Safety Journal
Safety Journal
Safety Journal
1
ISSN 1675-5456
PP13199/12/2012(032005)
Journal of
OCCUPATIONAL
SAFETY AND HEALTH
Journal of Occupational
Safety and Health
Editor-in-chief
Ir. Haji Rosli bin Hussin
Executive Director
NIOSH, Malaysia
Editorial Board
Associate Editors
Secretariat
Mohd Rashidi Rohmad
Ruzita Shariff
Nor Akmar Yussuf
Idayu Kassim
The Journal
-
Aims to serve as a forum for the sharing of research ndings and information across broad areas in
Occupational Safety and Health.
Publishes original research reports, topical article reviews, book reviews, case reports, short
communications, invited editorial and letters to editor.
Welcomes articles in Occupational Safety and Health related elds.
Journal of Occupational
Safety and Health
June 2012
Vol. 9 No. 1
Contents
Conformity to Occupational Safety and Health Regulations in Small and
Medium Enterprises
Baba Md Deros1, Ahmad Rasdan Ismail2, Mohd Yusri Mohd Yusof1
1-6
7 - 14
15 - 20
21 - 32
33 - 44
45 - 52
Original Article
Department of Mechanical and Materials Engineering, Faculty of Engineering and Built Environment,
Universiti Kebangsaan Malaysia, 43600 UKM Bangi, Malaysia
2
Sports and Human Engineering Group, Faculty of Mechanical Engineering, Universiti Malaysia
Pahang, 26600 Pekan, Pahang, Malaysia
hjbaba@eng.ukm.my
Abstract.
Regulation on occupational safety and health in Malaysia had evolved from the prescriptive Factory and Machinery Act
(1967) to a self-regulated Occupational Safety and Health Act (1994). However, from the authors observation the high
standards of occupational safety and health culture that surpass the legal requirement were not widely practiced by small
and medium enterprises (SMEs). The two main objectives of this study are: first, to identify and determine the level of
conformity; and second, to investigate the reasons of nonconformity to Occupational Safety and Health Act (1994)
regulation in SMEs involved the chemical industry sub-sectors. The survey questionnaire was distributed to 150 SMEs in
chemical industry sub-sectors. Forty one of the survey questionnaires were completed and returned, giving a response
rate of 27.3% for the survey. The survey results revealed that an overwhelming majority (92.7%) of the respondents
from SMEs are likely not conforming to the basic requirement of Occupational Safety and Health Act (1994). In addition
to this, the survey also found that only 3.1% of the management personnel can be considered competent in terms of
knowledge, skill and ability in carrying out occupational safety and health regulation within their respective organization.
While, 96.9% of the respondents that participated in the survey can be considered not competent. The authors hope the
result of this survey could assist the relevant authorities in formulating a better policy and strategy for implementing
occupational safety and health in SMEs involved in chemical industry sub-sectors.
Keywords: Occupational Safety and Health; industry; SMEs; Chemical
Introduction
chemical industry sub-sectors in Malaysia. Past
studies conducted by researchers such as Onn
(1999), Basri (2000), Man (2000), Ng & Selva
(2003), and Piah (2005) reported that SMEs
workplaces are prone to accidents and illness.
Conformity to Occupational Safety and Health Regulations in Small and Medium Enterprises
Methods
The important elements studied in this research
are the SMEs conformity, top managements
perceptions and competencies with respect to
characteristics found in FMA (1967) and OSHA
(1994) regulations in Malaysia.
Original Article
Chemical
industry
Not Conform
Intermediate
Conform
Total
36.5%
56.2%
7.3%
100%
Not Competent
4.88%
Intermediate
87.80
Competent
7.32%
Total
100.00%
Conformity to Occupational Safety and Health Regulations in Small and Medium Enterprises
Reason
No knowledge
Difficult and Expensive
Low Risk
Not aware
Following Others
No Advantage
No description
Total
Percentage
34.9
27.9
23.3
7.0
2.3
2.3
2.3
100.0
Original Article
Conclusion
are due to lack of staff with the required knowhow and financial resources to implement OSH
regulation. The survey indicates that majority of
the SMEs either did not have any OSH
management systems or only has very little OSH
expertise. On overall, the survey had indicated
that there is still much need to be done in
promoting more SMEs to conform to OSH
regulation in their workplace. To achieve this, the
Malaysian government through its agencies such
as DOSH, NIOSH and National Council for
Occupational Safety and Health are urged to
intensify their efforts in promoting OSH
awareness by visiting their premises, conducting
seminars, workshops, road-shows, and publishing
articles in the local mass media.
References
Bahari, I., 2006. Pengurusan Keselamatan dan
Kesihatan Pekerjaan, McGraw-Hill Education
(Asia), Edisi Kedua.
Conformity to Occupational Safety and Health Regulations in Small and Medium Enterprises
Walters, D. & James, P. 1998. Robens revisitedthe case for a review of OH&S, Institute of
Employment Rights
Original Article
Sports and Human Engineering Group, Faculty of Mechanical Engineering, Universiti Malaysia
Pahang, 26600 Pekan, Pahang, Malaysia
2
Department of Mechanical and Materials Engineering, Faculty of Engineering and Built Environment,
Universiti Kebangsaan Malaysia, 43600 UKM Bangi, Malaysia.
3
Faculty of Manufacturing Engineering, Universiti Teknikal Malaysia Melaka, Karung Berkunci No.1752,
Pejabat Pos Durian Tunggal, 76109 Melaka.
arasdan@gmail.com
Abstract
Environmental factors such as temperature, lighting and noise have very significant impact to workers health, safety,
comfort, performance and productivity. In an ergonomically design industrial work environment, these factors need to be
control at their optimum levels. The main objective of this study is to find the effect of temperature, illuminance and
sound pressure level on workers productivity in automotive industry. To perform this study a workstation in an
automotive component manufacturing was selected as the location of the study. Results of data analysis showed there
were relationships between temperature, illuminance and noise on workers productivity. Later, the authors developed
multiple linear equation models to represent the relationships between temperature, illuminance and noise on the
workers productivity. These multiple linear equation models could be used to predict the production rate for the
workstation by referring to the value of temperature, illuminance and noise level.
Keywords: temperature; illuminance; noise; productivity
Introduction
In industry, the productivity could be increased in
a variety of ways. A comfortable employee can
produce more than a counterpart who is working
in an uncomfortable work environment
throughout the day. A comfortable working
environment can do more than making workers
happy because it can also improve their
productivity. For example, raising workplace
temperature can have a drastic effect on office
productivity. Lee and Brand (2005) found in their
study that environmental factors in physical office
environment such as: noise, lighting, temperature,
existence of windows could influence employee
attitudes,
behaviours,
satisfaction
and
performance.
Methods
using Sound Level Meter equipment. The
production rate represents the workers
productivity. Amount of products taken at every
30 minutes interval were compared with the value
of temperature, illuminance, sound pressure level
and humidity measured. Figure 1 shows a flow
diagram for the study methodology carried out.
Original Article
PROBLEM DEFINITION
STUDY IMPLEMENTATION:
WORK STATION
DATA COLLECTION
DATA ANALYSIS:
SPPS
DECISION
contributes significantly to the model. But the tvalue for illuminance t2 = -1.158 has a p-value of
-0.083 and noise t3 = -0.549 has a p-value of
0.607 contributes insignificantly to the model. It
shows that only WBGT is significant for the
equation model.
Results from Kahya (2007) study showed that
there is a relationship between workers
performance and workplace environment. Poor
workplace
conditions
(physical
efforts,
environmental conditions and hazards) may result
performance.
in
lower
employees
Table 1: Data Collected for WBGT, Illuminance and Noise Level with Production Rate
Time (Hrs)
9.30-10.00
10.3011.00
11.0011.30
11.3012.00
12.0012.30
2.30-3.00
3.30-4.00
4.00-4.30
4.30-5.00
Producti
on Rate
(Units)
36
31
WB
GT (C)
Illumin
ance (lux)
26.2
26.8
367
412
Noise
Level
(dBA)
85.5
87.1
32
27.1
382
87.6
30
27.4
373
87.2
32
27.6
359
84.6
37
34
36
38
26.6
26.4
26.4
26.2
289
322
315
283
83.2
84.0
84.1
83.6
Table 2: Multi-linear Regression Analysis for the WBGT, Illuminance and Sound Pressure Level With
Production Rate
Model Summary
Multiple R
0.944
R Square
Adjusted R
Square
0.891
Standard Error
1.200
0.825
10
Original Article
ANOVA
df
SS
MS
Significance
F
Regression
58.794
19.598
13.599
0.008
Residual
7.206
1.441
Total
66.000
Coefficients
Unstandardized
Coefficients
Model
B
Constant
144.945
Standardized
Coefficients
Std.
