IMPROVEMENT OF ERGONOMIC RELATED TO RECTIFICATION

AT PT.PRATAMA SENTRA REHABILITASI

By:
ANNISA FITRI WULANDARI

POLYTECHNIC OF HEALTH SCIENCE JAKARTA I

CLINICAL ATTACHMENT PROGRAMME

2019

IN COOPERATION WITH
 TABLE OF CONTENT
...........................................................................................................................................1

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

1.1 Background........................................................................................................1

1.2 Reason why I choose this topic..........................................................................3

1.3 Objectives of Study............................................................................................4

1.4 Benefit of Study.................................................................................................4

CHAPTER II......................................................................................................................5

2.2 Activity (Time, Duration, Place)........................................................................5

2.2 Working Procedure.............................................................................................6

CHAPTER III..................................................................................................................10

REFERENCES................................................................................................................18

Attachment I. Observation Checklist............................................................................19

Attachment II. Interview List........................................................................................20

Attachment III. Postural Observational Checklist........................................................21

(Based on OSHA 2004)................................................................................................21

Attachment IV. Poster..................................................................................................22

 CHAPTER I
INTRODUCTION

1.1 Background
PT. Pratama Sentra Rehabilitation is a company which provides healthcare
services and mainly focused on delivering services in the field of
Prosthetics&Orthotics. PT. Pratama Sentra Rehabilitation is supported by as well
as the supplier of many Prosthetics&Orthotics company which known
Internationally for their outstanding products and high-quality services in P&O
field such as Allard International, Endolite, Streifeneder, and Ottobock (About
PT. Pratama Sentra Rehabilitasi, 2019).
In P&O field, prosthesis and orthosis are produced clinically in workshop
and the process are divided into 3 parts which are casting, recification, and
fabrication. In any orthotic and prosthetic workshops, prosthetist and orthotist are
exposed to occupational hazard because there are many tasks that are carried out
by manpower and the asks are labor-intensive which make the staff exposed to
risk factors of work-relate musculoskeletal injuries (WMSDs) (Anderson,
Stuckey, & Oakman, 2015).
Musculoskeletal disorders (MSDs) is injuries or disorders of the muscles,
nerves, tendons, joints, cartilage, and spinal discs. It remains as a major
occupational health problem, despite decades of research, outreach, and
intervention (Hunter & Silverstein, 2014). WMSDs result in disability, lost work
time, and increased production costs. In the United States approximately 29% of
absentee causing workplace injuries are due to WMSDs.
The MSDs can occur many parts of the body, such as neck, shoulder, wrist,
hip, knee, and foot (Cho, Cho, & Han, 2016). According to Canadian Center of
Occupational Health and Safety (CCOHS), pain is the most common symptom
associated with WMSDs. The symptoms are varied on each person, such as pain,

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"pins and needles," numbness, joint stiffness, muscle tightness, swelling, skin
colour changes, and even redness on the affected area.
According to IRSST, WMSDs are something that developed over time or
gradually. The body get used to the pain, which can be blamed on age or other
causes. Worker underestimates the symptoms and slowly it becomes normal
presence. They think that the discomfort will go away, however this situation of
ignoring the symptoms only increasing the risk of situation getting worse, to the
point where complete recovery becomes impossible.
Risk factors for WMSDs have been found to include workplace activities such
as heavy load lifting, repetitive tasks and awkward working postures. In
Australian orthotic and prosthetic workshops, it was reported physical job
demands (i.e., awkward postures, loads and exertion) as important occupational
health and ergonomic contributing risk factors of MSDs (Anderson, Stuckey, &
Oakman, 2015).
WMSDs can be prevented through proactive measures devised based on
ergonomics but unfortunately they are still seldom considered (Nodooshan &
Booshehri, 2016). According to the US Department of Labor, ergonomics itself is
the science of designing the job to fit the worker, rather than physically forcing
the worker’s body to fit the job. The aim of ergonomic is to achieve safer,
comfortable and healthier working environtment for the workers. Ergonomic
ensures that assigned tasks do not exceed the limits of workers performance
capacities and resulting in an increase of productivity and quality of the works
without them sacrificing their own health and safety (Adiputera, 2004).
Rectification process is one of the process of making prosthetics and
orthotics devices and there many things related to rectification are part of risk of
MSDs, including awkward postures and workstation design. In PT. Pratama
Sentra Rehabilitasi, the rectification process were done almost everyday and the
range time for rectification are varied depends on which device being rectified.
Rectification time for lower limb orhosis is around 3 hours, spinal orthosis takes
the whole day or more, while for prosthesis can take 4 hours or more. The result
of the preliminary study conducted in October 8 th 2019 shown that all workers

