International Journal of Industrial Ergonomics 80 (2020) 103058

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International Journal of Industrial Ergonomics

journal homepage: http://www.elsevier.com/locate/ergon

A new scoring system for the Rapid Entire Body Assessment (REBA) based
on fuzzy sets and Bayesian networks
Fakhradin Ghasemi a, *, Neda Mahdavi b
a
Department of Ergonomics, Center of Excellence for Occupational Health, Occupational Health and Safety Research Center, School of Public Health, Hamadan
University of Medical Sciences, Hamadan, Iran
b
Department of Ergonomics, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran

A R T I C L E I N F O A B S T R A C T

Keywords: Traditional methods for assessing the risk of work-related musculoskeletal disorders (WMSDs) have a low
Risk assessment sensitivity to changes in input variables. Using them, it is possible to obtain the same risk score for totally
Bayesian network different postures, and in some cases, the effectiveness of ergonomic interventions cannot be demonstrated. This
Work-related musculoskeletal disorders
study aimed to develop a new scoring system for REBA, FBnREBA, using fuzzy sets and the Bayesian network
(BN) approach to cover the drawbacks of the traditional REBA. First, the risk factors of WMSDs were defined in
terms of fuzzy membership sets. Next, a BN model was developed based on REBA. Fourteen different postures
were assessed using FBnREBA, and the results were compared with those of the original REBA. Lastly, a case
study was performed to demonstrate how the new scoring system can be used to rank various interventions based
on their effectiveness. FBnREBA is a BN model with 26 nodes and is based completely on REBA, but its results
differ from those of REBA for identical postures. A comparison of the results of FBnREBA with those of REBA
indicated that FBnREBA is more sensitive to changes in WMSDs risk factors than REBA. A case study was con­
ducted using FBnREBA, and the effectiveness of modifying each body segment was determined and ranked.
FBnREBA is more sensitive to changes in input variables so that it is unlikely to obtain the same risk score for
different body postures. The introduced methodology can be used to modify the scoring systems of other similar
methods.

1. Introduction
1.1. Methods for assessing the risk of work-related musculoskeletal
disorders
Work-related musculoskeletal disorders (WMSDs) are a major
problem for both employers and employees in occupational settings and
should be managed properly (Morse et al., 1998; Stewart et al., 2003).
Risk assessment is the main tool for identifying jobs or tasks which are
more prone to WMSDs. Using risk assessment, the level of exposure to
various WMSDs risk factors is determined and improvement in­
terventions are prioritized.
Methods and techniques for assessing the risk of WMSDs have been
categorized into four main groups: pen and paper observational
methods, videotaping and computer-assisted analyses, direct or instru­
mental techniques, and self-report assessment tools (Li and Buckle,
1999). Pen and paper observational methods are most popular, because
they are easy to learn, easy to implement, inexpensive, and less
time-consuming. OWAS (Ovako Working Analysis System) (Karhu et al.,
1977), RULA (Rapid Upper Limb Assessment) (McAtamney and Corlett,
1993), and REBA (Rapid Entire Body Assessment) (Hignett and McA­
tamney, 2000) are among the most popular pen and paper observational
methods.
1.2. Drawbacks of traditional methods
Although these methods are very useful in providing deep insight
into the risk of WMSDs, they have several drawbacks. One main draw­
back of traditional methods such as REBA is their low sensitivity to input
variables. For example, with traditional methods, different postures may
result in the same risk score, even though they impose different
biomechanical effects on the body. For example, according to REBA,

* Corresponding author. Hamadan University of Medical Sciences, School of Public Health, Ergonomics Department, 65178-3-8736, Shahid Fahmideh BLVD,
Hamadan, Hamadan province, Iran.
E-mail address: fk.ghasemi@gmail.com (F. Ghasemi).