Error
46.660
Sig.
3.106
0.027
25.002
264.888
Beta
WBGT
-2.802
0.965
-0.505
-2.905
0.034
-5.282
-0.323
Illuminance
-0.026
0.022
-0.400
-1.158
0.299
-0.083
0.032
Noise
-0.318
0.579
-0.188
-0.549
0.607
-1.806
1.170
11
Table 3: Optimum Factors for WBGT, Illuminance and Sound Pressure Level
Environment Factor
Standard Value
Calculated Value
WBGT
Illuminance
Sound Pressure
Level
30 C
500 lux
85 dBA
27.6 C
417.75 lux
88.16 dBA
New Value
28 C
424 lux
80 dBA
Conclusion
The objectives of the study are to obtain the
environmental parameters such as: temperature,
illuminance and sound pressure level on the
workers productivity at selected workstation in
automotive industry were achieved successfully.
Later relates them with mathematical model
equations to indicate the relationship between
environmental
parameters
and
employee
productivity. Apart from that, based on the
amount of product that produce in a time period;
the correlation and regression analysis represents
the
relationship
between
temperatures,
illuminance and sound pressure level on workers
productivity. Multi regression analysis indicates
there is a relationship between all parameters and
References
Attwood, D.A., Deeb, J.M. & Danz-Reece M.E.
2004. Ergonomic solutions for the process
industries. Elsevier Publisher. ISBN: 978-0-75067704-2
12
Original Article
http://www.steelcase.com/na/articles_and_paper_
knoledgedesign.aspx.
13
14
Original Article
Abstract
Work-related Musculoskeletal Disorders (WMSDs) are common occupational injuries among workers in the construction
industry. Epidemiological studies indicated that WMSDs include neck pain, lower back pain, knee pain, leg fatigue as well
as ankle and feet discomfort. The objectives of this study are to identify the WMSDs experienced by the workers during
construction works and discuss the causes of those WMSDs. Subjective approach associated with modified Nordic
Musculoskeletal Questionnaire (NMQ) was applied to identify the symptoms of WMSDs. A case study was conducted in
several construction sites situated at the southern region of Peninsular Malaysia. During the study, 37 construction workers
with different age and scope of works were interviewed to determine the WMSDs that they have experienced. Based on
distributed questionnaire, almost all workers experienced pain in the region of lower back, upper back and biceps. These
pains were contributed by manipulation of heavy load and high force exertion. Based on discussed causations, control
measures via engineering controls method and administrative controls method were proposed to alleviate the risk of WMSDs
among construction workers.
Key words: Work-related Musculoskeletal Disorders (WMSDs), construction industry, occupational risk factors, subjective
approach.
Introduction
It is well known that the construction field is unique
among other industries as the workers in this area are
exposed to indoor and outdoor conditions.
Construction industry is important to people because
it is capable to provide large opportunity of
employment to both skilled and unskilled workers 1)
either locally or from other countries. In Malaysia,
construction industry offers job opportunities to
791900 workforces in 2003 and rose to 798200 in
20042). Instead of providing good job opportunities,
the huge numbers of workers are susceptible to
occupational injuries associated with work-related
musculoskeletal disorders (WMSDs) if effective
measures are not given priority. In global scenario,
construction industry reports the highest industrial
accident rate in the world of work. Construction
workers are also those who are perceived to be
lacking of job safety. A study has shown workers in
the construction sites have to face constant change in
the nature of work, the location of work and the mix
of workers. Besides, the workers in this industry
frequently work with heavy materials and
machineries and are exposed to hazardous
environmental risk factors such as noise, dusts as
well as heat stress. Working in very hot weather has
physiological and psychological effects on workers;
it reduces their productivity, increases their
irritability and loss of their enthusiasm for their
work 3, 4).
Most of the people tend to relate construction
industry with dangerous working environment and
high risk as compared to others5). International Labor
15
16
Original Article
No. of report
11
1
0
0
0
10
4
2
10
Discussion
This section discusses the causes of major pain or
discomfort occurred during workers performing their
jobs. Based on the conducted survey, they are several
causes identified i.e. manipulation of heavy load,
high force exertion, awkward working posture, static
loading and repetitive works. Each cause is discussed
in the following sections.
17
Static loading
Risk factor associated with static loading was
observed while the workers performing painting of
the building wall. During the painting process, the
worker has to perform the job continuously in
standing posture. Prolonged standing can lead to
muscle fatigue and irreversible changes in the
muscular structure if the worker is not given
sufficient recovery time. Conversely, the risk of the
muscle fatigue also may contribute to injuries to the
worker. For example, when the worker performs
overhead painting work, he will tend to have major
problem on the neck and shoulder.
Repetitive works
Risk factor associated with repetition is identified
while the workers perform bricklaying process.
Bricklaying is part of construction work that are
mostly carried out conventionally. The researcher
found that the ways of bricklaying process, materials,
equipment and working environment are hazardous
and need immediate improvement actions to
minimize the occupational injuries. During the
bricklaying process, workers handled the brick with
average weight of 1 to 5 kg using one side of their
hand repetitively. Normally, bricklaying process is
performed by a group which consists of bricklayer
and assistant. The bricklayer will be lifting and
applying mortar or stone (1 to 5 kg), while the
assistant will be lifting and carrying the material with
average load of 25 kg for more than 4 hours a day.
Conclusion
The researchers have conducted a survey and
identified that lower back pain, upper back pain and
biceps pain are the most common WMSDs in
construction industry. From the study also, the
researchers found that the major causes of the
mentioned WMSDs are contributed by poor working
conditions such as manual manipulation of heavy
load and high force exertion. These causes were
discussed and suitable solutions were proposed to
improve the occupational health of worker in the
construction industry so that they will be more
productive and competitive in their works.
Acknowledgement
The researchers would like to acknowledge the
Faculty of Manufacturing Engineering (FKP) of
UTeM for providing the facilities in carrying out this
manuscript. Finally, the authors would like to thank
all the people who had participated in this study.
18
Original Article
References
1) Sudiajeng L, Adiptra N and Suyasning, H:
Hazards analyses through total ergonomics
approach for bricklayers in Bali Indonesia.
Proceeding of International Conference on
Ergonomics 2007, Kuala Lumpur, 311-316
(2007).
2) Construction Industry Development Board of
Malaysia (CIDB): Dicing with death 2008.
(online),
available
from
http://www.cidb.gov.my/cidbweb/bin/corporate/
media/20060205%20%20Dicing%20With%20D
eath.pdf., (accessed 2008-01-15)
3) Sherif M and Korb S: Forecasting labor
productivity changes in construction using the
PMV index. International Journal of Industrial
Ergonomics 35, 345-351 (2005).
4) Hancher and Abd-Elkhalek: The effect of hot
whether on construction labor productivity and
costs. Cost Engineering 40, 32-36 (1998).
5) Mohd S M and Abdul H M: Development of
safety culture in the construction industry: the
leadership roles. Proceeding of International
Conference on Ergonomics 2007, Kuala
Lumpur, 317-322 (2007).
6) International Labor Organization (ILO):
Chemical Safety in Asia: Law and Practice,
2000: (online), available from
http://www.ilo.org./public/english/protection/saf
ework/papers/asiachem/ch1.htm (accessed 200803-10)
7) Hsio H. and Stanevich R L. Injuries and
ergonomic applications in construction. In
Bhattacharya A. and McGlothin J. D.
Occupational
Ergonomics
Theory
and
Applications. New York: 1996: 545-568.
8) Social Security Organization of Malaysia
(SOCSO): 2001. (online), available from
http://www.aboutsafety.com/article.cfm?id=361.
(accessed 2008-07-01)
9) Kuorinka I., Jonsson B, Kilbom A, Vinterberg H,
Biering-Sorensen F, Anderson G. and
Jorgemsem
K:
Standardised
Nordic
Questionnaires
for
the
analysis
of
musculoskeletal symptom. Applied Ergonomics
18, 233-237 (1987).
10) Intaranont K and Vanwortergham K: Study of
exposure limit in constraining climatic
conditions for strenuous task: An ergonomic
approach. Final report. Bangkok: Department of
Industrial
Engineering,
Chulalongkorn
University (1993).
