National occupational research agenda (NORA) future directions in occupational musculoskeletal disorder health research.

Musculoskeletal disorders are among the most costly health care problems facing society today. The scientific literature has indicated that psychosocial factors, individual factors, workplace physical requirements, and workplace organizational factors have been associated with risk. Since musculoskeletal risk is multi-dimensional, the magnitude of risk attributable to various factors can be of importance to scientists and policy makers in designing countermeasures to reduce injury incidence. Traditionally, the disciplines of biomechanics, physiology, and psychophysics have dominated the body of knowledge that has defined exposure limitations to work. However, recent research has explored the association of psychosocial and work organization factors with musculoskeletal problems. Advances have been made to better quantify the levels of occupational exposure by improved exposure metrics, quantification of three-dimensional loads experienced by certain joints (e.g. the spine), identification of tissue tolerance limits and tissue response to mechanical stresses, and the impact of psychosocial stresses. However, efforts to quantitatively link epidemiological, biomechanical loading, soft tissue tolerance, and psychosocial studies should be pursued to establish a better understanding of the pathways of injury and resultant preventive strategies. Although we are beginning to understand how the major risk factors influence the load-tolerance relationship of human tissue, how these risk factors interact is virtually unexplored. Since the impact of the interactions may be far greater than that of any individual factor, the impact of the interactions between risk factors must be delineated so that work-related risk can be better quantified. Efforts to quantitatively link epidemiological, biomechanical loading, soft tissue tolerance, and psychosocial studies should be pursued to establish a better understanding of the pathways of injury and resultant preventive strategies.