https://doi.org/10.1016/j.ergon.2020.103058
Received 13 November 2018; Received in revised form 22 February 2020; Accepted 30 October 2020
Available online 10 November 2020
0169-8141/© 2020 Elsevier B.V. All rights reserved.
F. Ghasemi and N. Mahdavi
there is no difference between trunk scores at 21◦ flexion and 59◦
flexion, even though the biomechanical stresses imposed on the body at
these two postures are totally different. In contrast, when the upper arm
position is at 44◦ flexion, the risk score is 2, but when it is at 46◦ flexion,
the risk score is 3, which may result in different final REBA scores, even
though the difference between these two postures does not seem to be
significant. The scores associated with load/force suffer from the same
problem. For example, there is no difference between a 12-lb load and a
22-lb load (both of them receive a score of 1), while the biomechanical
stress they impose on the body can be totally different. This drawback
has been mentioned in several previous studies (David, 2005; Golabchi
et al., 2016; Madani and Dababneh, 2016) and may diminish the
inter-observer reliability of traditional methods, particularly when the
position of a body segment is close to the boundary between two ranges.
The low inter-observer reliability of REBA, RULA, and other traditional
methods have been mentioned by several studies, including Schwartz
et al. (2019), Dockrell et al. (2012), and David (2005). In confirmation
of these issues, McAtamney and Corlett (1993) explained that when the
position of a body segment is close to the boundaries of ranges, some
discrepancies may be observed in the result of risk assessment.
Low sensitivity to input variables makes it difficult to demonstrate
the effectiveness of ergonomic interventions. For example, assume an
intervention modifies the trunk position by altering its flexion angle
from 59◦ to 20◦ . This improvement has no effect on the final RULA or
REBA score. This problem has also been mentioned in previous studies,
such as Choobineh et al. (2004) and Sanchez-Lite et al. (2013). Simi­
larly, Li and Buckle (1999) stated that an acceptable ergonomic assess­
ment tool should be able to demonstrate the effectiveness of an
ergonomic intervention.
Accordingly, several studies have been conducted to develop new
methods for covering these drawbacks. For example, Sanchez-Lite et al.
(2013) developed the Novel Ergonomic Postural Assessment Method
(NERPA) as an alternative of RULA. Golabchi et al. (2016) recom­
mended the use of fuzzy set theory to deal with such deficiencies and
developed a fuzzy logic model based on RULA for assessing the ergo­
nomic risks in manual construction operations. They showed their
method to be more accurate and able to reduce the probability of human
error during assessment. Rivero et al. (2016) built a Fuzzy Inference
System (FIS) based on RULA for WMSDs risk assessment. Pavlovic-Ve­
selinovic et al. (2016) developed the fuzzy expert system known as
SONEX to predict WMSDs and suggest preventive interventions. In
another study, Nunes (2009) developed the fuzzy expert system FAST
ERGO X for auditing, assessing, and controlling exposure to ergonomic
risk factors in workplaces. In the same vein, Ahn et al. (2018) con­
structed a diagnostic model of WMSDs useful in assessing the effects of
various working characteristics such as working hours and work pace on
WMSDs. They also reported that BN was stronger than artificial neural
network, support vector machine, and decision tree approaches in
assessing risk factors and predicting WMSDs.
1.3. The present study
The low sensitivity of traditional methods to changes in input vari­
ables stems from the fact that they commonly follow the principles of
classical (crisp) set theory. A method developed based on these princi­
ples would lead to sharp boundaries between the angle ranges of a body
segment. Consequently, the final risk score suffers from low sensitivity
to changes in input variables, thereby leading to inaccurate results in
some cases. This drawback can be properly handled by fuzzy set theory
(Zadeh, 1965) and Bayesian networks (BNs) (Pearl, 2014).
Therefore, the main aim of the present study was to develop a new
scoring methodology based on fuzzy set theory and BNs to modify pre­
vious methods so as to increase their sensitivity to input variables.
REBA was selected to demonstrate how the methodology should be
implemented. This method was selected because it is general in nature
and applicable to a wide range of occupations. Moreover, it considers all
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International Journal of Industrial Ergonomics 80 (2020) 103058
body parts as well as all well-known WMSDs risk factors, i.e. awkward
posture, force, and types of activity (repetitive and static). This method
provides a better definition for neutral postures than RULA (Madani and
Dababneh, 2016) and is appropriate for both static and dynamic tasks
(Hashim et al., 2012). The intra- and inter-observer reliability of REBA
has been demonstrated to be satisfactory (Hignett and McAtamney,
2000; Kee and Karwowski, 2007). However, similar to most ergonomic
assessment tools, the predictive and concurrent validity of this method
needs to be further elucidated in future studies (Madani and Dababneh,
2016). Since its invention, the method has been utilized extensively for
ergonomic assessment in various sectors, including oil industries
(Motamedzade et al., 2011), hospital nursing (Ratzon et al., 2016),
dentistry (Jahanimoghadam et al., 2018), mining industries (Norhi­
dayah et al., 2016), forestry timber harvesting (Enez and Nalbantoğlu,
2019), sewing machine operation (Sakthi Nagaraj et al., 2019), and
other sectors (Chiasson et al., 2012). A recent study showed that the use
of this method is increasing among ergonomists (Lowe et al., 2019).
It should be emphasized that the new methodology can also be used
to modify the scoring system of other methods such as RULA. REBA
equipped with the new scoring system will be called FBnREBA for the
rest of the study.
2. Materials and methods
2.1. REBA method
This method, first introduced by Hignett and McAtamney (2000),
divides the body into two main parts; the first part is composed of the
neck, trunk, and legs. Their scores are combined using Table A in the
REBA worksheet to obtain a single value. The second part is composed of
upper arm, lower arm, and wrist, and their scores are aggregated using
Table B in the REBA worksheet. After adding the scores associated with
coupling and force, the scores of these tables are combined using
Table C. Lastly, the score associated with the type of activity is added.
The final REBA score has a range from one to greater than eleven; the
higher the final score is, the greater the risk of WMSDs will be. These
scores and associated action levels are presented in Table 1.
2.2. Fuzzy set theory
Fuzzy set theory, first introduced by Zadeh (1965), is a soft
computing technique that is very helpful in dealing with the vagueness,
partial truth, and uncertainty present in solving a problem (Gupta and
Kulkarni, 2013). According to this theory, a single value can belong to
several sets with different degrees of membership. Degree of member­
ship can adopt any value within the range of zero to one, which is
against the classical view of sets in which the degree of membership of a
variable to a set can only be either 0 or 1 (Jamshidi et al., 2013; Klir and
Yuan, 1996).
In the present study, fuzzy set theory was used to deal with the
sudden changes in angle ranges of a body segment. Using this theory, the
transition from one range to the next was gradual, which modified the
traditional way of scoring input variables. For example, assume that the
angle ranges of an upper arm position are defined using fuzzy mem­
bership functions as demonstrated in Fig. 1, and the angle of the upper
arm in a specific body posture is at 18◦ flexion. When using traditional
Table 1
The final risk score in the REBA method and associated action levels.
REBA score Action level
1 No action required
2–3 Modification may be needed
4–7 Further investigation may be needed
8–10 Modification is required
Modification is required immediately
>11
F. Ghasemi and N. Mahdavi International Journal of Industrial Ergonomics 80 (2020) 103058