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technologists, engineers, and managers. New
Jersey: 2004.
19
20
Original Article
ABSTRACT
This study analyzes the determinants of workplace injuries across 44 four-digit manufacturing industries in Malaysia from 1993
to 2008 through the business cycle and structural approaches. The results of fixed-effects estimations revealed that workplace
injuries in Malaysian manufacturing sector were negatively influenced by firm size and positively influenced by business cycle.
Consistent with the findings of previous studies in other countries, the empirical evidence of this study supports the pro-cyclical
behavior of injury rates in manufacturing industries towards business cycle. The analysis demonstrates that both structural and
cyclical variation effects are important determinants of workplace injuries in Malaysia.
Keywords: workplace injuries, cyclical variation, structural characteristics, Occupational Safety and Health Act.
INTRODUCTION
Studies on the incidence of industrial accidents or workplace injuries can be grouped into three approaches, viz.
business cycle, labor market and structural approaches. The business cycle approach to workplace injuries provides
explanations as to how injury rates may be expected to vary over the course of the economic cycle (Kossoris, 1938;
Leigh 1985; Robinson and Shor, 1989). These studies support pro-cyclical relation, showing that the number of
injuries tend to increase during economic upswings and vice versa. Nevertheless, this approach does not explicitly
consider the interaction of choices made by employers between safety and profits and the choices of employees
between safety and wages in determining the risk of injuries. This give rise to the second approach, the market
oriented approach to workplace injuries as proposed by Chelius (1974), Oi (1974), and Sider (1985). Their studies
relate the injury rates to the market factors, such as wage and government control. In general, their analysis shows
that, under firms optimization, occupational injury is determined by wage level and employers incentives in
accident prevention. However, the impact of government intervention through tax and compensation benefit is
inconclusive.
The third approach focused on structural effect of the industry such as workers characteristics, firm size,
and mechanization or capital intensity in the production process (Oi, 1974; Cooke and Gautschi, 1981; Viscusi,
1986; Currington, 1986). Demographic differentials in work injury rates could have been generated by several
structural forces. If other things being equal, (such as type of industry, occupation, firm size and safety of the work
site), certain workers are innately more liable to be involved in workplace injuries (Oi, 1974).
Despite the three approaches, it is often assumed that the causes of accidents vary across sectors (Coleman,
1981). A survey report by Centers for Disease Control and Prevention (1993) on fatal injuries in the United States
(U.S.) during 1980-1989 shows that the largest number of fatalities occurred in the construction sector, followed by
transportation, manufacturing, and primary economic sectors. A large body of existing empirical analysis on
workplace injuries focused on manufacturing and construction sectors. This is due to their natural hazard and both
sectors are found to be highly responsive to the business cycle, particularly in mature capitalist economies as well as
those in transition towards industrialized economies (Robinson and Shor, 1989; Davies et al., 2009).
With the vision of becoming an industrialized economy by the year 2020, Malaysia has started its
industrialization effort since 1960s. Industrialization has been an integral part in the Malaysian development
strategies and manufacturing sector has shown to be one of the important backbones and a major contributor to the
Malaysian economy. The share of manufacturing sector to Gross Domestic Product (GDP) increased significantly
from only 12.2 percent in 1970 to 30.1 percent in 2010. Apparently, this sector has been the major sector in creating
employment opportunities. In 1970, employment in the manufacturing sector represented only 9.4 percent of total
employment (Malaysia, 1976). In line with the industrialization process, the share of employment in the
21
manufacturing sector increased over the years. As at 2010, the share of employment in the sector has increased to
27.8 percent (Malaysia, 2010).
It is often the case that rapid expansion of manufacturing industries during economic expansion is
associated with large employment of new workers and new technologies, machineries and equipments. While the
application of new technologies would expose new hazards to the workers, hiring new worker might as well pose
higher risk of accident as they are not accustomed to the hazard of workplace environment. Therefore, a study of
workplace injuries in Malaysian manufacturing sector is particularly relevant since it would contribute to a greater
understanding of factors that determine workplace injuries in the sector.
Workplace injuries have been the subject of growing number of academic research since the last three
decades. However, large body of research focusing on the causes of injuries is dominated by empirical studies in
industrialized countries, such as European countries and the U.S. In Malaysia, existing studies on workplace injuries
were mainly focused on the issues of the establishment and enforcement of the Occupational Safety and Health Act
(OSHA) and the evolution of safety related regulations (Jamaluddin, 1994: Rahmah and Sum, 2000; Mansur et al.,
2003; Ariffin et al., 2006; Rampal and Nizam, 2006; Lugah et al., 2010; Surienty et al., 2011). Empirical study on
workplace injuries in Malaysia, however are still lacking and mostly concentrated on the construction sector (Abdul
Hamid et al., 2008; Ali et al., 2010; Zakaria et al., 2010). Apart from these studies, Mansor et al. (2011) examine the
influence of individual factors and nature of job on accident among workers at port sites. However, to the best of our
knowledge, no attempt has been made to specifically investigate factors that influence workplace injuries in
Malaysian manufacturing industries. Hence, the objective of our study is to empirically examine factors that
contribute to workplace injuries in Malaysian manufacturing industries during 1993-2008. We specify our empirical
model based on two approaches, viz. the business cycle and structural approaches. Difficulties of obtaining data on
wage premium and on employees protection measures for each industry prevent us from incorporating the labor
market oriented approach in our model.
The remainder of this paper is structured as follows. Next section provides an overview of workplace
injuries in Malaysia and followed by literature review. Subsequently, this study discusses the model specification
and data, which is followed by results and discussion. Finally, this study concludes and offers some policy
implications.
OVERVIEW OF WORKPLACE INJURIES IN MALAYSIA
Table 1 and Table 2 respectively present the number of industrial accidents by sectors and by types of accident in
Malaysia during 1994-2008. There was significant decline in the total number of industrial accidents reported for all
sectors, a decrease of 55.30 percent from 125,506 in 1994 to 56,095 in 2008. Among all sectors, the number of
accidents reported for the manufacturing sector has been the highest throughout the period. This reflects workers in
the manufacturing sector are exposed to higher accidental risks.
Table 1. Industrial Accidents Reported by Sectors, Malaysia, 1994 2008.
Sectors
1994
1997
2000
2003
2006
2008
27,268
24,390
13,293
8,796
5,739
3,962
1,406
763
643
736
541
368
68,281
37,829
42,915
33,901
27,066
19,041
588
372
592
513
515
524
Construction
4,536
3,648
4,966
5,113
4,500
3,814
Trading
9,173
9,248
15,472
13,576
11,783
11,342
Transportation
4,437
3,276
4,800
4,142
3,653
3,305
592
367
7,293
6,195
5,386
718
2,830
3,731
6,581
5,617
4,832
4,405
Total1
125,506
89,049
98,281
Note: 1 Total accident reported include total commuting accidents.
81,003
68,008
56,095
Financial Institution
Real Estates, Renting and
Business Services
!"
"
22
Original Article
Source: Labour and Human Resources Statistics (various issues), Kuala Lumpur: Ministry of Human Resource.
It can be observed that the pattern of accidents reported varies from one sector to another, reflecting the
difference of hazard across sectors. As shown in Table 2, 20.60 percent of total fatal accidents and 37.91 percent of
total disablement accidents in 2008 involved workers from the manufacturing sector. Although there has been
significant reduction of total accident in the manufacturing sector, accident cases which caused fatality and
disablement shown an increment. Between 1998 and 2008, fatal accidents increased from 256 to 268 cases, while
disablement increased from 5,823 to 9,701 cases.
Table 2. Types of Accidents Reported by Sectors, Malaysia, 1998 and 2008.
Fatal Accidents
Sectors
Disablement
1998
2008
1998
2008
69
154
1,730
1,769
15
130
194
256
268
5,823
9,701
12
13
98
272
124
139
102
231
804
1,494
1,736
4,142
Transportation
83
121
635
530
Financial Institution
15
16
162
1,649
109
114
767
1,982
Civil Service
Total1
1,135
1,301
13,698
25,592
Note: 1 Total includes fatal accidents and disablement from other services.
Source: Labour and Human Resources Statistics (1998) and (2008), Kuala Lumpur: Ministry of Human Resource.
Figure 1 illustrates the trend of industrial accidents in the manufacturing sector reported from 1993 to 2008.
