*Corresponding author. Tel.

: 1508-435-9061; fax: 1508-435-

8136; e-mail: patrick.dempsey@libertymutual.com.
International Journal of Industrial Ergonomics 24 (1999) 405}416
Utilizing criteria for assessing multiple-task manual materials
handling jobs
Patrick G. Dempsey*
Liberty Mutual Research Center for Safety and Health, 71 Frankland Road, Hopkinton, MA 01748, USA
Received 15 December 1997; received in revised form 6 July 1998; accepted 4 August 1998
Abstract
One approach to the design or evaluation of manual materials handling (MMH) tasks is through the use of various
criteria measures that have been developed. For evaluation purposes, the observed value of a criterion measure is
calculated from task and workplace parameters, and compared to a speci"c criterion to assess the level of `acceptabilitya
or `safetya associated with the task. This process is usually completed at the task level. Most criteria are for single MMH
tasks; however, the majority of jobs involving MMH are composed of multiple tasks. One of the biggest challenges to
exposure assessments of multiple tasks using criteria is the aggregation of the exposure from the individual tasks to
a single metric. This paper examines issues relevant to the aggregation of criterion values from multiple MMH tasks.
Assessment strategies for evaluating multiple-task MMH jobs are also discussed. The conclusions are: (1) basic and
applied research is needed to enhance methodologies for analyzing multiple-component MMH tasks, (2) research is
needed to assess the role of MMH criteria in the prevention of low-back disorders when MMH exposures are complex,
(3) "eld methodologies for applying MMH criteria to complex exposures need to be operationally de"ned to ensure
consistent use by practitioners, and (4) MMH criteria should be viewed as design and task analysis tools (i.e., compliance
assessment), and not as risk assessment tools.
Relevance to industry
Jobs in a variety of sectors (e.g., manufacturing, service, transportation) often require workers to perform multiple
manual materials handling tasks. However, most available evaluation methods focus on the stresses associated with
individual tasks. The methods for assessing exposure to multiple-task manual handling jobs are discussed, with particular
emphasis on epidemiological investigations and compliance assessments performed by practitioners. 1999 Elsevier
Science B.V. All rights reserved.
Keywords: Manual materials handling; Exposure assessment; Compliance assessment
1. Introduction
Losses associated with manual materials hand-
ling (MMH) represent the largest source of work-
related injuries and illnesses. Overexertion of the
low-back represents the majority of MMH losses
0169-8141/99/$- see front matter 1999 Elsevier Science B.V. All rights reserved.
PII: S 0 1 6 9 - 8 1 4 1 ( 9 9 ) 0 0 0 0 7 - 4
(Dempsey and Hashemi, 1999). In response to these
losses, criteria for quantitatively assessing MMH
tasks have been developed from Newtonian mech-
anics, psychophysics, and physiology. Although the
principles of mechanics, psychophysics and physi-
ology applied to MMH tasks are often unrelated,
the common goal is to design work such that the
stresses imposed upon the workforce are below the
threshold for fatigue, discomfort and injury (Ayoub
and Dempsey, 1999).
The application of MMH criteria to the design
and evaluation of MMH tasks, or using these cri-
teria for exposure assessments, is qualitatively and
quantitatively di!erent from other approaches. Ne-
cessary input parameters (e.g., moment arm, load
weight, kinematics) are collected at the workplace
and the observed criterion measure value is com-
puted. The observed value is compared to a speci"c
MMH criterion to assess the level of `acceptabil-
itya or `safetya associated with the task. This pro-
cess is usually completed at the task level.
Observational techniques are used often, and less
frequently, direct measurement. It is possible to use
self-reports in some cases.
Another approach to MMH task evaluation is
focusing on the role of long-term exposures to risk
factors (e.g., bending and twisting) in the develop-
ment of musculoskeletal disorders. The magnitude,
frequency, and duration of exposure to an indi-
vidual risk factor may be collected (e.g., the
worker's trunk is #exed 353 "ve times per minute
for eight hours). For these analyses, self-reports,
observation, and direct measurement may be used.
This leads to a broader focus on risk factors asso-
ciated with the tasks (i.e., the job), rather than
a judgment as to the acceptability or safety of
a particular task or set of tasks.
Aside from the di$culties collecting data needed
to apply MMH criteria, utilizing MMH criteria for
exposure assessments of multiple-component
MMH jobs is problematic. MMH criteria typically
assess individual tasks. A primary question is
whether or not data for all pertinent tasks in a job
have been collected. Thus, the "rst challenge is to
collect the pertinent data. Di$culties encountered
during this step will be discussed, with particular
reference to the sources of variability that pose
di$culties. For jobs with many MMH tasks, deter-
mining `pertinenta tasks may in and of itself be
extremely time consuming.
The primary challenge to exposure assessments
of multiple-task MMH jobs is the aggregation of
exposure from the individual tasks to a single met-
ric. After all relevant tasks have been captured, an
overall measure of exposure associated with the set
of tasks is needed. Some of the methods to be
discussed allow assessment of multiple component
tasks; however, these are based upon the assess-
ments of the individual tasks. The focus of this
paper is an examination of methods available for
the aggregation of criterion values from multiple
MMH tasks.
1.1. Dexnitions
The following de"nitions are provided to avoid
any ambiguity. These de"nitions are speci"c to the
context of risk and compliance assessments of mul-
tiple-task MMH jobs.
(1) Risk assessment } Risk assessment is com-
prises several components. The National Research
Council (1983) has de"ned these components
as: (a) hazard identi"cation, (b) dose}response as-
sessment, (c) exposure assessment, and (d) risk char-
acterization. As the National Research Council
(NRC) pointed out, not every risk assessment will
consist of all components.
