Thank you all for joining us. Really happy to see such a big turnout here on the last day of the conference, but I've had a chance to be with you for the whole event this week and have just seen some phenomenal sessions and a lot of great interactions, so hopefully we'll keep that going today. I'm John Doney. I'm the VP of Workplace Strategy at National Safety Council. Talk a little bit about who NSC is, although I suspect a fair number of you are pretty familiar with us. We've got two of our colleagues here with us, and I'll let them introduce themselves as they come up and speak, Sidney and Ram, so they're going to round out our presentations today. I'm really just going to deliver a little bit of upfront context information for you all before I sit back down, but wanted to first just walk you through what we're going to share with you today, and you can kind of see here a little bit of an outline of the agenda here. I'm going to do a little bit of background. We're going to talk to you about our context on MSDs more generally, and then Sidney's going to share quite a bit about our research approach and where we are, as well as some interim findings and future direction, and Ram and Sidney will kind of tag team that piece. And then we will try to leave as much time at the end for Q&A as we can. I think we've got a pretty full hour worth of content, so we'll try to move through it rapidly enough to give you a chance to engage here. So just a little bit about NSC, and I know our colleagues, Jenny and Claire, some of you may have seen them present on opioids and impairment at the start of the week here. They actually presented on Monday, and about half the room was familiar with NSC, so for the half that might not be, we're about 110-year-old nonprofit in the safety and health space. We've been around for many, many years, primarily working in two domains, workplace safety and roadway safety. The impairment work that we do really cuts across both of those practice areas. We have about 13,000 member companies covering about 41,000 work sites, some 7 to 8 million workers across our membership, and of course our reach extends far beyond just the members of the organization, too. You can see a little bit about our mission and vision here around eliminating the causes of preventable deaths so that people can live their fullest lives, and really we focus our efforts where we can have the most impact. I shared our practice area information there a little bit. Our drill down here just at the very end of this is, you know, we're all about saving lives from the workplace to any place, and so when we talk about MSDs, you know, we're talking about one of the primary sources of injury and ill health that really occurs in the workplace, so a big focus area for us for many years, but it's only recently that we've really focused on this with an intense intentional research and engagement effort, so more about that in a little bit, but really what's motivated all of our work over the years and continues to do so is a data-driven approach, so we go and follow the data and the evidence and the trends. We look at what's hurting and killing people in the United States and globally, and we build programs to go after those issues. What you see here is just one example of that. It's our injury facts publication, started and has been continuously published now since the 30s, you know, began as a paper journal and now we're constantly updated online. If you've never visited the injury facts website, highly recommend that, great source for information, totally free, we update it on a weekly basis with new stats and analysis as they're released to the public, so just one small example of what we do in that sense. More generally, on our workplace side, which is where the three of us are all hailing from here, we're going to focus on the workplace side of the equation here, we've got a variety of different things that we do. On the left side of this chart, you sort of see the things that we do for the greatest and widest impact, so we do what we call a number of workplace programs, you may be familiar with some of them, like Work to Zero or the Campbell Institute, or SAFER, our COVID-19 effort that we spun up back in 2020, and out of those programs, we prepare and release a wide number of tools and resources, cost calculators, guidance, white papers, peer-reviewed papers, statistics, infographics, all sorts of great tools that you can go grab. And then on the right side of the chart is, you know, where NSC is a little bit less traditional in a sense, in that we do have a wide number of service offerings, training, consulting things that we do as well that are fee-for-service, and we do a lot in the membership space and impact space, advocacy on the Hill, in state legislatures, et cetera, all in the name of safety and health. So if you take that kind of macro look at workplace and you drill it down one level to one of our biggest programs, the MSD Solutions Lab, you know, we kind of follow that same footprint in terms of how we organize our work and what we do. And so across the MSD Solutions Lab effort, which we started in 2021, it's really built on a vision of a world where all workplaces are free from MSD issues and muscle cell disorders, so that workers can thrive on and off the clock. And we then drill that vision down into, you know, the ways in which we're going to activate that and do that. So we have a four-pillar approach that includes engagement, and we have a wide number of experts and external folks that we engage with, but we're always looking for more. So if you're interested in this topic, feel free to come and see us after. Of course, research, and that's obviously where we're focused quite a bit today, in the research space of MSD prevention. And then we have efforts around solutions. So we just launched two really amazing grant programs, one that's kind of research to solutions and one that's a bit more about engaging for small businesses and vendor solutions with winners of our innovation challenges. I highly encourage you to check those out, where we do a number of sort of tech and practice innovation work that will culminate at our Congress and Expo for NSC in October, so looking forward to that. And, of course, we do a