Fig. 1. The process of translating the angle ranges of traditional REBA into fuzzy membership functions.

Fig. 2. The process of constructing FBnREBA based on REBA.

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F. Ghasemi and N. Mahdavi International Journal of Industrial Ergonomics 80 (2020) 103058

REBA, which is based on the crisp set theory, the score associated with It should be mentioned that GENIE software developed by Bayes­
this body segment would be 1. In contrast, when the fuzzy set theory is Fusion (www.bayesfusion.com) was used to perform all modeling and
used, this angle of flexion belongs to two sets and consequently adopts analyses related to BN.
two scores with different degrees of membership; its scores are 1 and 2
with 0.1 and 0.9 degrees of membership, respectively. 2.4. Calculating the final risk score of WMSDs based on FBnREBA
In the present study, all input variables of REBA were translated into
fuzzy membership functions using the process known as “fuzzification.” When the original REBA method is used, the final risk score is a single
Triangular fuzzy membership sets were used in this step. There are other integer value in the range of 1–13. When FBnREBA is used, however, the
types of fuzzy membership functions to be used; however, the calcula­ result is a set of integer values with different probabilities. To transform
tions associated with triangular membership sets for determining them into a single value, their weighted sum should be calculated using
membership degrees are simpler than those of other fuzzy membership the following equation:
functions. ∑
RS = Pi Si
2.3. Bayesian networks (BNs)
where RS stands for the final risk score, Pi is the probability associated
When the input variables of REBA or any similar method are with state i, and Si is the score associated with state i.
expressed in terms of fuzzy membership functions, tables presented in
the REBA or RULA worksheets (such as Tables A, B, and C in the REBA 2.5. Comparison of REBA and FBnREBA
worksheet) can no longer be used for merging the scores of various body
segments. Instead, studies have generally used fuzzy inference system In this step, several postures were analyzed using both REBA and
(FIS), which contains a set of rules that create relationships between FBnREBA, and the differences were investigated.
input variables and the output variable (Jamshidi et al., 2013). This
property of fuzzy set theory was not used in the present study, because it
2.6. Determining the most effective intervention strategy using BN
needs a high number of rules which are tedious for both determining and
reasoning
inserting into the inference engine. The BN approach was used in this
study to determine the relationships between the input variables and the
One of the main characteristics of a BN is its ability to perform
risk of WMSDs. BNs are graphical analytical tools which have been used
various types of reasoning, such as predictive, diagnostic, inter-causal,
extensively in modeling and assessing risk in complex systems (Jensen
and combined reasoning (Abolbashari et al., 2018). The most effective
and Nielsen, 2009). A BN is composed of a set of nodes representing the
way to reduce the risk of WMSDs can be determined using predictive
variables and a set of directed arcs depicting the causal relationships
reasoning. Accordingly, a real case was investigated, and the risk of
among the nodes (Ghasemi et al., 2017; Jensen and Nielsen, 2009). Each
WMSDs was determined using FBnREBA. Next, predictive reasoning was
BN has a quantitative part known as a conditional probability table
employed to determine the effectiveness of various interventions in
(CPT) that reflects how a variable is affected by its parents. In the other
reducing the final FBnREBA score. The case study was conducted in a
words, CPTs determine how a variable would change if its parents
desktop gas cooker assembly line. The line suffers from poor ergonomic
change (Jensen and Nielsen, 2009).
conditions, and we wanted to know which intervention strategy was
To benefit from this modeling approach, the qualitative part, i.e.
more beneficial than the others. Several postures were selected, and the
nodes and directed arcs, and quantitative part, i.e. CPTs, of the model
worst one was analyzed using FBnREBA. Then, the intervention options
must be determined. In this study, both of these parts were determined
were compared based on their effectiveness in reducing the risk of
using the information extracted from the original REBA. To determine
WMSDs.
the structure of the BN, all input variables and the A, B, and C tables in
