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2019, Evaluation of Ergonomic Working Conditions Among Standing Sewing Workstation in Sri Lanka
2019, Evaluation of Ergonomic Working Conditions Among Standing Sewing Workstation in Sri Lanka
Keywords: Background: Standing Sewing Machine Operators (SSMOs) are engaged in highly repetitive operations, and work
Musculoskeletal disorders while standing during their entire working hours. This leads to discomforts and Musculoskeletal Disorders
Standing sewing machine operation (MSDs). However, there is a dearth of research in SSMOs’ working conditions.
Prolonged standing Objective: Aim of the study is to evaluate the prevalence of MSDs and related ergonomic risk factors among
REBA
SSMOs in the Sri Lankan textile industry.
Textile industry
Methods: The sample included 552 female sewing machine operators. Data were collected through self-re-
ported questionnaires which included demographic, job-related factors and Cornell Musculoskeletal Discomfort
Questionnaire [CMDQ], along with the application of validated ergonomic tools (Rapid Entire Body Assessment
[REBA] and Strain Index [SI]) to assess the ergonomic risks amongst them. The inter-rater reliability test ensured
the reliability among observers. An individual regression model was developed for each body parts to assess the
associated risk factors.
Results: The highest occurrence of musculoskeletal symptoms were in knee, foot, thigh, lower leg and lower
back of SSMOs. REBA grand score (4–11) indicated that workers’ postures were at medium, high and very high
risk levels necessitating evaluation to change. Moreover, SI indicated medium and high risk of upper extremity
disorders. Finally, regression models revealed associated risk factors with musculoskeletal symptoms among
various body parts including age, Body Mass Index (BMI), marital status, SSMO experience, job satisfaction, job
stress, daily walking distance to the boarding place/factory, interest in job rotation and satisfaction with the
design of sewing machine.
Conclusion: The findings highlighted that the prevalence of discomfort and MSDs in the lower limbs were
higher than in the upper limbs among SSMOs. The findings revealed the working conditions of SSMO and
emphasised the need for ergonomic interventions to minimise the MSDs among them.
Relevance to industry: The findings highlighted ergonomic risks among SSMOs and associated risk factors which
will help managers and researchers better understand the working conditions of SSMOs. The identified risk
factors could be considered during the implementation of standing sewing operation layouts and during the
selection and allocation of new employees.
∗
Corresponding author.
E-mail addresses: sakthiamie@gmail.com (T. Sakthi Nagaraj), jeyapaul@nitt.edu (R. Jeyapaul), madii1984@yahoo.com (K. Mathiyazhagan).
https://doi.org/10.1016/j.ergon.2019.01.006
Received 1 October 2018; Received in revised form 12 December 2018; Accepted 19 January 2019
0169-8141/ © 2019 Elsevier B.V. All rights reserved.
T. Sakthi Nagaraj et al. International Journal of Industrial Ergonomics 70 (2019) 70–83
(Jackson and Mullarkey, 2000). Though positive effects like enhanced break. A sample of 552 sewing machine operators was selected based
productivity, performance and quality are evident in cellular manu- on their working experience, past and present medical records, and
facturing; on the other hand, increase in ergonomic risk and MSD was willingness to participate in the survey. Participants were volunteers
found among operators (Jonker et al., 2011; Nagaraj and Jeyapaul, and were not paid for their contributions. A 3-h training program was
2018). MSDs are common health issues not only in the textile industry conducted for 36 Industrial Engineering (IE) officers and two IE ex-
but also in various sectors globally (Dantas and de Lima, 2015; Dianat ecutives to familiarise them about the survey methods. Each participant
et al., 2015; Dianat and Salimi, 2014; Kumar et al., 2016), that sig- was instructed about the study, and their doubts were cleared by the IE
nificantly affect workers performance and their quality of life (Buckle officers and executives. Data collection was undertaken in two phases,
and Jason Devereux, 2002; Kogi et al., 2003). Generally, sewing ma- one, was self-reported study included combined survey sheet of de-
chine operators experienced high MSD prevalence due to poor work mographic, job-related characteristics and CMDQ, and the other was
posture throughout the working duration and highly repetitive arm/ direct observation, including REBA and SI survey sheet, of operators
hand motions (Dianat et al., 2015; Öztürk and Esin, 2011). Typically, a during their work by IE officers.
sewing machinist assembles cut panels to make a full garment. As-
sembling includes highly repetitive actions of both hands while leaning
2.2. Data collection
forward (inclined trunk and neck) for better concentration and better
visual control. In addition, operators also perform tasks like handling
2.2.1. Self-reported study
cut panel bundles, threading, winding bobbins, adjusting thread tension
A combined survey sheet was developed to record demographic,
and cleaning the machine. This leads to MSD symptoms in the back,
job-related characteristics and CMDQ questionnaires. The demo-
neck and upper limb (Dianat et al., 2015; Öztürk and Esin, 2011;
graphics included the age, weight, height, BMI (weight/heigh2), marital
Delleman and Dul, 2002; Lombardo et al., 2012). Moreover, working in
status (married or single), education level (primary school, secondary
prolonged standing has been recognised as an occupational risk
school, diploma) and daily walking distance to the factory/boarding
(Balasubramanian et al., 2009; Gallagher et al., 2014; Halim and Omar,
point (Below 1 km, 1–2 km, 2–3 km). Many questions were based on job
2012), and has been associated with discomfort and MSDs of the lower
and a few on lean practices. An excerpt of the questions is shown: ex-
back (Coenen et al., 2017; Gallagher et al., 2014; Marshall et al., 2011;
perience as a standing sewing machine operator?, satisfaction with the
Mendelek et al., 2011) and lower limbs (Antle and Côté, 2013; Coenen
job: “At what level are you happy with the job? (low, medium, high)”,
et al., 2017; Fewster et al., 2017; Halim and Omar, 2012).
perceived stress due to work: “Do you feel that your job is affecting your
Explicit knowledge of musculoskeletal symptoms and related vari-
physical and emotional wellbeing negatively? (yes/no)”, perceived
ables have the potential to impact on an organisation's performance and
speed of tasks: “Do you feel that your job forces you to work very fast?