lot of great amplification work and share this work and these messages around the world. I mentioned today, obviously, we're going to be focusing on the research side, so that's really my cue to turn it over to the research experts, which I am not, to do a dive into some of the most recent work that we've put forward from the lab. I'm really excited to share these results, and we're going to start with Sydney's overview, and then we'll move on from there. So Sydney, come on up and introduce yourself. Thank you all. All right. Thank you, John, for starting that off. My name is Sydney Mosser. I am a research associate with the MSD Solutions Lab, and I will be covering most of the background and methodology of the literature review. But first, starting off with a little bit of background about MSDs in general, I imagine a lot of people in the audience already are familiar with the term MSDs or musculoskeletal disorders, but I want to make sure we're all on the same page. So of course, starting off with the big one is musculoskeletal disorders, or MSDs, as I will refer to them from now on. These are injuries or disorders of the muscles, nerves, tendons, joints, cartilage, and spinal discs. More specifically, work-related MSDs are conditions in which the work environment contributes significantly to the condition, or work-related factors make the condition worse or longer persisting. Ergonomics is the science that's concerned with the fit between people and their work. It puts people first and ensures that the work tasks or environment fit each person's capabilities and limitations. And some common MSDs that are work-related disorders include low back pain, carpal tunnel syndrome, tennis elbow, as well as general sprains, strains, and tears. And these injuries can affect any area of the body and present a considerable threat both in and out of the workplace. In addition to the medical concern, MSD prevention has a strong business case. MSDs are the most common cause of disability and limitations to gainful employment, and they cause employers to lose time, money, and talent. The most recent data shows that MSD injuries cost billions of dollars a year, with $12.6 billion lost to overexertion alone, $4 billion lost to awkward postures, and $1.5 billion lost to repetitive motions. Additionally, in 2020, private sector workers suffered 247,620 MSD injuries that resulted in days away from work, with the median number of lost work days being 14 days. So moving into the research approach of our white paper, just a quick note, what is currently released is a corporate white paper, but we are also working on a peer-reviewed manuscript of this same research. So I will be referring to both of those throughout the presentation. But to start off, the white paper was based on a systematic literature review, which started off with a guiding research question. And that question was, what interventions have been demonstrated to be effective in preventing work-related MSDs and injuries for the top 10 afflicted industries among workers 18 years of age and older? Now the top 10 industries are in the chart on the right, and these top 10 industries are defined by the Bureau of Labor Statistics. Moving on to the inclusion criteria for the articles in our review, articles included had to be occupational health and safety relevant. They had to focus on workers 18 years of age or older, had to include one of those top 10 afflicted industries that I mentioned on the last slide, included a control or comparison group, were prevention or intervention-focused, written in the English language, peer-reviewed, and had data collected from 2011 to 2021, so just focusing on a decade range. Now the chart on the right shows, starting off with our full database search, we started with 13,500 articles and narrowed it down from there based on inclusion criteria. As you can see, a lot of articles got weeded out. This was especially due to the control and comparison group requirement, and we were left with 58 articles in our final review. These articles were split into intervention categories based on what intervention was done in the paper. As I mentioned, this information appears currently in a white paper, and in the white paper there were only three intervention categories with physical modification and physical activity being grouped into one, but as we have learned more working on the peer-reviewed manuscript, we have split those into two, which is what I'm presenting on here. Also note that some articles were grouped into more than one category, so for an example, an article could include a physical modification intervention as well as a cognitive processes intervention. So to explain these categories a little more, physical modifications are interventions that relate to physical environment or equipment as they relate to human interaction within the workplace, so more traditional physical ergonomics. Physical activity, of course, relates to physical activity, which is generally focused on strength training, stretching, walking, yoga, Pilates. Cognitive processes interventions were concerned with mental processes and decision-making among humans in the workplace. And finally, organizational change management interventions were concerned with realignment of organizational structures, policies, processes, to better address worker needs. So now I will move into findings. I will cover some general findings, and then I will turn it over to Ram for some more specific findings. So to start off, majority of the interventions, and again, in those 58 included articles, majority of interventions focused on educational trainings, participatory ergonomics, exoskeleton usage, which Ram will explain more on in a minute, introduction of novel tools or other materials, as well as exercise and physical activity. A high percentage of the 58 articles only focused on three industries, and many of the study designs included follow-ups with participants at six or 12 months. So here we have a chart. I know this is a lot to look at, but I will explain. Across the top are the intervention categories that I went over a minute ago, starting with physical activity, represented by PACT, physical modification, PMOD, OCM, of course, is organizational change management, and CP is