the REBA worksheet were regarded as the nodes constituting the BN. As
3. Results
the score of each body segment was determined using its fuzzified angle
ranges and the required adjustments, several new nodes related to the
3.1. Fuzzification of input variables
posture of various body segments and the required adjustments were
also added. This process for determining a trunk score is depicted in
Figs. 3 and 4 demonstrate the fuzzy membership functions associated
Fig. 1, part A.
with various input variables of REBA. It should be stressed that the
For merging the risk scores of the neck, trunk, and legs, Table A from
fuzzification process was not possible for some variables such as the
the REBA worksheet was regarded as a node in the BN model (see Fig. 2,
position of the legs, coupling score, and activity score; thus, they were
part B). Likewise, for merging the risk scores of upper arm, lower arm,
treated the same as the original REBA.
and wrist, Table B from the REBA worksheet was regarded as a new node
Moreover, each fuzzy membership set can be expressed using a set of
and inserted in the BN model.
equations. Equations (1)–(5) are associated with upper arm angles.
To determine the CPTs of nodes representing the tables from the
⎧ ⎫
REBA worksheet, the same principles as the original REBA were used. ⎨ 1 x > 90 ⎬
For example, Table A in the REBA worksheet contains values ranging f (x)f 4 = (x − 50)/40 45 ≤ x ≤ 90 (1)
⎩ ⎭
from 1 to 9, so the “score A′′ node in the BN model has nine states 0 x < 45
demonstrated by s1, s2, s3 … and s9. For assigning the CPT of this node, ⎧ ⎫
the same approach as Table A was adopted. For example, assume that a ⎪
⎪ 0 x > 90 ⎪ ⎪
⎨ ⎬
configuration of states of the neck, trunk, and leg positions corresponds f (x)f 3 =
(90 − x)/45 45 < x ≤ 90
(2)
to score 5 in Table A (based on the REBA worksheet). To determine the ⎪
⎪
⎩
(x − 20)/45 20 < x ≤ 45 ⎪
⎪
⎭
CPT of the “score A′′ node for this configuration, all states of “score A′′ 0 x < 20
were given a probability of zero, while state s5 received a probability ⎧ ⎫
one. An example of this process is presented in Fig. 2 (part C). In this ⎪
⎪
⎨
0 x > 20 ⎪ ⎪
⎬
(45 − x)/25 20 < x ≤ 45
figure, the CPT of Table B was built in the BN. Because the CPT of this f (x)f 2 = (3)
⎪ (x + 20)/20 0 < x ≤ 20 ⎪
node was too big in size to be presented, just that part which corresponds ⎪
⎩ ⎪
⎭
0 x<0
to that part of Table B, discriminated by a red rectangle, is presented
(Fig. 2, part C).

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Fig. 3. The fuzzy membership sets associated with force and positions of neck and trunk.

⎧ ⎫
⎪
⎪ 0 x > 20 ⎪ ⎪ 3. Trunk angle: This node represents the angle of trunk flexion. It
⎨ ⎬
(20 − x)/20 0 < x ≤ 20 has five states: e, f1, f2, f3, and f4. These states are associated
f (x)f 1 = (4)
⎪
⎪ (x + 20)/20 0 < x ≤ − 20 ⎪
⎪ with the fuzzy membership sets depicted in Fig. 3.
⎩ ⎭
0 x < − 20 4. Trunk adjustment: This node represents any adjustment required
⎧ ⎫ for assigning the trunk score, including trunk twisting and side
⎨ 0 x>0 ⎬ bending. This node has two states: no and yes. State no indicates
f (x)e = (− x)/20 0 ≤ x ≤ − 20 (5) that there is no need for adjustment; state yes indicates that
⎩ ⎭
1 x < − 20 adjustment is required.
5. Legs position score: This node represents the score of the legs,
3.2. BN model constructed based on REBA method which can range from 1 to 4. The node has four states: s1, s2, s3,
and s4 corresponding to scores 1, 2, 3, and 4, respectively.
The BN constructed based on the REBA method had a total number of 6. Force: This node represents the amount of force required for
26 nodes. A brief description of each node is presented below: performing a task. It has three states: s1, s2, and s3. The fuzzy
membership functions associated with these states are presented
1. Neck angle: This node represents the angle of the neck flexion. It in Fig. 3.
has three states: e, f1, and f2. These states are associated with the 7. Force adjustment: This node is used to make any adjustment
fuzzy membership sets depicted in Fig. 3. required for assigning the score of force, such as shock or rapid
2. Neck adjustment: This node represents any adjustment required buildup of force. This node has two states, yes and no, explaining
for assigning the neck score, which includes neck twisting and the need for adjustment.
side bending. It has two states: no and yes. State no indicates that 8. Coupling score: This node demonstrates the score of coupling.
there is no need for adjustment; state yes indicates that adjust­ The node has four states, s0, s1, s2, and s3, corresponding to
ment is required. scores of 0, 1, 2, and 3, respectively.

