Industrial workers’ postures analysis by a new method named “loading on the upper body assessment” in Iran


Background: Occupational diseases such as musculoskeletal disorders changed to be one of the most important issues in different workplaces. They could be obvious on various parts of the body. Although researchers can find different sorts of techniques to assess Work Related MusculoSkeletal Disorders (WRDSDs) they look forward to find newer ones that are more strength. Objective: This in this cross-sectional and descriptive-analytical study was objected to evaluate posture of workers in a publishing industry by Loading on the Upper Body Assessment (LUBA) as a new method and also Nordic Musculoskeletal Questionnaire (NMQ), to analyze risk factors of WRMSDs in a central province of Iran. Materials and Methods: All workers were included. Gathering data about musculoskeletal disorders was done using NMQ. LUBA considers postures of four body parts including neck, shoulder, elbow, and wrist. Finally, data were tested through SPSS Version 20 and by applying Mann–Whitney, Kruskal–Wallis and Kappa agreement tests. Results: NMQ depicted that the most problems were in lumbar with the prevalence of 35.1%. One more thing, it was found that postures in the second action level and needed to more studies were in majority results showed the position of posture can predict disorders in this part of the body (P < 0.05). Conclusion: Altogether, upper limbs were not in desirable conditions and need more attention in the form of correction in workstations and manners of doing the tasks. However, it is recommended to develop more studies.

Keywords: Loading on the upper body assessment, Nordic Musculoskeletal Questionnaire, printing industry, upper-limb musculoskeletal disorders, validation

How to cite this article:
Koohpaei A, Khandan M, Vosoughi S, Khammar A, Mobinizade V, Farrokhi M, Poursadeghiyan M. Industrial workers’ postures analysis by a new method named “loading on the upper body assessment” in Iran. Ann Trop Med Public Health 2017;10:973-7


How to cite this URL:
Koohpaei A, Khandan M, Vosoughi S, Khammar A, Mobinizade V, Farrokhi M, Poursadeghiyan M. Industrial workers’ postures analysis by a new method named “loading on the upper body assessment” in Iran. Ann Trop Med Public Health [serial online] 2017 [cited 2020 Aug 6];10:973-7. Available from:



Musculoskeletal disorders and injuries are known as a serious problem in jobs [1] and cause more than a million injuries annually.[2] The main reason of them is detected excessive force, awkward posture/static, repetitive movements, vibration exposure, pick up the pieces, and manual handling.[3],[4],[5],[6],[7] According to researches, 63%–93% of musculoskeletal disorders have been reported in the neck, shoulder, and worker’s hand.[8],[9],[10] Scientific researches show that 20%–25% medical costs spent in works cost of absenteeism from work and early retirement in North European countries related to these types of disorders. It is also estimated that about 1.25 billion pound to be spent annually in the UK for upper extremity musculoskeletal disorders.[11]

In scientific texts, around thirty scene methods are used from a group of assessment ergonomic risk factors tools.[12] Among the most prominent and most widely used of these methods we can mention OWAS,[13] RULA,[14] OCRA,[15] QEC,[16] REBA,[17] and LUBA [18] as simple procedures and ROTA, TRAC, HARBO, PEO, KIM, and PATH as advanced technique.[19],[20] There are also some methods based on self-reporting of individuals. Nordic questionnaire method is the most prominent in this group.[21],[22] Each of these methods has their strengths and weaknesses and show the performance differently for different jobs.[19],[23]

Many researches can be found with observational assessment methods in the scientific sources, but none of these methods is holistic, and they just can predict and describe musculoskeletal disorder in the future and according to the job situation.[24] Usage Nordic Questionnaire as a valid assessment method for low back pain, neck, and shoulder with observational methods in the same time, can lead to an increase in the reliability of the impairment and disorders assessment.[19],[21] If the observational methods in the limited time and resources are selected to establish health priority to intervention properly, it would be best adapted to the needs in terms of cost, capacity, and publicity.[19]

To make a measurement strategy for musculoskeletal disorders, there are some considerations that needs to be paid attention such as exposure measurement (posture, force), aspects of exposure (time, repetition), tools or techniques (accuracy, attention, and cost), workplace conditions, and its changes.[25] Hence, the design study is necessary to evaluate the conformity assessment methods and identify that in specific jobs and according to available resources and defined objectives, with what accuracy and precision, the ability to evaluate simple, fast, and low-cost assessment of musculoskeletal disorder are existing.