cognitive processes. And then those combination interventions, so articles that included different types follow after that using the same acronyms. On the left are the industries as defined by BLS. Do note here that office work is not a BLS-defined industry, but due to its prevalence in the articles and unique MSD concerns, it was included in this review. Total articles for the intervention categories and industries are listed on the bottom and right respectively. And then within the chart, check marks represent a unique study that showed statistically significant findings. Xs represent a unique study that did not achieve statistically significant results. And the tilde represents a study that showed mixed results. So their intervention decreased neck pain, but maybe didn't decrease back pain. Looking at these areas, it gets back to what I mentioned on that first finding slide where many of the articles fell into healthcare, manufacturing, and office work, and physical activity and physical modification. So moving into some general findings, starting off with the combined interventions. As we know, MSDs are multifactorial in origin, and they're often associated with physical, biomechanical, psychosocial, organizational, and individual factors. But most workplace prevention methods have historically focused on physical risk factors more than anything. Focusing on physical risk factors alone may not fully solve the workplace MSD issue. So we need to continue to consider these multifactorial or combined intervention approaches. Combined interventions seem like a promising approach in our review. However, only 18 of the 58 included studies were these combination interventions. So it's kind of hard to say based off of that small N. In the future, researchers and practitioners should be focused on designing, piloting, and evaluating interventions that utilize this multifactorial approach so that we can learn more. Moving on to the non-physical interventions. So in this review, these were the organizational change management and cognitive processes interventions. They showed process promise, but they were also substantially underrepresented. Only 16 of the 58 articles included in the review used organizational change management, either on its own or in combination with other interventions, with only five of those articles focusing on OCM alone. Additionally, 10 of the 58 used cognitive processes, either on its own or combined with other interventions, with only one of those articles using cognitive processes as their only interventions. The results of some of these non-physical studies were promising, but there simply aren't enough findings to draw firm conclusions from. So more work on that is needed. Physical activity. As I pointed out in that chart, physical activity was seen in a lot of the articles. 14 of the 17 interventions involving physical activity did find positive impacts on MSD pain and symptoms. While physical activity is not typically prescribed in MSD prevention, we did see these positive effects on MSDs and associated pain and symptoms. And so based on this, we think that employers could consider offering proper breaks for employees to engage in physical activity, stretching before a shift or doing another form of warmup, or offering flexible schedules and well-being initiatives to engage employees in their health. However, I do want to state here that the onus of MSD prevention remains on the employers. We don't want employers to turn around and say, you employees need to do more physical activity. That's the problem. Physical activity programs and initiatives are important, but they need to be employer-driven. Employers should focus on ways that they can encourage daily movement for their employees while at work as a means to lessen the propensity to suffer a work-related MSD. We know that engaging in physical activity can reduce pain, improve quality of life, and strengthen joints and muscles, which is why these employer-driven physical activity programs can be beneficial. Finally, I'm going to go over some general equipment and devices findings. These seem to have a positive impact as well, with 9 out of the 11 equipment and devices articles decreasing MSD symptoms or pain. However, there were some notable gaps. First of all, we know that technology is here in the workplace, and it is here to stay. We're seeing this in Industry 4.0 or even Industry 5.0. But studies on up-and-coming technologies were largely missing from our review. This is likely because studies on new technologies, such as digital twins, robotics, computer vision, have not been tested yet with that control and comparison study design. Or they may not yet have design or implementation standards. However, we would expect to see more of these studies in the coming years. There were also some notable gaps in the generalizability of some of the findings of equipment and devices. For example, some trials with equipment or devices, specifically exoskeletons, did not include women in their interventions. This was sometimes because it could not be done properly for women, or because these studies were being done in industries where women are less represented. Additionally, some studies implemented device or equipments, but did not provide participants instructions on how to use that. So, for example, there was a study on sit-stand desks, where they provided employees these sit-stand desks, but did not tell them how often to use the standing feature. And this highlights a lack of standardization in how equipment may have been used. Finally, studies included metrics on if MSD pain or symptoms were reduced, but not all studies ask participants if their perceptions of using new equipment or device. We know that buy-in and uptake of equipment and devices from employees is imperative for the success of implementing a new solution. Last thing I want to note on this slide is that we do need to see more of those standards for equipment and devices. For example, the American Society for Testing Materials is focusing on an exoskeleton or exosuit ergonomic assessment decision tree in which exoskeletons need to have gone through some rigorous testing before hitting market. Standards such as these ensure that only effective, safe, and viable products for MSD