Overall, total industrial accidents in the manufacturing sector were on a declining trend, except from 1998 to 2000
which shows an upward trend. An upward trend of industrial accidents during this period was attributable to
Malaysian economic recovery from the Asian financial crisis which hit Malaysia in the middle of 1997. The upward
and downward trend in total accidents during economic crisis and its recovery partly explain the influence of
business cycle over industrial accidents. During economic crisis in 1997, firms tended to reduce both the volume and
cost of production in response to decrease in aggregate demand. Reducing production involves the lay-off of newly
hired, less experienced and unskilled workers who are normally more vulnerable to accident at the workplace.
Hence by running the plants with the experienced and skilled workers during economic recession helps to reduce the
number of accident cases reported.
#"
"
23
Source: Labour and Human Resources Statistics (various issues), Kuala Lumpur: Ministry of Human Resource.
It can be observed that the pattern of accidents reported varies from one sector to another, reflecting the
difference of hazard across sectors. As shown in Table 2, 20.60 percent of total fatal accidents and 37.91 percent of
total disablement accidents in 2008 involved workers from the manufacturing sector. Although there has been
significant reduction of total accident in the manufacturing sector, accident cases which caused fatality and
disablement shown an increment. Between 1998 and 2008, fatal accidents increased from 256 to 268 cases, while
disablement increased from 5,823 to 9,701 cases.
Table 2. Types of Accidents Reported by Sectors, Malaysia, 1998 and 2008.
Fatal Accidents
Sectors
Disablement
1998
2008
1998
2008
69
154
1,730
1,769
15
130
194
256
268
5,823
9,701
12
13
98
272
124
139
102
231
804
1,494
1,736
4,142
Transportation
83
121
635
530
Financial Institution
15
16
162
1,649
109
114
767
1,982
Civil Service
Total1
1,135
1,301
13,698
25,592
Note: 1 Total includes fatal accidents and disablement from other services.
Source: Labour and Human Resources Statistics (1998) and (2008), Kuala Lumpur: Ministry of Human Resource.
Figure 1 illustrates the trend of industrial accidents in the manufacturing sector reported from 1993 to 2008.
Overall, total industrial accidents in the manufacturing sector were on a declining trend, except from 1998 to 2000
which shows an upward trend. An upward trend of industrial accidents during this period was attributable to
Malaysian economic recovery from the Asian financial crisis which hit Malaysia in the middle of 1997. The upward
and downward trend in total accidents during economic crisis and its recovery partly explain the influence of
business cycle over industrial accidents. During economic crisis in 1997, firms tended to reduce both the volume and
cost of production in response to decrease in aggregate demand. Reducing production involves the lay-off of newly
hired, less experienced and unskilled workers who are normally more vulnerable to accident at the workplace.
Hence by running the plants with the experienced and skilled workers during economic recession helps to reduce the
number of accident cases reported.
#"
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24
Original Article
$"
"
25
relationship between fatal accidents and business cycle. Similarly, in a study of workplace injuries for the United
Kingdom from 1986 to 2005 by Davies et al. (2009) found no significant relationship between business cycle and
major injuries.
Oi (1974) analyses various aspects of workplace injuries in the U.S. including the characteristics of
workers, labor turnover and establishment size. It appears that over all ages, males were three times as likely to be
injured at work as females. As for labor turnover, an increase in the accession rate or new hires of less experienced
workers during high employment gives rise to an increase in the overall work injury rates. Injury rates in relation to
establishment size exhibit an inverted U-shaped where the smallest and the largest establishments reporting lower
injury cases. Lower injury frequency in larger establishments could be explained by lower labor turnover, larger
fractions of workers in safer tasks and fewer young males.
Smith (1979) estimates the impact of OSHA inspections on the U.S. manufacturing industry for the years
1972 to 1974. The study finds that injury as it pertains to inspection effect varies across plant-size and hazardous
plant categories. Inspection effects were larger and statistically significant for the smallest plant and tend to be
greater in the more dangerous plants. Similarly, Smith (1979) suggests that the relationship between firm size and
injury rates probably is an inverted U-shaped. One possible explanation to the relationship is that small firms are less
hazardous and easily monitored, while large firms, with the advantage of economies of scale are able to apply safety
machineries and equipments.
Cooke and Gautschi (1981) examine the impact of OSHA citation activities and plant-specific programs
upon changes in the injury rates for 113 Maine manufacturing plants over the period 1970-1976. Apart from OSHA
citations, other factors included in the study are plant size and business cycle. The study employs the change in the
percentage of production workers receiving first payments as a proxy measure of business cycle. They found that
both firm size and business cycle were highly significant to injury rates. While firm size influences injury rates
negatively, business cycle affects positively. They concluded that OSHA investigation activities have reduced the
injury rates substantially for the case of larger firms.
Using a sample of 20 two-digit U.S. manufacturing industries from 1973 to 1983, Viscusi (1986)
investigates the impact of OSHA on workplace safety. The independent variables included in the analysis are
production workers, female workers and three variables to capture the influence of business cycle, namely the
percentage change in the industrys employment, average weekly work hours and average overtime hours. While
production workers are found to be positively related to accidents, female workers showed the reverse effect. A
positive relationship between business cycle and injury rates is only significant for percentage change in the
industrys employment. The results thus support for pro-cyclical relationship between employment and workplace
injuries.
Currington (1986) analyses the impact of OSHA standards on injury frequency rates for 18 manufacturing
industries in New York from 1964 to 1976. The analysis of the study is performed separately for all injuries,
caught in machine, and struck by machine injuries. The independent variables included are unionization, capital
intensity, firm size, new hire rate, employment ratio and production workers. All these variables are only significant
for all injuries except the employment ratio, a proxy measure for cyclical variation. Among the significant
variables, firm size is found to be the only variable which affects injury frequency negatively.
Jeong (1997) analyses the characteristics and causes of accidents for Korean manufacturing industry during
1991-1994. Analysis of causes of accidents in the study includes firm size, age and work experience. The analysis
shows that larger companies tend to have a lower accident rates and adults and less experience workers are more
prone to accidents. Fabiano et al. (2004) examine the relationship between workplace injuries and types of Italian
industry during 1995-2000 with a large sample of 2,983,753 firms. They identify four major factors that influenced
accident frequency, namely economical factors, technologies used, organizational factors and human factors and
relate these factors to the firm size effect. An inverse relationship between accident frequency and firm size is found
in all types of industries. The results of the study suggest that the four factors are unfavorable for small firms which
prove to be more liable to high accident frequency.
Previous studies on workplace injuries in Malaysia are mainly focused on the evolution and enforcement of
OSHA and level of awareness and knowledge on safety issue among employers and employees (Jamaluddin, 1994;
Mansur et al., 2003; Ariffin et al., 2006; Rampal and Nizam, 2006; Lugah et al., 2010). As shown by their studies,
safety and health regulations in Malaysia have evolved from very prescriptive legislations to detailed technical
provisions and to the one that is more flexible where self-regulations are encouraged under OSHA 1994. Rahmah
and Sum (2000) on the other hand, analyze the impact of OSHA on labor market demand in 50 manufacturing firms.
The results of cross-sectional analysis of their study show that OSHA has a significant impact on the demand for
labour by firms. The impact of OSHA is also different across types of industry where labor-intensive firms were
found to be more sensitive towards the regulations. A recent study by Surienty et al. (2011) investigates the impact
%"
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26
Original Article
of demographical variables (company size, type of organization and years of establishment), management
commitment, external support and legislation on Occupational Safety and Health (OSH) implementation in Small
and Medium Enterprises (SMEs) in Malaysia. The correlation analysis performed on surveyed data of 35 companies
shows that only management and external support were significant to OSH implementation where both variables
have positive correlation.
Several studies have attempted to examine the causes of accidents in the construction sector in Malaysia
(Abdul Hamid et al., 2008; Ali et al., 2010, Zakaria et al., 2010). Through analysis made on surveyed data, they
show that the main causes of accidents at construction sites are workers negligence, failure to obey the work
procedures, work at high elevation, operate equipments without safety devices, poor site management and low skill
and knowledge. A study on accidents at port sites by Mansor et al. (2011) focuses on two common dimensions of
workplace accidents, namely individual and job related factors. Using 177 surveyed samples, correlation test results
show that stress and fatigue, unsafe action, machinery and tools, design of workplace, training procedures are the
significant factors that contribute to workplace accidents.