(2) Compliance assessment } Some may argue
that risk assessment is impossible when MMH cri-
teria are used, as there are few, if any, dose}re-
sponse relationships between criterion values and
injury cost or severity. The dose}response relation-
ship is typically replaced by predictions of the acute
responses of the cardiovascular and musculos-
keletal systems to a particular task design. These
responses are assumed to approximate risk; how-
ever, there is not strong epidemiological support
for this assumption (Ayoub et al., 1997; Dempsey,
1998; Leamon, 1994). To avoid using less than
correct nomenclature, the term compliance assess-
ment will be used to denote the process of analyzing
MMH tasks when dose}response relationships
are replaced by comparisons of observed criterion
values to a speci"c MMH criterion. Within
the context of industrial hygiene, Claycamp (1996)
406 P.G. Dempsey / International Journal of Industrial Ergonomics 24 (1999) 405}416
de"ned compliance assessment as `compar[ing]
predicted/measured exposures with relevant stan-
dards or occupational exposure limitsa. MMH cri-
teria can be thought of as exposure limits and, in
some cases, standards. For example, the Occupa-
tional Safety and Health Administration in the
United States has used the National Institute for
Occupational Safety and Health (NIOSH) lifting
equation (Waters et al., 1993) for inspection and
enforcement purposes.
(3) Exposure assessment } The process of
measuring or estimating the intensity, frequency,
and duration of human exposures to MMH tasks
in the workplace (adapted from NRC (1983)). As
will be shown later, not all exposure assessment
techniques currently utilized incorporate intensity,
frequency and duration of exposure. Exposure as-
sessments can be used for epidemiological invest-
igations or as the basis of a compliance assessment
performed by a practitioner.
(4) MMH criterion } An MMH criterion is
a quantitative limit for designing or analyzing an
MMH task. Typically, observed criterion measure
values are calculated from task and workplace vari-
ables, and predetermined levels indicate unaccept-
able risk. For example, 3400 N of lumbosacral
compression has been suggested as a spinal com-
pression limit for lifting tasks (NIOSH, 1981;
Waters et al., 1993).
1.2. Fundamental diwerences between exposure as-
sessments used for diwerent purposes
Since exposure measurements taken at the work-
place for epidemiological investigations and com-
pliance assessments have di!erent purposes, the
manner in which the data are collected often di!ers.
For epidemiological investigations, the data are
often used directly or indirectly as variables for
statistical analyses. Sample size demands and cost
constraints often encourage investigators to take
many measurements with lower precision. For
compliance assessments, the data are used for de-
termining the acceptability or safety of an MMH
task. Detailed data are usually collected on a lim-
ited number of tasks comprising the job or a por-
tion of the job. Thus, the level of detail used often
di!ers in that exposure assessments used for com-
pliance assessments are often more detailed than
those used for epidemiological investigations.
2. MMH criteria
The most commonly used MMH criteria will be
discussed brie#y. For a more detailed discussion of
MMH criteria, the interested reader is referred to
Ayoub et al. (1997), Ayoub and Mital (1989), or
Mital et al. (1997).
2.1. Biomechanical criteria
Biomechanical criteria are related to limiting ex-
ternal or internal forces to levels that do not exceed
the musculoskeletal system capacity. Joint and
composite strengths can be compared to strength
required to perform a task, whereas tissue limits
can be compared to shear and compressive forces
acting on intervertebral discs. Biomechanical mod-
els of the low-back are used to estimate the shear
and compressive forces acting upon the spine, par-
ticularly the L

/L

joint and the L

/S

joint (e.g.,
Cha$n and Page, 1994; Granata and Marras, 1996;
McGill and Norman, 1986). Although shear forces
are often estimated, the author is aware of only one
epidemiological study incorporating shear loading
as an exposure determinant (Kumar, 1990). The
most common spinal compression criterion is the
3400 N peak limit suggested by NIOSH (1981),
although alternate values have been suggested
(JaK ger and Luttmann, 1997; Mital et al., 1997).
JaK ger and Luttmann (1997) recommend incorpor-
ating age and gender as important factors when
setting a criterion. Lumbosacral compression is the
most commonly used biomechanical criterion.
2.2. Physiological criteria
Physiological criteria focus on limiting energy
expenditure to levels that do not result in excessive
whole-body or localized fatigue. The level of ac-
ceptable energy expenditure is dependent upon the
duration of the task, as acceptable energy expendi-
ture and task duration are inversely related.
Physiological criteria apply to repetitive tasks per-
formed continuously. Heart rate, rate of oxygen
P.G. Dempsey / International Journal of Industrial Ergonomics 24 (1999) 405}416 407
consumption (or the equivalent energy expendi-
ture), and percentage of maximum oxygen uptake
can potentially be used as criteria. It should be
noted that physiological criteria have not shown
much promise with regards to di!erentiating the
low-back disorder risk of di!erent work designs
(Dempsey, 1998; Leamon, 1994); thus, their use as
exposure measures may be limited.
The rate of oxygen consumption is the most
common measure of energy expenditure. Often,
a rate is chosen that corresponds to a majority of
the population being accommodated. Oxygen con-
sumption can be expressed in absolute terms
(ml/kg/min or ml/min) or in relative terms (percent-
age of maximum oxygen uptake). A criterion of one
liter of oxygen per minute has historically been the
most commonly used physiological criterion, al-
though recent NIOSH guidelines (Waters et al.,
1993) used more conservative values.