Printing is one of the most important industries in Iran. The Qom province as one of the most important centers for production and distribution network in the publishing industry has a noticeable activity in this field. Workers in this industry along with exposure with chemicals and solvents, involved with poor posture extensive manual handling due to their responsibility and tasks.[26] Accident and occupational diseases in the printing industry depend on the final product, as part of the employment problems in the newspaper printing industry is 13%, but in book printing and binding industry is 40% of the total printing industry.[26]

Cleaning and preparing printing machine, separating paper, fixed-consuming, maintenance, monitoring the printing process, handling printed paper, cutting papers, and binding are the important tasks defined in this industry that put people in hard condition and cause musculoskeletal disorders.[26]


According to the statement, the investigations are designed with the aim of the validity of upper body assessment method with the standard Nordic Questionnaire in one of the Qom printing industries in 2014.

Materials and Methods

This cross-sectional study was conducted on all operating personnel employed in one of the printing companies located at Qom province, including 94 employees. LUBA method as a pen-paper and observational method was used to evaluate the status of ergonomics aspects of jobs. First, some work cycles of each participant was shot, and then, the images were reviewed. With the help of available images, postures with the most frequent and the most duration of the time in every work cycles were selected to evaluate with this method.

The standard Nordic Questionnaire was used to gather data about musculoskeletal disorders.[27] This questionnaire seeks the issue that musculoskeletal disorders have focused on which of the organs of the body.[28],[29],[30] For statistical analysis of data, version 20 of SPSS statistical software and Kruskal–Wallis and Mann–Whitney statistical test were used.

Evaluating load on the upper body posture

This method against many other observational methods which qualitatively describe the person’s body evaluates the pressure on a person’s body in a posture that is taken during work quantitatively. In this way, the body status will be assessed according to the angles that the organs of neck, shoulder, back, hand, and elbow take in a series of joint actions during activities, by the index with the name of postural load index (PLI) that show musculoskeletal load related to one’s posture. Equation 1 shows how to calculate the index:[18]

PS: Posture score, j: The jth joint, i: The ith motion of the joint, n: The number of joints that took score, Mj: The number of assessed motions of the jth joint, and Sij: Score of the ith motion of the jth joint.

Based on the PLI, corrective measures, in terms of ergonomics, are divided into four categories, which can be seen in [Table 1].

Table 1: Level of corrective action in loading on the upper body assessment method

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In this study, which was done on the whole operational personnel of a printing industry (94 people), 84.4% of workers were in the range of 36–50 years and 15.6% of workers aged over 50 years. All the subjects had work experience for 15–20 years, which indicates a high history of work and long-term presence in the studied workplace. Information of the frequency of age and occupational groups are presented in [Table 2].

Table 2: Distribution of subjects according to age and occupational groups

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Nordic Questionnaire data have been shown that all staff has been experienced musculoskeletal disorders at least in one area of their body during the last year. Problems in the lower back or lumbar region with 1.35% prevalence, 33 people have pain in this part of their body, the highest and the shoulder and ankle respectively by 28.7% and 27.6% between 26 and 27 people are next in rank. On the other hand, elbow is the only part that people did not report any problem and after that wrist with one case have the best situation [Table 3].

Table 3: The prevalence of musculoskeletal disorders in the last year (Nordic Musculoskeletal Questionnaire) (n=94)

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The results of LUBA method showed that respectively 5.40 and 3.38 of their wrist and shoulder’s postures are at levels three and four of their related assessment and exposed. Furthermore, neck’s postures with the highest rate at one level, have a better situation than other organs. Elbow is also found 61.7 of its evaluated postures at the intermediate level. Finally, it was found that none of the discussed postures are not at the fourth level of corrective action. More than 95% of postures were at level two of the corrective actions, and two levels (1 and 3) had also an equal share (13.2%). The results of the evaluation of the risk of musculoskeletal disorders among workers in LUBA study is given in [Table 4].