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F. Ghasemi and N. Mahdavi
Fig. 4. The fuzzy membership sets associated with positions of upper arm, lower arm, and wrist.
9. Upper arm angle: This node demonstrates upper arm angle
flexion. The node has five states: e, f1, f2, f3, and f4. The fuzzy
membership functions associated with these states are presented
in Fig. 4.
10 . Upper arm adjustment: This node is used to insert the effect of
any adjustment associated with the upper arm position on the
upper arm score. The node has four states, s_1, s0, s1, and s2,
corresponding to scores − 1, 0, 1, and 2.
11. Lower arm angle: This node demonstrates the lower arm angle
and has three states: h_e, n, h_f. The fuzzy membership functions
associated with this node are presented in Fig. 4.
12. Wrist angle: This node demonstrates the wrist angle and has three
states: h_e, n, and h_f. The fuzzy membership functions associated
with these states are presented in Fig. 4.
13. Wrist adjustment: This node demonstrates any adjustment
required for assigning the score of the wrist. These adjustments
are required when the wrist is twisted or is deviated from the
midline. The node has two states, yes and no, demonstrating the
need for any adjustment.
14. Trunk score: This node demonstrates the final score associated
with trunk posture, which should be determined by considering
the states of its parent nodes, i.e. “trunk angle” and “trunk
adjustment.” The node has five states, s1, s2, s3, s4, and s5,
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International Journal of Industrial Ergonomics 80 (2020) 103058
corresponding to scores 1, 2, 3, 4, and 5, respectively. The CPT of
this node is presented in Fig. 5.
15. Neck score: This node represents the final score of the neck and is
determined by its angle and required adjustment. The node has
three states, s1, s2, and s3, corresponding to the scores of 1, 2, and
3. The CPT of this node is presented in Fig. 5.
16. Force/load score: This node demonstrates the final score of force
which is affected by its amount and required adjustment. The
node has four states, s0, s1, s2, and s3, corresponding to scores 0,
1, 2, and 3. The CPT of this node is presented in Fig. 5.
17. Upper arm score: This node demonstrates the final score of upper
arm and is determined by its parent nodes, i.e. “upper arm angle”
and “upper arm adjustment.” It also has six states, s1, s2, s3, s4,
s5, and s6, corresponding to scores 1, 2, 3, 4, 5, and 6,
respectively.
18. Lower arm score: This node demonstrates the final score of the
lower arm and is determined by its angle. The node has only two
states, s1 and s2, corresponding to scores 1 and 2, respectively.
19. Wrist score: This node demonstrates the final score of the wrist
and is determined by its angle and required adjustments. The
node has three states, s1, s2, and s3, corresponding to scores 1, 2,
and 3, respectively. The CPT of this node is presented in Fig. 5.
F. Ghasemi and N. Mahdavi International Journal of Industrial Ergonomics 80 (2020) 103058

Fig. 5. CPTs of several nodes of the BN model constructed based on the REBA.

Fig. 6. The BN model constructed based on the REBA method.

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F. Ghasemi and N. Mahdavi International Journal of Industrial Ergonomics 80 (2020) 103058