workers' quality of life. At present, the studies to understand prevalence
(yes/no)”, perceived workload: “Do you feel that you are always en-
of MSDs and related risk factors among Sri Lankan sewing machine
gaged in your work? (yes/no)”, perceived physical porosity in between
operators in sitting posture (For example, Abeysekera and Illankoon,
work: “Do you relax in-between work? (yes/no)”, perceived job rota-
2016; Attanapola, 2003; Lombardo et al., 2012; Sealetsa and Thatcher,
tion at work: “Are you interested in job rotation?” and regarding
2011) and standing posture (Nagaraj and Jeyapaul, 2018) are limited.
workstation design: “How much are you satisfied with the design of the
In the Nagaraj and Jeyapaul (2018) study, there is a lack of statistical
standing sewing machine? (low, moderate, high)”.
analysis to reveal associations between self-reported symptoms and
The frequency, severity and interference with work of MSDs were
corresponding variables. Hence, there is a dearth of information about
gathered by a CMDQ (Cornell University Ergonomics Web, 2003)
MSDs prevalence and the associated risk factors for SSMOs. To fill this
survey sheet modified with the addition of a row to obtain discomfort in
research gap, this study aims to examine the working conditions of
the head region. The CMDQ has three sections (frequencies, severity
standing sewing machine operators in cellular manufacturing and
and interference) and rating (R) for each section in different scales as
findings help to identify potential suggestions for ergonomic interven-
shown in Table 1 (According to scoring guidelines of Cornell Muscu-
tions for SSMOs. To achieve this the following objectives were.
loskeletal and Hand Discomfort Questionnaires). The score of frequency
(F), severity (S) and interference (I) sections were calculated by the
• To evaluate the occurrence of MSDs among SSMOs using the Cornell equation (1)
Musculoskeletal Discomfort Questionnaire,
• To evaluate ergonomic risk factors using the REBA and SI, r
• To examine the relationship between MSDs and demographic fac- F (or) S (or) I =
i=1
ni Ri
(1)
tors, job-related characteristics, REBA scores, and SI risk levels.
Where ni is the total number of workers with specific symptoms, and
2. Research methodology Ri is the rating of corresponding symptoms. Multiplying of the fre-
quency, severity and interference scores resulted in the overall dis-
2.1. Study design and methods comfort score of a worker's specific body part.
The combined survey sheet in English was translated into Tamil and
The study was conducted over a six-month period between February Sinhala. The translation was done by an expert committee including a
and July 2017 in a garment manufacturing unit located in the Uva researcher (first author), two translators (Tamil and Sinhala) and three
Province of Sri Lanka. Around 1008 female sewing machine operators industrial engineers. The translated combined survey sheet was vali-
were working in two shifts, and a shift was for 8 h including a half hour dated through face validation method by two academicians and two
Table 1
Rating (R) for frequency, severity and interference in different scales.
Frequency Severity Interference
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T. Sakthi Nagaraj et al. International Journal of Industrial Ergonomics 70 (2019) 70–83
industrial engineers. It was also verified through a pilot study with 25 six task variables, the SI score is calculated and indicates the risk level
workers. The test-retest reliability of questionnaires was assessed with of the job (Moore and Garg, 1995). The SI score and corresponding risk
Kappa coefficients (0.80–0.91) representing good reliability of the levels of job are shown in Fig. 2.
questionnaires. Trained IE officers observed the working postures and scoring of the
The self-reported study was conducted at the end of the shift on the SI task variables. Each operator was observed for 15 min by an IE officer
last working day of week. The participants were asked to specify ex- to select the most occurrence and static work posture to conduct REBA
perienced discomfort and pain or ache in the last week in different parts and to score SI task variables. A separate REBA sheet and SI scoring
of body. Moreover, the severity of the discomfort and interference with sheet were used for each operator.
the work were recorded through the CMDQ sheet for the corresponding
body parts. This study was extended for 1 h, and participants were as- 2.2.3. Reliability test
sisted by IE officers to fill the survey sheet. As the IE officers were familiar with English, the original version of
REBA and SI scoring sheets were used to conduct the study. The eval-
2.2.2. Direct observational method uated inter-rater reliability test (Krippendorff's alpha α = 0.81–0.89)
The direct observational method was used to record the REBA (Hayes and Krippendorff, 2007) for both REBA and SI scoring indicated
(Hignett and McAtamney, 2000) sheet and strain index (Moore and better reliability among IE officers. Moreover, the Chi-square test was
Garg, 1995) scoring sheet for each individual separately by the IE of- conducted and confirmed that REBA and SI score were significantly
ficers. REBA was used to examine the standing work posture of sewing associated with discomforts in the corresponding body parts and pro-
machine operators at their workstations, and the most engaging sewing vided a good indication of the MSDs (Dianat et al., 2015; Öztürk and
work posture was selected for analysis. REBA is a reliable (inter-rater Esin, 2011).
reliability = 62–85%) and validated observational tool to assess pos-
tural and biomechanical loading on musculoskeletal systems which 2.3. Data analysis
contributes to MSDs and was applied to various tasks (Hignett and
McAtamney, 2000) similar to the standing sewing machine operations. Data analysis was performed by SPSS software version 25.0.
In this method, critical work posture was selected based on more static, Demographic and job-related factors of sewing machine operators were
perceived severity and frequency of occurrence. The posture of different reported in frequency, mean, standard deviation (SD), ranges and
body part was observed to calculate overall REBA Grand Score which percentages. The frequency and severity of discomfort and its inter-
indicated the risk level of the posture and one of the action level to ference with work in the last week of the sewing machine operators
consider. REBA score was represented under three classifications as were presented in frequency and percentage. The overall discomfort
“Group A” (neck, trunk and leg), “Group B” (wrist, lower arms and score was calculated for the corresponding part of the body. The as-
upper arm) and the combined REBA “Grand Score”. The risk levels and sociations between study variables (demographic and job-related fac-
suggestions of working postures are shown in Fig. 1. tors) and prevalence of musculoskeletal symptoms (frequency of dis-
As sewing task includes highly repetitive actions and hand intensive comfort in last one week from CMDQ) was evaluated through
tasks, a separate strain index scoring sheet (The Ergonomics Center of univariate ordinal logistic regression analysis (Denham, 2017). Multi-
North Carolina, 2013) was used to observe the risk level of tasks which variate ordinal logistic regression analysis was also conducted to eval-
lead to the distal upper extremity (DUE) musculoskeletal disorders. The uate the relationship between musculoskeletal symptoms and in-
SI is a job analysis tool to identify the risk of DUE musculoskeletal dependent variables for each body part (Dianat et al., 2015). Separate
disorders. DUE includes hand, wrist, forearm and elbow. SI considers regression models were developed for each part of the body. The in-
six task variables such as duration of the task per day, efforts per dependent variables comprised the demographic factors (BMI, age,
minute, posture of the hand, intensity and duration of the exertion, and educational level, marital status and daily walking distance to factory/
speed of the work to describe external demand for a job. Based on these boarding point), job-related factors (job satisfaction, SSMO experience
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T. Sakthi Nagaraj et al. International Journal of Industrial Ergonomics 70 (2019) 70–83
in years, job stress, perceived speed of work, workload, physical por- Table 3
osity, interest in job rotation and satisfaction with the design of Job-related variables of standing sewing operators.
