[2004] 대한이연 근골격계질환 진단 및 대안마련을 위한 연구 보고서
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1. 2004. 10. 2. ( /) ( /) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) () () () (S/T) (, ) ( ) ( /) ( ) ( ) ( ) 3. . 1 . 6 . 8 . 17 . 24 1. 242. 3.-2943 . 197 200 4. I. . (WHO) (WHO,1985)1985 (multifactorial) . (Sluiter JK et al, 2001). 1. () , , . . (David . 11992Stubbs). . , . 10 . 1 . (risk .- 1 -assessment) 5. -(work- - - system) (KlausJ. Zink, 2003) .- -(performance) (quality- ODAM(Organizational Design and Management : ODAM) of working life)(Macroergonomics) (macro-ergonomics) . (ScottPA and Zink K, 2003).- 2 -1 6. 1. ( MICRO -ERGO NO MICS ) ( MACRO -ERGO NO MICS ) ( P hy sical demension) - () ( P scy chological demension) ( Q ualification) ( Economic demension) , , . , .WHO 1985 (multifactorial) . . , , , , , , , , , ( , 2003-24)- 3 - 7. , ( ), ( ), : , , , ( ): , . (macro-ergonomics) . , . 1 . 2. () , - , , () , () , , , - 4 - 8. , - , , , . (movement)(vibration) (physical()(posture), (force), factors) () ( : ) ( (decisionlatitude)factors) ) (nonphysical. 3. ()1. , , , (, : ) (, )2. (EU) , ,Punnet11226,Bergqvist 1997 1999NIOSH,(IEA)UEMSD1997 NIOSH , (ICOH)DG-5ISO/DIS . . , . , (NIOSH,1997).,WHO (WHO,1985). . .- 5 - 9. . : ( : 60(autonomy)10 ), (decision latitude), . . , , , . , , . , .Karasek job content . , , . , .II. , . , . , , , , , . .- 6 - 10. III.1. : (Participatory action research) (Participatoryaction research) . , , (De Kong Martin 1996). --> (Participatory--> -->action research) --> --> --> (Ritchie action research)1996).--> --> (Participatory, , .1): , . : 2) : 1 2 , 1. . : , .3) : , , . : , , , , O/T, , , - 7 - 11. 4) : . : , , 5): , . : 6): . : (87)30~31 ) ( ): . . : 8) (1) : , , . : , , (2) : , , , , . : 2. . .- 8 - 12. 1) . 2 . , 1, . .(1) . 4. - , , , , , , - - , , , - , (, ) - , , - : , , - (HAL) - (NPF) - - - - - - , , - , - , - - , - - , , - - - : , , /, /, /, /, / - , , , - , - , - - 9 - 13. (2) Occupational Safety and Health, NIOSH)(National (1), ( 4)Institute 2,3,. . 1 :2 1 1 1 : 1(NIOSH) (NIOSH , )3 : 1 ( )4 : 3 1 ( (3) . Karasek(1979) . . , , , , , . , (Karasek,1979)().- 10 -4 14. 2 (lowstrain group) . , , . (passivegroup) . . (active (highgroup)strain group) . . , , , , (Karasek ,1988). Karasek Theell(1990) . Karasek(1988) . , . Karasek(1979) . Karasek(1982) . (4) (4) .- 11 - 15. (4) .3, 6, 1 51, 7, 2 , , , , . . [,intensity of labor] ( EnCyber (http://www.encyber.com/). . 5. [ , intensity of labor] () . , . () , () , . . , () , . , 1 , 1 , 1 , . , . , (RMR). . RMR = ( - ) / = / . RMR 0.1 10.0 , () RMR 01 (), 12 , 24 , 47 , 7 () . , , , . , , . , () . ( EnCyber (http://www.encyber.com/)- 12 - 16. 6. (2) [ , intensity of labour] , , . . . 1 . . , 1 . , . ( , http://nisweb.nonghyupi.com/dic/aac/aac206.html) ( ) ( ) , . , . . . 7. ( ) = ( ) = - 13 - 17. . , . , , , . 8. 2)(1)(, , ) , , , : , , , , : , , 2003-24: 2003-24(2003.7.15) . . 11 .1. 4 2. 2 , , , 3. 2 , , - 14 - 18. , 4. , 2 5. 2 6. , 7.2kg2 1kg 2 4.5kg 8.1025kg 9.2510kg , , 10. 2 , 2 11. 2 104.5kg (2) ANSI(ANSI) 10ANSI(ANSIZ-365 Quick Checklist) . , , / , (>3m), ( / / / , / , / : , / / / / / / , ) (8 ) .(3) JSI RULAJob Strain Index .Strain IndexWisconsin ( , ) . . 6 .