Table 4: Frequency of posture and corrective measures in loading on the upper body assessment method

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In the analysis that was carried out to determine the differences between the various activities with regard to corrective measures and musculoskeletal disorders, with the help of Kruskal–Wallis test, it was found that in both cases there is no significant difference (P > 0.05). Although the amount of P regarding to disorders was obtained 0.065. The relationship between musculoskeletal disorders symptom sand the posture score of quadruplet organs (neck, wrist, elbow, and shoulder) was analyzed with LUBA method and with the help of nonparametric Mann–Whitney test. The results showed that there is a significant relationship between the score of elbow posture and the prevalence of musculoskeletal disorders in a related organ (evaluated by Nordic Questionnaire) (P < 0.05). Regarding three other members, the association was not significant (P > 0.05). It is noteworthy that regarding to disorders in the neck, P = 0.076, was obtained. Furthermore, the agreement between calculated points of posture of each of the four organs Investigated in LUBA method and the reported symptoms of relevant musculoskeletal disorders was checked with Kappa coefficient. The results show that the agreement between the shoulder posture assessment conducted by LUBA method and announced disorder in the worker’s shoulder is significant (P < 0.05), the coefficient is equal to −0.073. Agreement on other organs was not statistically significant (P > 0.05).


Scientific literature’s review showed that despite the dangers and spread of the printing industry in the country, there is not sufficient scientific evidence related to the profession, especially in the evaluation of musculoskeletal disorders. In addition to flaws in previous studies, the implementation of the study had some limitation because of the high volume of activity in the surveyed companies and the limitation of access time to assess posture and interviews with staff in order to evaluate musculoskeletal disorders, which was resolved with the help of managers and staff.

Kruskal–Wallis test result on the difference priority corrective action and musculoskeletal problems in the various activities indicate that the print industry employees in different occupational categories, listed in [Table 2], have relatively similar postures statistically and on this basis the risk of developing musculoskeletal injuries in work activities and consequently the type of control intervention was required in the printing industry have been reported alike. Nordic Questionnaire with a high credit rating has been used in several studies. For example, on computer users,[31] drivers,[32] medical staff,[9],[33],[34] and welders [35] have been used successfully and based on their results musculoskeletal disorders have been reported in these industries.

In this case, the output of Whitney analysis indicates that the LUBA method marked difference only in elbow posture between the groups with and without symptoms of musculoskeletal disorders. Since agreement that was calculated using the Kappa coefficient is negative, it can be stated that this agreement may be obtained accidental and do not have a necessary statistical reliability. In addition, while the results show the disagreement of other members, neck posture with P = 0.07 and Kappa coefficient 0.021, can be substantial. In a study by Mohammadfam et al. at industrial, Quick Exposure Check and LUBA methods were used to analyze the posture.[36] The results showed that the conformity of the results of Nordic Questionnaire with the level of determined priority QEC is more than LUBA’s results. Kamalinia et al. also used LUBA methods in the construction industry, which showed that a significant percentage of surveyed employees, having state pressure index more than five.[37]

The results of pain in the upper limbs and postural stress index also showed that there is a significant relationship between pain in the limbs and pressure indicator status (P < 0.05).[30] According to the percentage recorded in [Table 3] and [Table 4] and the statistical analysis in this study, it can be concluded that the results determined by the LUBA compared with disorders reported by workers in the Nordic Questionnaire, have not been able to recognize the posture of the body parts that are in poor working conditions exactly and come to work as an ergonomic assessment tool in the printing industry. Heterogeneity of results in the scientific literature reveals the fact that ergonomics evaluation methods should be selected according to the job and to assess workplace conditions and if possible used methods that their accuracy have been reported in the scientific literature previously and to the industry or with observation method, used one of the method, self-report or direct report.[38],[39]


The risk of musculoskeletal disorders according to LUBA in this industry is average. In other words, we need more studies and more accurate ergonomic interventions such as redesigning the workstation or changes in the performance of their duties. Given that all people in this research have a high work experience and with regard to this important that the duration of exposure are considered as a major risk factors in musculoskeletal disorders, the wide attention to the conditions in the workplace is essential. According to analyses conducted in this study, about the credibility or reliability of the forecast LUBA posture assessment methods in the printing industry, it can be said that the method to assess posture in the industry cannot be a trusted method. However, further studies are recommended to ensure further.


Authors would like to thank all honorable participation by all people who helped to conduct the study.

Financial support and sponsorship

This study was supported by Qom University of Medical Sciences, Qom, Iran.