standing sewing machines) and three REBA scores as well as strain Variables (n = 552) n (%)
index of job. The odds ratios (ORs), p-value and 95% confidence in-
tervals (CIs) were calculated from the ordinal logistic regression Job Satisfaction
models. The statistically significant level, p < 0.05 was considered for Low 158 (28.6)
Moderate 252 (45.7)
all statistical tests.
High 142 (25.7)
Job Stress
3. Results Low 169 (30.6)
Moderate 252 (45.7)
High 131 (23.7)
3.1. Demographic and job-related factors
Working very fast
Yes 474 (85.9)
The demographic and job-related factors of the participants are No 78 (14.1)
represented in Table 2 and Table 3, respectively. Participants’ ages Workload- Always engaged with work
Yes 508 (92.0)
ranged from 18 to 36 years (mean = 25.04; SD = 3.8), with around
No 44 (8.0)
55% participants being educated to the primary school level. Around Physical porosity- relaxing in-between work
80% participants were married and had an average BMI of 21.3 kg/m2 Yes 37 (6.7)
(range = 15.6–30.6 kg/m2; SD = 2.7). Most participants (68%) walked No 515 (93.3)
1 km or less to reach the factory/boarding place, whereas, a few (18%) Interest in job rotation
Yes 401 (72.6)
participants walked two-three kilometres. Only 26% of workers were
No 151 (27.4)
Satisfy with the design of standing sewing machine
Low 120 (21.7)
Table 2 Moderate 250 (45.3)
Demographic variables of standing sewing operators. High 182 (33.0)
Variables (n = 552)
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T. Sakthi Nagaraj et al. International Journal of Industrial Ergonomics 70 (2019) 70–83
Table 4
Percentage of operators with REBA score for corresponding body parts.
Score Neck Trunk Leg Upper Arm Lower Arm Wrist Score A Score B Grand Score
3 (61.2%), as most operators stood on one leg with the other at a 30° - body parts that should be considered for ergonomic interventions. It
60° angle. Most lower arm (57.1%) and wrist (52%) score for operators was observed that most operators experienced greater discomfort in the
were 1, indicated that the lower arm was at a 60° - 100° angle while that lower limbs. Among the lower limbs, the foot (left-13.9%, right-10.7%)
of the wrist was at a ± 15° angle. According to the REBA grand score and knee (left-10.3%, right-6.3%) were more critical than the thigh
(4–7), almost all operators (91.5%) were at medium risk based on their (left-4.6%, right-6.8%) and lower leg (left-6.8%, right-4.8%). It was
working posture. Hence, further investigations were needed to change observed that the left lower body parts suffered more than the right
in their working postures. The typical working posture of SSMO is il- except the thigh. Concerning the upper body parts; lower back (6.2%),
lustrated in Fig. 3. neck (4.2%) and right shoulder (3.6%) were identified as being more
critical than other upper body parts. Body parts on the right suffered
3.3. Risk level of distal upper extremity disorders among the operators more discomfort than the left side including the shoulder (right-
3.6% > left-2.6%), wrist (right-3.0% > left-2.5%), upper arm (right-
Half the participants (52.5%) were at strain index risk level of 3–7 2.9% > left-2.1%) and forearm (right-1.8% > left-1.2%). It was re-
and few (6.5%) at SI ≥ 7, indicated that they faced the risk of distal vealed that the foot was the most critical part (13.9%) and hip/buttocks
upper extremity disorders, the only consolation being that 40.9% op- (0.0%) was the least critical for ergonomic interventions amongst
erators were at a probable safe risk level (SI ≤ 3). SSMOs.
3.4. Musculoskeletal symptoms among operators 3.5. Casual relationship between musculoskeletal symptoms and
independent variables
The first part of Table 5 represents the prevalence of MSDs in the
various body parts of the operators. Around 81% of operators felt dis- The logistic regression models of both univariate and multivariate
comfort at least once a day. The second and third part of Table 5 re- context revealed a significant association between musculoskeletal
presents the severity and interference with work. Most of the operators symptoms and independent variables in different body parts as shown
reported moderate to very uncomfortable (73%) discomfort interfered in Appendices A, B, C and D respectively. Multivariate logistic regres-
with their work (69%), and these were more prevalent in the lower sion models indicated that age, operators BMI, marital status, daily
body. walking distance to factory/boarding point, years of experience as a
Table 6 represents the discomfort score for the corresponding body standing sewing machine operator, satisfaction with job, job stress,
parts of operators. The body parts were ranked, based on overall dis- interest in job rotation and satisfaction with the design of sewing ma-
comfort scores. The overall discomfort score indicated the most critical chines were significantly related to discomforts of different body parts.
74
T. Sakthi Nagaraj et al.
Table 5
Prevalence of MSDs among operators for corresponding body parts.