2.3. Psychophysical criteria
The most commonly used psychophysical cri-
terion is the percentage of the population (male,
female, or combined) that a task accommodates
with respect to weight or force values found in
tables of psychophysical data. The largest and most
comprehensive single set of tables can be found in
Snook and Ciriello (1991). A criterion that at least
75% of workers are accommodated has been sug-
gested (Snook, 1978; Snook et al., 1978). In some
cases, more conservative values are used (e.g.,
Waters et al., 1993).
2.4. Composite criteria
The term composite criteria refers to those cri-
teria that are developed from two or more of the
individual criteria discussed above. One of the most
widely recognized composite criterion is the 1991
NIOSH lifting equation (Waters et al., 1993), which
incorporates biomechanical, psychophysical, and
physiological criteria. Another example is the
guidelines developed by Mital et al. (1997). In gen-
eral, guidelines such as these attempt to satisfy
criteria based upon multiple approaches. These
methods provide a common exposure metric for
multiple criteria.
3. Parameter measurement
One of the biggest challenges to utilizing MMH
criteria for exposure assessments is measuring spe-
ci"c parameters required to calculate an observed
criterion measure value for a particular task, when
in fact, workers rarely perform an MMH task in
a completely repeatable fashion. Often times, the
parameter measurements are based upon an `aver-
agea of sorts. In practice, this `averagea is typically
determined qualitatively at the discretion of the
evaluator. When performing compliance assess-
ments, practitioners rarely take multiple measure-
ments of the same task(s). This area of variation has
been largely ignored by ergonomists when discuss-
ing the application of MMH criteria in the work-
place. However, valid assessment of a worker's
average exposure requires either that workers are
monitored repeatedly, or that the time frame over
which the measurements are taken is increased. The
number of measurements or length of exposure
monitoring depends upon variation in exposure to
load (Burdorf, 1995).
The in#uence of task variability on compliance
assessments is a particular concern when one con-
siders that resource allocation for redesign e!orts
may be based upon the results. For example, the
horizontal multiplier in the 1991 NIOSH equation
reacts considerably to relatively small changes in
the horizontal location. However, the reality of the
workplace is such that the exposure assessment will
rarely, if ever, be as accurate and precise as the
equation demands. The same holds true for fre-
quency. Depending on the time window used to
determine frequency, the observed frequency may
vary enough over time such that the results are
biased.
Aside from variation that occurs within a par-
ticular task and within a particular worker, other
sources of variation also exist. The major sources of
variation that may need to be considered during an
exposure assessment are discussed below.
3.1. Between-subject variation
From the standpoint of exposure assessment, it is
likely that assessments performed at the individual
level will provide di!erent exposure values for
408 P.G. Dempsey / International Journal of Industrial Ergonomics 24 (1999) 405}416
workers performing the same job. Factors such
as training, work technique, age and individual
anthropometry may a!ect exposure (KilboK m,
1994). For example, a taller worker may perform
a particular lifting task such that the moment arm
of the load acting about the low-back is larger
than for a shorter worker. Likewise, a worker with
a history of low-back disorders may alter their
kinematics.
In the author's opinion, exposure assessments
used for epidemiological studies should be done
at the level of the individual. This is also bene"cial
from the standpoint of statistical principles.
Reduction of the data via grouping is harmful since
the sample sizes are reduced, thereby reducing
power of tests and e$ciency of parameter esti-
mates. Comparisons of variation within and be-
tween jobs is also lost when data are not collected
at the individual level (Dempsey and Westfall,
1997). An additional problem with analyses per-
formed with aggregated data is the di$culty con-
trolling confounding (Rothman, 1986). The
numerous possible confounding personal variables
(e.g., Andersson, 1992; Dempsey et al., 1997) pro-
vide further support for this approach. On the
other hand, multiple exposure assessments on dif-
ferent individuals for compliance assessment pur-
poses are unlikely to yield vastly di!erent redesign
recommendations.
3.2. Within-subject variation
The most troublesome sources of variation tend
to be those that a!ect within-subject variation. For
example, van der Beek et al. (1995) estimated that
approximately 80% of the total variance in expo-
sure to non-neutral trunk postures was within-
subject variance. The author is not aware of esti-
mates for sources of variation in exposure to MMH
tasks. Within-subject sources of variation tend to
be related to factors that a!ect the frequency and
duration of speci"c MMH tasks, such as variable
production schedules, job rotation, and non-repeti-
tive tasks.
In many industries, production schedules change
frequently as a result of factors such as seasonal
variation in product demand and variation in de-
mand due to national economic indicators (e.g.,
unemployment rates). In craft industries and job
shops, the length of production runs are often lim-
ited to the size of individual orders. Machine shops,
in particular, often produce products in single or
occasional production runs.
In some cases, production schedules may change
frequently due to production runs for multiple
products occurring in the same facility, and in some
cases with the same equipment. Flexible manufac-
turing cells have become more prevalent in recent
years, accentuating the problem in some industries.
An inherent aspect of these cells is the ability to
quickly change over equipment to produce di!er-
ent products. This ultimately changes the exposure
to MMH tasks.
At least in the United States, job rotation is
becoming a popular means of attempting to reduce
over-all exposure to physically-demanding tasks.
This results in increased cost and di$culty per-
forming exposure assessments at the individual
level. The author has observed rotation schemes
that permit rather easy exposure assessments; in
one case, the workers alternately performed two
sets of tasks for 20-minute periods. However, there
are also cases where workers perform upwards of
10 sets of tasks, with no particular structure. In the
latter case, exposure assessment at the individual
level requires observing the worker perform all sets
of tasks. In some cases, the exposure assessment
would have to span several days.