2
experienced work-related pain at some part of their body during and after
performing rectification procedure. Workers were aware that their posture duirng
rectification were wrong. The observation following the Ergonomic guidelines fro
m International Labour Organization (ILO) are also done in several aspect such as
working posture and workstation condition in rectification room for example
workstation design and improper design of hand tools. The result shown that
awkward posture are found on the workers in PT.Pratama Sentra Rehabilitation
during rectification process and the rectification workstation are also improper.
And those

1.2 Reason why I choose this topic

MSDs is something that shouldn’t be underestimate by workers. It develops
gradually and people tend to ignore the symptoms when it occured. MSDs can
result in lost work time and even disability, then it’s important to recognized its
symptoms and prevention action need to be done.
In PT. Pratama Sentra Rehabilitation, during the clinical placement time,
through observation it was found that the rectification facilities in Pratama is
different from other clinics or P&O school and not following guidelines of
ergonomic which causing the workers to do the rectification with the wrong
posture in daily basis and that could be the reason why they experienced pain at
some part of the body and can lead WMSDs. Based on problems above, this topic
is choosen to improve the ergonomics in rectification at PT. Pratama Sentra
Rehabilitasi and as part of MSDs prevention to the workers.

Pict 1.1 Rectification room Pict 1.2 Awkward posture during rectification

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1.3 Objectives of Study
 Increase the knowledge of WMSDs and ergonomic to the workers.
 Improve the ergonomic during rectification in order to prevent the
WMSDs.
1.4 Benefit of Study
1.4.1 PT. Pratama Sentra Rehabilitasi
 Workers will get more knowledge about Musculoskeletal disorder
and the importance of ergonomic during rectification and in
general.
 As suggestion to PT. Pratama Sentra Rehabilitasi to improve
rectification facilities based on ergonomic checkpoints/guidelines
from International Labour Organization (ILO).
1.4.2 Student
Students will gain more knowledge about the important of
ergonomic during working as a prevention of the WMSDs.

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 CHAPTER II

2.2 Activity (Time, Duration, Place)

Rotation period :1
Date : October 2019 – February 2020
Venue : PT. Pratama Sentra Rehabilitasi
Table 1. Detail preparation schedule for CBL presentation

No Activity Date Duration Place

1. Discussion to find topic of October, 7th –

Varied PT. Pratama
CBL I 22th 2019 Sentra Rehabilitasi

2. Searching information October, 22th – 1-3 PT. Pratama

regarding the topic 10th 2019 hours/day Sentra Rehabilitasi

4. Discussion with CA team October, 31th 30 minutes PT. Pratama

2019 Sentra Rehabilitasi

5. Held preliminary study November, 8rd 30 minutes PT. Pratama

(interview) to the selected 2019 Sentra Rehabilitasi
participants and
observation

6. Start the intervention. November 11th During work PT. Pratama

– 25th 2019 time Sentra Rehabilitasi

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7. Held a post-intervention November 26th 30 minutes PT. Pratama
interview to the selected 2019 Sentra Rehabilitasi
pacticipants.

