
A VADS scale is provided for 10 body areas (Neck, Shoulders, Upper Back, Upper
Arms, Mid Back, Lower Arms, Lower Back, Buttocks, Thighs, and Legs) for each time
interval for each working day.
A body map image depicting each of the 10 body areas is provided on the next page.
You are asked to indicate the level of discomfort for each body area on the relevant
VADS scale. Please mark the VADS scale with a vertical line ( | ) that corresponds with your
level of perceived discomfort intensity (See Example).
Light Moderate Average Hard Unbearable
E.g.: In the sample VADS scale, the blue vertical line indicates that the subject is
experiencing moderate discomfort.
Repeat the survey for ALL 10 body areas, FOUR times a day for FIVE consecutive
working days.
In addition, two questionnaires are also included for each working day to obtain
details about the work carried out during each of the intervals.
Thank you in anticipation,
Ms Rachel Nugent (Researcher) Mr. Enda Fallon, (Project Supervisor)
~ 307 ~
Appendices
Instructions:
Study the map below and indicate the level of comfort for each body area on the Visual
Analogue Discomfort Scales (VADS) given on the following pages by marking them with a
vertical line.
BODY MAP
~ 308 ~
Appendices
VADS for Each Time Event - DAY: TIME
Please complete the following scales: Indicate the level of discomfort for each body area (see
body map) on the relevant visual analogue scale by marking with a vertical line.
NECK
UPPER
BACK Light Moderate Average Hard Unbearable
SHOULDERS
MID BACK
ELBOWS
LOW BACK
WRISTS/
HANDS Light Moderate Average Hard Unbearable
BUTTOCKS/
HIPS/
THIGHS Light Moderate Average Hard Unbearable
KNEES
ANKLES/
FEET Light Moderate Average Hard Unbearable
~ 309 ~
Appendices
Questionnaire 1) – To be completed during Lunch Break
Please give a brief description of the work you carried out from the start of work this
morning up to lunch time.
What time did you start work? ____________

Did you take a morning break? ____________
If yes, what time did you take your morning break? ____________
And, how long was your morning break? ____________
What time did you take your lunch break? ____________
What standing surface did you work on this morning? (Please √)). tick Please
( give an
approximate length of time for each surface that you worked on.
Ground _____ Length of time _______
Scaffolding _____ Length of time _______
Stilts _____ Length of time _______
Trestle and boards _____ Length of time _______
Step-Up _____ Length of time _______
What type of work tasks were you involved in this morning? Please give an approximate
length of time for each task that you were involved in.
Erecting framework and supporting structures _____ Length of time _______
Hanging drywall boards _____ Length of time _______
How did you hang the drywall? Nails and hammer _______
Screws and drill _______
Other (Please specify) ____________________
Taping and filling _____ Length of time _______

Preparing and mixing plaster _____ Length of time _______
Applying skim coat _____ Length of time _______
Applying finishing coat _____ Length of time _______
Other (Please Specify) _________________ Length of time _______
Did you carry out your work activity on the wall, or on the ceiling? Please give an
approximate length of time for each.
Wall _____ Length of time _______
Ceiling _____ Length of time _______
~ 310 ~
Appendices
Questionnaire 2) – To be completed at End of Workday
Please give a brief description of the work you carried out from when you returned to
work after lunch until you finished work today.
What time did you return from your lunch break? ____________
How long was your lunch break? ____________
Did you take an afternoon break? ____________
If yes, what time did you take your afternoon break? ____________
And, how long was your afternoon break? ____________
What time did you finish work? ____________
What standing surface did you work on this morning? (Please √)). tick Please
( give an
approximate length of time for each surface that you worked on.
Ground _____ Length of time _______
Scaffolding _____ Length of time _______
Stilts _____ Length of time _______
Trestle and boards _____ Length of time _______
Step-Up _____ Length of time _______
What type of work tasks were you involved in this morning? Please give an approximate
length of time for each task that you were involved in.
Erecting framework and supporting structures _____ Length of time _______
Hanging drywall boards _____ Length of time _______
How did you hang the drywall? Nails and hammer _______
Screws and drill _______
Other (Please specify) ____________________
Taping and filling _____ Length of time _______

