OOS\Chap3

Computers Byte Back - Chapter 3, OOS Today - Its Causes and Prevention

Chapter 3
OOS Today - Its Causes and Prevention

3.1 Introduction

Although many aspects of OOS are still not understood, there are many facets of the disease that are widely understood and accepted. This chapter draws on the existing knowledge of the causes of OOS, as well as the methods used to prevent OOS. It is through an understanding of OOS that we can become empowered to prevent it.

3.2 Causes of OOS

There is a plethora of literature available through trade journals, books and the Internet explaining how OOS comes about. The main causes of OOS relate to personal factors, stress and tension caused by the workplace, ignorance of employees regarding OOS and poor working conditions [Wigley et al, 1992; Arndt, 1986].

3.2.1 Personal Factors

Some people are naturally more predisposed to OOS than others. Stack points out that, just as not all smokers will contract lung cancer, nor will all computer keyboard operators develop OOS [Stack, 1987]. Some of the factors that increase the likelihood of an individual developing OOS are:

Being a woman [Arndt, 1986]
Having existing injuries
Having a tense personality [Wigley et al, 1992]

Medical conditions such as pregnancy, thyroid disorder, diabetes and various forms of arthritis may dispose an employee to OOS [Guinter et al, 1995], as will other non occupational factors, including congenital wrist defects, the use of oral contraceptives, obesity, vitamin deficiencies and being aged over 40 [Shimpock-Vieweg, 1995].

3.2.2 Stress and Tension

Throughout the literature it is quite widely accepted that stress is one of the leading causes of OOS in computer operators. A study carried out by the American National Institute of Occupational Safety and Health found the stress levels among operators of computers were the highest of any workers (including air traffic controllers) [Arndt, 1986, p.24]. Stress can be brought about by a myriad of factors, both personal (for example family problems) and work-related. Examples of work-related stressors include high work loads, high work rates and unreasonable data input targets [Bawa, 1994].

Monitoring of Keystrokes

Arndt states that "work monitoring facilities", which count the number of keystrokes per minute, are a source of stress in the workplace. [Arndt, 1986, p.25]. Not only does measuring employees' key strokes place employees under additional pressure and stress, it also discourages workers from taking breaks that can prevent injuries [Ala et al, 1994], as well as placing additional physical stress on the computer operator's joints [Linden, 1995].

In a ground breaking OOS court case in the UK (McSherry and Lodge vs. British Telecom), two data entry staff were awarded damages due to negligence from their employer. The two staff members involved with the case were expected to enter up to 13,000 keystrokes an hour under threat of job loss [Bawa, 1994]. In this case the court unequivocally acknowledged that keyboard work, exacerbated by a combination of factors including performance monitoring, was cause of OOS [Khilji and Smithson, 1994].

3.2.3 Ignorance

If computer operators are unaware of the risks of OOS, then they will not know what measures they can take to avoid these risks and will therefore be more susceptible to OOS. The literature describes the failure of management to educate and train their employees about the risks of OOS, and the incorrect posture of computer operators, as causes of OOS [Arndt, 1986; Khilji and Smithson, 1994].

3.2.4 Working Conditions

A poorly set up working environment can cause OOS. For example Arndt sates that workstations that are not ergonomically designed can cause OOS [Arndt, 1986, p.13]. Other aspects of the working environment that are less tangible, but still very real in terms of

influencing OOS, relate to the work ethics of the organisation. If an employee is dissatisfied with their job (due to a lack of control over the job content, boredom or poor career prospects), then they will be more likely to develop OOS [Bawa 1994; Stack, 1987].

If the organisation's work ethic encourages high levels of output, then they may be putting their computer operators at risk of OOS. If an employee is expected to produce large amounts of work, they will be less likely to take regular breaks from the keyboard - increasing their chances of developing OOS [Arndt, 1986; Khilji and Smithson, 1994; Guinter et al 1995]. OOS has also been found to develop in organisations where production levels are sped-up or where a bonus system is in place and payment is made by results (ie: the more work that is completed, the higher the payment) [Arndt, 1986].

3.3 Prevention of OOS

The literature repeatedly states that the best weapon against OOS is prevention [Huskisson, 1992; Turner, 1994]. Turner states that "in advanced stage OOS the consequences of chronic pain from repetitive work mean loss of existing skill... thus, prevention is more of a reality than a cure" [Turner, 1994; CH14, p.16]. The prevention of OOS requires the co-operation of everyone involved in the workplace, both management and employees, and and involves every facet of the work environment. With OOS, blind determination to "make things right" is not enough - everyone involved needs to become aware of how OOS comes about and how it can be prevented. Some of the major factors relating to the prevention of OOS are described below.