Body Parts Frequency of discomfort in last week Severity of discomfort Discomfort interfered with work
Never 1-2 times 3-4 times Once every day Several times every Slightly Moderately Very Uncomfortable Not at all Slightly Substantially
day Uncomfortable Uncomfortable Interfered interfered
Head 110 (19.9) 70 (12.7) 146 (26.4) 173 (31.3) 53 (9.6) 172 (38.9) 194 (43.9) 76 (17.2) 152 (34.4) 156 (35.3) 134 (30.3)
Neck 101 (18.3) 102 (18.5) 112 (20.3) 120 (21.7) 117 (21.2) 102 (22.6) 156 (34.6) 193 (42.8) 104 (23.1) 178 (39.5) 169 (37.5)
Shoulder Left 104 (18.8) 89 (16.1) 122 (22.1) 124 (22.5) 113 (20.5) 212 (47.3) 182 (40.6) 54 (12.1) 182 (40.6) 174 (38.8) 92 (20.5)
Right 96 (17.4) 70 (12.7) 129 (23.4) 130 (23.6) 127 (23.0) 139 (30.5) 192 (42.1) 125 (27.4) 166 (36.4) 169 (37.1) 121 (26.5)
Upper Back 126 (22.8) 77 (13.9) 116 (21.0) 126 (22.8) 107 (19.4) 198 (46.5) 145 (34.0) 83 (19.5) 216 (50.7) 131 (30.8) 79 (18.5)
Upper Arm Left 124 (22.5) 92 (16.7) 135 (24.5) 112 (20.3) 89 (16.1) 196 (45.8) 161 (37.6) 71 (16.6) 191 (44.6) 154 (44.6) 83 (19.4)
Right 106 (19.2) 81 (14.7) 129 (23.4) 129 (23.4) 107 (19.4) 150 (33.6) 189 (42.4) 107 (24.0) 180 (40.4) 175 (39.2) 91 (20.4)
75
Lower Back 72 (13.0) 56 (10.1) 117 (21.2) 143 (25.9) 164 (29.7) 78 (16.3) 156 (32.5) 246 (51.3) 98 (20.4) 214 (44.6) 168 (35.0)
Forearm Left 162 (29.3) 136 (24.6) 149 (27.0) 55 (10.0) 50 (9.1) 189 (48.5) 171 (43.8) 30 (7.7) 167 (42.8) 138 (35.4) 85 (21.8)
Right 137 (24.8) 128 (23.2) 142 (25.7) 76 (13.8) 69 (12.5) 160 (38.6) 190 (45.8) 65 (15.7) 164 (39.5) 164 (39.5) 87 (21.0)
Wrist Left 126 (22.8) 129 (23.4) 148 (26.8) 73 (13.2) 76 (13.8) 161 (37.8) 156 (36.6) 109 (25.6) 117 (27.5) 146 (34.3) 163 (38.3)
Right 116 (21.0) 119 (21.6) 136 (24.6) 93 (16.8) 88 (15.9) 149 (34.2) 169 (38.8) 118 (27.1) 101 (23.2) 157 (36.0) 178 (40.8)
Hip/Buttocks 392 (71.0) 114 (20.7) 39 (7.1) 5 (0.9) 2 (0.4) 126 (78.8) 29 (18.1) 5 (3.1) 155 (96.9) 5 (0.0) 0 (0.0)
Thigh Left 92 (16.7) 76 (13.8) 116 (21.0) 139 (25.2) 129 (23.4) 63 (13.7) 168 (36.5) 229 (49.8) 156 (33.9) 178 (38.7) 126 (27.4)
Right 61 (11.1) 36 (6.5) 113 (20.5) 176 (31.9) 166 (30.1) 49 (10.0) 178 (36.3) 264 (53.8) 131 (26.7) 197 (40.1) 163 (33.2)
Knee Left 29 (5.3) 29 (5.3) 96 (17.4) 172 (31.2) 226 (40.9) 52 (9.9) 176 (33.7) 295 (56.4) 58 (11.1) 168 (32.1.) 297 (56.8)
Right 76 (13.8) 55 (10.0) 126 (22.8) 159 (28.8) 136 (24.6) 73 (15.3) 157 (33.0) 246 (51.7) 67 (14.1) 179 (37.6) 230 (48.3)
Lower Leg Left 51 (9.2) 68 (12.3) 91 (16.5) 130 (23.6) 212 (38.4) 101 (20.2) 129 (25.7) 271 (54.1) 181 (36.1) 172 (34.3) 148 (29.5)
Right 79 (14.3) 106 (19.2) 96 (17.4) 132 (23.9) 139 (25.2) 104 (22.0) 116 (24.5) 253 (53.5) 163 (34.5) 189 (40.0) 121 (25.6)
Foot Left 12 (2.2) 28 (5.1) 69 (12.5) 108 (19.6) 335 (60.7) 32 (5.9) 191 (35.4) 317 (58.7) 61 (11.3) 207 (38.3) 272 (50.4)
Right 28 (5.1) 46 (8.3) 84 (15.2) 98 (17.8) 296 (53.6) 58 (11.1) 182 (34.7) 284 (54.2) 107 (20.4) 189 (36.1) 228 (43.5)
Average n (%) 105 (19) 81 (15) 115 (21) 118 (21) 133 (24) 122 (27) 161 (36) 164 (37) 139 (31) 164 (37) 145 (32)
International Journal of Industrial Ergonomics 70 (2019) 70–83
T. Sakthi Nagaraj et al. International Journal of Industrial Ergonomics 70 (2019) 70–83
Table 6
Ranking of different body parts based on a total discomfort score.
Body Parts Frequency Score Severity Score Interference Score Total discomfort Score Total discomfort Score (%) Rank
However, the educational level, perceived speed of work, workload, strain index) and musculoskeletal symptoms among different body
and physical porosity of operators were not associated with any mus- parts. Most variables were associated with the existence of MSD
culoskeletal symptoms. symptoms at least in one body part. Regarding individual risk factors,
age was a significant risk factor for the knee, lower leg and foot
4. Discussions symptoms with an odds ratio (OR) around 1.1 to 1.2. Previous studies
reported that age was significantly related to knee symptoms among
The study's findings helped to understand the working conditions of sitting sewing operators (Dianat and Salimi, 2014; Öztürk and Esin,
SSMO with respect to the MSDs prevalence and related risk factors in 2011; Dianat et al., 2015), whereas the present study reveals that age
the lean environmental textile industry. The occurrence of muscu- was significantly related not only to the knee but also to the lower leg
loskeletal symptoms among SSMO was found to be very high, where and feet among SSMOs. This study also revealed the BMI was positively
highly affected body parts included the knee, foot, thigh, lower back, associated with lower and upper body symptoms (OR = 1.1–1.8) and
lower leg and neck, respectively. The most significant result of the study agreed with similar studies in the literature (Dianat et al., 2015; Gell
was that around 81% of operators felt MSD symptoms at least once or et al., 2011; Kaergaard and Andersen, 2000). In the present study,
twice a week. About 25% of operators experienced such symptoms marital status, daily walking distance to boarding place/factory and
many times a day. Higher discomfort was related to the lower limbs, work experience had a significant relationship with musculoskeletal
whereas among upper body parts, maximum discomfort was in the symptoms in the lower limbs. Married operators had higher symptoms
lower back, which agreed with earlier studies (Capodaglio, 2017; (OR = 2.0–2.2) than unmarried operators due to being involved in
Coenen et al., 2017; Fewster et al., 2017; Tissot et al., 2009; Widanarko household work also. Increase in daily walking distance to the boarding
et al., 2015). Most operators experienced discomfort severity from place/factory developed musculoskeletal symptoms (OR = 1.4–49).