20. Score A: This node represents Table A from the REBA worksheet
and is used to integrate the scores of the neck, trunk, and legs. It
has nine states, s1, s2, s3 … s9, corresponding to scores 1, 2, 3 …
9, respectively.
21. Adjusted score A: This node is created to integrate the score ob­
tained from Table A with that of force/load. It has 12 states, s1,
s2, s3 … s12, corresponding to scores 1, 2, 3 … 12, respectively.
22. Score B: This node represents Table B from the REBA worksheet
and is used to integrate the scores of the upper arm, lower arm,
and wrist. The node has nine states, s1, s2, s3 … s9, corre­
sponding to scores 1, 2, 3 … 9, respectively.
23. Adjusted score B: This node is created to integrate the scores of
Table B and the coupling type. Similar to the “adjusted score A′′
node, this node has 12 states, s1, s2, s3 … s12, corresponding to
scores 1, 2, 3 … 12, respectively.
24. Table C score: This node represents Table C from the REBA
worksheet and is used to integrate the scores of the two nodes of
“adjusted score A′′ and “adjusted score B". This node has 12 states,
s1, s2, s3 … s12, corresponding to scores 1, 2, 3 … 12,
respectively.
25. Activity score: This node demonstrates activity type and has two
states, s0 and s1, corresponding to scores 0 and 1, respectively.
When the activity is repetitive or static, the state of the node is s1;
otherwise, it is s0.
26. WMSDs risk: This node demonstrates the final risk of WMSDs. It
has 13 states, s1, s2, s3 … s13, corresponding to scores 1, 2, 3 …
13.
By implementing the above-mentioned methods, the BN model
demonstrated in Fig. 6 was obtained.
3.3. Comparison of REBA and FBnREBA
For comparison purposes, 14 different hypothetical postures
(Table 2) were made and assessed using both REBA and FBnREBA. The
two leftmost columns of this table demonstrate the results of these as­
sessments. To demonstrate the differences between these two methods,
the following comparisons were made:
• Comparison of Posture I and Posture II: These two postures are
similar to each other in all body segments except the trunk position.
In Posture I, the trunk angle is at 1◦ flexion, while in Posture II, the
trunk angle is at 19◦ flexion. These two postures exert different
biomechanical effects on the body. 3D modeling using CATIA soft­
ware package showed that the L4/L5 compression forces for these
two angles are 580N and 1384N, respectively. Although REBA is
unable to discriminate between the risk scores of these two postures,
FBnREBA provides two different risk scores for them.
• Comparison of Posture II and Posture III: These two postures are also
similar in all body regions except the position of the neck. The angles
of the neck flexion in Posture II and Posture III are 10◦ and 19◦ ,
respectively. In contrast to REBA which provides the same risk score
for these two postures, FBnREBA discriminates between them by
providing two different risk scores: 4.81 for Posture II, and 6.74 for
Posture III.
• Comparison of Posture III and Posture IV: The only difference be­
tween these two postures is the angle of the trunk flexion, which is 2◦
higher in Posture IV than in Posture III. It is clear that the biome­
chanical stress of Posture III is slightly greater than that of Posture IV.
The REBA method is unable to demonstrate this gentle difference,
whereas FBnREBA differentiates between them by providing slightly
different risk scores.
• Comparison of Posture IV and Posture V: The only difference be­
tween these two postures is the angle of the trunk flexion, which is
21◦ for Posture IV and 59◦ for Posture V. Similar to previous pair
comparisons, REBA cannot discriminate between these two postures,
whereas FBnREBA provides different risk scores for them.
• Comparison of Posture V and Posture VI: The only difference be­
tween these two postures is the angle of the neck flexion, which is
slightly higher in Posture VI. REBA demonstrates this difference by
providing a huge difference in risk scores for the two postures. An
increase of 2◦ in the angle of the neck flexion increases the REBA
score from 5 to 7, whereas FBnREBA treats this slight change in a
more rational manner such that the risk scores for these postures are
very close together.
• Comparison of Posture VII and Posture VIII: The difference between
these two postures is an increase of 2◦ in the angle of the trunk
flexion. REBA reacts to this change by increasing the risk score from
7 to 8; however, there is a slight difference between risk scores
provided by FBnREBA, which is more rational.
• Comparison of Posture XIII and Posture XIV: What stands out in this
comparison is the effect of force/load on the risk scores provided by
REBA and FBnREBA. When the amount of force increases from 1 lb to
10 lbs, there is no change in the risk scores provided by REBA, while
the risk score provided by FBnREBA increases from 10.1 to 10.9.
From the above comparisons, it can be inferred that FBnREBA is
more sensitive to changes in input variables.
The trend of changes in the risk scores obtained from these two
methods is demonstrated in Fig. 7. As can be seen, the trends are
ascending in both methods. However, the final REBA score increases in a
stepwise manner, whereas the final FBnREBA score increases with a
steady slope.
3.4. Case study
A case study was conducted in a desktop gas cooker assembly line.

Table 2
Characteristics of fourteen postures used for comparing FBnREBA and REBA.
Posture Neck angle Trunk angle Legs score Force Upper arm angle Lower arm angle Wrist position adjustments REBA score FBnREBA