prevention make it to market and are important to consider when designing future studies on MSD interventions. And so now I will turn it over to Ram for some more specific findings on exoskeletons and medical-related findings. Thank you. Thanks, Sidney. By the way, thank you all for coming and still sticking around. It's almost the last day and last, maybe one more session to go, so thank you. You all get some special prizes. All right, so let's look at some of the studies we looked into in terms of which are good ones. So I'm gonna just focus on, because of time, I'm going to focus on exoskeleton studies. So since all of you are MDs, I think this may be a good topic. So one of the studies looked into surgeons using exoskeletons. And so this is from the UCSD, Study University of California, San Diego, and they used a progressive arm support, 20 surgeons. Some of them are residents. So they were randomized to where the surgical exosuit. As Sidney pointed out, we were looking at studies which have cases and controls, okay? So all of the studies included in our systematic review do have cases and controls. So they used, again, the technology with the progressive arm support. And the findings are, basically, if you're looking at the subjective responses, obviously, if you're wearing exosuit versus without wearing, you see the differences in the body discomfort, okay? And the fatigue, and also the pain scores. And what it says is surgeons with exosuit experienced less musculoskeletal pain after performing the surgery. And 85% of the surgeons reported some form of pain reduction over the day. And these surgeons experienced less fatigue in the arm because it was a progressive arm support. It's designed in such a way that as you operate it, it basically takes care of the whole load from the arms. So again, it decreases the stress at the shoulder. So bottom line is, this progressive arm support can minimally be intrusive to the surgeons, and it can reduce the pain and the discomfort as well. And interestingly, they didn't have much issue with the dexterity when they were doing surgery. So another study is, again, they're looking at exoskeleton systems. They're all passive. They're not active exoskeletons. As you know, some of them are power-driven, which are typically the active exoskeletons. But all the studies which we looked into were active exoskeletons, sorry, the passive exoskeletons. So again, they were doing a simulated manual repetitive handling task. And with and without exoskeletons, there are two postures, looking at the stoop and squat, and also the load, three different loads. And they were looking at EMG activity in terms of thoracic erector spinae, lumbar erector spinae, and the rectus abdominis in the external optics. They used the subjective responses, the Borg scale of perceived exertion, and also they looked at the local perceived pressure, and also the usability scale, which is being very important, because as you know, in the last 10 years, so many exoskeletons came up. Still, every other day you'll see a new exoskeleton being in the market. And so the usability is always a question mark. So they also looked into this. So what it says is that if you're looking at either lifting a load or exoskeleton system showed significant difference in the EMG activity of all the muscle studies. It's not that you guys don't know about the muscles, but it's for me because I'm an engineer. So I just put what kind of muscles they're looking into. And use of the exoskeleton system reduces erector spinae muscle, the extensor muscle in the back, with a greater reduction for the heaviest lifting load, so which is pretty good, right? And also the posture had no significant difference for all the muscles studied, except the external oblique muscles, okay? Again, if you're looking at perceived or the subjective ratings, you see the difference of discomfort scores with respect to the load. And also the perceived pressure, you look at the load increase as looking at the different body parts. So definitely you see some differences with respect to wearing an exosuit. And in terms of usability, everybody liked that particular exoskeleton system. So another study, which is a longitudinal study from the Virginia Tech, a pretty good study. They were looking at arm support, again, in the overhead tasks. They looked at the 18-month field study. It was done at the Ford manufacturing facilities. And so, again, it's an overhead work, and nine automotive manufacturing facilities. They had a good control group, and of course, the sample size is pretty good. I come from the experimental side of it. If you look at this kind of population, the sample size, that's a pretty good sample. And they were collected at different milestones, baseline, first month, six months, 12 months, 18 months. Still, it's one of the very good studies in terms of the usage of exoskeleton. So what did they find? They looked at work intensity. That's more of a subjective, okay, when I work, I really exert myself to the fullest. Those are the questions they looked at it. And the second question was, I feel exhausted at the end of the shift. So if you look at the graph, across the facilities, the perceived work intensity did not differ between the exos and non-exo groups. Okay, and unfortunately, lack of consistent findings with respect to the longitudinal study. Yes, you know, discomfort scores, looking at that did not differ between the exo group and the control groups. But you see that there is some facilities, you see that it has decreased over a period of time in particular regions of the body. Again, the scores were unchanged. And so basically what they're saying is that the longitudinal effect of the arm support used on the perceived physical demands were not found. So yes, you can use the exoskeletons to take care of certain work, but you need to look at the longitudinal effect of it. So that's one of the very interesting findings. It's one of the very few studies which looked at the longitudinal aspects of it. So again, I'll give you another example. Before I moved to NSC, I worked at the hospital system in the West Coast Providence hospital system where I taught safe patient handling and so there are some studies which kind of made sense for me to cover in