moderate (36%) to very uncomfortable (37%) which interfered with Increased work experience as a SSMO developed musculoskeletal
their work (69%). Higher discomfort was felt in the right of the upper symptoms (OR = 0.6–5.2) in the knee and foot whereas earlier studies
body and left of the lower limbs due to the body being balanced on the reported that neck and shoulder symptoms were associated with work
left leg and most activities being performed by the right hand. experience in sitting posture (Dianat et al., 2015; Öztürk and Esin,
Though there is no similar study for standing sewing operations, the 2011). These findings highlight the necessity for deliberation of in-
present study's findings can rely on earlier studies of MSDs among sit- dividual factors such as the age, BMI, marital status, daily walking
ting sewing machine workers and standing workers of some other tasks. distance to boarding place/factory and work experience in future
The prevalence of musculoskeletal symptoms was high in the upper analysis of MSDs among SSMO.
body among sitting sewing operators (Dianat et al., 2015; Öztürk and The findings revealed that decrease in job satisfaction led to upper
Esin, 2011; Kaergaard and Andersen, 2000). Prolonged standing for limb symptoms (OR = 1.2–9.4), but not in sitting sewing operations
different tasks leads to high MSDs in the lower limbs and lower back but (Dianat et al., 2015; Dianat and Salimi, 2014). Job satisfaction was
not in other upper body parts (Balasubramanian et al., 2009; significantly associated with the time available to complete a task and
Capodaglio, 2017; Coenen et al., 2017). However, the present study pauses (Saurin and Ferreira, 2009). In the present study, workers had
highlighted the high occurrence of musculoskeletal symptoms in both the limited time to complete a task to maintain smooth material flow and to
lower and upper bodies of SSMOs, which agreed with an earlier study cope with other operators whereas sitting sewing operators had enough
(Nagaraj and Jeyapaul, 2018). This was due to the highly repetitive buffer inventory and time for completing tasks and pauses. Increase in
actions of the upper limbs and due to prolonged standing together. stress levels led to musculoskeletal symptoms in the upper limbs and
Multiple logistic regression models indicated a significant relation- foot (OR = 1.5–2.6) among SSMO whereas earlier studies considered
ship between variables (demographics, job characteristics, postures and work pressure and reported that significant relationship with various
76
T. Sakthi Nagaraj et al. International Journal of Industrial Ergonomics 70 (2019) 70–83
body parts of sitting sewing operators (Dianat et al., 2015; Öztürk and every 30 min for joints (ankles and hip) (Lin et al., 2012), and Coenen
Esin, 2011). Work pressure is desirable to complete a task on time et al. (2017) suggested a safe exposure limit of 40 min of uninterrupted
whereas work stress is not. Moreover, work stress leads to headaches, standing to eliminate low back symptoms and recommended provision
unmotivated, tears, aggression, fatigue, irritability and depression for laying down or sitting in the rest area during breaks. Providing anti-
(Michie, 2002). In this study, around 80% operators had headaches fatigue mats was recommended to reduce the discomforts due to pro-
which interfered with 65% of operators’ work and was further evidence longed standing (Coenen et al., 2017). Moreover, Balasubramanian
of the presence of job stress among SSMOs. Operators interested in job et al. (2009) recommended the dynamic standing to reduce the risk of
rotation had lesser symptoms than those who lacked this interest lower extremity disorders.
(OR = 1.1–25). Moreover, decrease in satisfaction with the sewing
machine design developed musculoskeletal symptoms with the 5. Conclusions
OR = 0.5–3.7. No such association was reported among sitting sewing
operators. These findings provide evidence that both physical and The research improves the understanding about the prevalence of
psychological work factors are related to increased risk of MSDs among MSDs and associated ergonomic risk factors which helps for developing
standing sewing machine operators which was in agreement with stu- procedures to ensure improved ergonomic working conditions of
dies among sitting sewing operators (Dianat et al., 2015; Öztürk and SSMOs in the lean environmental textile industry. Since the higher
Esin, 2011). prevalence of MSDs in both upper and lower body parts among SSMOs
Sewing operators working posture was a vital factor related to indicate a necessity for pay more attention to enhance their quality of
musculoskeletal symptoms in a sitting posture (Dianat et al., 2015; life. The higher prevalence of MSDs can be reduced by providing anti-
Öztürk and Esin, 2011). The results of the multiple logistic regression fatigue mats, provision for sitting and laying down in rest area during
revealed that an increase in working posture risk levels significantly breaks, stretching exercises and effective job rotation. Moreover, the
related to increased musculoskeletal symptoms in different body parts study helps managers to consider associated ergonomic risk factors
of SSMOs which was in agreement with other standing operations while implementation of standing sewing operation layouts and selec-
(Capodaglio, 2017). This study's REBA grand score indicated that tion and/or allocation of employees to prevent ergonomics risks. Hence,
91.5% of operators were at medium risk and the remaining at high the study helps to guide MSD prevention efforts for standing sewing
(6.7%) and very high (1.8%) risk levels which highlighted the need to machine operators in Sri Lanka.
evaluate and change operators' work posture to avoid permanent dis- The present study has few limitations, particularly, operators had
orders. only three-year experience in standing sewing machine operations.