&"
"
27
(Kossoris, 1938; Leigh, 1985; Robinson and Shor, 1989). Thus, we expect a positive relationship between injury
rates and cyclical variation. Similarly, capital intensity, production worker, and female worker are expected to have
positive influence over the injury rates. As for firm size, a negative relationship with injury rate is expected in the
sense that larger firms are better in controlling accidents among workers as compared to smaller firms (Cooke and
Gautschi, 1981; McVittie et al., 1997)
Three types of workplace injuries are included in the study, viz. fatal accidents, permanent disability and
temporary disability. Data on workplace injuries were obtained from Annual Report published by Social Security
Organization (SOCSO). The Annual Survey of Manufacturing Industry, published by the Department of Statistics,
provides data on total employees, fixed assets and total establishments for each industry. Unpublished data of
production and female workers in manufacturing plants were obtained from the Department of Statistics.
Table 3 presents a summary of the descriptive statistics of the variables used in this study. During 19932008, the average injury rate among the sample manufacturing industries was approximately 3.90 percent ranging
from a minimum of 0 to a maximum of 54.86 percent. The lowest and the highest injury rate came from tanneries
and leather finishing industries and metal and wood working machinery manufacturing respectively. The average for
firm size and capital intensity was 134.21 and 120.63 percent respectively. The mean for total production worker
and female worker were 57.86 and 21.33 percent respectively. The average cyclical variation was 5.60 percent
throughout the period of study.
Table 3. Descriptive Statistics.
Variables
IR
Mean
Median
Maximum
Minimum
Std. Dev.
3.90
1.99
54.86
0.00
5.50
KI
PW
FW
CV
134.21
75.80
1399.63
1.51
202.49
120.63
73.76
1367.41
1.76
174.46
57.86
65.06
92.17
0.13
21.26
21.33
17.40
75.20
0.00
18.20
5.60
3.06
136.61
-83.87
23.65
Model 1
Model 2
-1.780
-1.876
'"
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28
Original Article
(-5.24)***
Capital Intensity (KI)
Production Workers (PW)
(-5.58)***
0.339
0.517
(1.07)
(1.50)
0.020
(1.82)**
0.013
0.036
(0.60)
(2.02)**
0.018
(2.47)
0.017
**
(2.35)**
R squared
0.49
0.49
Adjusted R squared
0.44
0.44
F-statistic
9.84
9.91
4.11
4.11
1.52
1.52
Durbin-Watson statistic
Notes: Figures in parentheses are t-statistics value. ** Significant at 5% level, *** Significant at 1% level.
Our result for business cycle (CV) impact on industrial accident is consistent with pro-cyclical relation in
previous studies (Kossoris, 1938; Leigh 1985; Cooke and Gautschi, 1981; Robinson and Shor, 1989). The
coefficient for cyclical variation remains positive and significant under the two different estimations, suggesting that
business cycle is an important determinant of injury rate in Malaysian manufacturing industries.
CONCLUSION AND POLICY IMPLICATION
This paper sought to analyze the determinants of workplace injuries in Malaysian manufacturing industries during
the period 1993 to 2008. Adopting the structural and business cycle approach, our panel data was tested using fixedeffects estimation method. The results of this study reveal that firm size, production workers, female workers and
cyclical variation are the important factors for workplace injuries in Malaysian manufacturing industries. Our
empirical findings, however, provide no evidence to support the effect arising from the level of capital intensity of
manufacturing industries.
The most robust findings of this study are that workplace injuries were negatively influenced by firm size
and positively influenced by cyclical variation. Consistent with previous studies, this study found that large
manufacturing firms are more capable of controlling accidents at workplace as compared to small firms. This
reflects greater level of awareness on OSH matters among large firms. Efforts by employers from SMEs in Malaysia
in promoting safety and health in the workplace are still lacking (Rampal and Nizam, 2006) possibly due to low
awareness over OSH requirements (Surienty et al., 2011). Under OSHA 1994 (Section 30), every employer shall
establish a safety and health committee at the place of work if there are 40 or more persons employed. Lack of law
enforcement on smaller firms is possibly the underlying factor that they are less sensitive towards OSH issues.
Therefore, to improve safety at workplace in Malaysian manufacturing industries, higher priorities should as well be
given to small firms through supplementary and special inspections to ensure that small firms apply the appropriate
safety and health standards and codes of practices.
Similarly, focus of safety regulations should as well be given to reduce business-cycle-related injuries.
Since business cycle is an unpredictable phenomenon, advanced preventive efforts towards potential accidents
among workers during economic upswing might be useful to reduce accidental risks in industries. Preventive
measures may include training programs and technical skills education. In Malaysia, there have been concerted
efforts among government agencies to prepare the Malaysian youths with relevant skills, knowledge and experience
through vocational and technical schools, polytechnics and industrial training institutions. On the employers side,
hiring safety machineries and equipments as well as safety devices will further help to reduce the risks of getting
injured at workplace.
The results of this study also reveal that production workers and female workers in manufacturing plant are
equally significant for injury rates. It is generally known that production workers, either male or female, are those
who directly perform the operation in the plants and have a direct contact with machinery and equipments. Poor
working attitude, inadequate knowledge and experience, and poor supervision by the management are among the
("
"
29
factors that place them into accidental risks. Therefore, improved training programs and enforcement of compliant
safety regulations should be the priorities by both the employees and employers.
This study has shown that workplace injuries in Malaysia are generally attributed to both business cycle
and structural factors. Hence, it suggests the importance of OSHA enforcement and its compliance to codes of
practices among manufacturing industries in Malaysia. Our study is limited by some measures which were not able
to be included in the analysis, such as compensation, level of workers knowledge and experience and other relevant
factors. We leave these limitations to be improved in future in-depth analysis.
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*+"
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32
Original Article
Department of Occupational Therapy, Faculty of Medicine, Nursing and Health Sciences, Monash University,
Australia
2. Department of Occupational Therapy, Faculty of Health Sciences, MARA University of Technology, Malaysia
3. Occupational Therapy Division, School of Health and Rehabilitation Sciences, University of Queensland,
Australia
Abstract
Introduction:
This study explores the health status of injured workers in return to work (RTW) programs based on their ability and
capacity. Injured workers were diagnosed with work-related musculoskeletal disorders. The findings will help not only the
service provider plan a specific strategy but also allow stakeholders to review their role in the RTW program.
Methods:
102 participants were chosen from a national RTW program, and categorized into three groups based on different phases of
the RTW program: off-work (n=30, 29.4%), work re-entry (n=44, 43.1%) and maintenance (n=28, 27.5%). Self-report
questionnaires identified demographic data, health surveillance via SF-36 and perceived physical and psychological
workload by 10-point numerical scales. Analysis of variance (ANOVA) and Kruskal-Wallis Test was employed to examine
the differences in three phases of the RTW program. Paired t-test analyzed the differences of related samples of physical and
psychological workload before and after injuries.
Results: The domains of health status are below the average compared to the norm-based population. Mental health
component summary is better than physical health. At the domain level, there are significant differences among injured
workers, specifically in the three RTW program phases. The SF-36 domains are: role-physical, vitality, bodily-pain, general
health, and mental health (p ! 0.049). In contrast, non-significant differences were found in physical and social functioning,
and role of emotion status. Moreover, their self-perceived physical and psychological work-load significantly worsened after
injuries (p ! 0.020).
Conclusions: The case manager-coordinated RTW program provided further opportunities to improve injured workers
health status when looking at their differences for different phases of RTW. Other health professionals like occupational
therapists, ergonomists and psychologists should become involved in the RTW program. Specific guidelines and regulations
have to be implemented to ensure full participation with all parties in the workplace.
Keywords: Health status, return to work, phases and musculoskeletal disorders
Introduction
Work-related musculoskeletal disorders (MSDs)
may develop over time or as the result of acute
injuries, and are caused either by the work itself or
the immediate environment [1-4]. Typically, MSDs
affect peoples back, neck, shoulders and upper
limbs, with lower limbs less often affected [5].
People with MSDs often experience a number of
complications associated with their injury, for
example pain, stress, anxiety and depression. A
number of previous studies found that pain is one
of the major impairments of MSDs [1, 6, 7].
Psychological symptoms such as anxiety, stress and
depression also commonly affect workers who are
absent from work for long periods [1, 6, 8, 9].