I 10◦ 1◦ 2 1 lb 5◦ 80◦ 0◦ Trunk 5 4.19

II 10◦ 19◦ 2 1 lb 5◦ 80◦ 0◦ Trunk 5 4.81
III 19◦ 19◦ 2 1 lb 5◦ 80◦ 0◦ Trunk 5 6.74
IV 19◦ 21◦ 2 1 lb 5◦ 80◦ 0◦ Trunk 5 6.93
V 19◦ 59◦ 2 1 lb 5◦ 80◦ 0◦ Trunk 5 7.98
VI 21◦ 59◦ 2 1 lb 5◦ 80◦ 0◦ Trunk 7 7.99
VII 21◦ 59◦ 2 1 lb 40◦ 80◦ 0◦ Trunk 7 8.87
VIII 21◦ 61◦ 2 1 lb 40◦ 80◦ 0◦ Trunk 8 8.90
IX 21◦ 61◦ 2 1 lb 40◦ 99◦ 0◦ Trunk 8 9.28
X 21◦ 61◦ 2 1 lb 40◦ 101◦ 0◦ Trunk 8 9.32
XI 21◦ 61◦ 2 1 lb 40◦ 101◦ 14◦ Trunk 8 9.78
XII 21◦ 61◦ 2 1 lb 40◦ 101◦ 16◦ Trunk 9 9.80
XIII 21◦ 61◦ 2 1 lb 46◦ 101◦ 16◦ Trunk 10 10.1
XIV 21◦ 61◦ 2 10 lb 46◦ 101◦ 16◦ Trunk 10 10.9

8
F. Ghasemi and N. Mahdavi
Fig. 7. The trend of changes in the risk scores obtained from the REBA (the
solid line) and FBnREBA (the dash line).
Fig. 8. The worst working posture of an operator from a desktop gas cooker
assembly line.
This case study was conducted to determine the risk of WMSDs and to
demonstrate which body segment should receive particular attention in
order to reduce the WMSDs risk. The image in Fig. 8 was the worst
posture in the assembly line. The angles of various body segments can be
determined using Digimizer software or a goniometer. Since the position
of various body segments were determined, the state of each segment
was assigned using the fuzzy membership sets depicted in Figs. 3 and 4.
Based on our measurements, the neck position was at 18◦ flexion, which
belonged to two fuzzy membership sets: f1 with a membership degree of
0.8 and f2 with a membership degree of 0.2. Consequently, the “neck
angle” node in FBnREBA was 80% at the “f1” state and 20% at the “f2”
state, as demonstrated in Fig. 9. The same procedure was used to
determine the states of other variables.
9
International Journal of Industrial Ergonomics 80 (2020) 103058
The FBnREBA score for the posture was 7.63, while the REBA score
was 6. In the next step, the effects of modification of various body seg­
ments on the final risk score of REBA and FBnREBA was investigated,
and the results are presented in Table 3. All modifications could reduce
the final FBnREBA risk score to some extent. In contrast, REBA was
unable to demonstrate the effects of modifications on the neck and the
lower arm postures (the prior and posterior risk scores were equal).
Moreover, in contrast to REBA, FBnREBA was able to differentiate the
positive effects of modifications on the upper arm and trunk postures.
Furthermore, as FBnREBA is totally software-based, it is easier and less
time-consuming to use in assessing the effects of modifications on the
final risk score.
4. Discussion
The present study aimed to develop a new scoring system for REBA
such that the final risk score would become more sensitive to the posi­
tion of body segments. Fuzzy sets and Bayesian network approaches
were used in developing the new system. Previous studies have only
used fuzzy set theory to solve such a deficiency in traditional methods.
The reason behind the use of fuzzy set theory is obvious: to avoid the
sharp boundaries between angle ranges of a body segment, which lead to
sudden changes in the scoring of input variables. Traditional methods
are based on principles of classical (crisp) set theory, and fuzzy set
theory is able to cover the deficiencies of these principles. Today, the
application of fuzzy set theory instead of classical methods is
commonplace in other areas of research and practice. For example,
Jamshidi et al. (2013) used it to modify the Kent-Muhlbauer method of
pipeline risk assessment, and Kutlu and Ekmekçioglu (2012) employed
the theory to apply soft computing principles in modifying failure modes
and the effects analysis (FMEA) method.
The most prominent difference between the present study and pre­
vious ones is that most previous studies utilized FIS to relate the input
variables to the output variable. To develop FIS, several steps should be
carried out, including fuzzification of inputs, development of the rule
base (a set of If-Then rules), determination of the aggregation method,
and selection of the defuzzification method (Jamshidi et al., 2013).
There are several ways to perform each of these steps, and each way may
lead to a different output. Interestingly, there is no universally-accepted
criterion for selecting the most appropriate way to perform each step
(Yazdi and Zarei, 2018). Furthermore, the rule base, as the heart of FIS,
is commonly developed based on the opinions of domain experts. This
approach has some potential drawbacks which can affect the final re­
sults. For example, how many experts should participate in developing
the rule base? What is the best approach to integrating the knowledge of
experts? Who can be considered an expert in the area of interest?
Therefore, because of the above-mentioned issues, the modification of
traditional methods using FIS may cause deviation from the principles
used in the original method. When BN is used instead of FIS, none of the
above-mentioned obstacles will be faced, because the CPTs of the BN are
developed based on the tables presented in the original method. In other
words, the tables used in the REBA worksheet for merging the scores of
various parts of the body are exactly mapped in the CPTs of the BN
model constructed based on REBA.
The methodology presented in this study is unique and, to the best of
the authors’ knowledge, this paper is the first to have utilized BN to
improve classical methods. Using BN to assess the risk of exposure to
ergonomic risk factors has several advantages. BN is very flexible and
widely used to model complex systems based on their causal relation­
ships (Akbari et al., 2018; Ghasemi et al., 2017). Moreover, the BN
approach has an easy-to-understand and easy-to-interpret interface
which demonstrates the causal relationship among variables in a
transparent manner (Correa et al., 2009). To date, the number of studies
using this approach to assess the risk of WMSDs is limited. To the best of
the authors’ knowledge, the study carried out by Thanathornwong et al.
(2014) is the only research to have used this approach for predicting
F. Ghasemi and N. Mahdavi International Journal of Industrial Ergonomics 80 (2020) 103058

