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    • repetition, force, and vibration are particularly important work-related factors.

    • Work-related psychosocial factors recognized by the panel to be associated with low back disorders include rapid work pace, monotonous work, low job satisfaction, low decision latitude, and job stress. High job demands and high job stress are work-related psychosocial factors that are associated with the occurrence of upper extremity disorders.

    5. A number of characteristics of the individual appear to affect vulnerability to work-related musculoskeletal disorders, including increasing age, gender, body mass index, and a number of individual psychosocial factors. These factors are important as contributing to and modifying influences in the development of pain and disability and in the transition from acute to chronic pain.

    6. Modification of the various physical factors and psychosocial factors could reduce substantially the risk of symptoms for low back and upper extremity disorders.

    7. The basic biology and biomechanics literatures provide evidence of plausible mechanisms for the association between musculoskeletal disorders and workplace physical exposures.

    8. The weight of the evidence justifies the introduction of appropriate and selected interventions to reduce the risk of musculoskeletal disorders of the low back and upper extremities. These include, but are not confined to, the application of ergonomic principles to reduce physical as well as psychosocial stressors. To be effective, intervention programs should include employee involvement, employer commitment, and the development of integrated programs that address equipment design, work procedures, and organizational characteristics.

    9. As the nature of work changes in the future, the central thematic alterations will revolve around the diversity of jobs and of workers. Although automation and the introduction of a wide variety of technologies will characterize work in the future, manual labor will remain important. As the workforce ages and as more women enter the workforce, particularly in material handling and computer jobs, evaluation of work tasks, especially lifting, lowering, carrying, prolonged static posture, and repetitive motion, will be required to guide the further design of appropriate interventions.

RECOMMENDATIONS

    1. The consequences of musculoskeletal disorders to individuals and society and the evidence that these disorders are to some degree prevent-



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