Comments on the National Occupational Research Agenda for Musculoskeletal Health

fter releasing the NORA, NIOSH asked for comments regarding the proposed agenda and the suggested research it indicates as a priority. As an invested stakeholder in the state of musculoskeletal health, Briotix reviewed the document in depth and provided the below comments in response.

Recently, the National Institute for Occupational Safety and Health of the Centers for Disease Control and Prevention (NIOSH) announced the creation of a National Occupational Research Agenda (NORA) for Musculoskeletal Health. The agenda incorporates information about musculoskeletal injuries, the current state of musculoskeletal science, and proposed research to address gaps in existing knowledge. The NORA was created to identify the research, information, and actions most urgently needed to prevent occupational injuries.


After releasing the NORA, NIOSH asked for comments regarding the proposed agenda and the suggested research it indicates as a priority. As an invested stakeholder in the state of musculoskeletal health, Briotix reviewed the document in depth and provided the below comments in response.

Improved Surveillance of Musculoskeletal Disorders

In reviewing Objective 1.1 – Improve Surveillance of MSDs, it is suggested that additional research should be dedicated to the development of new surveillance tools to address the challenges of our changing workforce. Additionally, these tools should focus on areas of high risk sectors. Given Briotix’ experience in working in a wide-variety of work environments, we agree with the importance of this research. We would add that when you review the list of occupations with the most MSDs, the vast majority of those fields are considered remote workers, i.e. a worker population that is not easily reached through traditional means. In our experience, current industry tools do not do justice to the various task demands of remote workers despite these workers being at the highest risk of suffering an MSD.

Creating New Assessment Methods and Tools

As indicated in Objective 2.2 – New Risk Assessment Models and Methods, current tools only capture biomechanical risks associated with job-related tasks. Not only is the data limited with the current industry tools, but application of the tools is both costly and timely often requiring several hours of in-person observation to accurately capture the variety of tasks completed. With emerging technologies, including wearable sensors and mobile devices, research should be done to develop tools using these technologies to offer a more complete picture of risks associated with MSDs. Briotix is currently field testing a variety of wearable sensors for numerous clients in various settings. We are continually learning about the best use cases and how to best implement the technology. However, our testing is aimed at meeting specific client needs. Thorough industry research should be conducted to validate these new methods and establish new thresholds for ergonomic risk.  

Additionally, beyond the development of technologically-advanced tools, the creation of better predictive tools that allow for side-to-side comparison of relative risk associated with various tasks should be a priority. Current tools operate in a silo-fashion by only accurately assessing the risk of a task on one part of the body. This does not allow for a comparison of total risk of one task to another preventing specialists from creating an accurate prioritization of injury prevention. New tools should allow for a comprehensive picture of whole-body risk for each task and comparison of those tasks for the successful implementation of injury prevention initiatives.

Further, the new tools that are developed must be user-friendly to encourage employers to use the resource and implement prevention techniques. To maximize the impact of these new tools, they must be designed in a way that a supervisor can be trained to easily use and then understand the results of the risk assessment. Creating accessible tools that can be used by a variety of professionals will have the greatest impact on lowering the number of work-related MSDs.

Behavioral Intervention Effectiveness

We agree that a research priority must be the evaluation of the effectiveness of interventions in reducing known risk factors for work-related MSDs as discussed in Objective 4.2 – Evaluate Intervention Effectiveness. As professionals, we work under the assumption that behavioral interventions lower the risk of work-related injuries. Specifically, at Briotix we have seen changes in behavior and culture lower the occurrence of work-related MSDs and worker claims. However, this assumption is not validated by thorough research. The results we see at Briotix are showing us that something is working from our on-site training and consultations, but research is needed on a larger scope to identify what portions of education and behavioral interventions are most effective in risk reduction.

Need for Statistically Significant Research

After reviewing the objectives provided in the NORA, Briotix is in support of the proposed covered topics, however, we would suggest an additional emphasis be placed on ensuring the research conducted is of statistical significance. Larger population sample size assessments are critical to creating research that can provide accurate and reliable data to guide industry practices. When research is conducted on small sample sizes (i.e. 30, 60, or even 100 subjects), the research fails to meet the burden of statistical significance and is unreliable. We find that much of the United States occupational research fails on the simple principals of sample validity (e.g. sample size relative to prevalence). At Briotix, we will perform more than half of a million injury prevention interventions this year, achieving measurable outcomes for clients across industries and job classes. Given the shortcomings of the US-based research, we must instead rely upon our own R&D program to observe and measure risks and interventions or utilize research from Europe and Asia. Dollars should be allocated to research which will produce results that are measurable, are statistically significant, and provide a greater understanding into the industry’s body of knowledge and practices.

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