The findings of the study revealed that the increase in job strain was Also, limitations related to the reliability and validity of collected data
significantly related to increased upper body symptoms (OR = 1.6–32) could lead to recollection bias (where operators may forget data and
among SSMOs. Around 60% of operators were at increased risk of upper bias among the observer and participants). The data were collected
extremity musculoskeletal disorders due to the high frequency of re- from an industry and the results related to the particular industry which
petitive actions, less porosity and awkward hand posture of standing may differ for other industry. The study can be further extended to
sewing operations. This finding highlights the need for further ergo- consider organisational and environmental (noise, humidity and light)
nomic development to reduce risk of upper extremity disorders and factors as confounders. Further research is needed to investigate the
consideration of SI during ergonomic assessments among SSMOs. significant impacts of anti-fatigue mats among SSMOs’ discomforts.
Some general guidelines provided by literature to reduce discomfort Moreover, an empirical study from various garment industries can also
among standing workers: standing only for 1 h with stretching exercise provide the most reliable significant ergonomic risk factors of SSMOs.
77
Appendix
Appendix A
Univariate and Multivariate logistic regression analyses of factors related with head, neck, upper back and shoulder symptoms
Variables Head symptoms Neck symptoms Upper back symptoms Shoulder left symptoms Shoulder right symptoms
T. Sakthi Nagaraj et al.
Univariate Multivariate Univariate Multivariate Univariate Multivariate Univariate Multivariate Univariate Multivariate
OR (95% CI) OR (95% CI) OR (95% CI) OR (95% CI) OR (95% CI) OR (95% CI) OR (95% CI) OR (95% CI) OR (95% CI) OR (95% CI)
Age
BMI 1.1 (0.05–0.16) 1.1 (0.01–0.13)
Education Primary school ® 1 1
Secondary school 1 (−0.3–0.36) 0.8 (−0.6–1.5)
Diploma 0.6 (-0.9–-0.02) 0.6 (-1.0–-0.1)
Marital Status Unmarried ®
Married
Daily walking distance Below 1 km ®
1–2 km
2–3 km
SMO Experience Below 1 Year ®
1–2 Year
2–3 Year
Job Satisfaction High ® 1 1 1 1 1 1
Moderate 1 (0.08–0.7) 1.2 (−0.2–0.6) 2.1 (0.36–1.1) 2.8 (0.6–1.4) 2 (0.32–1.1) 2.8 (0.61–1.4)
Low 2.9 (0.65–1.5) 2 (0.1–1.2) 3.5 (0.84–1.7) 4.5 (0.9–2.1) 3.3 (0.8–1.6) 4.7 (0.98–2.1)
Job Stress Low ® 1 1 1 1 1
Moderate 1.1 (−0.2–0.47) 1.4 (−0.03–0.7) 1.5 (0.06–0.8) 1.4 (0.02–0.7) 1.6 (0.12–0.9)
78
High 2 (0.3–1.1) 2.3 (0.42–1.2) 1.8 (0.1–1.1) 2.2 (0.39–1.2) 1.8 (0.11–1.1)
Working very fast No ® 1 1
Yes 1.9 (0.2–1.1) 1.7 (0.08–0.9)
Workload- Always engaged with work No ® 1
Yes 3.2 (0.6–1.7)
Physical porosity- Relaxing in work Yes ® 1 1
No 3.5 (0.6–1.9) 1.9 (0.07–1.3)
Interest in job rotation Yes ® 1 1 1 1
No 4.1 (1.1–1.8) 4.1 (0.89–0.19) 2.4 (0.53–1.2) 2.2 (0.46–1.1)
Satisfaction-Sewing machine design High ® 1 1 1
Moderate 0.6 (-0.9–-0.2) 0.7 (-0.8–-0.1) 0.8 (−0.5–0.2)
Low 2.1 (0.33–1.2) 2.4 (0.43–1.3) 3.2 (0.7–1.6)
REBA Score A 2-3 ® 1 1 1 1 1 1 1 1
4–7 2.2 (0.5–1.1) 2.1 (0.4–1.1) 2 (0.39–0.98) 1.9 (0.3–0.97) 1.9 (0.32–0.9) 1.8 (0.26–0.9) 2 (0.40–1.0) 2 (0.37–1.0)
REBA Score B 1® 1 1 1 1 1 1 1 1
2–3 2.2 (0.39–1.2) 2.4 (0.45–1.3) 2 (0.32–1.1) 1.7 (0.1–0.98) 1.8 (0.2–0.98) 2.1 (0.3–1.2) 1.9 (0.25–1.0) 2.3 (0.39–1.2)
4–7 8.4 (1.7–2.6) 7.2 (1.5–2.5) 4.2 (1.0–1.9) 3.6 (0.8–1.76) 3.3 (0.8–1.6) 3.1 (0.7–1.6) 3.6 (0.85–1.7) 3.4 (0.76–1.7)
REBA Grand Score 4-7 ® 1 1 1 1 1
8–10 4.8 (0.94–2.2) 3.3 (0.49–1.9) 5.8 (1.1–2.4) 5.6 (1.1–2.4) 3.9 (0.61–2.1)
≥11 3.3 (0.05–2.3) 0.6 (−1.8–0.1) 7.2 (0.74–3.2) 11(1.1–3.8) 3.6 (−0.3–2.9)
Strain Index 1-3 ® 1 1 1 1 1 1 1 1 1 1
4–6 1.2 (−0.13–0.5) 1.3 (−0.04–0.6) 1.8 (0.3–0.9) 1.8 (.26–0.9) 2.9 (0.76–1.4) 3.1 (0.78–1.5) 3.2 (0.83–1.5) 3.7 (0.96–1.6) 2.8 (0.73–1.4) 3.2 (0.82–1.5)
≥7 5.4 (1.0–2.4) 5.2 (0.90–2.4) 48 (2.9–4.9) 32 (2.4–4.6) 8.2 (1.4–2.8) 7 (1.2–2.7) 11 (1.8–3.2) 11 (1.6–3.2) 13 (1.9–3.3) 11 (1.6–3.3)
Variables Left - Upper arm symptoms Right - Upper arm symptoms Left - Forearm symptoms Right - Forearm symptoms Left - Wrist symptoms Right - Wrist symptoms
Univariate Multivariate Univariate Multivariate Univariate Multivariate Univariate Multivariate Univariate Multivariate Univariate Multivariate
