Development of a Recommendation for Action for the individual prevention of musculoskeletal diseases

Status:

completed

Aims:

Following Germany’s reform of its legislation on occupational diseases on 1 January 2021, there has been a greater focus on the individual prevention (IP) of such diseases. It can therefore be assumed that there will also be an increased demand for suitable IP programmes in relation to musculoskeletal diseases (MSDs). The IP programmes for back and knee joint disorders that have been offered by some accident insurance agencies for several years now will therefore need to be expanded, and potential areas of standardisation will need to be identified.

The Managing Directors’ Conference of the DGUV (GFK) runs a working group for strengthening individual prevention, especially in occupational diseases. This group has instructed the Institute for Occupational Safety and Health of the German Social Accident Insurance (IFA) to coordinate a cross-agency working group and also to make its own contributions. The aim was to develop a Recommendation for Action with harmonised quality standards for the transparent presentation of content requirements of IP programmes that are offered. This should include the production of a catalogue of options for DGUV committees and their members as a way of helping them to organise and control their IP activities. Also, in the long term, access to IP programmes was to be improved across all accident insurance agencies and for a range of target groups (suspected cases of occupational diseases and early intervention).

Activities/Methods:

For this purpose, the IFA chaired three cross-agency working groups, entitled "Back and Knees", "Hips" and "Shoulders", comprising representatives of the providers of existing IP MSD programmes, i.e. the German Social Accident Insurance Institutions for Health and Welfare Services (BGW), the Building Trade (BG BAU) and the Foodstuffs and Catering Industries (BGN) as well as the department ‘VL’ of the DGUV and also further interested accident insurance agencies and experts from the medical centres of the German social accident insurance (‘BG Kliniken’).

The Recommendation for Action was to describe a standardised, modular overall policy for a quality-controlled IP programme covering four locations: "Lower Back", "Knees", "Hips" and "Shoulders". To this end, the IFA coordinated the development of fact sheets to describe a best-practice standard for each module and contributed its own content, focusing, in particular on the areas of "ergonomics" and preventive occupational health. The following modules were to be created: assessment and screening, determination of preventive capability (by a specialist physician), sports therapy, ergonomics (including job-specific exercises), physiotherapy, physical therapy, mental health training, nutritional advice, advice provided by accident insurance agencies, assessments and evaluations and possible follow-up measures (such as refresher courses).

Further areas to be included in the Recommendation for Action concerned a description of the requirements for participants, therapists and lecturers as well as the infrastructures of the implementing institutions and suitable evaluation criteria and process parameters.

Thanks to an ongoing exchange between the three working groups that were involved and, in parallel, with the DGUV research project FB 320 (Individual Prevention of Workplace-Related Musculoskeletal Disorders), it was possible to ensure the consistent further development and standardisation of all planned IP MSD programmes.

Results:

The three working groups coordinated their outcomes with one another and then pooled them in the form of a joint "Recommendation for Action for the Individual Prevention of Musculoskeletal Disorders" (IP MSD). The policy paper has four chapters.

The chapter "Individual Prevention of Musculoskeletal Diseases" introduces the topic and provides a comparison of the IP programmes of the accident insurance agencies on back and knee joint disorders (programmes that were available before the project), including the existing access requirements and access routes. The purpose of the new development, it says, was to expand the available options for further locations (shoulder joints and hip joints), target groups (occupational diseases and early intervention) and recommended quality standards.

The chapter "Medical Findings and Screening" describes parameters for a medical screening, which can be a starting point for the evaluation measures that are to be carried out as part of the proposed IP measure. A distinction is made between the insured individual’s self-reported medical history (stress, discomfort and pain), their medical history taken by a physician (discomfort, ability to work, pain and stress) and a medical examination for active functional abnormalities and for the targeted identification of location-specific functional deficits.

The chapter "Basic Modules", is the centrepiece of the Recommendation for Action. The basic modules must be understood as quality standards that are based on the tried and tested IP programmes and which have been expanded in the Recommendation for Action. Some of these apply uniformly to all IP MSD measures, while others need to be formulated differently, depending on each joint, and may also need to be implemented with certain occupation- or sector-specific features. Overall, the Recommendation for Action comprises the following basic modules: assessment of potential prevention (specialist), sports therapy, ergonomics, physiotherapy, physical therapy, mental health training, nutritional advice, assessment and evaluation, ensuring sustainability and advice provided by accident insurance agencies.

In the final chapter, the working group formulated specific "Recommendations for the Implementation and Future Development of IP MSD Programmes" from a practical perspective as well the parameters that must be taken into account. As planned, after the completion of the work, the policy paper was presented to the initiators (’GFK-A BK’) at the end of 2022 and was accepted by them as an excellent decision-making basis for further committees and future developments in connection with IP MSD programmes.

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