Hand Arm RiskbedömningsMetod (HARM)

AbstractIntroduction: Hand Arm Risk Assessment Method (HARM) is a tool to assess the risks of deve­lo­ping complaints of the arm, neck or shoulders during manual work. The method was developed in the Netherlands primarily for employers, but is also used as an aid to work environment in­spec­tors. The purpose of this study was to evaluate the HARM-method for assessment of biomecha­nical exposure of the upper limbs when performing manual tasks as well as its suitability to be used within work environment inspection. Methods: Ten labour inspectors conducted assessments of five video-recorded work tasks. Assess­ments made with HARM were compared with those made with the Assessment of Re­pe­titive Tasks (ART) tool and with ACGIH Hand Actvity Level (HAL) - both methods for assess­ment of bio­mecha­nical exposure of the upper limbs - and with the model for the assessment of re­pe­titive work in the pro­visions of the Swedish Work Environ­ment Autho­rity on ergonomics for the prevention of mus­culo­skeletal disorders, AFS 1998:1. HAL is based on a threshold limit value for hand activity. The method combines the assessment of hand activity with per­ceived effort in the hand and forearm. The assess­ments were made twice, two weeks apart. Following each assessment the inspec­tors answered questions about the suitability of each method. Three experts (X) made the same assess­­ments, first individually just like the inspectors?, and then they agreed upon a consensus estimation. Head and upper arm position were registered by inclinometer, wrist movements with electro goniometer. The observers' assessments were com­pared with a ?gold standard? that was created by the results of the technical measure­ments which re­placed the consensus esti­mates for the head and arm positions as well as wrist motions in the HARM, ART and HAL assessments.Results: The inspectors' assessment of HARM and ART showed in comparison with the res­pective ?gold standard? some under­esti­ma­tion of risks. Conformity in the test-retest was 68 % at appraisal with HARM and 66 % with ART. Based on the inspectors' observations it was re­vealed that force and frequency were experienced as the most difficult to assess. On the other hand the indi­vi­dual assess­ments indicated that the work position of the hand and forearm showed the lar­gest deviation. Hand activity was both over and undervalued in comparison with tech­nical measurements, suggesting that it is difficult to simply assess hand activity by ob­ser­va­tion. Fur­thermore, the model for identifying repetitive work in AFS 1998:1 was perceived to be the most difficult to use for performing assess­ments, as it has few criteria and no support for the assessment of hand/arm and hand inten­si­ve move­ments. This under­lines that there is a need for other models as a supplement to the pro­visions.Conclusions: The results showed that the HARM and ART are relatively similar in content and struc­ture and provided relatively similar results. HARM is more detailed than ART as it takes into account the vibration exposure as a single factor and shows more consideration to the duration of exposure. The HARM-method provides support for the assessment; it is easy to use, it needs pen and paper only and is in that sense readily available, it is fast and takes into account the whole of the assessment of biomechanical exposure of the upper limbs. ART is very similar to HARM; HAL is more limited and can be used as a rapid screening of hand load.

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