A particular challenge to exposure assessments
at the individual level using MMH criteria is pre-
sented by non-repetitive MMH tasks. At the ex-
treme end of the spectrum are jobs in which the
materials handled are continuously changing, as is
common in, for example, some shipping and receiv-
ing, transportation, and service jobs. Additionally,
some facilities have job titles such as `material
handlera that require varied MMH activities to be
performed. Attempting to perform an overall expo-
sure assessment in these cases will require selective
sampling of speci"c MMH tasks, simplifying data
collection by collapsing tasks through the use of
aggregates of parameter values across tasks, or
spending an enormous amount of time perform-
ing the exposure assessment. These issues are essen-
tially independent of the end use of the exposure
assessments.
P.G. Dempsey / International Journal of Industrial Ergonomics 24 (1999) 405}416 409
4. Methods for aggregating multiple tasks
Various methods for aggregating MMH cri-
terion values will be presented. For clarity, it will be
assumed that the following de"nitions and dis-
cussions pertain to the exposure assessment of
a single worker. The focus will be within the context
of aggregating values from multiple and distinct
MMHtasks. However, the methodologies may also
be applied to multiple measurements of the same
task. As was mentioned earlier, workers rarely per-
form a task in a completely repeatable fashion.
Distinctions between using the aggregation tech-
niques for these di!erent purposes will be discussed.
4.1. Peak value
The peak criterion value (C

) is de"ned as
follows:
C

"max(C

, C

,2,C
L
)
where
n"number of distinct MMH tasks performed
by the worker,
C
G
"observed value of criterion measure for task
i, where i"1,
2
,n.
The above method for aggregating criterion
values across tasks is quite simple. The only deter-
minant of exposure captured by this method is
magnitude. Unfortunately, the potential for bias in
magnitude estimation is high when the peak value
is considerably di!erent from the other values.
Thus, the distribution of observed criterion
measure values a!ects the bias of this method.
A peak value can also be used to select an ob-
served criterion value from multiple measurements
taken on the same task. While the potential for bias
also exists, the bias is likely to be minimal since all
criterion values computed for multiple repetitions
of a single task should be similar in value. In prac-
tice, it is not uncommon to use the `worst casea
parameters when performing compliance assess-
ments. Likewise, it is not uncommon to analyze
what the observer perceives to be the most stressful
task, or most stressful subsample of tasks. This is
not technically a peak value, but similar in concept.
Peak values have been used as exposure assess-
ments used for epidemiological studies because of
the reduced costs relative to measuring multiple
tasks.
4.2. Average value
The average criterion value (CM) is de"ned as
follows (C
G
and n retain the de"nitions used above):
CM"
L
G
C
G
n
.
Like the peak value, the average value only con-
siders magnitude as a determinant of exposure.
However, the average is likely to be a less biased
estimate of exposure than the peak. When the fre-
quency and duration of multiple MMH tasks are
similar, the bias introduced by the average is lower,
i.e. if frequency and duration are nearly equal for all
tasks, the average may represent a less-biased ag-
gregate of magnitude than the peak.
When calculating criterion measures from mul-
tiple observations of task parameters, the average is
another method sometimes used for compliance
assessments. More often than not, the observer
takes measurements on what they perceive to be an
average value. This is far less desirable than a strat-
egy in which multiple measurements are taken;
however, practitioners are unlikely to use a mul-
tiple-measurement strategy.
Averages can also incorporate weighting
schemes to better represent additional determi-
nants of exposure, such as duration and frequency
of exposure. Perhaps one of the soundest methods
is a time- and frequency-weighted value such as the
following (based on Liles et al., 1984):
I

G
hours
G
;days
G
hours
R
;days
R
K
G

H

F
H
F
G
;
C
H
CLIM
H

where
k"number of task groups,
hours
G
"exposure hours/day for group i,
days
G
"exposure days/week for group i,
hours
R
"total hours/day for job,
days
R
"total days/week for job,
m
G
"number of tasks in group i,
C
H
"the observed value of the criterion measure
for task j,
410 P.G. Dempsey / International Journal of Industrial Ergonomics 24 (1999) 405}416
CLIM
H
"the MMH criterion value for task j,
F
H
"lifting frequency for task j,
F
G
"KG
H
F
H
"total lifting frequency for group i.
A time- and frequency-weighted average is ca-
pable of capturing the primary determinants of
exposure. With regard to MMH, e!orts to incor-
porate exposure measures which consider the dura-
tion and frequency of exposure, in addition to
magnitude, should be encouraged. The potential
role of cumulative loading in the development of
low-back disorders (Kumar, 1990) supports using
more complete exposure assessments.
4.3. Integrated values
Integration of stresses over time is one area of
exposure assessment that has not been investigated
in much detail. There are several potential integ-
rated values that can be used, with the choices
depending upon the length of time over which the
values are integrated. This approach is best suited
to direct measurements, although other measure-
ment types are amenable to integration.
One area of consideration when using integrated
values is the time frame over which the stresses are
integrated. The variability of the measurements will
tend to be higher for shorter measurement periods
and vice -versa. The integration approach may be
largely untenable for jobs with considerable varia-
bility, since the costs of exposure assessment will be
very high.
One example of integrating a criterion measure
is Kumar's (1990) investigation of the relation-
ship between cumulative spinal shear and compres-
sion loading and back pain. The cumulative
measure used was found to discriminate between
a group reporting back pain and a group reporting
no pain.
Advances in direct measurement devices may
provide the potential for more feasible integration
of mechanical loads over time. Relatively unobtrus-
ive direct measurement devices capable of captur-
ing the determinants of exposure to MMH would
provide a means of collecting the needed time-
varying input data. Costs of exposure assessment
would be minimized, while at the same time, more
information would be captured.