Conflicts of interest

There are no conflicts of interest.



Siegel JH. Risk of repetitive-use syndromes and musculoskeletal injuries. Tech Gastrointest Endosc 2007;9:200-4.
Delleman NJ, Haslegrave CM, Chaffin DB, editors. Working Postures and Movements: Tools for Evaluation and Engineering. Boca Raton, FL, USA: CRC Press; 2004.
Liskiewicz ST, Kerschbaum WE. Cumulative trauma disorders: An ergonomic approach for prevention. J Dent Hyg 1997;71:162-7.
Moradi M, Poursadeghiyan M, Khammar A, Hami M, Darsnj A, Yarmohammadi H. REBA method for the ergonomic risk assessment of auto mechanics postural stress caused by working conditions in Kermanshah. Ann Trop med Publ Health 2017;10:589-94.
Khandan M, Zamir SR, Maghsoudipour M. Survey of workload and job satisfaction relationship in a heavy metal manufacturing company. Iran Occupational Health 2012;9:30-6.
Poursadeghiyan M, Azrah K, Biglari H, Ebrahimi MH, Yarmohammadi H, Baneshi MM, et al. Effects of The Manner of Carrying The Bags on Musculoskeletal Symptoms in School Students in The City of Ilam, Iran, Ann Trop med Public Health 2017;10:600-5.
Azrah K, Poursadeghiyan M, Fani M J, Rezazade M, Solaimanian A. Predicting health risks of exposure to whole body vibration in the urban taxi drivers. JHSW 2016;6:59-72.
Rundcrantz BL, Johnsson B, Moritz U, Roxendal G. Occupational cervico-brachial disorders among dentists psychosocial work environment, personal harmony and life-satisfaction. Scand J Publ Health 1991;19:174-80.
Tirgar A, Javanshir K, Talebian A, Amini F, Parhiz A. Musculoskeletal disorders among a group of Iranian general dental practitioners. J Back Musculoskelet Rehabil 2015;28:755-9.
Parno A, Sayehmiri K, Parno M, Khandan M, Poursadeghiyan M, Maghsoudipour M, et al. The prevalence of Occupational Musculoskeletal disorders in Iran: A Meta-analysis study, work, 2017. (preprint).
Carter JB, Banister EW. Musculoskeletal problems in VDT work: A review. Ergonomics 1994;37:1623-48.
Takala EP, Pehkonen I, Forsman M, Hansson GA, Mathiassen SE, Neumann WP, et al. Systematic evaluation of observational methods assessing biomechanical exposures at work. Scand J Work Environ Health 2010;36:3-24.
Karhu O, Kansi P, Kuorinka I. Correcting working postures in industry: A practical method for analysis. Appl Ergon 1977;8:199-201.
McAtamney L, Nigel Corlett E. RULA: A survey method for the investigation of work-related upper limb disorders. Appl Ergon 1993;24:91-9.
Occhipinti E. OCRA: A concise index for the assessment of exposure to repetitive movements of the upper limbs. Ergonomics 1998;41:1290-311.
Li G, Buckle P. Evaluating Change in Exposure to Risk for Musculoskeletal Disorders – A Practical Tool. CRR251. Suffolk: HSE Books; 1999.
Hignett S, McAtamney L. Rapid entire body assessment (REBA). Appl Ergon 2000;31:201-5.
Kee D, Karwowski W. LUBA: An assessment technique for postural loading on the upper body based on joint motion discomfort and maximum holding time. Appl Ergon 2001;32:357-66.
David GC. Ergonomic methods for assessing exposure to risk factors for work-related musculoskeletal disorders. Occup Med (Lond) 2005;55:190-9.
Yarmohammadi H, Ziaei M, Poursadeghiyan M, Moradi M, Fathi B, Biglari H, et al. Evaluation of occupational risk assessment of manual load carrying using KIM method on auto mechanics in Kermanshah City in 2015. Res J Med Sci 2016;10:116-9.
Omidianidost A, Hosseini SY, Jabari M, Poursadeghiyan M, Dabirian M, et al. The relationship between individual, occupational factors and LBP (Low Back Pain) in one of the auto parts manufacturing workshops of Tehran in 2015. J Eng Appl Sci 2016;11:1074-7.