Preparing and mixing plaster _____ Length of time _______
Applying skim coat _____ Length of time _______
Applying finishing coat _____ Length of time _______
Other (Please Specify) _________________ Length of time _______
Did you carry out your work activity on the wall, or on the ceiling? Please give an
approximate length of time for each.
Wall _____ Length of time _______

Ceiling _____ Length of time _______
~ 311 ~
Appendices
Appendix VIII: Documents for Laboratory Study
~ 312 ~
Appendices
INFORMATION LETTER TO POTENTIAL PARTICIPANTS
Ergonomic Analysis of Plastering Activity in Ireland to evaluate Work Related

Musculoskeletal Disorder (WRMSD) Risk
Dear Plasterer,
You are invited to take part in a study to assess the musculoskeletal risk to
plasterers working in the Irish construction industry. The information we get from this
study will be used to find out if plasterers are at risk of musculoskeletal injury when
carrying out wet-plastering activities with respect to plastering working conditions. The
study is being carried out as part of a PhD program in Occupational Safety & Health and
Ergonomics in the National University of Ireland Galway.
Background information for this research
Musculoskeletal disorder is a term that is used to describe symptoms affecting
muscles, bones, joints, tendons, ligaments, nerves and blood vessels. Symptoms can
range from mild to severe, with people experiencing aches, pain, discomfort, numbness,
tingling, and/or pins and needles.
The Research Problem
The construction industry is one of the highest risk industries for injuries such as
musculoskeletal disorders. At times affected individuals require time off work to recover
and in very extreme cases they are forced to take early retirement. Consequently, they
experience financial loss which can impact on the affected individuals’ family, social,
and daily lives.
Research has shown that the plastering trade has a particularly high instance of
musculoskeletal disorders which individuals reporting symptoms affecting the lower
back, neck, shoulders, elbows, wrists and hands.
Benefits of the Research
Participation in this research will help to identify if wet-plastering tasks and
working conditions increase the risk of musculoskeletal injury for plasterers working in
~ 313 ~
Appendices
Ireland. The information can be used to identify interventions and recommendations to

reduce musculoskeletal injury risk.
About the study:
Assessments will be carried out in the FÁS apprentice-training centre in Tuam
Co. Galway. Workstations will be set up to simulate wet-plastering working conditions
observed on active construction sites. It is proposed to assess ten qualified plasterers,
one subject to be assessed per day over ten days. Each subject will carry out a simulated
wet-plastering activity in six assessment conditions.
Assessment methods
A selection of assessment methods will be used to observe how Plasterer’s
bodies respond when working at a wet-plastering activity in simulated working
environments. The instrumentation that will be used in this assessment has been selected
for their ability to collect specific data to identify if Plasterers are at risk of
musculoskeletal injury.
Questionnaire
To ensure the accuracy of the data recorded in this study, personal information is
required to be entered into the instrumentation used in the assessments. A brief
questionnaire will be used to gather the required information about the subjects i.e. their
date of birth, height and weight. Height will be measured using a measuring tape and
weight measured using a weighing scales.
Video Recording
A Video camera will be set up to record each subject’s activities when working
at a wet-plastering activity in simulated working environments. The video recordings
will be synchronised with other equipment below to ensure a detailed analysis of the
assessment conditions.
Heart Rate Monitor
Heart rate monitors are used to record a person’s heart rate. They consist of a
transmitter attached to a strap which is placed around the person’s chest so the
transmitter sits over the heart. The receiver, a watch, is worn on the wrist. The image
below demonstrates how the transmitter and watch are worn. The information from your
questionnaire will be entered into the watch at the start of the assessment and removed at
~ 314 ~
Appendices
the end of the assessment. The transmitter and watch will be positioned approximately
15 minutes before the start of the assessments and will remain in place for the duration
of the assessments.
Heart rate will be recorded for ten minutes while you rest in a chair to obtain
your resting heart rate and record your heart rate while you carry out the wet-plastering
activity. You will take a break after each assessment while the researcher uploads the
heart rate data onto a laptop.
Figure 1: A Polar™ S810 Heart rate monitor, positioning of transmitter and