4.4. Statistical sampling
One approach to dealing with the various sour-
ces of exposure variability is to use statistical samp-
ling techniques, some of which are rooted in
classical work sampling. When all tasks cannot be
analyzed, sampling may be the only viable alterna-
tive. This approach has particular appeal for jobs
with high variability, and in a sense may provide an
`averagea exposure. While the methodologies
available in time and motion study textbooks
may need some adaptation, there is a considerable
amount of intuitive appeal. For the practitioner,
sampling may be used to simultaneously de"ne
exposure to MMH task demands as well as to
perform what have historically been traditional
industrial engineering functions (e.g., occurrence
sampling). An example of a sampling approach
to investigate postural loading is the Ovako Work-
ing Posture Analysing System (OWAS) (Karhu
et al., 1977). While this method is observational
and less demanding than applying MMH criteria,
the success of the sampling approach has been
demonstrated (Kant et al., 1990; Karhu et al., 1981;
Kivi and Mattila, 1991). OWAS provides an
example of an analysis technique that focuses on
exposure to risk factors (e.g., bent and twisted trunk
postures) associated with a job rather than focusing
on stresses associated with a particular task
or tasks.
4.5. NIOSH composite lifting index
The NIOSH composite lifting index is a fairly
complex calculation for aggregating individual task
assessments made with the 1991 NIOSH equation
to a single index, termed the composite lifting index
(CLI). A detailed explanation of the methodology
has been presented by Waters et al. (1994). The
technique is applicable to sets of lifting/lowering
tasks performed during the same time period, such
as several tasks involved in a palletizing operation.
The di!erent tasks are weighted using individual
frequencies, and the weighting is strongly in-
#uenced by physiological concerns. There does not
appear to be any epidemiological support for the
method.
P.G. Dempsey / International Journal of Industrial Ergonomics 24 (1999) 405}416 411
Table 1
Comparison of di!erent techniques discussed
Determinant(s) of exposure captured
Technique Duration Magnitude Frequency
Peak ! # !
Average ! # !
Weighted average ? # ?
Integration # # #
Sampling ? # ?
NIOSH CLI ! # #
Note: #: method captures determinant, !: method does not
capture determinant, ?: method may capture determinant.
4.6. Comparison of techniques
In order to provide a comparison of di!erent
techniques, the determinants of exposure that will
be used for comparing the methods will be magni-
tude (i.e., intensity), frequency, and duration of ex-
posure expressed in terms of the criterion. These
parameters comprise a su$cient operational quan-
ti"cation of mechanical exposure (Winkel and
Mathiassen, 1994), as well as a su$cient opera-
tional quanti"cation of exposure as expressed by
criterion values. Table 1 provides a comparison of
the methods discussed thus far.
With regard to Table 1, the observed criterion
value is assumed to represent magnitude. For
example, it is assumed that a spinal compression
value represents the magnitude of exposure for
a particular task or particular aggregation scheme.
The adequacy of this assumption needs to be inves-
tigated. Frequency refers to frequency as expressed
in tasks per minute (or similar measures), and dura-
tion refers to the amount of time that a worker is
exposed.
As discussed earlier, peak and average values
only capture the magnitude of exposure. Depend-
ing on the choice of weighting, a weighted average
can add additional information, particularly con-
cerning duration and frequency. Integration of
stresses is capable of capturing the three primary
determinants of sampling, whereas work sampling
approaches may or may not capture duration or
frequency. Traditionally, one use of work sampling
has been to estimate the relative proportion of time
spent performing di!erent tasks. If used properly,
sampling can capture an estimate of duration.
However, frequency and duration may not be com-
pletely de"ned by work sampling. Finally, the
NIOSH CLI captures frequency and magnitude.
Although duration is involved in the calculation of
the frequency multiplier, the duration is related to
physiological concerns rather than established rela-
tionships between duration of exposure and injury
outcomes. Furthermore, the NIOSH CLI is not
suited to exposure patterns with varying durations
of di!erent exposures (e.g., a worker performs one
set of tasks for two hours, and another set of tasks
for the remainder of the shift).
Looking to other areas of occupational epidemi-
ology may provide insight and suggestions for how
we choose to aggregate stresses in the future. For
example, Checkoway and Rice's (Checkoway and
Rice, 1992) discussion of averages and peaks may
be relevant. The role of di!erent exposure measures
depends on whether chronic or acute outcomes are
being investigated. With regard to low-back dis-
orders, there is still considerable question concern-
ing whether or not the disorders are the result of
cumulative exposures (average or integrated values)
or discrete exposures (peak values).
It should be noted that the di!erent aggregation
methods have varying applicability to di!erent cri-
teria. For example, most biomechanical criteria can
be measured at discrete points or continuously
throughout performance of a repetition of a task.
Thus, spinal compression, for example, could be
integrated within and across tasks. Psychophysical
criteria, on the other hand, have only one discrete
value for each task repetition; thus, integration is
only applicable across tasks. Sampling approaches
are more suited to sampling discrete criterion
values, and peak values are always discrete
measures; thus, these methods can be used with
most types of criteria.
Physiological criteria deserve special mention.
Since physiological criteria are applicable to tasks
performed continuously for some period of time,
they are rarely applicable to complex exposures
when the criterion is calculated from task para-
meters rather than directly measured. Continuous-
ly recorded heart rate or oxygen consumption is
amenable to any of the aggregation methods,
412 P.G. Dempsey / International Journal of Industrial Ergonomics 24 (1999) 405}416
whereas physiological criteria based on task
parameters have restricted use. The duration of
the exposure must be su$cient for the workers to
have reached physiological steady state, or the
values estimated from task parameters will be
biased by the preceding MMH tasks or other
physical activities.