3.3.1 Laws and Guidelines

All employers are bound by the New Zealand Health and Safety in Employment Act 1992 (henceforth referred to as "the HSE Act") to provide a safe working environment for their employees' health and safety (OSH, 1995(a)). To detail how this law applies to keyboard users, the Labour Department of the New Zealand Government has produced a set of guidelines relating to computer use. These guidelines are entitled the Approved Code of Practice for the Use of Visual Display Units in the Place of Work (henceforth referred to as the "OSH Code"), and relate to section 20 of the HSE Act. In legal terms, a court may examine an organization's workplace with reference to the recommendations in the OSH

code. Put simply, if a workplace complies with the OSH Code, a court may deem that the workplace complies with the HSE Act, (OSH, 1995(a)).

More specifically, the OSH code contains recommendations referring to five main areas;

The organization of computer work (including recommendations on work loads, work monitoring and breaks)
The design of the computer components (including recommendations regarding the visual display unit (VDU), keyboard, mouse and software)
The design of the office furniture (including recommendations concerning the computer desk, chair, foot-rest, copy-holder, wrist rests, and telephone headsets)
The design of the office environment (including recommendations on space allocated to a computer user, general house keeping, atmospheric conditions, noise, lighting and decor)
Information and training (including recommendations on educating the employees about workplace hazards, including OOS)

The OSH code offers a comprehensive list of recommendations that will assist an organisation in creating a healthy work environment. If an organization were to follow the recommendations contained in the Code to the best of their ability, then they would benefit in two ways. First, they would greatly reduce the risk of OOS in the workplace. Second, if any employee within the organisation were to develop OOS, it would be unlikely that the organization would be prosecuted under the HSE Act - giving both the organisation and the affected employee more time to concentrate on alleviating the disease.

3.3.2 OOS Policy

The severity and complexity of OOS, together with legal responsibilities of organisations implies an increasing need for companies to formulate an effective health and safety policy with regards to computer use. (Khilji and Smithson, 1994, p.104)

In order for OOS to be taken seriously in an organisation, it must be taken seriously by the organisation's management. One way the management can show that they take OOS seriously is to create a workplace policy on OOS.

Without an OOS policy, an organisation will have no clearly defined strategies for preventing OOS. Hence any actions taken will most likely be ad hoc, inconsistent and difficult to measure for their effectiveness. Experience has shown that 'blindly throwing money" at the OOS problem is not enough to prevent it - a structured approach (inherent in a policy) is required [Minter, 1994].

In the policy creation process, the computer users need to be involved to ensure that the policy is realistic and fair. It is the user, after all, who is affected most by OOS [Harwin and Haynes, 1991]. The policy should also specify OOS reporting mechanisms. It is widely accepted that the early reporting of OOS symptoms is critical to the probability an speed of recover [Macfie, 1995;Wigley et al, 1992], and that someone presenting OOS symptoms should be dealt with "sympathetically and supportively" [Linden; 1995, p.223]. An example of an OOS policy is included in Appendix C (this particular policy is from the New Zealand Inland Revenue Department [IRD, 1996]).

3.3.3 Environmental Factors in the Office Environment

Employers are bound by the HSE Act to provide a safe and healthy working environment for their employees. A safe working environment includes factors such as lighting, air quality and noise. Huskisson states that OOS is more likely to occur in an environment involving confined spaces and poor lighting and atmosphere [Hukisson, 1992] - hence the office environment must have appropriate lighting, air control and noise conditions. The literature abounds in advice on the technical details of providing a healthy and safe environment. For example, one of the main aspects of good lighting involves its ability to be adjusted to suit the particular task at hand [Brown 1992; Turner, 1992]. OSH describe in detail how a healthy working environment can be maintained for computer users, including considerations such as space, housekeeping, thermal comfort (including temperature and humidity), ventilation, noise and visual conditions (lighting and decor) [OSH, 1995(a)]

3.3.4 Ergonomic Equipment

It is the workplace that is 'sick', not the worker [Turner, 1992, CH12, p2]

Wilson defines ergonomics as "the science of adapting working conditions to the human being" [Wilson, 1994, p.4]. Thus ergonomic computer equipment is essentially any piece of equipment (for example, a desk or a keyboard) that has been specifically designed to

accommodate the many different human forms. One of the essential features of ergonomic equipment is that it is adjustable [Grandjean, 1987]. This ensures that the user is not forced to adjust themselves to fit their equipment; instead they become empowered by being able to adjust their equipment. It is important to remember that ergonomic equipment, on its own, is not going to eliminate the risk of OOS [Darby, undated]. The organisation must also address the other myriad of factors associated with OOS (for example, poor working conditions, ignorance of OOS). Once an organisation addresses their ergonomics, as well as the other OOS risk factors, they will gain the advantage of not only increased productivity, but also heightened employee morale [Wigley et al, 1992]. The following paragraphs examine a cross-section of the ergonomic equipment available today.