Balogh I, Orbaek P, Winkel J, Nordander C, Ohlsson K, Ektor-Andersen J; Malmö Shoulder-Neck Study Group. Questionnaire-based mechanical exposure indices for large population studies – Reliability, internal consistency and predictive validity. Scand J Work Environ Health 2001;27:41-8.
Kohammadi YH, Sohrabi Y, Poursadeghiyan M, Rostami R, Rahmani Tabar A, Abdollahzadeh D, et al. Comparing the posture assessments based on RULA and QEC methods in a carpentry workshop. Res J Med Sci 2016;10:80-3.
Mirzaei R, Moussavi Najarkola SA, Khanoki BA, Ansari H. Comparative assessment of upper limbs musculoskeletal disorders by rapid upper limb assessment among computer users of Zahedan universities. Health Scope 2014;3:e15226.
Burdorf A, van der Beek A. Exposure assessment strategies for work-related risk factors for musculoskeletal disorders. Scand J Work Environ Health 1999;25 Suppl 4:25-30.
Barkhordari A, Poorabdian S, Khoobi G, Karchani M. The study of changes in the serial peak fowmetery test in the workers of car painting workshops in Isfahan. SJKU 2011;15:73-80. [Full Text in Persian].
Kuorinka I, Jonsson B, Kilbom A, Vinterberg H, Biering-Sørensen F, Andersson G, et al. Standardised Nordic questionnaires for the analysis of musculoskeletal symptoms. Appl Ergon 1987;18:233-7.
Crawford JO. The Nordic musculoskeletal questionnaire. Occup Med 2007;57:300-1.
Khandan M, Eyni Z, Ataei Manesh L, Khosravi Z, Koohpaei AR, Poursadeghiyan M, et al. Relationship between musculoskeletal disorders and job performance among nurses and nursing aides in main educational hospital in Qom Province, 2014. Res J Med Sci 2016;10:307-12.
Khandan M, Ataei Manesh L, Eyni Z, Khosravi Z, Koohpaei AR, Poursadeghiyan M, et al. Relationship between Job content and Demographic Variables with Musculoskeletal Disorders among Nurses in a University Hospital, Qom Province, 2014. Res J Appl Sci 2016;11:547-53.
Cook C. The prevalence of neck and upper extremity musculoskeletal symptoms in computer mouse users. Int J Ind Ergon 2000;26:347-56.
Porter JM, Gyi DE. The prevalence of musculoskeletal troubles among car drivers. Occup Med (Lond) 2002;52:4-12.
Zamanian Z, Salimian Z, Daneshmandi H, AliMohammadi Y. The REBA technique ergonomic assessment of musculoskeletal disorders risk level among midwives of Shiraz state hospitals. J Urmia Nurs Midwifery Fac 2014;12:24-18.
Smith DR, Wei N, Zhao L, Wang RS. Musculoskeletal complaints and psychosocial risk factors among Chinese hospital nurses. Occup Med (Lond) 2004;54:579-82.
Rahimian J, Choobineh A, Dehghan N, Rahimian R, Kolahi H, Abbasi M, et al. Ergonomic evaluation of exposure to risk factors of musculoskeletal disorders in welders. J Ergon 2014;1:18-26.
Mohammadfam I, Kianfar A, Afsartala B. Assessment of musculoskeletal disorders in a manufacturing company using QEC and LUBA methods and comparison of results. Iran Occup Health J 2010;7:54-60.
Kamalinia M, Nasl Saraji G, Kee D, Hosseini M, Choobineh A. Postural loading assessment in assembly workers of an Iranian telecommunication manufacturing company. Int J Occup Saf Ergon 2013;19:311-9.
Mehrabi Matin A, Nazari Z, Ebrahimi MH, Poursadeghiyan M, Yarmohammadi H, Mehdi R, Measurement of chair dimensions used by nurses and comparing with ANSI/HFES100 standard. IJPT 2016;8:14028-37.
Khandan M, Aligol MH, Shamsi M, Poursadeghiyan M, Biglari H, Koohpaei A. Occupational health, safety, and ergonomics challenges and opportunities based on the organizational structure analysis: A case study in the selected manufacturing industries in Qom Province, Iran, 2015. Ann Trop Med Public Health 2017;10:606-11.

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ATMPH.ATMPH_304_17


[Table 1], [Table 2], [Table 3], [Table 4]

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