4.7. Aggregating multiple types of MMH tasks
One issue that has not been discussed so far is
methodologies for aggregating exposure to di!er-
ent types of MMH tasks. It is quite common for
jobs to require more than one type of MMH task
(lift, lower, push, pull, carry and hold). In order to
provide an assessment of an individual's exposure
using MMH criteria, a common criterion would
have to be used. In e!ect, an internal or external
measure of exposure that can be calculated for all
types of MMH tasks would have to be used.
There are several types of criteria that can be
used as a common metric across di!erent types of
MMH tasks. Spinal compression can be computed
for each type of MMH task, as can the percentage
of the population accommodated with respect to
psychophysical values. A biomechanical criterion
would result in tremendous costs for exposure as-
sessments unless the exposures were very simple.
Physiological criteria can also be used, but energy
expenditure measured at the workplace would be
a re#ection of the combined energy demands of all
tasks performed. Indirect methods of estimating
energy consumption, such as linear regression
models, may be based on predictions of consump-
tion associated with the individual tasks performed.
5. Discussion
The discussions thus far have presented a fairly
broad overview of the issues involved with using
MMH criteria for exposure assessments. In reality,
the problems are probably more complex than this
paper conveys. Certainly, what is easily measured
and quanti"ed in the laboratory is usually not as
easy in the workplace. As we look forward, a focus
of our e!orts should certainly be to have a clear and
established link between empirical laboratory re-
search, theoretical bases of MMH criteria, actual
MMH exposures in the workplace, and considera-
tion of how usable practitioners will "nd an analy-
sis technique or MMH guideline.
Issues of variability call into question the use of
MMH criteria that require exacting measurements
of MMH task parameters. Certainly, applied "eld
research can provide a better understanding of how
to deal with such variability. This can be viewed as
a "rst step, followed by addressing the issues dis-
cussed in more detail below.
5.1. Analyzing multiple-task MMH jobs with
available techniques
Although most manual handling exposures are
far more complex than performance of a single
MMH task, methodologies for analyzing multiple-
task MMH jobs are limited to very few options.
The methods available for analyzing multiple-
task exposures using biomechanical, physiological
and psychophysical methods have been sum-
marized in considerable detail by Straker et al.
(1996, 1997a, b). The literature reviews presented
clearly indicate that there is a paucity of techniques
for analyzing multiple-task MMH exposures.
Most approaches to MMH task analysis focus
on speci"c types of MMH tasks such as lifting
(Cha$n and Park, 1973; Dempsey and Ayoub,
1996; Liles et al., 1984; Marras et al., 1993; Waters
et al., 1993), although a few are appropriate
for analyzing a broader spectrum of MMH
tasks (Mital et al., 1997; Snook and Ciriello,
1991).
The results of the empirical study reported by
Straker and his colleagues (Straker et al.,
1996, 1997a, b) indicate that using single task
methods to assess multiple task exposures will
yield, on average, 15}20% errors. This is the most
comprehensive empirical study of analyzing combi-
nation MMH tasks. Other studies summarized by
Straker et al. (1996, 1997a, b) have shown even
larger errors. Clearly, there is a need for future
empirical work as well as "eld studies aimed at
better understanding realistic exposure patterns
so that appropriate task analysis methods can be
developed.
P.G. Dempsey / International Journal of Industrial Ergonomics 24 (1999) 405}416 413
5.2. Are we analyzing complex MMH exposures in
the proper manner?
In practice, it is common to analyze multiple-
task MMH jobs using techniques that assess indi-
vidual tasks. Either implicitly or explicitly, it is
often assumed that satisfying MMH design criteria
will also reduce the injury propensity of a given
task design. Unfortunately, the validity of this as-
sumption has not been demonstrated.
Given the complexity of the relationships be-
tween MMH exposures and low-back disorders, it
is time to question whether or not current task-
based MMH criteria can adequately re#ect the
associated risk. At least in the United States, there
has been a tendency to focus both "eld (Cha$n and
Park, 1973; Liles et al., 1984; Marras et al., 1993)
and laboratory studies (Dempsey and Ayoub, 1996;
Garg et al., 1978; Snook and Ciriello, 1991) on
assessing MMH exposures at the task level. The
di$culties encountered when attempting to per-
form complete exposure assessments of complex
exposure patterns hampers validation e!orts, as
well as compliance assessments.
It is possible that MMH criteria hamper the
exploration of broader job-focused approaches to
the control of work-related low-back disorders. As
manufacturing processes become more #exible, de-
mand changes more frequently in response to inter-
national markets, and jobs in the service industries
expand, the exposures at the workplace may in-
crease in a concomitant manner. This may require
approaches capable of adequately expressing the
load workers undergo performing their job.
Broader analysis measures that also incorporate
low-back stressors, such as static e!ort and pos-
tural loading, present in non-MMH activities may
be necessary.
One method of dealing with the shortcomings
associated with the current state of MMH criteria
is to focus on how and when the criteria are most
useful. In the case of pure design, MMH criteria
provide a theoretical framework from which design
decisions can be guided. In a sense, task and work-
place parameters can be thought of as more deter-
ministic variables which can be controlled at the
present state of knowledge. However, the variabil-
ity of human responses to the "nal design selected
should always be a concern at this stage. Even the
present MMH criteria should be used in the design
process to allow the `besta trade-o!s to be made
among the various parameters.
