IMPROVEMENT OF ERGONOMICS RELATED TO RECTIFICATION

AT PT. PRATAMA SENTRA REHABILITASI

By : An’nisa Fitri Wulandari

CASE BASE LEARNING I

CLINICAL ATTACHMENT PROGRAMME
AT PT. PRATAMA SENTRA REHABILITASI
 CHAPTER I :
Background, Reason why choose selected topic, Objective

CHAPTER II :
Activity, Working Procedure

CONTENT
CHAPTER III :
Analyze the procedure, comparing with experienced
before, limitation, proposed idea, summary

CHAPTER IV :
References
 BACKGROUND

PT. Pratama Sentra Rehabilitation is a company which provides healthcare services

and mainly focused on delivering services in the field of Prosthetics&Orthotics.

“In P&O workshop, there are many tasks that are carried out by manpower
and the asks are labor-intensive which make workers are exposed to risk
factors of work-relate musculoskeletal injuries (WMSDs)”
– (Anderson, Stuckey, & Oakman, 2015).
 BACKGROUND

“Musculoskeletal disorders (MSDS) are injuries or disorders of the

muscles, nerves, tendons, joints, cartilage, and spinal discs.”
– U.S. Department of Health & Human Services, 2018.

According to Canadian Center of Occupational Health and Safety

(CCOHS), pain is the most common symptom associated with WMSDs.

In Australian orthotic and prosthetic workshops, it was reported that

awkward postures, loads and exertion as important occupational health
and ergonomic contributing risk factors of MSDs (Anderson, Stuckey, &
Oakman, 2015). The risk are presented in all proses of the making of
prosthetics&orthotics devices, including rectification.
 BACKGROUND

WMSDs can be prevented through proactive measures devised

based on ergonomics but unfortunately they are still seldom
considered (Nodooshan & Booshehri, 2016)

“Ergonomics itself is the science of designing the job to fit the worker,
rather than physically forcing the worker’s body to fit the job. The aim of
ergonomic is to achieve safer, comfortable and healthier working
environtment for the workers.” – US Department of Labor
 BACKGROUND

The result of the preliminary study conducted in October 8th 2019

shown that all workers who usually do rectification experienced
work-related pain at some part of their body during and after
performing rectification procedure.

The observation was also done in several aspect such as working posture
and workstation condition (workstation design and improper design of hand
tools). The result shown that workers worked with an awkward posture and
the rectification workstation are also improper.
 Reason to choose this topic

MSDs is something that shouldn’t be underestimate by workers. It develops

gradually and people tend to ignore the symptoms when it occured. MSDs can
result in lost work time and even disability, then it’s important to recognized its
symptoms and prevention action need to be done.
 Reason to choose this topic

In PT. Pratama Sentra Rehabilitation, through observation it was found that the
rectification facilities in Pratama is different from other clinics or P&O school and
not following guidelines of ergonomic which causing the workers to do the
rectification with the wrong posture in daily basis.

Rectification room

Awkward posture
Objectives of Study

• Increase the knowledge of Musculoskeletal

disorder and ergonomic to the workers.
• Improve the ergonomic during rectification in
order to prevent the WMSDs.
 Benefit of Study

• Workers get more COMPANY Students will gain more

knowledge about knowledge about the
Musculoskeletal disorder important of ergonomic
and the importance of during working as a
ergonomic prevention of the WMSDs.
• As suggestion to PT. STUDENTS
Pratama Sentra
Rehabilitasi to improve
rectification facilities based
on ergonomic guidelines
from ILO
ERGONOMIC
• Ergonomics is designing a job to fit the worker so the work is safer and
more efficient.
• Ergonomic are include general working conditions, workstation design,
working posture, work organization, hand tools, and manual material
handling
• Designing work stations and tools to reduce work related
musculoskeletal disorders (MSDs) can help workers stay healthy and
companies to reduce or eliminate the high costs associated with MSDs.
Working Postures
 Time and Place

PT. PRATAMA SENTRA

REHABILITASI

October-November 2019
 No Activity Date Duration

1. Discussion to find topic of CBL I October, 7th – 22th 2019 Varied

2. Searching information regarding the October, 22th – 10th 2019 Varied

topic
A
4. Discussion with CA team November, 31th 2019 30 minutes
C
T 5. Held preliminary study (interview) to November, 8rd 2019 30 minutes
I the selected participants and
V observation
I 6. Start the intervention. November 11th – 25th During work time
T 2019
Y 7. Held a post-intervention interview to November 26th 2019 30 minutes
the selected pacticipants.
Work Procedure (Before Intervention)
Based on Observational Checklist problems
found in Pratama Workshop :
1. Not proper workstation ;
• Floor as worksurface : very low
worksurface.
Rectification room
• Small plastic chair for sitting : very low
height of chair, no backrest option

Small plastic chair for

workers to seat
Work Procedure (Before Intervention)
2. Worked with awkward posture.
• The head is not held straight (the
neck is flexion and twisted sideways)
• Too much forward leaning of the body
• The body leaning sideway and not
straight
• The knee joint position is higher than
the hip joint.
3. Lack of tools to hold the positive cast
4. Repetitive movements
Work Procedure (Before Intervention)
Based on Observational Checklist problems found in Pratama Workshop :
• All 4 participants :
• Experienced pain during and after rectification
• Pain sometimes disturb their work flow
• Knew the the good posture but difficult to apply due to the condition of
workstation
• Agree that rectification facilities causing them to do rectification in awkward
postures
• Agree that occurance of pain depends on the duration of rectification and
whether they remembered to take rest during rectification.
• Knew that take occasional rest is important but some didn’t always do it.
• Not all participants took occasional rest during rectification nor they agree that
workstation and workposture could be the cause of the pain.
 Work Procedure (Before Intervention)
Graphic 2.1 Areas of pain among workers due to rectification
at PT. Pratama Sentra Rehabilitation