Workstation (Chairs and Desks)

The most important items of computer hardware as far as comfort and health are concerned are your chair and your desk, especially the chair. [Harwin and Hayes, 1992, p.112]

The essential feature of the chairs and desks in the workstation is that they can be easily adjusted to suit different users (especially if two or more people regularly use the same workstation [Harwin and Hayes, 1992]). It is widely agreed that the chair must be adjustable for height, backrest angle and backrest height [Linden, 1995; Turner, 1992; OSH, 1995(a)]. The OSH code details many aspects concerning the ideal computer user's chair.

Copy-holders

Copy-holders are devices that hold documents beside the computer screen, so the user can view the document in the same viewing pane as the screen [OSH, 1995(a)]. Bawa states that they are one of the "most effective ergonomic accessories" [Bawa, 1994, p.142].

Foot-rests

In some situations where the user is unable to touch the floor with their feet while sitting at the computer desk, a foot-rest is required [Turner, 1992; OSH, 1995(a)].

Headset Telephone

Telephone headsets are recommended for people who often type and use the phone at the same time. Linden states that when the user is using a standard phone, scrunches up

their shoulder to hold the telephone hand piece in position - which may eventually result in severe strain [Linden, 1995, p.182 OSH, 1995(a)]
.

Keyboards

It is widely believed that computer keyboards (either directly or indirectly) are one of the main causes of OOS [Williamson, 1994; Guinter et al, 1995]. Standard keyboards, designed in the days of mechanical typewriters, can promote poor postural and typing habits, increasing the chances of the operator developing OOS. Yet the manufacturers of standard keyboards deny their products cause OOS, and their claims are backed by the general scientific community [Dubbs, 1995]. Most OOS experts agree as well, stating that it is not the keyboard that causes OOS, but the poor postural habits of the operators [Brown, 1992; Linden, 1995].

Despite there being not substantial evidence linking standard keyboards to OOS, numerous computer hardware manufacturers have attempted to design "safer" and more ergonomic keyboards. To date, few studies of these alternative keyboards have been performed. In those studies that have been completed, no significant statistical benefits of alternative keyboards have been found [Dubbs, 1995]. It must be noted that most manufacturers do not claim that their keyboards will help prevent OOS [Lenckus, 1995]. The alternative keyboards, though generally more expensive than traditional keyboards, are purportedly cost effective because the "reduced fatigue and productivity [gained from using the alternative keyboards] soon recovers the cost" [Anonymous, 1995]. Of all of the "ergonomic keyboards", Microsoft's Natural keyboard has the greatest market share [Glatter, 1996].

Computer VDUs/Anti-glare guards for VDUs

Computer screens should be both adjustable for brightness and contrast [OSH, 1995(a)] and in the tilt and height of the screen [Brown, 1992; OSH, 1995(a)]. If these conditions are not met, then the computer user may experience eyestrain or a headache [Arndt, 1986].

Some organisations utilize glass or plastic anti-glare screens for monitors to increase the clarity of the screen image, but these screens can be actually do more harm than good [Miller,

1995]. Mardesich states that such screens may "make the type on the screen harder to see, increasing the risk of eye-strain" [Mardesich, 1994, p.56].

Wrist-rests

Although the OSH code mentions wrist-rests as a viable ergonomic piece of equipment, there is an opposing school of thought. For example, Linden believes that if the computer user is using their body "correctly", wrist-rests will cause discomfort and may even encourage poor posture [Linden, 1995, p.175].

Other types of ergonomic equipment

There is a cornucopia of ergonomic equipment available to today's computer users, including ergonomic mice, speech recognition equipment, as well as the types already mentioned. All ergonomic equipment must be analysed critically, as not all equipment claiming to be ergonomic is actually ergonomic or useful [Bawa, 1994; Betts, 1994].

3.3.5 Education and Training

There is a growing realisation that equipment alone is not enough to prevent RSI among computer users. [Jones and Mattinson, 1994]

The prevention of OOS requires a holistic approach from management. Purchasing ergonomic equipment is only one step in the right direction - once the equipment is purchased, the computer users need to be trained in how to use it effectively [Khilji and Smithson, 1994].