Fig. 9. Analysis of the working posture using FBnREBA.

the effectiveness of such interventions.

Table 3
REBA was developed to be a quick and easy-to-administer tool;
Prior and posterior risk scores obtained from FBnREBA and REBA based on the
FBnREBA is software-based, so the use of it is also easy and quick. As
modification of various body segments.
previously mentioned, many researchers and practitioners employ REBA
Intervention Prior risk score Posterior risk score Risk reduction and other similar methods to demonstrate the effectiveness of ergo­
FBnREBA REBA FBnREBA REBA FBnREBA REBA nomic interventions in improving the working postures of individuals. In
Neck position 7.99 6 7.63 6 0.36 0 such situation, the advantages of being quick and easy are the second
Trunk position 7.99 6 5.43 4 2.56 2 priority, and sensitivity to changes in input variables is the main inter­
Upper arm 7.99 6 4.87 4 3.12 2 est. The new method is more helpful in such situations, because it is
Lower arm 7.99 6 7.8 6 0.19 0 more sensitive to input variables The new scoring system can solve some
position
Wrist position 7.99 6 7.08 5 0.91 1
of the problems in previous studies in which demonstrating the effec­
tiveness of practical improvements in the workstation design using the
risk scores of traditional methods was found to be difficult (Choobineh
WMSDs risk. Their study was conducted on dentists, and various factors et al., 2004; Sanchez-Lite et al., 2013).
including gender, BMI, vibration, duration, and body posture were The present study further revealed that by using predictive
included in the BN model. reasoning, the effectiveness of each intervention strategy can be deter­
The comparisons performed among the hypothetical postures mined; i.e. how the modification of each body segment can affect the
demonstrated that, in contrast to REBA, a slight change in the score of risk of WMSDs can be determined. In contrast, using REBA, this process
any input variable affects the final FBnREBA risk score. Likewise, a huge would be very time-consuming, because the REBA worksheet should be
change in body posture causes a considerable change in the final completed separately for each intervention. However, it should be
FBnREBA score. This is a very important advantage for several reasons. mentioned that there are other factors to be considered in selecting and
First, in contrast to traditional methods, it is very unlikely that exactly implementing an intervention. Cost, feasibility, and acceptability are
similar risk scores will be obtained for different postures. Secondly, it some of them. Cost indicates the cost of implementing the intervention;
would be possible to show the effect of any modification in workstation feasibility shows how easy the intervention is to be implemented; and
design on the risk of WMSDs. It should be noted that REBA and other acceptability shows the acceptance of intervention by the workers (Chen
similar methods are both used in research and practice to demonstrate et al., 2014). Moreover, the modification of a body part can have a
the effectiveness of ergonomic interventions in improving the working negative impact on the posture of other body segments (Choobineh
posture of individuals. For example, Pillastrini et al. (2010) employed et al., 2004), and this issue should also be considered when selecting
REBA to demonstrate the effectiveness of ergonomic interventions in intervention options.
improving the working posture of video display terminal operators. In
another study, Choobineh et al. (2004) used RULA to assess the effec­ 5. Conclusion
tiveness of a newly designed workstation in correcting the working
posture of carpet menders. Likewise, Ratzon et al. (2016) also utilized The new scoring system developed based on fuzzy set theory and BN
this approach to assess the effect of ergonomic interventions on the was more sensitive than traditional methods to changes in input vari­
working postures of nurses. As FBnREBA has more sensitivity to changes ables. The new method is also capable of predicting the effectiveness of
in input variables, it can be more helpful and accurate in demonstrating various interventions in reducing the risk of WMSDs.

10
F. Ghasemi and N. Mahdavi
Declaration of competing interest
Authors declare that there is no conflict of interest regarding this
paper.
Acknowledgement
The authors would like to thank Hamadan university of medical
sciences for financial support (grant number: 9610196743).
Appendix A. Supplementary data
Supplementary data to this article can be found online at https://doi.
org/10.1016/j.ergon.2020.103058.
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