watch
Electromyography
Contracting muscles generate a small electrical signal that can be detected using
Electromyography sensors, which are placed on the skin surface above contracting
muscles. A physiotherapist will use sterile alcohol wipes to clean a small section of the
skin surface over three sets of muscles, one set in the neck and two sets in the back.
Electromyography sensors will be placed on the cleaned skin surface approximately 15
minutes before the start of the assessments and will remain in place for the duration of
the assessments. The image below gives an indication of where the sensors will be
located. The sensors will be connected by leads to a recording device that weighs
approximately 0.5 kg and sits in a pocket on an adjustable belt worn by the subject. It is
recommended that you wear a loose fitting shirt or tee shirt when you are being assessed
to prevent the sensors from moving. You will take a break after each assessment while
the researcher uploads the Electromyography data onto a laptop.
~ 315 ~
Appendices
Locations of EMG sensors, middle back, upper back and neck
Flash Marker
The video recorder and Electromyographic data recorder will be connected using
a Flash Marker. You will notice a flash of light similar to a camera flash each time it is
activated. The researcher will use this instrument to separate the recording video and
Electromyographic data into smaller sections.
Your Requirements to Take Part in This Study

You must be trained, experienced and qualified in the wet-plastering activity that
occurs on a daily basis throughout the course of a typical working day in the Irish
construction industry. You must not participate in the research if you have a medical
condition that may affect your health or wellbeing while carrying out the assessments
(e.g. heart disease, diabetes).
• You must be free from muscular aches, pain, or discomfort at the time of
the assessment
• You should be reasonably fit to carry out the plastering tasks
• You must sign a consent form before taking part in this study
• You should inform the researcher as early as possible if you want to drop
out of the study
Confidentiality
There is no risk to you in taking part in this study. The information obtained in
this study will not be shared with your employers. ALL person–identifiable data
collected in this research will be kept strictly confidential. Video recordings,
photographs, and data from the assessments will be stored in a secure location at all
~ 316 ~
Appendices
times. Any publications resulting from this research will be reported anonymously and
no individuals will be identified.
Freedom to Withdraw
Your participation in this study is voluntary. You can pull out of the study at
any time and for any reason.
Please feel free to ask questions at any time
Thank you for your help
Please ensure that you have you have read the above information carefully and if
you have any additional questions about the study you can contact me by email at
r.nugent1@nuigalway.ie or by telephone at +353 (0)86 3175594.
Rachel Nugent
Doctoral Student, Centre for Occupational Health & Safety Engineering and
Ergonomics (COHSEE), College Of Engineering and Informatics, NUI Galway
Enda F. Fallon
Research Supervisor and Senior Lecturer in Industrial Engineering, College of
Engineering and Informatics, NUI Galway
~ 317 ~
Appendices
PARTICIPANTS CONSENT FORM
Ergonomic Analysis of the Plastering Activity in Ireland to evaluate

Work Related Musculoskeletal Disorder (WRMSD) Risk
I have read the Ergonomic Analysis of Plastering Activity in Ireland to evaluate

Work Related Musculoskeletal Disorder (WRMSD) Risk: Information Form for this
research project and understand the nature of the project and my duties as a participant
in the assessments.
I hereby consent to participate in the research with the understanding that I can
withdraw my participation at any time and without any consequences if I chose to do so.
I consider myself fit to carry out the tasks for which I am trained and would carry out
during a normal working day.
To the best of my knowledge I am free form any muscle aches and pains, cardiac
problems, diabetes or other illnesses that may hinder my work performance or cause
undue stress upon my health.
I am a qualified and experienced Plasterer who routinely uses trestles, stilts and a
hop-up when carrying out plastering activities.
All information provided by you will be kept strictly confidential. You will
not be identified in any way.
Signature ____________________________________________
Date_____________________
~ 318 ~
Appendices
GENERAL QUESTIONNAIRE: DEMOGRAPHIC DETAILS &

INFORMATION
ALL INFORMATION WILL BE KEPT STRICTLY CONFIDENTIAL

Name: ____________________________________
Contact Number: ____________________________________
Contact Email/address ___________________________________
Date of Birth: ____________________________________
Age: ____________________________________
Height: __________________________________cm
Weight: __________________________________kg
Do you smoke? Yes No

