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Computers Byte Back - Chapter 2, Definition and History of OOS
Chapter 2
Definition and History of OOS


2.1    Introduction
 
Occupational Overuse Syndrome (OOS), under its various guises, has been in existence for centuries. However, OOS, in the Information Technology (IT) industry, only became prevalent in the early 1980's. Despite the wide range of literature about OOS (its definition, its causes etc.), not everyone believes OOS is a real problem - preferring to believe the the symptoms of OOS are "all in the mind". To be able to discern the true state of OOS, we must first gain an understanding of the issues underlying OOS. Hence this chapter begins with a definition of OOS, including its causes and symptoms. It then gives a brief history of OOS, and examines the perception and incidence of OOS in New Zealand today. 

 
 
2.2    Definition
 
OOS is referred to by many names, including: Cumulative Trauma Disorder (CTD), Repetitive Strain Injury (RSI), Musculo-Skeletal Injury/Disorder, and has been defined as: 

 

A complex disorder producing a variety of symptoms brought about by repeatedly carrying out the same movements over a period of time which may vary from hours to years. The condition often develops in an atmosphere of tension and stress. [Arndt, 1986 p.1]

The current understanding of OOS separates OOS into two categories:

        Type One OOS

2.2.1    Symptoms
 
Some of the early symptoms of OOS include [OSH, 1991]; 

 
Often with OOS there will be symptoms (this is especially typical of type two conditions) but no actual physical manifestation of the disease. For example, the person with OOS may feel that their muscles are weak, but a medical explanation will reveal that their muscles are not wasted or weakened in any way [Huskisson, 1992] 

 
 
2.2.2    Causes
 
OOS usually develops over a period of time, and is "usually caused or aggravated by types of work where sustained or constrained postured, repetitive movement, and/or forceful moments are involved" [OSH, 1995 (b)]. Sitting at a computer workstation can involve "sustained or constrained postures" and typing on a computer's keyboard involves both repetitious movement of the hands as well as potentially constrained postures of both the hands and body. Hence anyone using a computer and its keyboard is at the risk of developing OOS. 
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2.3    The Beginnings of OOS
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OOS is not a new disease. Bernardino Ramizinni³, as far back as 1713 said "No sort of exercise is so healthful or harmless that is does not cause serious disorders, that is, when overdone" [Ramizinni, 1713]. Since then, occurrences of the disease have been frequently recorded. Some examples include cotton twister's cramp, process worker's arms, washer woman's wrist, telegraphist's cramp and typist's cramp [Khilji and Smithson, 1994]. 
 
2.4    OOS in Computing
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OOS has been found to stem from a broad range of activities, including those encompassing many of today's occupations (ranging from cleaners to keyboard operators); today's industries (ranging from footwear production to electrical/electronic component production) and leisure activities (ranging from playing sports to playing video and computer games) [Arndt, 1986, pp. 10-11]. 
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Yet it was not until the early 1980s that OOS became prominent in the IT industry. Since IBM's unveiling of the personal computer, in 1981, the computer has become more and more a part of everyday life. The resulting increase in computer use has caused a marked increase in the number of OOS cases. For example, in the United States of America, OOS accounted for 18 percent of all workplace illnesses in 1981. By 1992, when there were over 50 million desktop computers in use, the percentage had increased markedly to 62 percent [Sellers, 1994, pp. vii-viii]. 
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The first cases of OOS that were undeniably linked to keyboard (computer) use occurred in Australia in the early 1980s. At first, the tens of thousands of workers who were affected by OOS used the term "kangaroo paw" to describe their unnamed condition. It was not long before the link between keyboard use and the "new" disease became the apparent - and "kangaroo paw" became known as "RSI" (OOS). The estimated cost to Australian industry in the years leading up to 1989 was half a billion Australian dollars [Glatter 1996]. Since this first epidemic of OOS, the incidence of OOS has became more and more frequent in the IT industry. 
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2.5 Acceptance of OOS in the Community
 
The evidence is substantial - OOS is a real disease and has the power to debilitate employees. Yet OOS is still the subject of speculation, mainly due to the fact that the symptoms of OOS often lack in a "clearly defined pathological basis" [Huskisson, 1992, p.1]. 
For instance Shimpck-Vieweg states that many employers believe that most of their employees claiming to have OOS are "disgruntled employees" who merely want to get money (in the form of compensation)  from their employer [Shimpock-Vieweg, 1995]. 
Huskisson challenges these myths, stating that "few RSI [OOS] sufferers have received more than trivial amounts of compensation; most have received nothing" [Huskisson, 1992, p.55]. 
 
2.5.1   OOS - All in the mind?
 
Despite the wide publicity that OOS has been given in the last few years, there are still those who do not accept that OOS is a true medical condition. For example, articles detailing the risks of OOS and preventative actions have appeared in journals ranging from Food Management [Brown, 1994], Managing Office Technology [Gallagher, 1996,], Business Insurance [Fletcher, 1994] to MacWorld [Sellers, 1996 (a) and (b)]. 
 
Even some doctors maintain that OOS symptoms are either "all in the mind" or pain that should be worked through. A library worker suffering from OOS said, "...my GP says that a clean bill of 'metal health' from an eminent psychologist will not convince her that my injury [OOS] is not caused by a mental problem." [LHC, 1988, p.8]. A general practitioner, Dr. Nancy Ball, medical director with a disability insurer Unum Corp (Portland, USA) has commented "If you love playing a sport you work through the discomfort. At work you're not so motivated so your pain perception may be higher." [Hequet, 1995, p.46]. Darby (an ergonomist from OSH) dispels these attitudes, saying "The phrase 'all in the mind' is meaningless because the brain cannot generate pain signals" [Darby, updated; Turner, 1994, CH12, p.35]. 
 
2.5.2    Studies Gauging the Acceptance of OOS as a Disease.
 
Few studies have been carried out to date that examine the acceptance of OOS as a disease in the IT industry. With the wide publicity that OOS is getting, coupled with increasing government laws and regulations regarding the health of computer users - it would be 
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expected that most people would agree that the OOS is a real condition (as, for example, the government will carefully research the authenticity of any new phenomenon, such as OOS, before publicising its existence). 
 
A survey carried out by Khilji and Smithson, in 1992, which involved 120 large organisations within the UK [Khilji and Smithson 1994, p.99], revealed that 78.4% of the 51 respondents felt that OOS was a "serious illness", 15.7% thought that OOS was a "minor illness" (the remaining 5.9% of the respondents had no opinion). These results, although initially promising  (it does appear that the majority of the companies see OOS as a real illness) are misleading. They are misleading because only 47 out of the 120 organizations surveyed replied to this question. We cannot assume that the 73 companies that did not reply shared similar views to those which did reply. It could equally be the case that those companies did not reply felt that OOS was of no importance to them - which would indicate that many companies still do not view OOS as a real problem. 
 
2.5 Incidence of OOS in New Zealand
 
It is difficult to gauge the incidence of OOS in the New Zealand IT industry for several reasons: 

 
What is clear, is that OOS is becoming "a serious public health problem" [NZPA, 1997 (a)], and that the number of OOS cases has been increasing in New Zealand since the early 1980s 
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[Turner, 1994]. This is despite the fact that both the causes and preventative measures for OOS are widely understood, as discussed in the following chapter. 
 
³ Bernadino Ramizinni was a Professor of Medicine at the University of Medona. 
ACC - Accident Compensation.

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