Analysis of tasks with respect to human limita-
tions and task demands naturally may utilize
MMH criteria. For example, if one uses a limiting
subsystems (Sinclair and Drury, 1979) approach to
task analysis, the limiting subsystem (e.g., bio-
mechanical, metabolic) will likely have a corre-
sponding approach to MMH (e.g., biomechanics,
physiology). Thus, it is possible to e!ectively use
MMH criteria for analyzing tasks (compliance as-
sessments). However, prediction of acute bio-
mechanical and physiological responses including
injury or illness outcomes (risk assessments) has not
been validated, particularly when exposures are
complex.
In order to perform such risk assessments of
MMH exposures, research will be needed to provide
required dose}response relationships, an under-
standing of the e!ect of measurement variability,
and the de"nition of suitable aggregation methods
for realistically complex exposures. Until then,
MMH criteria should be viewed as design and task
analysis tools, and not as risk assessments tools.
The author does not wish to imply that MMH
criteria are not useful. The primary concern is how
the criteria are used. MMH criteria are useful de-
sign and task analysis tools that have been applied
e!ectively for many years to encourage the reduc-
tion of task demands through engineering controls.
However, it is important to note that MMH cri-
teria applied at the task level do not necessarily
equate with the injury propensity of a job com-
prising complex MMH exposures.
6. Conclusions
Based upon the discussions presented, the fol-
lowing conclusions are drawn:
(1) There is a need for basic and applied re-
search to enhance the methodologies for aggregat-
ing multiple-component MMH tasks with MMH
criteria. In particular, research is needed to de"ne
which methods of aggregation provide the best
assessment of exposure to complex jobs involving
414 P.G. Dempsey / International Journal of Industrial Ergonomics 24 (1999) 405}416
MMH. This will require an interactive approach
incorporating both "eld and laboratory research,
and will bene"t compliance and risk assessments.
(2) The role of MMH criteria in the prevention
of low-back disorders when MMH exposures are
complex is unclear, leading to the inability to per-
form risk assessments. Unfortunately, few MMH
exposures are as simple as methods available to
analyze them. Research is needed to address
whether or not a criteria-based approach to assess-
ment is adequate. Of course, this issue must be
addressed either simultaneous to or subsequent to
the "rst issue.
(3) The numerous sources of variability in
the workplace call for operational de"nitions of
parameter measurement techniques and methods
for analyzing multiple-task exposures when ap-
plying MMH criteria. This will increase the consist-
ency with which compliance assessments are
performed. An attempt to apply the NIOSH lifting
equation or a biomechanical model to a palletizing
operation will quickly show the importance of this
issue. Given the geometrical diversity of items
on a pallet, deciding which pallet location to ana-
lyze can be rather confusing. Laboratory and "eld
studies will be needed to assess the reliability and
validity of di!erent measurement and assessment
techniques.
(4) Due to the absence of dose}response rela-
tionships in the literature, MMH criteria should be
viewed as design and task analysis tools (i.e., com-
pliance assessment), and not as risk assessments
tools.
Acknowledgements
The author would like to thank Alex Burdorf,
Peter Hancock, and Fadi Fathallah for their exten-
sive comments on earlier drafts of this manuscript.
References
Andersson, G.B.J., 1992. Factors important in the genesis
and prevention of occupational back pain and disability.
Journal of Manipulative and Physiological Therapeutics 15,
43}46.
Ayoub, M.M., Dempsey, P.G., 1999. The psychophysical
approach to manual materials handling task design. Ergo-
nomics 42, 17}31.
Ayoub, M.M., Dempsey, P.G., Karwowski, W., 1997. Manual
materials handling. In: Salvendy, G. (Ed.) Handbook of
Human Factors and Ergonomics, Second ed. Wiley, New
York, pp. 1085}1123.
Ayoub, M.M., Mital, A., 1989. In: Manual Materials Handling.
Taylor and Francis, London.
Burdorf, A., 1995. Reducing random measurement error in as-
sessing postural load on the back in epidemiologic surveys.
Scandinavian Journal of Work and Environmental Health
21, 15}23.
Cha$n, D.B., Page, G.B., 1994. Postural e!ects on biomechani-
cal and psychophysical weight-lifting limits. Ergonomics 37,
663}676.
Cha$n, D.B., Park, K.S., 1973. A longitudinal study of low back
pain as associated with occupational lifting factors. Ameri-
can Industrial Hygiene Association Journal 34, 513}525.
Checkoway, H., Rice, C.H., 1992. Time-weighted averages,
peaks, and other indices of exposure in occupational epi-
demiology. American Journal of Industrial Medicine 21,
25}33.
Claycamp, H.G., 1996. Industrial health risk assessment: indus-
trial hygiene for technology transition. American Industrial
Hygiene Association Journal 57, 423}435.
Dempsey, P.G., 1998. A critical review of biomechanical, epi-
demiological, physiological and psychophysical criteria for
designing manual materials handling tasks. Ergonomics 41
(1), 73}88.
Dempsey, P.G., Ayoub, M.M., 1996. The role of power in predic-
ting lifting capacity. Proceedings of the Human Factors and
Ergonomics Society Fortieth Annual Meeting, Human Fac-
tors and Ergonomics Society, Santa Monica, pp. 609}613.
Dempsey, P.G., Burdorf, A., Webster, B.S., 1997. The in#uence
of personal variables on work-related low-back disorders
and implications for future research. Journal of Occupa-
tional and Environmental Medicine 39, 748}759.
Dempsey, P.G., Hashemi, L., 1999. Analysis of workers' com-
pensation claims associated with manual materials handling.
Ergonomics 42, 183}195.
Dempsey, P.G., Westfall, P.H., 1997. Developing explicit risk
models for predicting low-back disability: a statistical per-
spective. International Journal of Industrial Ergonomics 19,
483}497.