2.2 Working Procedure

After some discussion regarding to the topic about work posture with both
Clinical Instructor (CI) from CA team and site as well as searched for literature
related to the topic, I started to collect the data. The procedure are:
1) Observation and 1st interview
The observation checklist or ergonomic assessment used was adapted
from ergonomic guidelines from International Labour Organization (ILO).
The observation were performed on several aspects of working condition
during rectification procedure which are awkward working posture,
improper workstation design and hand tools.
Activity Work Posture Description
Reduce  The head is not
held straight (the
neck is flexion and
twisted sideways)
 Too much forward
leaning of the body
 The body leaning
sideway and not
straight

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Build Up
 The knee joint
position is higher
than the hip joint.
 Using one hand to
hold the cast and
the other hand to
reduce plaster
(Repetitive
movement)

Pict 2.1 Rectification room Pict 2.2 Small plastic chair for workers to seat

The workers in PT.Pratama Sentra Rehabilitation worked with awkward

posture. According to (Ergonomic : Awkward Posture, 2018)Yale
Environtmental Health and Safety, Awkward posture refers to positions of
the body that deviate significantly from the neutral position while
performing work activities. Examples of awkward postures are twisting,
bending, reaching, pulling or lifting. Other examples of awkward postures
are working with your hands above your head, your elbows above your
shoulders. While the example of neutral position according to OSHA (2004)
are no excessive twisting or bend of the neck, keep the shoulders relaxed –
not “shrugged-up”or “slumped-down.”, keep your elbows close to your
body, keep work at about elbow height, keep the upper body straight (no
excessive bending or twisting of the body), keep the hands straight and in

7
line with the forearms – avoid twisting hands and if sitting, the knee joint
position is slightly lower than the hip joint
The reason why the worker in Pratama work with awkward posture
during rectification were because they worked with non proper worksurface
and also non proper chair. The worker use floor as a worksurface which
means the worksurface was very low and they only use small plastic chair
for them to sit which means the height of chair is very low. There’s also
nothing to hold the positive cast while they were doing rectification. Those
problems causing the worker to bend and twist the neck and trunk too much,
as well as causing the knee to flex too much and the knee position above the
hip joint. There’s no backrest as support for the back.
From the interview, it was to find the condition of workers related to
rectification. All 4 participants who usually do the rectification claimed that
they ever experienced pain during and after rectification and sometimes
disturb their work flow and need.
All the participants knew that they had to take a rest every once in a
while during rectification to prevent occurance of pain but there were still
participant who didn’t do that occationaly. They stated that how often they
experienced pain is all depends on the duration of rectification that they did
on that day and whether they remembered to take rest during rectification.
Half of respondent claimed that they did feel pain when the rectification was
done more than an hour straight without rest. The rest feel pain if the
rectification was done more than 2 hours without rest.
The result also shown that all the subjects experienced pain at several
body region after doing rectification procedure (see graphic 3.1).

Graphic 2.1 Areas of pain among workers due to rectification

at PT. Pratama Sentra Rehabilitation

Are as of pai n among worke rs due Re cti fi cati on

4

0 8Body Region

Neck Shoulders Elbows Wrists/Hands Upper Back

Lower Back Thighs Knees Legs/Feet
 The graphic 2.1 shown that the most commonnly affected regions among
the subjects were neck, lower back and knees with all the subjects
experienced these pain. And No one had ever experienced non-work related
injury at the pained areas.
All the respondents knew the the good posture for rectification but
difficult to apply the knowledge because the current rectification facilities in
Pratama workshop. They all agree that rectification facilities in Pratama
workshop causing them to do rectification in awkward postures but not all of
them think that both workstation and work posture could be the cause of the
pain that they experienced after rectification.
They hope to have more proper rectification facilities which will support
them to do the rectification with a good posture. Most of them stated that it
would be nice to be able do rectification while standing but still have a free
will to sit down every once a while for resting. Also tube clamp to hold the
positive cast while they do rectification. One of them said that adjustable
rectification station which can fit in PT. Pratama Sentra Rehabilitation’s
small rectification room would also be nice.