T. Sakthi Nagaraj et al.
OR (95% CI) OR (95% CI) OR (95% CI) OR (95% CI) OR (95% CI) OR (95% CI) OR (95% CI) OR (95% CI) OR (95% CI) OR (95% CI) OR (95% CI) OR (95% CI)
Age
BMI 1.1 1.1(.01–0.1) 1.1 1.1
(.06–0.2) (.02–0.1) (.01–0.1)
®
Education Primary school
Secondary
school
Diploma
Marital Status Unmarried ®
Married
Daily walking distance Below 1 km ®
1–2 km
2–3 km
SMO Experience Below 1 Year ®
1–2 Year
2–3 Year
Job Satisfaction High ® 1 1 1 1 1 1 1 1 1 1 1
Moderate 1.6 1.98 1.6 2.2 1.1 1.2 1.3 (-.1–0.7) 1.6 2.7 2.4 1.2 (0.4–−.2)
(0.1–0.86) (0.3–1.1) (0.1–0.9) (0.4–1.2) (−0.3–.5) (−0.3–.6) (.07–0.9) (0.6–1.4) (0.4–1.3)
Low 2.6 2.4 2.5 2.9 2.7 1.9 2.7 (0.6–1.4) 2.2 9.4 3.7 2.4
(0.56–1.4) (0.3–1.43) (0.5–1.3) (0.5–1.6) (0.6–1.4) (.08–1.1) (0.2–1.3) (1.8–2.7) (0.7–1.9) (0.5–1.3)
Low ® 1 1 1 1 1 1 1 1 1 1 1 1
79
Job Stress Moderate 1.6 1.69 1.4 1.5 1.5 1.5 1.1 (-.2–0.5) 1.1 (-.3–0.5) 1.5 1.1 0.9 (-.5–0.3) 0.9 (-.5–0.2)
(0.1–0.78) (0.2–0.9) (−0.1–1) (.04–0.8) (.08–0.8) (.04–0.8) (0.1–0.8) (−0.4–.5)
High 1.9 1.8 1.9 1.9 2.8 2.6 2.4 (0.5–1.3) 2.1 4.7 2.6 2.8 (.6–1.5) 2.5
(0.24–1.1) (0.12–1.1) (.2–1.03) (0.2–1.1) (0.6–1.5) (0.5–1.4) (0.3–1.2) (1.1–2.0) (0.4–1.5) (0.5–1.4)
Working very fast No ® 1 1 1 1
Yes 3.9 1.99 1.6 2.4
(0.91–1.8) (.04–1.4) (.06–0.9) (0.5–1.3)
Workload- Always engaged with No ® 1 1 1 1
work Yes 3.3 2.4 29 (2.5–4.3) 1.8
(0.6–1.75) (0.3–1.5) (.01–1.1)
®
Physical porosity- Relaxing in wo- Yes 1 1 1 1
rk No 4.4 1.9 3.1 1.9 (.04–1.3)
(0.85–2.1) (0.1–1.2) (0.5–1.8)
®
Interest in job rotation Yes 1 1 1 1 1 1 1 1 1 1
No 2.1 1.9 2.9 1.9 2.9 (0.7–1.4) 1.1 8 (1.7–2.5) 3.97 (0.8–2) 3.5 3.3 (.7–1.7)
(0.4–1.06) (0.3–.98) (0.7–1.4) (0.1–1.2) (0.2–1.2) (0.9–1.6)
Satisfaction-Sewing machine de- High ® 1 1 1 1 1 1 1 1 1
sign Moderate 0.95 (-.4–0.3) 0.5 (-1–-.3) 0.6 (-.9–−.4) 0.7 (-.6–.04) 0.8 (-.5–0.2) 0.6 (-.9–-.3) 0.5 (-1–-0.3) 0.7 (-.7–.01) 0.8 (-.5–0.2)
Low 1.96 2.3 3.7 2.2 (0.4–1.2) 3.7 1.2 (-.2–0.6) 2.2 1.8 3.2
(0.2–1.1) (0.4–1.3) (0.9–1.8) (0.9–1.8) (0.3–1.3) (.2–1.01) (0.7–1.6)
REBA Score A 2-3 ®
4–7
REBA Score B 1® 1 1 1 1 1 1 1 1 1 1 1 1
2–3 1.8 2.0 (0.3–1.1) 1.7 1.95 1.8 2.1 1.6 (0.1–0.9) 1.8 1.5 1.7 (0.05–1) 2.1 2.3
(0.2–0.95) (0.2–0.9) (.3–1.1) (0.2–.97) (0.3–1.2) (0.1–.98) (.01–0.8) (0.4–1.1) (0.4–1.3)
4–7 4.9 5 (1.1–2.08) 4.9 4.9 3.1 3.6 3.5 (0.8–1.7) 4 (0.9–1.86) 1.7 2.1 3.3 3.7
(1.15–2.0) (1.2–2.0) (1.1–2.1) (0.7–1.6) (0.8–1.8) (.1–0.96) (0.3–1.2) (0.8–1.6) (0.8–1.8)
REBA Grand Score 4-7 ® 1 1 1 1 1 1 1 1 1 1 1 1
8–10 9.78 (1.6–3) 4.9 (0.98–2) 3.4 (.5 1.96)
International Journal of Industrial Ergonomics 70 (2019) 70–83
Variables Left - Upper arm symptoms Right - Upper arm symptoms Left - Forearm symptoms Right - Forearm symptoms Left - Wrist symptoms Right - Wrist symptoms
Univariate Multivariate Univariate Multivariate Univariate Multivariate Univariate Multivariate Univariate Multivariate Univariate Multivariate
T. Sakthi Nagaraj et al.
OR (95% CI) OR (95% CI) OR (95% CI) OR (95% CI) OR (95% CI) OR (95% CI) OR (95% CI) OR (95% CI) OR (95% CI) OR (95% CI) OR (95% CI) OR (95% CI)
Appendix C
Univariate and Multivariate logistic regression analyses of factors related with lower back, thigh and knee symptoms
Variables Lower back symptoms Left - Thigh symptoms Right - Thigh symptoms Left - Knee symptoms Right - Knee symptoms
Univariate Multivariate Univariate Multivariate Univariate Multivariate Univariate Multivariate Univariate Multivariate
80
OR (95% CI) OR (95% CI) OR (95% CI) OR (95% CI) OR (95% CI) OR (95% CI) OR (95% CI) OR (95% CI) OR (95% CI) OR (95% CI)
Variables Lower back symptoms Left - Thigh symptoms Right - Thigh symptoms Left - Knee symptoms Right - Knee symptoms
Univariate Multivariate Univariate Multivariate Univariate Multivariate Univariate Multivariate Univariate Multivariate
