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      of musculoskeletal disorders using these well-defined and validated measures of exposure.

    2. Develop improved measures of outcomes and case definitions for use in epidemiologic and intervention studies. These should include but not be limited to:

    • Develop prognostic tools to identify clinical cases at increased risk for poorer outcomes and to tailor interventions to identified risk factors (e.g., ergonomic stressors, job stress).

    • Develop tools and measures that are capable of quantifying the extent of a musculoskeletal disorder with adequate precision so that they can be used as precise dependent measures for prospective epidemiologic studies involving the workplace.

    • Further develop and refine standardized survey instruments to identify symptomatic musculoskeletal outcomes with adequate sensitivity and specificity for use in epidemiologic studies in work environments.

    • Further develop and refine physical examination and sensory discrimination criteria to identify musculoskeletal outcomes with adequate specificity and sensitivity for use in epidemiologic studies in work environments.

    • Develop and refine epidemiologic case definitions of musculoskeletal disorders with adequate sensitivity and specificity for epidemiologic study in work environments. Case definitions that rely solely on self-report information are particularly useful for large survey studies. Case definitions that use both self-report and physical examination data are needed for more detailed studies.

    • As these criteria evolve, particular attention needs to be paid to nonspecific pain syndromes that are not congruent with established clinical syndromes. There is a need to develop an appropriate classification of subgroups of nonspecific pain syndromes in order to carry out more effective epidemiologic studies of these syndromes.

    • Further develop and refine physiological measures appropriate for use in epidemiologic studies that measure relevant features of the various musculoskeletal disorders, including for example, nerve conduction testing.

    • Develop and evaluate definitions of musculoskeletal disorders currently used in epidemiologic studies to identify the best symptom-based and physical exam-based criteria for musculoskeletal disorders that can be recommended as the standards for use in epidemiologic studies of the different syndromes in the work environment.

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