Furthermore, people who suffer work-related
MSDs may experience physical restrictions in daily
life activities which could further compromise their
133
The Impact of Return to Work Programs on the Health Status of Injured Workers with Work-Related
Musculoskeletal Disorders: A Malaysian Study
Return to work (RTW) programs involving a multidisciplinary approach have been largely developed
34
Original Article
1.
2.
3.
Methods
Subjects and procedures
A randomized stratified sampling strategy, based
on body part injured, was used to ensure that the
sample for this study included representative ratios
of workers with different disabilities. Inclusion
criteria were: (1) a current work-related MSD; (2)
ability to read and understand the Malaysian
Language; and (3) involvement in the SOCSO
RTW program between early 2008 and the end of
2010.
Four hundred potential participants were
identified using a randomized computer sequence
from SOSCOs database which includes records for
a total of 997 injured workers. These identified
participants received an official letter providing
participation information sheets and a stamped
envelope that can be used to return their written
consent for participation. A total of 105
participants agreed to take part in the study as
indicated by their consent form. They then received
the SF-36 questionnaire [24] and a brief participant
data survey that collected demographic, injury,
treatment, and work-related information. In this
survey, workers were also asked to categorize their
current RTW status (by using the criteria described
by Young et al. 2005) into one of the four phases
(off-work,
re-entry,
maintenance,
and
advancement). As described by Young et al. 2005
the injured workers may move between phases in a
non-linear fashion. Some of the injured worker
probably has experienced one or more phases of
RTW phases, or due to recurrent injuries they
returned back to off-work phase, in this study, they
only have to choose only one phase that best
describe their RTW status recently. These criteria
were:
Phase Off-work:
You are off work due to your MSDs injuries. You
are at no time during this phase back at work, either
in pre-injury or in an alternative capacity, and are
.
Instruments!!
The SF-36 is a self-report questionnaire to measure
the overall health status by understanding the
effects of the disorders or illnesses on activity
limitations and participation restrictions. There are
eight domains regarding physical and mental health,
and each domain consists of 210 items that are
related. The 8 domains are physical functioning (10
335
The Impact of Return to Work Programs on the Health Status of Injured Workers with Work-Related
Musculoskeletal Disorders: A Malaysian Study
Ethics
Ethical approval was obtained from the Monash
University Human Research Ethics Committee as
Statistical analysis
the difference of the SF-36 scores (at both the subscale and component level) among the injured
workers at different RTW phases [27]. The Levene
statistics prior to the ANOVA, was used to
examine the homogeneity of the SF-36 scores [27].
In addition, a paired t-test was employed to analyse
the differences regarding the participants physical
and psychological workload before and after
injuries [27]. All statistical analyses were
performed using the Statistical Package for Social
Sciences, Version 18 (SPSS, SPSS Inc, Chicago,
IL) software.
Results
Total
(n=102)
Gender, n (%)
Male
Phase 1
Off-work
(n=30)
Phase 2
Re-entry
(n=44)
Phase 3
Maintenance
(n=28)
84 (82.4)
25 (83.3)
33 (75.0)
26
18 (17.6)
5 (16.7)
11 (25.0)
2 (7.1)
Age, n (%)
18 to 25 years old
22 (21.6)
5 (16.7)
7 (15.9)
10(35.7)
26 to 35 years old
32 (31.4)
10 (33.3)
13 (29.5)
9(32.1)
Female
36 4
(92.9)
Original Article
36 to 45 years old
29 (28.4)
11 (36.7)
13 (29.5)
5 (17.9)
46 to 55 years old
17 (16.7)
3 (10.0)
11 (25.0)
3 (10.7)
2 (2.0)
1 (3.3)
0 (0.0)
1 (3.6)
Ethnicity, n (%)
Malay
57 (55.9)
15 (50.0)
26 (59.1)
16(57.1)
Chinese
17 (16.7)
5 (16.7)
8 (18.2)
4(14.3)
Indian
23 (22.5)
9 (30.0)
8 (18.2)
6(21.4)
Others
5 (4.9)
1 (3.3)
2 (4.5)
2 (7.1)
4 (3.9)
1 (3.3)
2 (4.5)
1 (3.6)
Neck
2 (2.0)
0 (0.0)
2 (4.5)
0 (0.0)
Trunk
25 (24.5)
7 (23.3)
12 (27.3)
6(21.4)
Upper Limb
19 (18.6)
7 (23.3)
6 (13.6)
6(21.4)
Lower Limb
32 (31.4)
6 (20.0)
13 (29.5)
13 (46.4)
Multiple injuries
20 (19.6)
9 (30.0)
9 (20.4)
2 (7.1)
20 (19.6)
10 (33.3)
5 (11.4)
5 (17.9)
Physiotherapy
45 (44.1)
10 (33.3)
28 (63.6)
7 (25.0)
Occupational Therapy
3 (2.9)
2 (6.7)
1 (2.3)
0 (0.0)
20 (19.6)
4 (13.3)
7 (15.9)
9 (32.1)
14 (13.7)
4 (13.3)
3 (6.8)
7 (25.0)
15 (14.7)
3 (10.0)
10 (22.7)
2 (7.1)
Labor work
12 (11.8)
6 (20.0)
4 (9.1)
2 (7.1)
Technical work
14 (13.7)
4 (13.3)
4 (9.1)
6 (21.4)
Factory work
29 (28.4)
6 (20.0)
12 (27.3)
11(39.3)
32 (31.4)
11 (36.7)
14 (31.8)
7 (25.0)
23 (22.5)
3 (10.0)
13 (29.5)
7 (25.0)
26 (25.5)
10 (33.3)
9 (20.4)
7 (25.0)
45 (44.1)
11(36.7)
21(47.7)
13 (46.4)
8 (7.8)
6 (20.0)
1 (2.3)
1 (3.6)
37
The Impact of Return to Work Programs on the Health Status of Injured Workers with Work-Related
Musculoskeletal Disorders: A Malaysian Study
207.2208.2 327.89286.88
163.0139.7 152.2151.1
Table 2. Overall mean scores of the subscales and physical and mental components summary of the SF-36
SF-36 subscale/
Mean (SD)
p-value
95 % Confidence Interval
Component summary
Physical functioning (PF) 35.68 (9.44)
<0.001
-16.80 - (-11.85)
Role physical (RP)
36.12 (9.03)
<0.001
-16.27 (-11.50)
Bodily pain (BP)
35.67 (8.47)
<0.001
-16.54 ( -12.12)
General health (GH)
40.26 (9.56)
<0.001
-12.26 (-7.21)
Vitality (VT)
43.38 (9.59)
<0.001
-9.13 (-4.11)
Social functioning (SF) 39.56 (9.75)
<0.001
-13.00 (-7.89)
<0.001
-19.44 (-13.05)
Role of emotion (RE)
33.75 (12.12)
Mental health (MH)
37.58 (10.87)
<0.001
-15.27 (-9.56)
PCS
37.77 (7.69)
<0.001
-14.27 (-10.19)
MCS
38.98 (11.11)
<0.001
-13.96 (-8.07)
Note:
PCS=Physical component summary, MCS=Mental component summary. Results are compared to norm-based
scoring (each scale score mean =50.00 SD10) [28]
significant differences between the groups based on
the phase of the RTW program. There were no
significant differences between the other sub-scales
(physical functioning). Furthermore, their physical
and mental summary scores were found to have no
significant variations among the different phases of
the RTW program.
Since the social functioning (SF), role of emotion
(RE) and mental health (MH) were not normally
distributed, the Kruskal-Wallis Test was used. Only
MH was found to exhibit significant differences
between the groups of injured workers at different
phases of the RTW program. There were no
significant differences between the other 2 subscales (SF and RE). Details of the results of the
ANOVA and Kruskal-Wallis tests are summarized
in Table 3.
38
Original Article
workload demonstrated significant increases postinjury with the participants in the Re-entry and
Maintenance phases. Details of the results are
shown in Table 4.
Discussion
This study, using a sample of Malaysian workers
with MSDs, is the first to investigate the
differences in injured workers health status across
Youngs different phases (off-work, work re-entry
and maintenance). We found that all the SF-36 subscales and physical/mental summary components
of the injured workers attending the SOCSO RTW
program were below average compared to the
internationally-established normative population.
Their physical component summary was also found
to be lower than mental component summary.
Moreover, by dividing them based on different
phases of the SOCSOs RTW program, the five
sub-scales of health status, i.e. role-physical (RP),
bodily-pain (BP), general health (GH), vitality (VT)
and mental health (MH), exhibited significant
differences between groups. This indicates that the
health status of the injured workers in some areas
may improve as they regain considerable capacity
and ability while progressing to higher phases in
RTW program.