this systematic review. So in terms of opportunities, what are the ways we can look into prevention of MSDs? So I'll give some examples. Majority, as you know, that safe patient handling policy works, but there are still some states which don't have patient handling policy. So that means you need to have a state legislation. There are a lot of hospitals have a zero lift or a minimal lift policy where you can't lift the patient with your muscles basically and there are efficacy studies which looked at the safe patient handling programs in the hospital systems and also what are the equipment you can purchase? So those are the policies which are very important, one aspect of opportunities and of course, bottom line is you need to have a stakeholder buy-in. So the senior leadership should understand that that is important. The physicians at the hospital system should understand that these are important and there's a huge difference between nursing and therapy. Nurses want to take care of the patient where a therapist wants to, they love mobility, get up and walk. So there is a huge difference between where they come from in terms of looking at the patient handling, looking at the safe patient handling champions at the workplace and also having educators for safe patient handling and obviously bottom, again, we need to have a frontline education in terms of how best you can use this safe patient handling equipment. Training and education, still this is a huge issue. Again, part of the previous job, we used to have a new employee orientation. It doesn't matter if you have 40 years of experience, it doesn't matter if you have only one month of experience. Before you go onto the floors, you need to have some patient handling training. And so again, there is no strict regulation in terms of how many hours is needed in terms of the safe patient handling education. We also develop quick mobility screening. There's like a BMAT bed mobility assessment tool from the system in Arizona. They developed this, but at least in Providence, we used to call it quick mobility screening. So you need to have some kind of screening tools to assess the patient so that you can use the patient handling equipment. And also Skills Fair, Lstream have some education modules in terms of patient handling education and just-in-time education. Some of this, before I left Providence, we developed just-in-time videos. Say for example, yes, you went through the work and you know everything about it, but in a certain period of time, you end up becoming a supervisor or a manager and all of a sudden you're short-staffed, you need to take care of the patient. Do you know how to use the patient handling equipment? So we developed some simple two to five minute videos as well. So again, you need to have some just-in-time education to refresh your memory. And also we developed some QR codes. Say again, if you haven't used a ceiling lift for a long time, do you know how to use it? So we have a QR code on the ceiling lift. So you just put your, you use your cell phone and just look and on the QR code, the video will come out and it'll give you just two minutes of education. So there are many ways to educate yourself as a caregiver. Okay. And of course, again, the training education is very important in terms of the opportunities. Risk assessments, at the healthcare facility, you have some safety champions, have a safety huddle every day. Gimbal walks is typical, where you walk through the facility, try to ask the caregivers, do you need help? Do you want me to give some education? And look at the monthly reports of injuries and illnesses. Okay, just culture. This is very important. It's not that you guys don't know. Everywhere, high reliability organization, hospitals are now known as, they are trying to have this high reliability training. So those are important too. So let me come to this safe patient handling legislation. I talked about legislation is important. Well, I mean, Texas started in the very first state in this country is Texas, which looked into legislation and they're doing pretty good job. And now so far in the last, again, 2005 to now, still only 12 states have legislation out of 50 states. So there's legislation is very important. And there are some studies which looked at the states which have a legislation and they have the patient handling equipment, look at the injury rates, see the difference. And what it says is the patients in California, Illinois, Ohio, and Texas, they were more likely to have a lift used. So these states which have legislation, they have these ceiling facilities, they do help in terms of taking care of the patients. And what it says is that the patient in states with this particular legislation were 1.6 times more likely to have a lift used during care. So what, again, I want to reiterate that legislation is important if you are looking at injury prevention. And there is enough evidence with respect to patient handling programs as well. Again, they show that if you go back to Audrey Nelson's is a classic study, they looked at injury prevention and they said that having an established safe patient handling program reduces injuries for you as a caregiver and also for the patients. And again, if you're looking at the workers comp data, you see that a reduced lost time days and the direct costs. And again, these are guidelines, because again, we all know that the ergonomics rule never went through the proper legislation and it failed. So it's more of a guidelines. If your hospital is looking at developing a safe patient handling program, which is, again, we are looking at prevention of injuries. So legislation is important. So if you can develop a safe patient handling program as an ophthalmic physician, that's pretty, it's a very good, important aspect of it. Again, the question is, well, you buy an equipment. If we use it, do they at least influence in terms of reduction of injuries? Yes, there are studies, enough studies show that there is improved therapy outcomes if you use a patient handling equipment and it requires less people and less time. And of course, you see that there's a decrease in the caregiver injuries. So I'll just give this practical example because it was during COVID time, people started looking at