Do you drink coffee? Yes No
How would you describe your level of physical fitness? (Please circle one)
You do not participate regularly in programmed recreation sport or heavy
Low: physical activity. E.g. you walk only for pleasure or occasionally exercise
sufficiently to cause heavy breathing or perspiration.
You participate regularly in recreation sports. E.g. you run 3-6 miles per
Middle:
week or spend 0.5-2 hours per week in comparable physical activity or,
your work requires modest physical activity
You participate regularly, at least 3 times a week, in heavy physical
High: exercise. E.g. you run 6-12 miles per week or spends 2-3 hours per week in
comparable physical activity
You participate regularly in heavy physical exercise at least 5 times a week.
Top:
E.g. you exercise to improve performance for competitive purposes.5.
Excellent (exercise every day of the week)
~ 319 ~
Appendices
Where did you receive your plastering training? ____________________________

When did you receive your training? Age _______ # year’s ago________
Was this an apprenticeship? Yes No
What plastering qualifications/certificate do you have? __________________________
Trestle Yes No
Do you have experience using Stilts Yes No
Hop-up Yes No
Do you have your own stilts? Yes No
Do you have your own plastering tools? Yes No
What age were you when you started working in the construction industry? ________
What is the brand/manufacturer of the stilts that you use? _______________________
Are the stilts extendible? _________-___________mm
What materials are your stilts made from? _____________________
Have your stilts inbuilt shock absorbers? _____________________
Where did you purchase your stilts? _____________________
When did you purchase your stilts? _____________________
Approximately how much did you pay for your stilts? _____________________
Where did you learn how to use stilts? _______________________
What is the dimension of the trowel that you use when applying a skim coat?
____________
What material is your trowel made from? _______________________
Approximately what is the weight of your trowel? _______________________
What is the dimension of the hawk that you use when applying a skim coat?
____________
What material is your hawk made from? _______________________
Approximately what is the weight of your hawk? _______________________
NB: Plasterers must bring their own stilts and tools on the day of assessment
~ 320 ~
Appendices
Do you have a medical condition that may have a negative influence on your health or
wellbeing while carrying out the assessments (e.g. heart disease, diabetes)?
Yes No
Have you previously experienced muscular aches, pain, or discomfort within the past 12
months? Yes No
Are you currently experiencing muscular aches, pain, or discomfort?
Yes No
What body areas are most affected? (Shade in affected area)?
~ 321 ~
Appendices
Appendix IX: Checklists – Laboratory Study WRMSD Risk Assessment
~ 322 ~
Appendices
Laboratory Study Equipment Checklist

Datalogger
Leads
Batteries
Electrodes
EMG
Manual
Alcohol wipes
Belt
Medical tape
Batteries
Polar T-61 Transmitter & elastic chest strap
Polar S810 Heart
Rate Monitor S-610 Wrist receiver
Polar IR interface
Rs232 Connector cable SN R9-2C0136AE1027
Batteries
Videos
Chargers
Video
Recording media
Tripod
Power – cable extension lead
Environmental Thermometer
Installed with Polar Precision Performance
Software
Installed with EMG software (MegaWin) Software
Laptops
Charger & cables
PCMCIA card
Weighing Scales
Measuring tape
Information letter
Documents Subject letters of consent
General Questionnaire
Storage Terabyte Drive
~ 323 ~
Appendices
Checklist - DAY of ASSESSMENT - ASSESSMENT sequence & timing

(Estimated)
Assessor Arrive Approximately 7.45am (30 minutes)

♦ Set-up equipment
♦ Position video at assessment location
♦ Set up laptop
♦ Organise & layout EMG – alcohol wipes, leads, electrodes, datalogger, belt
Plasterers Arrive Approximately 8.00am (30

minutes)
♦ Pre Assessment Requirements
♦ Document Check (questionnaire, Info, consent form etc)
♦ Check data entered in EMG & HR is correct
Physiotherapist arrive Arrive approximately 8.30am (30 minutes)

♦ Prepare skin surface and position electrodes
♦ Electrode Positioning
♦ Position HR Monitor & Watch
Heart Rate Pre-Assessments