The MH, RP, BP, GH and VT statuses
were improved significantly, probably because the
workers recovered from their injuries or they were
given light duties to reduce physical demands when
they returned to work. This may also be the result
of therapy received (such as Physiotherapy) as this
treatment primarily focuses on improving injured
workers pain and physical abilities. It was thus
expected that any significant changes would be
similar to those reported in another previous study
[29], where physical training that included aerobic
capacity, muscle strength and endurance supervised
by physiotherapists had a positive effect on
physiological outcomes and functional status of job
demand [29].
The most significant gains were in the
mental health (MH) status scores as participants
returned to work and carried on with their usual
duties. This may be the result of the support and
services provided or funded by SOCSO and
reduced financial concerns during sick leave due to
the payment of temporary disablement benefits.
Injured workers may also have received additional
support from family, relatives, peers and employers
when they re-entered to workplace or maintained
their work. Previous studies found that sick leave
without financial and family, peer and employer
support caused more stress, depression and anxiety
among injured workers [13, 30]. Therefore, mental
health support can be considered as a potential
benefit of RTW programs conducted by
Malaysians SOCSO.
739
The Impact of Return to Work Programs on the Health Status of Injured Workers with Work-Related
Musculoskeletal Disorders: A Malaysian Study
Conclusion
Overall, the findings of this study indicate that
SOCSOs RTW program may provide further
opportunities for improving the health status of
injured workers across different phases of the RTW
and
program
(off-work,
work
re-entry,
maintenance). Greater attention is needed with
injured workers who have different capacities and
abilities, especially in relation to physical
emotional and social functioning. The findings
suggest that involving multidisciplinary healthcare
providers such as occupational therapists,
ergonomists and psychologists may be needed to
ensure that injured workers experience improved
health and can return to work. Furthermore, it is
suggested that rules and guidelines regarding
occupational rehabilitation management be further
developed and enforced. This would lead to
increased awareness of the importance of securing
the full participation of injured workers, case
managers, healthcare providers and employers.
Acknowledgement
This study was supported by Department of
Occupational Therapy at Monash University and
cooperation with the Return to Work unit,
Malaysian Social Security Organization, Head
Office, Kuala Lumpur.
40 8
Original Article
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941
The Impact of Return to Work Programs on the Health Status of Injured Workers with Work-Related
Musculoskeletal Disorders: A Malaysian Study
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4210
Original Article
35.
36.
37.
38.
39.
40.
1143
The Impact of Return to Work Programs on the Health Status of Injured Workers with Work-Related
Musculoskeletal Disorders: A Malaysian Study
5.11 (3.05)
4.45 (2.82)
3.94 (3.26)
2.86 (2.95)
4.78 (3.08)
3.98 (3.08)
5.46 (2.34)
5.68 (2.52)
6.17 (2.42)
6.42 (3.22)
7.74 (2.20)
5.81 (2.67)
6.37 (2.45)
-1.39 (2.91)
-0.44 (3.68)
-0.57 (4.00)
-1.71 (3.09)
-2.48 (5.08)
-4.88 (3.49)
-1.03 (4.27)
-2.40 (3.43)
-1.86-(0.99)
-1.82-(0.67) 0.358
-2.68- (-0.75) 0.001
-4.58-(0.38) 0.022
-6.39- (-3.37) <0.001
-1.90-0.16
0.020
-3.10- (-1.69) <0.001
0.537
5.03 (2.92)
5.56 (2.30)
12
4.17 (2.59)
Table 3. The differences in scores on the sub-scales of the SF-36 between the group of injured workers in Phase Off-work, Phase Re-entry and
Phase Maintenance
SF-36 Subscale/
Phase
Phase
Phase
Test statistic
p-value
Component summary
Off-work
Re-entry
Maintenance
Mean (SD)
Mean (SD)
Mean (SD)
Physical functioning (PF)
34.59 (10.25) 35.86 (8.48) 36.62 (10.23)
F=0.33
0.718
Role physical (RP)
33.20 (9.38) 36.11 (8.38) 39.63 (8.77)
F=3.65
0.030
Bodily pain (BP)
34.66 (7.27) 34.22 (8.03) 38.40 (9.60)
F=3.14
0.048
General health (GH)
37.40 (9.05) 40.60 (8.74) 42.32 (11.47)
F=3.12
0.049
Vitality (VT)
39.72 (9.25) 43.38 (9.38) 47.12 (9.82)
F=4.35
0.016
Social functioning (SF)
38.72 (10.30) 38.76 (9.24) 43.08 (10.11)
H=4.23
0.121
Role of emotion (RE)
31.42 (12.74) 33.88 (12.85) 37.03 (10.38)
H=3.09
0.213
Mental health (MH)
35.12 (12.29) 36.37 (9.70) 43.34 (9.66)
H=8.37
0.015
PCS
36.08 (8.34) 38.11 (6.66) 39.08 (9.08)
F=1.36
0.261
MCS
36.78 (11.67) 38.33 (11.09) 43.85 (9.99)
F= 2.90
0.060
Note; PCS=Physical component summary, MCS=Mental component summary, F indicates that the analysis was performed by one-way ANOVA,
H indicates that the analysis was performed by Kruskal-Wallis
Table 4. Differences between participants ratings of physical and psychological workloads before and after injuries.
Before injury
After injury
Paired differences
CI
p-value
Mean (SD)
Mean (SD)
Mean (SD)
Total participants (n=102)
Physical work load
Psychological workload
Phase Off-work (n=25)
Physical work load
Psychological workload
Phase Re-entry (n=42)
Physical work load
Psychological workload
Phase Maintenance (n=28)
Physical work load
Psychological workload
Note: CI= Confidence Interval
44
Original Article
Abstract
Rapid development of technology has made simulator as a promising training tool. Advantages offered such as
interactive and realistic training environments, mistake tolerance and training in hazardous scenario without causing
harm to trainee, cost effectiveness, opportunity of training review and training time flexibility makes simulator widely
used in aviation training, driver training, medical training and rehabilitation. Despite of these advantages, a major
drawback of simulator is simulator sickness. Simulator sickness is a condition caused by inconsistency perceived by
our vestibular system. Effected individual reported that they are experiencing nausea, fatigue, postural instability,
headaches and difficulty in focusing which linger for hours or days in some cases. This paper will discuss the simulator
usage and simulator sickness condition in Malaysia as experienced by researchers and a few organizations that use
simulator as their training tool.
Introduction
Training is essential in determining competitiveness of an organization as training supplies knowledge,
skill and attitude required by organization. Training also be regarded as crucial in safety perspective which
make it outlined as one of employers responsibility in OSHA 1994 (Occupational Safety and Health Act,
Act 514, 1994. Regulation and Order, 1998). On job training is one of the most effective and simple
method in knowledge and skill transfer. With learning by doing motto, the beginner and intermediate
employees can really earn the benefit of training since theyll be trained in actual working environment.
Rapid development of technologies make simulator as one of promising on job training tool. Simulators
offer interactive and realistic training environments, mistake tolerance and training in hazardous scenario
without causing harm to trainee, cost effective training method, opportunity of training review and training
time flexibility (Powell, 2011; Wang & Song, 2011; ADSO, 2005; Coutermash, McDonald & Shoop, 2011).
These advantages make simulator widely used in aviation training, driver training, medical training and
rehabilitation. This paper will discuss the simulator usage and simulator sickness as experienced by a few
organizations in Malaysia. This information was captured during MIROS Simulators Team visit to these
organizations in understanding the simulator operation.
Simulator sickness
Beside electrical and other physical hazards poses by simulator, there is a health hazard induced by
simulator, namely simulator sickness. Simulator sickness is a type of cyber sickness which occurred as a
result of exposure to Virtual Environment (VE). A VE is an environment simulated by a computer to
imitate real environment or imaginary environment and be displayed on a computer screen or special
equipment like driving and flight simulator.