proning the patient, right? This, if you're looking at a manual handling, manually proning a patient, you need to go through at least 10 to 12 steps. It depends on the facility. I remember at the time I was in the hospital system and we, you know, as patient handling educators and therapists, we developed using a ceiling lift. You know, we wanted to avoid this manual proning, which is very, very tough. Imagine if you're a bariatric patient, if you're handling eight to 12 caregivers, including, you know, physician, respiratory therapist and nurses, it's just not easy. We were trying to develop this and I was teaching in one facility and the facility, one of the ICU supervisors come and said that, you know, you can't teach this here because we do manual handling, manual proning. And I said, you know, there are difficulties with manual proning. Why can't we use a, you know, equipment to take care of it? Because, you know, out of 12 people versus six people, there's a huge difference, but still there is some culture that, you know, that, you know, yes, this is how we do it. Don't come and teach us the new ways of doing it. But anyway, so we developed this protocol, very interesting, so I just want to give you a few steps here what you're doing is we're, again, bottom line is you are trying to take care of the caregiver too because yes, patient is important, but as a caregiver, as an employee, are you taking care of your patient? Sorry, are you taking care of yourself? So this is a simple protocol. We use a lift, a ceiling lift, if you look at, you know, on the top, and this is the slings. There are five steps. Basically, you use the ceiling lift to get the patient near the, you know, to the one end of the bed and then you slowly prone the patient. And so we taught this, you know, for almost a year, but in one facility, we couldn't even teach it. But again, you know, these are the, we have the barriers, we also have the opportunities. We should look into those aspects of it when you are trying to have, you know, some injury prevention programs at workplace. So this is the, you know, basically, there are six steps essentially versus 10 or 12 steps you see when you're manually handling the patient. Again, you know, if you're looking at the legislation versus lift use, you know, there's a classic study from a Baxter rather, I should say Hillram, and the Baxter bought Hillram now, but this is a study coming from Hillram. They looked at 642 facilities and unfortunately they had, you know, 328 did not even use a lift. These are the facilities who have lifts, but still people don't like to use it, okay? And 18 facilities used a lift for 20% or more on their patients. And again, the patient mobility status is important. You know, the classification like moderate assist versus minimal assist to completely dependent patients. So typically the max dependent patient is in ICU. So that's where you see maximum utility of a ceiling lift, but if you have a lift, you should use it, okay, so that was so again low rates of lift use is proportional to high rates of musculoskeletal injury. It's no you know rocket science but you know again if you are not using ceiling lifts you end up getting hurt as a caregiver. So again now Sydney back to you, so thank you. All right thank you Ron. Looks like we are doing pretty good on time so I will run us through some limitations and future directions. Obviously we've thrown a lot of information at you, so what now? Well to start off for any researchers in the audience, some of the limitations that we saw in the study design and characteristics of the articles in our review. Future studies should seek to include larger sample sizes to get higher fidelity from these studies. We should strive for an experimental design. As I mentioned we required the control comparison style which is a very strict experimental study design, but when this is not possible a pre post design in which comparisons can be made between engaging in the intervention and not engaging in the intervention are also adequate. We need to focus on adequate adherence and follow-ups. As Ron mentioned going over one of his articles longitudinal effects of your interventions are very important especially when you're seeking to reduce MSDs in the workplace as a whole. Studies should also be designed for quality such as including blinding when possible. Future studies should also include diverse study participants. As I mentioned some of the exoskeleton studies were unable to include women in their studies, but we need to include a diverse population so we can better understand how interventions impact all workers. We should also seek to include a wide array of industries. As I was going over that chart if you recall most of our articles fill within only three industries. We've also had conversations with people so for example we've had conversation with those who work in the mining industry and as they're seeking to implement these practices in their workplace they're actually turning to construction studies because there haven't been studies done in the mining industry so they're using construction as a kind of the closest equivalent but we know it would be an easier decision for them if they could just look at mining studies for what would be useful in their workplace. Finally future studies should aim to measure true instances of MSDs and not just MSD symptoms and pain. Many of the studies we assessed in the white paper looked at these symptoms or pains and studies would be strengthened if they looked at actual instances of injuries and not just these self-reported measures. Some practical implications for any employers or any of you who advise employers. There are things that organizations should take into consideration when planning to implement interventions to prevent MSDs in their workforce. For starters organizations should strive to trial interventions through high-quality pilots. From a research perspective it would be ideal to have that control or comparison group but we understand that implementing control and comparison groups within industry may be difficult due to several factors and while the study design is able to provide effectiveness results with the most fidelity a pre post design can be used if implemented