T. Sakthi Nagaraj et al.
OR (95% CI) OR (95% CI) OR (95% CI) OR (95% CI) OR (95% CI) OR (95% CI) OR (95% CI) OR (95% CI) OR (95% CI) OR (95% CI)
81
Appendix D
Univariate and Multivariate logistic regression analyses of factors related with hip/buttock, lower leg and foot symptoms
Variables Hip/Buttocks symptoms Left - Lower leg symptoms Right - Lower leg symptoms Left - Foot symptoms Right - Foot symptoms
Univariate Multivariate Univariate Multivariate Univariate Multivariate Univariate Multivariate Univariate Multivariate
OR (95% CI) OR (95% CI) OR (95% CI) OR (95% CI) OR (95% CI) OR (95% CI) OR (95% CI) OR (95% CI) OR (95% CI) OR (95% CI)
Age 1.1 (0.03–.11) 1.1 1.1 (0.01–0.10) 1.1 (0.05–0.14) 1.1 1.1 (0.08–0.17) 1.2 (0.11–0.23)
(0.03–0.10) (0.06–0.19)
BMI 1.2 (.08–.22) 1.1 1.4 (0.30–0.43) 1.7 1.5 1.7 (0.45–0.61) 1.37 (0.24–0.38) 1.7 1.3 (0.22–0.36) 1.5 (0.32–0.50)
(0.01–0.17) (0.46–0.64) (0.41–0.55) (0.41–0.62)
®
Education Primary school 1 1
Secondary 1 (−0.3–0.36) 1 (0.41–0.30)
school
Diploma 0.6 (-0.9–- 0.6 (-0.98–0.05)
0.02)
®
Marital Status Unmarried 1 1 1 1 1 1
Married 3.7 (0.93–1.7) 22 (2.6–3.7) 2.1 (0.37–1.1) 3.2 (0.71–1.60) 1.6 (0.06–0.83) 2.2 (0.25–1.3)
Daily walking distance Below 1 km ® 1 1 1 1
1–2 km 2.3 (0.4–1.29) 2 (0.19–1.17) 1.9 (0.18–1.13) 1.6 (−0.1–1.04)
2–3 km 5.1 (1.2–2.1) 11 (1.88–2.90) 47 (2.68–5.0) 49 (2.98–5.2)
SMO Experience Below 1 Year ® 1 1 1
1–2 Year 0.8 0.7 (-0.73–0.03) 0.6 (-0.9–-0.07)
(−0.7–0.23)
2–3 Year 3.1 (0.4–1.86) 1.4 2.1 (0.1–1.42)
(−0.12–0.82)
®
Job Satisfaction High 1 1 1 1 1 1
International Journal of Industrial Ergonomics 70 (2019) 70–83
Variables Hip/Buttocks symptoms Left - Lower leg symptoms Right - Lower leg symptoms Left - Foot symptoms Right - Foot symptoms
Univariate Multivariate Univariate Multivariate Univariate Multivariate Univariate Multivariate Univariate Multivariate
T. Sakthi Nagaraj et al.
OR (95% CI) OR (95% CI) OR (95% CI) OR (95% CI) OR (95% CI) OR (95% CI) OR (95% CI) OR (95% CI) OR (95% CI) OR (95% CI)
Moderate 0.6 (-0.96–- 0.5 (-1.1–-0.2) 0.6 (-0.9–- 0.6 (-1.2–-0.18) 0.65 (-0.8–-0.03) 0.6 (-0.88–- 0.5 (-1.1–-0.15)
0.2) 0.15) 0.10)
Low 0.7 0.6 0.9 (-.48–0.33) 0.6 2.44 (0.39–1.4) 1.7 (0.07–0.98) 0.8
(−0.7–0.09) (−1.1–0.16) (−1.08–0.07) (−0.86–0.48)
®
Job Stress Low 1 1 1 1
Moderate 0.86 0.9 0.9 0.8 (−0.68–0.2)
(−0.52–0.23) (−0.6–0.34) (−0.51–0.21)
High 2.95 (0.57–1.6) 2.3 (0.13–1.5) 2.6 (0.47–1.4) 2.3 (0.22–1.4)
Working very fast No ®
Yes
Workload- Always engaged with No ® 1 1
work Yes 1.89 (0.06–1.2) 5.5 (0.04–3.4)
Physical porosity- Relaxing in work Yes ®
No
Interest in job rotation Yes ® 1 1 1 1 1 1 1 1
No 1.5 (0.09–0.77) 2.6 (0.37–1.5) 2.0 3.4 (0.69–1.77) 26.5 (2.4–4.1) 35 (2.8–4.3) 6 (1.4–2.3) 15 (2.0–3.4)
(0.35–1.03)
Satisfaction-Sewing machine design High ® 1 1 1 1 1 1 1 1
Moderate 1 (−0.5–0.5) 0.9 (−0.45-. 0.8 (-.59–0.08) 1 (−0.41–0.33) 0.92 1.1 (0.39–0.57) 0.7 (−0.71–0.0) 0.6 (-0.9–-0.04)
23) (−0.45–0.29)
Low 3.8 (0.78–1.9) 2.3 (0.4–1.28) 3 (0.67–1.58) 2.6 (0.46–1.41) 1.89 (0.15–1.1) 2.4 (0.24–1.5) 2.3 (0.35–1.31) 3.8 (0.7–1.94)
REBA Score A 2-3 ® 1 1 1 1
82
4–7 1.5 (0.11–0.71) 1.4 (0.01–0.6) 1.5 (0.09–0.73) 1.5 (0.01–0.84)
REBA Score B 1® 1 1 1 1 1
2–3 1.8 1.7 1.6 (0.06–0.83) 1.7 (0.16–0.9) 1.5 (0.02–0.82)
(0.04–1.1) (−0.08–1.1)
4–7 2.9 2.1 (0.07–1.4) 1.3 1.4 (-.05–0.78) 1.4 (−0.1–0.77)
(0.51–1.6) (−0.2–0.68)
REBA Grand Score 4-7 ® 1 1
8–10 7.3 (1.4–2.6) 5.1 (0.88–2.4)
≥11 10 (1.2–3.5) 1.1 (−1.3–1.5)
Strain Index 1-3 ®
4–6
≥7
83