Approximately 9.00 am (30 minutes)
♦ Plasterer rest for minimum five minutes – advised to lie quietly without
moving
♦ Turn on HR Monitor – Run Polar fit test - Approximately five minutes
♦ Record HR rest , determine VO 2 and HR max
♦ Update HR watch with VO 2max and HR max –P
♦ Upload data onto laptop
ASSESSMENT - Area 1
Subject applying wet plaster to the wall when standing on the ground and a
hop-up
Approximately 10.00am (1hr 30)
♦ Connect electrodes to leads/channel socket
♦ Tape leads if required
♦ Connect Flash Marker to datalogger
♦ Turn on flash marker
♦ Turn on video and commence recording
♦ Turn on EMG and commence recording
♦ Observe subject carrying out task
♦ Turn on Heart rate monitor once plaster is mixed and before loading the
mortarboard
~ 324 ~
Appendices
♦ Flash Mark video and EMG at start of task, at end of task and to separate
between subtasks - Mix Plaster, Load Mortarboard, Load hawk, Load Trowel,
Plaster
♦ Record Video, EMG & HR for duration of activity
♦ Stop EMG
♦ Stop HR Monitor
♦ Stop video recording,
♦ Turn off flash marker and disconnect from datalogger
♦ Disconnect datalogger from leads and connect to laptop
♦ Remove watch and connect to laptop
Plasterer REST
♦ Upload EMG to laptop - label data – Plasterer ref & Assessment Condition #
♦ Upload HR data to laptop – label data– Plasterer ref & Assessment Condition #
♦ Remove disk from camera - Label video – Plasterer ref & Assessment Condition
#
♦ Insert new memory disk into camera
♦ Re-locate video cameras to Assessment location 2
Post/Pre Assessment Check

♦ Check electrodes are still in correct position
♦ Re-connect leads to datalogger
♦ Check leads are securely connected
♦ Reposition Watch
ASSESSMENT Area 2:
Plasterer applying wet plaster to the ceiling while standing on a trestle
Approximately 11.30am (1hr 30)
mortarboard
Plaster
♦ Stop EMG
♦ Stop HR Monitor
~ 325 ~
Appendices

Plasterer REST
#

ASSESSMENT Area 3:
Plasterer applying wet plaster to the ceiling while standing on stilts & using a
low mortarboard stand Approximately 1.00pm (1hr 30)
mortarboard
Plaster
♦ Stop EMG
♦ Stop HR Monitor
Plasterer REST
~ 326 ~
Appendices

ASSESSMENT Area 4:
Plasterer applying wet plaster to the ceiling while standing on stilts & using a
high mortarboard stand Approximately 2.30pm (1hr 30)
mortarboard
Plaster
♦ Stop EMG
♦ Stop HR Monitor
Plasterer Finish Assessments
♦ Re-locate video cameras to Assessment location
~ 327 ~
Appendices
Appendix X:: Outline of the Contents of an Occupational Health & Safety Module
for third level construction related Engineering courses & the Potential
Learning Output
~ 328 ~
Appendices
Construction Organisation & Construction management

Project lifecycle
Stakeholders, Hierarchy of organisation, Roles & Responsibilities
Construction legislation
Applicable legislation, standards, COP, Duty of Care
Health & Safety Related Documentation
Safety Statements
Method Statements
Permit to Work System
Risk Assessments
Construction Hazards
Ergonomics
Subjects & Manual Handling
Topics Working at heights & Fall Arrest Systems
Abrasive wheels
Vehicle safety
Confined space
Electricity
Excavation
Evacuation & Emergency Responses
PPE
Injury & Illnesses statistics in the industry
WRMSDs, Accidents, Health & Lifestyle, Absenteeism and early
retirement Associated costs
Training Options available
FAS SafePass, CSCS Scheme, Manual Handling
Upon completion of this course, the student should:
Understand legal requirements & personal obligation to manage
occupational health and safety in the construction industry
Learning
Recognise hazards & hazardous activities in the construction industry and
Outcomes &
throughout a project’s lifecycle
Core
Recognise the potential risk associated with hazards & hazardous activities
Competence
and their potentially negative impact to all workers, employers, and society
Learning
Be capable of identifying control measures to reduce the risk when
Objectives
exposure to hazardous activities occurs
Appreciate the importance of engaging individuals and groups in the
organisations risk management process
Having completed this module and gained an awareness of the hazards and
risks in the construction industry:
Participants should appreciate the value of knowledge development for self
Personal & and others in order to manage occupational health and safety
Professional Recognise the value of networks in gathering and supplying the necessary
Development information to promote occupational health and safety
Be capable of identifying and participating in appropriate professional
debates, discussions and reviews regarding construction safety
Understand the roles & duties of the employees and employers
~ 329 ~