Garg, A., Cha$n, D.B., Herrin, G.D., 1978. Prediction of meta-
bolic rates for manual handling jobs. American Industrial
Hygiene Association Journal 39, 661}674.
Granata, K.P., Marras, W.S., 1996. An EMG-assisted model of
trunk loading during free-dynamic lifting. Journal of Bi-
omechanics 28, 1309}1317.
JaK ger, M., Luttmann, A., 1997. Assessment of low-back load
during manual materials handling. In: SeppaK laK , P.,
LuopajaK rvi, T., Nyga rd, C., Mattila, M., (Eds.), Proceedings
of the Thirteenth Triennial Congress of the International
Ergonomics Association, vol. 4. Helsinki, Finnish Institute of
Occupational Health, pp. 171}173.
P.G. Dempsey / International Journal of Industrial Ergonomics 24 (1999) 405}416 415
Kant, I., Notermans, J.H.V., Borm, P.J.A., 1990. Observations
of working postures in garages using the Ovako Work-
ing Posture Analysing System (OWAS) and consequent
workload reduction recommendations. Ergonomics 33,
209}220.
Karhu, O., HaK rkoK nen, R., Sorvali, P., VepsaK laK inen, P., 1981.
Observing working postures in industry: Examples of
OWAS application. Applied Ergonomics 12, 13}17.
Karhu, O., Kansi, P., Kuorinka, I., 1977. Correcting working
postures in industry: a practical method for analysis. Applied
Ergonomics 8, 199}201.
Kivi, P., Mattila, M., 1991. Analysis and improvement of
work postures in the building industry: application of the
computerized OWAS method. Applied Ergonomics 22,
43}48.
Kilbom, As ., 1994. Assessment of physical exposure in relation
to work-related musculoskeletal disorders } what informa-
tion can be obtained from systematic observations?. Scandi-
navian Journal of Work and Environmental Health 20,
30}45.
Kumar, S., 1990. Cumulative load as a risk factor for back pain.
Spine 15, 1311}1316.
Leamon, T.B., 1994. Research to reality: a critical review of the
validity of various criteria for the prevention of occupation-
ally induced low back pain. Ergonomics 37, 1959}1974.
Liles, D.H., Deivanayagam, S., Ayoub, M.M., Mahajan, P., 1984.
A job severity index for the evaluation and control of lifting
injury. Human Factors 26, 683}693.
Marras, W.S., Lavender, S.A., Leurgans, S.E., Fathallah, F.A.,
Ferguson, S.A., Allread, W.G., Rajulu, S.L., 1993. Bi-
omechanical risk factors for occupationally related low back
disorders. Ergonomics 38, 377}410.
McGill, S.M., Norman, R.W., 1986. Predicting the L4/L5 dy-
namic moment into disc, ligamentous, and muscular compo-
nents during lifting. Spine 11, 666}678.
Mital, A., Nicholson, A.S., Ayoub, M.M., 1997. In: A Guide to
Manual Materials Handling, Second ed. Taylor and Francis,
London.
National Research Council, 1983. Risk Assessment in the Feder-
al Government: Managing the Process. National Academy
Press, Washington, D.C.
NIOSH, 1981. Work Practices Guide for Manual Lifting,
DHHS(NIOSH) Pub. No. 81}122. U.S. Department of
Health and Human Services, Cincinnati, OH.
Rothman, K.J., 1986. Modern Epidemiology. Little, Brown
and Company, Boston.
Sinclair, M.A., Drury, C.G., 1979. On mathematical modelling in
ergonomics. Applied Ergonomics 10 (4), 225}234.
Snook, S.H., 1978. The design of manual handling tasks. Ergo-
nomics 21, 963}985.
Snook, S.H., Campanelli, R.A., Hart, J.W., 1978. A study of three
preventive approaches to low back injury. Journal of Occu-
pational Medicine 20, 478}481.
Snook, S.H., Ciriello, V.M., 1991. The design of manual handling
tasks: revised tables of maximum acceptable weights and
forces. Ergonomics 34, 1197}1213.
Straker, L.M., Stevenson, M.G., Twomey, L.T., 1996. A com-
parison of risk assessment of single and combination manual
handling tasks: 1. Maximum acceptable weight measures.
Ergonomics 39, 128}140.
Straker, L.M., Stevenson, M.G., Twomey, L.T., 1997a. A com-
parison of risk assessment of single and combination manual
handling tasks: 2. Discomfort, rating of perceived exertion
and heart rate measures. Ergonomics 40, 656}669.
Straker, L.M., Stevenson, M.G., Twomey, L.T., Smith, L.M.,
1997b. A comparison of risk assessment of single and combi-
nation manual handling tasks: 3. Biomechanical measures.
Ergonomics 40, 708}728.
van der Beek, A.J., Kuiper, J.I., Dawson, M., Burdorf, A., Bon-
gers, P.M., Frings-Dresen, M.H.W., 1995. Sources of vari-
ance in exposure to nonneutral trunk postures in varying
work situations. Scandinavian Journal of Work and Envir-
onmental Health 21, 215}222.
Waters, T.R., Putz-Anderson, V., Garg, A., Fine, L.J., 1993.
Revised NIOSH equation for the design and evaluation of
manual lifting tasks. Ergonomics 36 (7), 749}776.
Waters, T.R., Putz-Anderson, V., Garg, A., 1994. Applications
Manual for the Revised NIOSH Lifting Equation.
DHHS(NIOSH), Cincinnati, OH.
Winkel, J., Mathiassen, E., 1994. Assessment of physical work
load in epidemiologic studies: concepts, issues and opera-
tional considerations. Ergonomics 37, 979}988.
416 P.G. Dempsey / International Journal of Industrial Ergonomics 24 (1999) 405}416