Areas of pain among workers due Recti fi cati on

• Most commonnly
4.5
affected regions among
4
the subjects were neck,
3.5
lower back and knees
3
with all the subjects
2.5 experienced these pain.
2
1.5
• And No one had ever
experienced non-work
1
related injury at the
0.5
pained areas.
0
Body Region

Neck Shoulders Elbows Wrists/Hands Upper Back

Lower Back Thighs Knees Legs/Feet
 Analysis of Procedure

Interview and Apply Evaluation of

Observation intervention Intervention

The intervention are:

1. Changing the rectification position
2. Changing the workstation
3. Provide pipe holder to hold the positive cast in place
4. Give education regarding to MSDs and working posture
 Analysis of Procedure

Standing bench vice and tube Chair with backrest and

clamp adustable height
Analysis of Procedure

Sosicalization
about MSDs
and Good
posture to the
workers
Analysis of Procedure
BEFORE AFTER
Analysis of Procedure

BEFORE AFTER
 Analysis of Procedure
RESULT OF INTERVIEW

NO. BEFORE AFTER

1 Understand about good posture and that it’s Understand about good posture and that it’s
can influenced by workstation&hand tools can influenced by workstation&hand tools

2 Not all agree that pain can be influenced by Understand that both posture, workstation
posture, workstation and hand tools and hand tools influenced the pain

3 Feel pain Still feel pain but its occurance become

lesser

4 Rectification was not efficient Felt that rectification is more efficient

 Analysis of Procedure
RESULT OF INTERVIEW

NO. BEFORE AFTER

5 Not all workers remembered to take rest Still not all workers remembered to
during rectification occasional resting, but they feel that rest
occasionally became more comfortably due
to appropriate chair

6 Want to do rectification in standing position The solution are similar to what workers
with occasional sitting, have something to hope the rectification room would be, except
hold the cast, and adjustable workstation. for adjustable workstation
 Comparing with experience before

When I was students, rectification was done with :

• Standing position
• Rectification station height is at around elbow level.
• Clamps are provided to hold the positive cast during rectification
procedure as well as allowing students to rotate the positive cast to make
work more efficient.
• No chair provided for occasional sitting.
• The repetitive movements in both place are still performed.
 Limitations during activity

• PT. Pratama Sentra Rehabilitation is now under constraction so it’s

disturb the research data taking procedure because there were days
which the rectification was disturbed with the constraction works.
• The standing bench vise used as solution in this study is not suitable
for Spinal Orthotics positive cast because the the bench vice wasn’t
permanently fix to the ground so it will not able to hold the weight of
spinal orthotics positive cast.
 Propose idea/Alternative solution

• Make the standing rectification station which allow

the worker to work with natural posture
• Provide footrest for the workers
• Planning and implementing training programs
about risk factors of musculoskeletal injuries and
adequate methods of working
 Summary (Lesson Learn)

• Learn how important the ergonomic is in not only during rectification but
also other task during the making of proshesis and orthosis. It can
prevent the MSDs or other occupational accidents/injuries.
• Learn that workstation design and hand tools are have direct effect on
worker’s posture during rectification. Appropriate workstation and hand
tools will support good posture and reduce the number of pain occurance
during or after rectification.
 REFERENCES
• About PT. Pratama Sentra Rehabilitasi. (2019, April 4). (PT. Pratama Sentra Rehabilitasi) Diambil kembali dari
https://pratama-sentra-rehabilitasi.business.site/posts/7296046848138135528?hl=en
• Anderson, S., Stuckey, R., & Oakman, J. (2015). Prosthetists’ and Orthotists’ experience of their work and
workspace.
• Ankle Foot Orthotis Course Manual Book. (2015). Jakarta: Jakarta School of Prosthetics and Orthotics.
• Cho, K., Cho, H., & Han, G. (2016). Risk factors associated with musculoskeletal symptoms in Korean Dental
Practitioners.
• Ergonomic : Awkward Posture. (2018, May). Diambil kembali dari Yale Environtmental Health and Safety.
• Hunter, D., & Silverstein, B. (2014). Perceptions of risk from workers in high risk industries with work related
musculoskeletal disorders.
• Kuorinka, I., Jonsson, B., & et al. (1987). Standardized Nordic Questionnaires for the analysis of musculoskeletal
symptoms. Applied Ergonomics.
• Nodooshan, H. S., & Booshehri, S. K. (2016). Ergonomic workplace assessment in orthotic and prosthetic
workshops.
• U.S. Department of Health & Human Services. (2018). Work-Related Musculoskeletal Disorders & Ergonomics.
Diambil kembali dari Center for Disease Control and Prevention:
https://www.cdc.gov/workplacehealthpromotion/health-strategies/musculoskeletal-disorders/index.html
• WHO. (2003). Preventing Musculoskeletal Disorders in the Workplace. 1.
• Wright State University. (2015). Diambil kembali dari Are You Sitting All Wrong? Find Out Here:
https://www.wright.edu/facilities-management-and-campus-operations/about/article/are-you-sitting-all-wrong-find-
out-here
Attachment I
Attachment II
Attachment III