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 CHAPTER III
DISCUSSION

3.1 Analyze The Procedure

According to the US Department of Labor, ergonomics is the science of
designing the job to fit the worker, rather than physically forcing the worker’s
body to fit the job. Ergonomic ensures that assigned tasks do not exceed the limits
of workers performance capacities and resulting in an increase of productivity and
quality of the works without them sacrificing their own health and safety
(Adiputera, 2004).
Every workplace have the risk of occupational hazards including the
ergonomic hazard. Salmani Nodooshan et al (2016) found that the main
ergonomic hazards in P&O workshop are awkward working posture, improper
workstation design and improper hand tools. These hazards are one of the
ergonomic contributing risk factors of MSDs.
Regocnizing the symptoms MSDs in workplace is very important. Also,
there should be an ergonomic assessment performed in the workplace to find the
ergonomic risk which can lead to MSDs. According to International Labour
Organization (ILO), the aim of ergonomics assessment is to find out the
ergonomics problems in workplace in order to find the most suitable solution or
intervention following the ergonomic guidelines.
Based on the problem found in PT.Pratama Sentra Rehabilitation, which were
worker feel pain during and/or after rectification, doing rectification in awkward
posture and inappropriate workshop station and hand tool. The solution for the
problem are:
 Changing the rectification position
The position are changed from sitting to standing and occasionally
sitting by changing the workstation. The reason is because Standing
posture is more suitbale because standing workstation is less restricted and

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 thus allow worker to use great force which is needed during rectification.
According to Singapore Ministry of Manpower Occupational Safety and
Health Division, standing are required in certain task such as frequent
handling of heavy objects, mobility to reach and perform work, and
manual downward forces of substantial magnitude. And according to
Ergonomic guidelines by Interational Labour Organization, a standing
workstation for a job which required a lot of body movement and greater
force.
 Changing the workstation
The workstation are changed from doing rectification on the floor
with only a small and very low plastic chair as a seat to using the bench
vice stand and chair near the area of rectification room for occasional
sitting. The reason is because According to Singapore Ministry of
Manpower Occupational Safety and Health Division, sitting requires the
muscles to hold the trunk, neck and shoulders in a fixed position. When
workers are in prolonged sitting, it may reduced body movement which
causing muscles more likely to pull, strain or cramp when stretched
suddenly.
If workers sit in a chair that’s too low, forcing both knees above the
hips, that can put a lot of pressure on the spine and it’s a bad things if it’s
done for a long periode of time (Wright University, 2015). And according
to Canadian Center for Occupational Health and Safety, a chair that is too
low increases weight on the ischial tuberosities. If the workers work with
working surface that is too low it can causing the work has to be done with
the body bent forward which can causing low back pain and shoulder
discomfort in a long run.
 Provide pipe holder to hold the positive cast in place.
The reason is because the pipe holder will make the work more
effisien because worker can do rectification using both hands. According
to International Labour Organization Ergonomic Manual (2015), lack of
tube clamps to hold the material/object during working can reduce the

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 efficency of the work because it allows the workers to use both hands for
productive work and allow them to use different sizes and shapes of work
pieces steadily during the work. Vices and clamps also reduce accidents,
as they prevent slippage of material, reduce the need for maintaining a bad
posture and provide better control over the work item.
 Give education regarding to MSDs and working posture
The education are done using poster as the media. It’s to improve
the knowledge about MSDs and working posture among workers.

Those solution also similar to what workers wish to have for the
rectification facilities. They want more proper rectification facilities which will
support them to do the rectification with a good posture. Most of them stated that
it would be nice to be able do rectification while standing but still have a free will
to sit down every once a while for resting. Also tube clamp to hold the positive
cast while they do rectification. One of them said that adjustable rectification
station which can fit in PT. Pratama Sentra Rehabilitation’s small rectification
room would also be nice.
The intervention then applied for 10 working days. After 10 working days,
the interview was held for the second time (post-intervention) in order to find the
effect of the intervention to the workers.