Not only must the computer users be educated about the use of their equipment, they must also be informed about other issues relating to OOS prevention, including relaxation, proper job design and correct posture. Management needs to ensure that all employees are educated about OOS prevention, including new employees. It is also important that there are periodic refresher courses to reinforce the knowledge required to prevent OOS, as well as enabling new developments in the prevention of OOS to be mentioned [Linden, 1995]. Putz-Anderson states that as the employees are the life-blood of the organisation they should be treated with respect and given "as much knowledge and information as possible " [Putz-Anderson, 1988, p.77].

An example of the effectiveness of OOS education is found through Levi Strauss & Co. Levi Strauss & Co is a company which takes a proactive stance when it comes to educating its 35,000 employees about safe computer use. Each year the company spends literally millions of dollars on ergonomic related products and services, because of the benefits its gains in both improved productivity and improved morale [Mardesich, 1994]. Note that an example of an OOS education flier (reproduced by the author for an OOS awareness seminar) can be found in Appendix E.

3.3.6 Taking Breaks, Relaxation and Exercises

To reduce the risk of the computer user developing OOS it is widely agreed that the user must take frequent breaks [Turner, 194; Grandjean, 1987, Brown, 1992]. Taking rest breaks not only improves performance and prevents the onset of fatigue [Linden, 1995], they also allow "tight muscles to relax thereby clearing the accumulation of lactic acid which causes... pain (and OOS)" [Turner, 1994, CH14, p21].

There are two main types of breaks: keyboard work [Bawa, 1994] and "micropauses". A micropause is a short period of relaxation (usually only three seconds) taken every three minutes by the keyboard operator [Wigley et al, 1992]. Micropauses are an essential component of preventing OOS. Wigley et al. recommend that micropauses could be built into the work rhythm as natural pauses (such as waiting for a file to save, or a document to repaginate) [Wigley et al, 1992].

To augment the benefits of taking regular rests, it is recommended that computer operators also carry out exercises involving the upper limbs [Albin and Gutman, 1994; Turner, 1994]. To encourage the computer user to take breaks and carry out exercises, OOS preventative software is available.
.

3.3.7 Preventative Software

There are two main types of software that claim to help prevent OOS in computer users. The first type is known as a "break reminder took" [Donkin, 1996]. Break reminder tools remind the user to take frequent micropauses and hourly rest breaks away from the keyboard. The programs produce a sound or a message on the screen when it is time for the user to rest. Such tools are seldom mentioned in the literature, and, to the author's knowledge, no

objective experiments have been carried out to test their effectiveness. The only mention of their effectiveness comes from advertising brochures (for example the RSI MAnager brochure from Corsair [Corsair, undated]) and personal accounts. Jones and Mattison , from SUN Microsystems, noted that staff at the corporation were "encouraged to activate programs in their computers to remind them to take breaks" [Jones and Mattinson, 1994, p.42], but made no mention of how many people actually used the software, or found it effective. An example of a break reminder tool is shown in figure 2.

The second type of preventative software offers a set of exercises that the user can carry out to reduce the risk of developing OOS [Glatter, 1996]. As with the first type of software, exercise software is rarely mentioned in the literature. New Zealand's Department of Occupational Safety and Health (OSH) has developed an example of exercise software entitled "The Floppy Ergonomist" [OSH, 1993, p.161]. The Floppy Ergonomist not only describes a series of exercises that the computer user can carry out, but also contains a series of hyper-linked articles on the OSH code and practical measures that can be taken to prevent OOS. Figure 3 and 4 show excerpts from the Floppy Ergonomist.

Figure 3 : The opening screen to the Occupational Safety and Health "Floppy Ergonomist", software that offers a set of preventative exercises, as well as additional information on preventing OOS.

Figure 4: An example of a preventative exercise contained in OSH's "Floppy Ergonomist".

3.3.8 Self Care

...ultimately computer users must be motivated to help themselves. An organisation can provide the tools and show the way, but it cannot completely dictate the solution [Jones and Mattison, 1994, p.46]

No matter how much time and effort an organisation puts into OOS prevention, at the end of the day, it is the computer user who must take responsibility for their own health. Computer users need to be aware of the risks of OOS [Sellers, 1996 (a)], and be prepared to make an effort to protect themselves from these risks (for example, by learning appropriate body posture for computer use) [Wigley et al, 1992]. They should also become a strong advocate for themselves as this will empower them to demand appropriate health care and treatment at work, and help to prevent them from becoming dependent on outside help [Sellers, 1996(a), Wigley, 1996].

3.4 Summary

It cannot be refuted that all organisations have access to detailed information on the causes of OOS, as well as copious details of actions they can take to prevent OOS. Yet prevention costs time and money. To motivate an organisation to spend money on prevention schemes, it needs to be shown the costs OOS inflicts on both the individual and the organisation, as well as the benefits of prevention schemes. This is addressed in the following chapter.