properly. Additionally when looking to broaden your MSD prevention programs consider interventions that assess psychosocial and organizational factors in addition to just those physical factors. If you're planning to utilize technology when starting out it may be beneficial beneficial to use technology in combination with other interventions before fully adopting. As technology continues to emerge we encourage people to pilot such technologies to see if they might be the fit for your workers and your risks. Finally while most of us here today probably already know this we need to remember that MSD interventions are not one-size-fits-all. What works to mitigate some risks might not work to mitigate others and what works for another organization may not work for your organization especially as job tasks vary. More nuanced factors such as culture of your organization will impact solution effectiveness making it difficult to generalize solutions from one industry to the next. Knowing this while we can and certainly should learn from our peers in MSD prevention we need to understand that interventions might need to be tweaked in order to fit the unique characteristics of individual organizations. So take it one step at a time. We have covered a lot of the highlights of the white paper here today but we do encourage you to read the full text version which can be accessed through this QR code or from our website at nsc.org slash MSD and as I mentioned we are preparing a peer-reviewed manuscript so keep an eye out for that in the future. I'll give you a minute to scan the QR code. I see a lot of phones. And then covering what's next for the MSD solutions lab if any of you are interested in additional MSD prevention efforts. We are currently working on a DE&I paper and workbook. This resource is intended to inform business owners and industry leaders about the connection between diversity, equity, and inclusion and MSDs. It will feature a workbook that will have suggested solutions for addressing DE&I concerns in your workplace and that is slated to be released this summer. We are in the early stages of a paper on the relation between MSDs and psychosocial, individual, and organizational factors. As I mentioned in today's presentation we have historically mainly focused on physical factors but we know that these non-physical factors do play a role and so we're starting to look into that. As John mentioned at the beginning of the presentation we did just release two grant programs. Information about that can be found on our website as well. And then finally we'll be planning we are planning to present our work at this year's NSC Safety Congress and Expo which will be held in New Orleans if that's something any of you are interested in. If you have any questions about this presentation or our other initiatives you can reach out to us at MSD solutions lab at NSC.org. You can also go to our website NSC.org slash MSD to access free resources and learn more about our programs. But now we'll turn it over to question and answer. Thank you all for coming. Great talk. Thank you very much. So just had a question on the assistive devices is what we call it. Costs and risks. So risk of injury with using the devices and also what were some of the barriers to the folks who are refusing to implement the technology. Some of those risks and barriers are kind of one of the same. In some of the articles that featured exos or assistive devices while the device did help certain muscle groups it could create pinch points or it could stress other muscle groups where the exo is actually sitting. And so that is one of the reasons we see a barrier to implementation is it may take more time to put on or you know you're sweaty in the warehouse and you don't want to wear this giant suit or it's you know sitting on your back or your hips or whatever it may be in creating pinch points. So that is an ongoing field of study. Thank you very much for the talk. To tag along with that question, what about the economic assessment especially with those exosuits in terms of how much it costs for each exosuit and the benefits? In terms of the cost I think it's gone down considerably. So people use it quite a bit. There are so many as I said markets there's so many types of exos are coming in. Some of them are closed out too like their business are gone out too but it's not that expensive. But in terms of the fit which is more important especially the physical fit and also they say that cognitive fit that is having exoskeleton sometimes the mental workload increases. So in terms of the cost your first question it has gone what do you call they're a lot cheaper now and so it's yeah but it has its limitations as well you know some of them are only focused on certain body part which helps but you know and also having a exosuit versus exoskeleton is a bit different. So the exosuits if you are wearing it you need to make sure that you wipe them and all that you know so it has its own life cycle too. So yeah thank you. One of the things that I didn't really see or pick up on is the some of the downstream effects of the the preventions you're talking about. What do I mean by that? I can envision the scenario where we have zero MSDs because you've got so many devices and assist devices but now we've created the the vision from the movie WALL-E where now nobody's doing every any sort of work and how do we handle the downstream issues if we're now no longer working on the overall fitness. So I work for NASA and we do a lot of work in in mitigation of musculoskeletal injury by fitness and preparation prior because the job may or may not have the ability to bring in exoskeletons and assist devices but I'm imagining in the hospitals or whatever if we stop doing any sort of lifts now we're stopping that whole level of fitness that comes with it so the downstream issues of that too much sitting too much lack of fitness. Well let me not answer your question and answer it in a different way. If you're looking at say for example the typical risk factor if you want to as you know the NIOSH hierarchy of controls the best prevention is to eliminate that exposure. If you can't eliminate it you reduce the exposure right. So having that and then exoskeletons in a way it's still assisting them. Any