Pict 3.1. The standing bench vice and vice clamp Pict. 3.2 Chair with backrest

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 and adustable height

Pict. 3.3 Poster about MSD and good posture at rectification room

 Improvement of work posture and ergonomic during rectification

No. (BEFORE) (AFTER)

1.

13
2.

The table 3.1 shown that there are improvement of the work posture and
ergonomic. Before the intervention, the workers did the rectification in sitting
position with inappropriate rectification facilities and causing the awkward
posture. The intervention which is bench vice stand made workers do the
rectification in standing position and improve the posture. The working posture
are improved means that now the trunk and neck posture relatively straight and
close to neutral posture during working. It means that there are less pressure or
stress on the spine and muscles. The knee is no longer flex too much. The other
improvement is the use of tube clamp to hold the positive cast, this allow worker
to rotate the positive cast and allow them to work with both hands which makes
the work more efficient.

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 The other improvement is that now the chair is provided for the worker to
occasionally resting and sitting. Occasional rest and sitting for standing worker is
important, according to International Labour Organization, standing all the time is
very tiring because it increases pain in the back, legs and feet, and affects work
quality and the occasional sitting will helps to reduce fatigue. Also, rectification
procedure force the workers to do repetitive movements such as reduce plaster
and having a break every once in a while during rectification will help the muscles
to rest for a while.
The result of the interview shows that all the participants understand about
the posture for rectification, the influenced of posture, workstation, and hand tools
to the pain, and how the workstation and hand tools are important to support them
to work with good posture during rectification.
During the intervention time for approximately 10 working days,
participants stated that they still felt pain during or after rectification and it
depends on the duration of rectification that they did on that day and how often
they did remembered to take rest during rectification. However, they stated that
the occurance of pain is lesser compared to before intervention. They also said
that they felt doing rectification is more efficient and the chair is a great addition
for them because they could occasionally resting comfortabily while sitting. They
also said that the solution is similar to what they want, except for the adjustable
workstation.

3.2 Comparing with experience before

When I was students, rectification was done in standing position
with the rectification station height is at around elbow level. The
rectification station also provided clamps to hold the positive cast during
rectification procedure as well as allowing students to rotate the positive
cast to make work more efficient. However, during school days there were
no chair provided for occasional sitting. The repetitive movements in both
place are still performed.
3.3 Limitations during activity

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 PT. Pratama Sentra Rehabilitation is now under constraction so it’s
disturb the research data taking procedure because there were days which
the rectification was disturbed with the constraction works. Also, the
standing bench vise used as solution in this study is not suitable for Spinal
Orthotics positive cast because the the bench vice wasn’t permanently fix
to the ground so it will not able to hold the weight of spinal orthotics
positive cast.
3.4 Propose idea/Alternative solution
a) Make the standing rectification station which allow the worker to
work with neutral posture.

16
 The height of the worksurface will be around elbow height or below
because the rectification need lots of force and is consider heavy work.
According to Canadian Center for Occupational Health and Safety (CCOHS),
different tasks require different work surface heights and for Heavy work
with demanding downward forces the workstation height can range even
range from 20-40 cm below elbow height.

b) Provide footrest for the workers

c) Pl
a nn
i ng

and implementing training

programs about risk factors of musculoskeletal injuries and
adequate methods of working

3.5 Summary (Lesson Learn)

1. Learn how important the ergonomic is in not only during rectification
but also other task during the making of proshesis and orthosis. It can
prevent the MSDs or other occupational accidents/injuries.
2. Learn that workstation design and hand tools are have direct effect on
worker’s posture during rectification. Appropriate workstation and hand
tools will support good posture and reduce the number of pain
occurance during or after rectification.

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 REFERENCES
About PT. Pratama Sentra Rehabilitasi. (2019, April 4). (PT. Pratama Sentra
Rehabilitasi) Diambil kembali dari https://pratama-sentra-
rehabilitasi.business.site/posts/7296046848138135528?hl=en

Anderson, S., Stuckey, R., & Oakman, J. (2015). Prosthetists’ and Orthotists’ experience
of their work and workspace.