2012rachel NugentPhD

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Ergonomic Analysis of Work Related Musculoskeletal

Author(s) Nugent, Rachel

Item record http://hdl.handle.net/10379/3404

Rachel Nugent, B.Sc., M.App.Sc. (Res)

Submitted for the degree of Doctor of Philosophy

Location: Industrial Engineering,

Research Supervisor: Mr. Enda F. Fallon, Senior Lecturer in Industrial Engineering

Date Submitted: July 2012

LIST OF TABLES .................................................................................................................................. X

LIST OF EQUATIONS ......................................................................................................................... XI

EXECUTIVE SUMMARY .................................................................................................................... XII

DECLARATION ................................................................................................................................ XIV

PUBLISHED WORK ........................................................................................................................... XV

ACKNOWLEDGEMENTS ................................................................................................................. XVII

LIST OF ABBREVIATIONS............................................................................................................... XVIII

FOREWORD .................................................................................................................................... XXI

STATEMENT OF CONFIDENTIALITY ................................................................................................ XXII

CHAPTER 1. INTRODUCTION .......................................................................................................... 1

1.1 THE PROBLEM AND ITS SETTING .............................................................................................. 1

CHAPTER 2. WORK RELATED MUSCULOSKELETAL DISORDERS ..................................................... 19

2.1 INTRODUCTION .................................................................................................................. 19

CHAPTER 3. FACTORS INFLUENCING THE PRESENCE OF WRMSD RISK FACTORS .......................... 63

3.1 INTRODUCTION .................................................................................................................. 63

CHAPTER 4. METHODOLOGY 1: RISK ASSESSMENT PROTOCOL .................................................... 99

4.1 INTRODUCTION .................................................................................................................. 99

CHAPTER 5. METHODOLOGY 2: PLASTERERS WRMSD RISK ASSESSMENT .................................. 115

5.1 INTRODUCTION ................................................................................................................ 115

CHAPTER 6. RESULTS ................................................................................................................. 145

6.1 INTRODUCTION ................................................................................................................ 145

CHAPTER 7. DISCUSSION AND RECOMMENDATIONS................................................................. 213

7.1 INTRODUCTION ................................................................................................................ 213

CHAPTER 8. RESEARCH CONCLUSION ........................................................................................ 253

8.1 INTRODUCTION ................................................................................................................ 253

REFERENCES ................................................................................................................................... 269

_____________________ Date: ___________

Nugent, Rachel; Fallon, Enda, F. (2009) Evaluating musculoskeletal disorder (MSD)

Nugent, R, Fallon, E.F., and Gill, D. (2008) An ergonomic assessment of blocklaying

Mr Enda F. Fallon, Senior Lecturer in Industrial Engineering

Tel.: +353 (0)91 522745

1.1 The Problem and its Setting

1.2 The Irish Construction Industry

Office (CSO), 2011). Subsequently residential construction has declined by approximately

120 All building and

Figure 2: Total Production in Building and Construction Sector (2000-2010)

1.3 Motivation behind the Research

1.4 Significance of Research

1.5 Research Aim and Objectives

• To determine if plasterers were at increased risk of developing WRMSDs because of

The objectives of the study were as follows:

• To obtain knowledge and understanding of plastering tasks, specifically the wet-

1.6 Research Hypothesis

H 1 is considered to be true. The result is considered to be significantly significant i.e. unlikely

• Heart rate values

The hypotheses tested in this study were as follows:

Primary Research Hypothesis

• H 0 - Plasters working in Ireland are not at risk of developing WRMSDs

Assessment Method 1: Visual Analogue Discomfort Survey (VADS)

• H 0 – Independent variables have no influence on the level of perceived discomfort

Assessment Method 2: Polar HR monitor - Heart Rate Analysis

• H 0 - Independent variables have no influence on heart rate variables (bpm, Percent of

• H 1 - Independent variables influences heart rate variables ((bpm, Percent of time

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