Kolasinski (1995) reported that simulator sickness was initially documented by Havron and Butler in 1957
in helicopter training. Researchers came out with few theories in identifying the causes of simulator
sickness and the most widely accepted theory is sensory conflict theory. This theory suggests that the
human body is unable to handle the conflict between movements captured by the human eye and the
nonmovement of the human body which is being picked by the human body vestibular system (Nichols &
Patel, 2002; Kennedy & Frank, 1985). Simulator sickness look a lot like motion sickness but it normally
affects smaller proportion of exposed population and usually much less severe. However, Kennedy and
Fowlkes (1992) as cited in Nichols and Patel (2002) states that the after effects of simulator sickness can
persevere for several hours and it may present a safety risk to the subject. The main difference between
simulator sickness and motion sickness is simulator sickness can be induced by visual simulation alone.
There are complex signs and symptoms associated with simulator sickness which make it being described
45
as polysymptomatic. This is because the symptoms exhibited are varied among people. Most common
symptoms reported by simulator user are general discomfort, fatigue, sweating, salivation, headache,
nausea, disorientation and stomach awareness. Predicting simulator sickness is not an easy task since the
sickness is contributed by many factors (polygenic); technologically and individually. Some of technology
contributing factors are projection quality, viewing condition: field of view, flicker and lag Nichols and
Patel (2002) and position tracking error. For individual factor, gender, age, illness, adaptation and position
in simulator has been identified as contributing factor to simulator sickness (La Viola Jr., 2000; Kennedy &
Frank, 1985).
Consequences of simulator sickness
Crowley (1987) as cited in Kolasinski (1995) identified four important consequences of simulator sickness
which are (1) decrease simulator use, (2) compromised training, (3) ground safety and (4) flight safety.
Flight safety is included since Crowley work is based on simulator sickness in army aviation. Even the
consequences are noted from aviation field, most of his ideas were supported by other researchers as they
were applicable to other type of simulator. Simulator sickness has been a notable obstacle in training and
research using simulator (Cobb, Nichols, Ramsey, & Wilson, 1999). Nichols and Patel (2002) review
shows that early exits due to high symptom levels ranged from 4% to 16% and 10% of simulator users
report that they are experiencing simulator sickness. 9% of participants from Lee, Cameron and Lee (2003)
study also reported mild degree of dizziness after simulator driving session. Early exit recorded by these
researchers is an evidence of decrease in simulator usage as sickness experienced discourages them from
continuing operating the simulator (La Viola Jr., 2000). Training may be compromised when the trainees
are experiencing simulator sickness (La Viola Jr, 2000). Firstly, sickness could distract the trainee during
the session which make them less attentive and effecting their performance. This condition has been
supported by Cobb et al (1999) and Brooks et al (2010) when they found a negative correlation between
simulator sickness symptoms and participant performance. Secondly, trainee might adopt behaviours to
avoid the symptoms in simulator which could be injurious if transferred into real life task. For example,
trainee might close the eye to avoid the symptom (headache) during the training in driving simulator. This
action is forgivable as it is safe in simulator but it could lead to road crash if the trainee close the eye during
real life driving activity when he experiencing headache. Postural instability and flashback induced by
simulator exposure associate simulator sickness with fall risk (Kolasinski, 1995) and ground safety. This
condition is evidenced by a case of a pilot whose vision suddenly inverted 180 degrees while he was
driving home hours after exposure to VE: attending flight simulator training (La Viola Jr., 2000).
Simulator usage in Malaysia
In Malaysia, at least four organizations were identified using simulator for their training purposes.
Simulators used were flight simulator, driving simulator, ship simulator and cargo handling simulator.
These simulators are categorized as virtual interactive simulation since operator or trainees input is crucial
in determining the direction of simulation while the human element is not modeled (ADSO, 2005). From
the discussion, all of these organizations acquire simulator as their training tools mainly because of cost
effectiveness, training benefit and safety issue. For costing, simulator usages reduce the cost of machines
fuel, less or no dependencies on the real machine which make the real machine available for operation and
reduce the cost of real machine maintenance due to trainings incidents. In term of safety and training
benefit, these organizations agreed that simulator enable them to train the trainee in controlled and safe
environment even when they are conducting training on hazardous environment. For example, pilot can be
train on how to operate the flight when they are having engine failure and crane operator can be train to
manage their crane during storm. This condition also give the courage to the trainee that they are able to
face the unexpected event without harming themselves. Other benefits of training effectiveness offered by
these simulators are the structured and computerized module where every trainee is undergoing the same
training, opportunity in training repetition and replay to ensure the trainee really master the skill and
knowledge, improvement in trainees psychomotor skill, cognitive and perception about task, recordable
and evaluable training performance and effective scheduling. Effective scheduling was reported as very
important for flight and cargo organization as simulator allows them to have training around the clock
regardless of weather or external condition.
46
Original Article
i) Flight simulator
In aviation industry, simulators are mainly used as a training tool for pilot to perform their conversion
training and to renew their flying license. A flying license for every pilot is only valid for 6 months and
they need to undergo test on simulator to renew it before they are allowed to fly again. Department of Civil
Aviation (DCA) is the responsible agency in granting the certificate of use for each simulator before it can
be used as pilots qualifier. This certificate is only valid for 1 year after the DCA auditor conduct the plot or
objective and subjective testing on the simulator.
47
48
Original Article
49
50
Original Article
awareness, some organization took some initiative to make the training session better. For driving simulator
organization, they reported that the trainee are required to do some exercise before the simulator training
while cargo handling simulator organization allow the adaptation and frequent break during the training.
All of organizations encourage the trainee to stop the training if they fell unwell.
Suggestion for improvement
Since Malaysian doesnt have a solid data on criticality of sickness in Malaysia, therefore it is highly
suggested that we adopt the current practice use by simulator users in other countries as an added value on
organizations current unwritten practice. For example, La Viola Jr. (2000) reported that many air forces
bases implement a mandatory policy where a pilot is prohibited from flying an aircraft within 12 24 hours
after flight simulator exposure. ADSO (2005) also report that Advance Flight Simulator (AFS) team
patrolling the disorientation caused by simulator sickness by disallowing the crew from driving motor
vehicle within 2 hours of simulator training. In entertainment industry, many VR entertainments centre
require the user to not to drive for at least 30 45 minutes after exposure to reduce the road
crash risk (La Viola Jr., 2000). Organizations are also advised to document the feedback and sickness
symptoms showed by the simulator users after the simulation exposure. This documentation is believed to
be very meaningful to support the sickness identification before MIROS work on sickness measurement
completed. Feedback recorded can be compiled with the absenteeism and incidents occurrence after the
training to find the simulators after effects in Malaysia environment. Currently, MIROS is working on the
simulator sickness measurement validation. Once the validation process completed, the measurement
process is expected to be one of step in simulator usage procedure. This measurement has a twofold
function which is firstly concern about users and secondly is about the simulator performance (Kennedy,
Lane, & Lilienthal, 1993). By identifying the degree of simulator sickness severity, the operator is able to
provide immediate users awareness on the effect and take necessary precautions to reduce risk in
subsequent activities. Reports on symptoms may be indicative of a simulator malfunction, and can be used
for troubleshooting purposes. It also can be used to assess the impact of technology modification and
training syllabus changes. In driving training industry, there is a plan of using simulator as training tool in
driving institute. This plan believed to benefit the new driver in term of exposure of varieties of driving
condition like raining, congestion and night time driving which hardly be done in current training module.
However, in simulator sickness point of view, this plan cant be executed for time being due to risk of
sickness and unavailability of simulator usage procedure. Furthermore, managing and monitoring the
sickness will be a huge challenge since it would involve variety of people and they are scattered after
training.
Conclusion
Simulator is a great training tool as it offers interactive and realistic training environments, mistake
tolerance, enable the training in hazardous scenario without causing harm to trainee; cost effectiveness,
opportunity of training review and training time flexibility. However, a special attention need to be given
on simulator sickness as it is a complex syndrome and could counter the benefit offered by simulator. A
proper documentation, simulator usage and simulator sickness management procedure are believed be able
to mitigate the sickness and result in more effective training.
Reference
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Wang, J. H., & Song, M. (2011). Assessing Drivers' Tailgating Behaviour and the Effect of Advisory Signs
in Mitigating Tailgating. Proceeding of the Sixth Intenational Driving Symposium on Human
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52
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Book:
Perez, A.K., Little, T.H., & Brown, Y.J. (1999). Safety in numbers. Itasca, IL: National Safety Council.
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safetytips.asp?safetyid=1 (accessed October 2004)
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Ministry of Health Malaysia & Academy of Medicine Malaysia (2003). Clinical Practise Guidelines on
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Tel. (603) 8941 2313 Fax. (603) 8943 0313 Email:kreatif@visualpress.com.my