Ankle Foot Orthotis Course Manual Book. (2015). Jakarta: Jakarta School of Prosthetics
and Orthotics.

Cho, K., Cho, H., & Han, G. (2016). Risk factors associated with musculoskeletal
symptoms in Korean Dental Practitioners.

Ergonomic : Awkward Posture. (2018, May). Diambil kembali dari Yale Environtmental
Health and Safety.

Hunter, D., & Silverstein, B. (2014). Perceptions of risk from workers in high risk
industries with work related musculoskeletal disorders.

Kuorinka, I., Jonsson, B., & et al. (1987). Standardized Nordic Questionnaires for the
analysis of musculoskeletal symptoms. Applied Ergonomics.

Nodooshan, H. S., & Booshehri, S. K. (2016). Ergonomic workplace assessment in

orthotic and prosthetic workshops.

U.S. Department of Health & Human Services. (2018). Work-Related Musculoskeletal

Disorders & Ergonomics. Diambil kembali dari Center for Disease Control and
Prevention:
https://www.cdc.gov/workplacehealthpromotion/health-strategies/musculoskeleta
l-disorders/index.html

WHO. (2003). Preventing Musculoskeletal Disorders in the Workplace. 1.

Wright State University. (2015). Diambil kembali dari Are You Sitting All Wrong? Find
Out Here: https://www.wright.edu/facilities-management-and-campus-
operations/about/article/are-you-sitting-all-wrong-find-out-here

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19
 Attachment I. Observation Checklist

No CHECKLIST Yes No

1 Appropriate work surface

- Use desk or other worksurface with height
at elbow level or slightly lower

- The height is around elbow level

- Worksurface with adustable height
2. Appropriate chair design
- The chair has backrest
- The chair allows adjustable height
- The chair is not too low or too high
3. Availability of tube clamp to hold the positive
cast

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 Attachment II. Interview List
WAWANCARA

THE IMPROVEMENT OF ERGONOMIC DURING RECTIFICATION

AT PT. PRATAMA SENTRA REHABILITASI

A. Pertanyaan Survey
1. Apa yang anda tahu mengenai Ergonomic yang baik untuk Rektifikasi?
2. Bagaimana pendapat anda mengenai postur tubuh anda saat anda
melakukan kegiatan rektifikasi?
3. a. Selama 3 bulan kebelakang, apakah anda pernah merasakan sakit
pada bagian tubuh anda setelah proses rektifikasi? Dan apakah rasa
sakit tersebut menggangu pekerjaan anda?
b. Seberapa sering anda merasakan rasa sakit tersebut?
c. Pada bagian tubuh mana saja anda merasakan rasa sakit tersebut?
4. Apakah anda pernah mengalami cedera/injury yang tidak ada
hubungannya dengan pekerjaan (non-work related injury) pada bagian-
bagian tubuh yang anda sebutkan tadi?
5. Bagaimana menurut anda mengenai pengaruh fasilitas rektifikasi di PT.
Pratama Sentra Rehabilitasi terhadap rasa sakit yang anda rasakan?
6. Apa harapan anda terhadap fasilitas rektifikasi di PT. Pratama Sentra
Rehabilitasi agar kegiatan rektifikasi dapat menjadi lebih efisien?

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 Attachment III. Postural Observational Checklist

No CHECKLIST Yes No

1 No excessive twisting or bend of the neck

Keep the shoulders relaxed – not “shrugged-up”or

2
“slumped-down.”

3 Keep your elbows close to your body.

4 Keep work at about elbow height.

Keep the upper body straight (no excessive bending

5
or twisting of the body)
Keep the hands straight and in line with the forearms
6
– avoid twisting hands.
If sitting, the knee joint position is slightly lower than
7
the hip joint
(Based on OSHA 2004)

22
 Attachment IV. Poster

23