worker can do it but fitness is again it's increasing human performance so it has definitely we are not saying that okay you know you wear this and you're not going to be you know in the sense fitness is definitely important it's a lifestyle it's a life. Agreed but it seems that that the controls and all is taking away a lot of fitness that the work might offer an employee and so do we need to keep that in mind for the long-term health issues when we're taking out that fitness roles. I think that's also somewhere looking into those physical activity studies an employer driven fitness program might help fill in that gap. I also think it's a little bit of a misconception of exoskeletons you are still using your muscles it's just reducing the risk of injury to serious exertion of the muscles at least. There are some studies coming back to your physical activity there are some studies which looked at combination so that's why you have some combine interventions. I was looking for that in this presentation I didn't feel like I saw that because I know you mentioned it earlier. Okay got it sorry yeah okay yes there are some combinations of it but I completely agree with you 100% in terms of physical fitness. Just give a quick example where when when I was in the hospital system we started a stretching program okay but it also it's voluntary you can't force the worker so we were doing in the hospital system but only for distribution what loading and unloading dog you know those folks some people love it some people basically said I do it every day other activities I bike to work so I really don't need to do activities so I mean I mean fitness is I mean of the some for some it's it's a lifestyle you know but for some they're forced to you know so that's why I don't know how to answer your question so that's how I was gonna make another comment I know we're tag teaming this one maybe to it to it the nth degree here but you know where I would look to establish a better baseline on the broader well-being analysis you're doing of the employee base in the first place we published a lot of work on that back in the mid 2010s about getting more systemic and more dimensional with your understanding of employee well-being or worker well-being and I think you know as you see more technological interventions that are removing the worker from work totally understand your point that you know when you get through those extreme cases where you may need to exert will that fitness will you will you be hardened for work in that direction so I think it's a multi-step process of the technological intervention understanding the additional risk you bring into the equation when you bring in a technology because you're always introducing new potential risk when you make a process change technology that goes double right and then I think you know if you look more more analytically more holistically at well-being and start to chart that and analyze that data across your worker cohort you can maybe start to mirror up those data those those sets of information to understand where your risk factors may be for you know things that would have once been normal but now look like overexertion for potential injury because you're less physically physically fit so excellent talk thank you very much I know this is systematic reviews and there are limitations based on that but I have some previous experience in the healthcare system specifically with mechanical lifts and with concept of exoskeletons did these studies that you examined and compile this report address a stratification of the need for these devices for instance as you mentioned dependent patients would probably benefit most but if the employees as my previous colleague mentioned may have been more physically fit no had pre-existing comorbid conditions I know in the hospitals they sometimes have certain postural techniques to lower the bed down and and it could produce similar solutions I don't know if this was addressed head-to-head on the musculoskeletal injuries as opposed to routinely putting a Hoyer lift on everyone who's dependent because previous colleagues have mentioned you know cost is something we have to look into when we look into a health care system while safety is first but we have to also examine that as well for our employees as well as for patients the examples I gave you in terms of the patient handling was more of a it's not definitely from that systematic review there are some studies that covered the patient handling lifting you know ceiling lifts and other lifts as well I think the question is in terms of whether if if you have a patient handling equipment it doesn't matter if you have a 900 pound patient versus 200 pound patient the best way is to use a ceiling lift or a floor lift I'm just saying a mechanical device I apologize assisted assistive device it does really help and I have done some time motion studies in terms of how much time it takes because the the but the best and the first excuse they give employees is that it takes too much time but if you integrate with respect to the last work time days imagine your colleague who got hurt while lifting a patient is now at home for almost a year and it costed this much workers you know workers comp versus you so when we teach patient handling we bring in these workers as well the health care workers who got hurt to tell their story to the new employees so we are trying to inculcate that kind of education in the very first day so but going back to in terms of you know stratification right that's what you're talking about I don't know whether there are enough studies which looked at in that aspect but there are some studies looked at the combination aspects of you know yes you do have you know patient handling equipment is important but also physical activity is important as well so there are some combined interventions which looked into different aspects of you know but the particular intervention whether it affects or not so I'm sorry I'm not sure if I answered your question but thank you we could after thank you very much

musculoskeletal disorders

interventions

physical activity programs

exoskeletons

non-physical interventions

organizational change management

limitations

emerging technologies

grant programs