- 15 - 19. Intensity of Exertion()% Duration of Exertion(Efforts per Minute(Hand/Wrist Posture(/Speed of Work()Duration of Task per Day(%) ) ) ) . SI3SI5 . ( ) SI7( )(4) RULA McAtamneyCorlett(1993)RULA(Rapid Upper Limb Assessment) . ( ), , , (), , . , 3 . 1(1 - 24 ) , 2() ( ), 5 - 6) (soon) , 4(3(7)3 - 4 (immediately) . .- 16 - 20. 10. RULA 1 2 3 4 1-2 3-4 5-6 7 , , (5) ACGIH Lifting TLV ACGIH Lifting TLV (ACGIH) . , . , (TLV) 1/230 . NLE (the Revised NIOSH Lifting Equation) (TLV) .- 17 -NLE 21. .1. 1) ( 11. ( ) : % 1 150 (77.32) 2 71 (36.60)%) 3 33 (17.01) . 4 28 (14.43)3. ( ) 807 7 .3 270 60 50 (% )3 6 .640 301 7 .0 1201 4 .4 310 0 1 2 3 4 . 1:21 1 )(NIOSH : 1 (NIOSH , )3 : 1 ( )4 : 3 1 ( )- 18 - 22. . 1 (NIOSH))77.32%, 36.60%,))2)3( 17.01%.11( 1(NIOSH2(1 1 , )) ( . 12. ( )% S/T (56) (43) (44) (23) (28) 1 47 (83.93) 35 (81.40) 33 (75.00) 19 (82.61) 16 (57.14) 2 20 (35.71) 21 (48.84) 14 (31.82) 7 (30.43) 9 (32.14) 3 8 (14.29) 10 (23.26) 8 (18.18) 3 (13.04) 4 (14.29) 4 7 (12.50) 8 (18.60) 7 (15.91) 3 (13.04) 3 (10.71) , 3)S/T, , , . 13. / / / /N 101 89 52 141 124 69 116 72- 19 -95% 2.12071.1643-3.86270.33650.1747-0.64814.13792.2094-7.74983.38791.8178-6.3142 23. 2.12 . 0.34 . / / / 4.14, 3.39 . , / .4) 14. 16.7 22.5 9.1 3.0 5.8 56.9 17.9 23.2 9.2 3.1 5.7 59.0p-value 0.0103 0.0702 0.3080 0.1858 0.8324 0.0057 , . 1.2 . 2.1 . , .2. 1) ( , ) 51.6 ( 8.4)1 . , , , , , , .- 20 - 24. 2) RULA RULA 7( ) . RULA (, ) () . (, ) . , ( , ) , , . , , , . 3) JSI 7 . , . . 4) ANSI , KK1, JS 1, 2, , ANSIS/T15HP, , . 5) ACGIH (TLV) , , , .6) .7) , , . .- 21 - 25. 6 4 , 4S/T 5 S/T . . 5 S/T , , , . . 6 , , (), , , , , , . 40 46 . . 85db , - 22 - 26. , . .3. 1) , , , . . .2) . . . () 15 . 3)5010 . . . .- 23 - 27. . 1. 1) , . 5 , . 18. ( ) / 2) 5(2.79) 30(16.67) 2(1.12) 10(5.59) 48(26.67) 10(5.62) 5(2.82) 69(38.55) 64(35.56) 114(64.04) 104(58.76) 73(40.78) 34(18.89) 43(24.16) 60(33.90) 22(12.29) 4(2.22) 9(5.06) 8(4.52) 15 14 16 17 (58.4),S/T(58.3),57.7. (57.7) .- 24 - 28. 19. S/T (56) 16.9 (43) 17.8 (44) 17.9 (23) 15.9 (28) 16.3 17.1 (2.9) 23.6 9.0 3.0 5.7 22.7 9.2 3.0 5.8 22.0 9.1 3.0 5.9 22.1 9.3 3.1 5.7 22.5 9.2 3.0 5.7 22.8 (2.2) 9.1 (0.7) 3.0 (0.3) 5.8 (0.5) 17.7 58.3 18.0 58.4 18.0 57.7 18.1 55.7 17.9 56.9 17.94 57.7 (4.0)7. 59 58 57 56 55 54 S/T . 17.1. 6 (17.9), (17.8) . 22.8 S/T(23.6) (22.7) .- 25 - 29. 8. / 26 24 22 20 18 16 14 12 10 S/T (9.2) , (3.1) , (5.9) . 17.94 (18.1), (18.0), (18.0) . 9. 10 9 8 7 6 5 4 3 2 1 0 S/T- 26 - 30. 3) ( ) . . . . . ( 000) . 20% . . . (000) . . (S/T000) , .(S/T000) . . .(S/T 000)10% (S/T . 000) .( 000) . .(000)- 27 - 31. . . LOT 150 . LOT LOT36003750 (S/T000) . . (000) , ( ) . . . .(S/T301010, . 000) . . .(20~3010~20()000)20 . , 20.(000) . 1520 . (000)- 28 - 32. 2. 1) - . 2 , , , , , , . Windows V82)The SAS System for. . 25(13.02%). 194 . 107(56.61%) ,. 167(86.98%),38.7,138(73.40%) 115(60.53%) . 15. (cm) (kg) . 38.7 169.3 66.08.7 7.3 8.9- 29 - 167 25(%) 86.98 13.0234 145 0 0 0 107 59 23 138 50 75 11518.99 81.01 0.00 0.00 0.00 56.61 31.22 12.17 73.40 26.60 39.47 60.53 2 14 15 19 15 5 6 4 33. 3) . 120(11.17%) 51.68.2 . . 87(45.79%)2 17(9.50%),101(53.16%), 2 . . 30% ./ // . 5.7, 4.2 , .(, 5.9, 4.3, ZF 6.6, 4.06.2, 4.5,.)- 30 -5.1, 3.5, MK 5.9, 4.2, 34. 16. 2000 2500 2500 3000 3000 3500 () 4000 () 1 () () () 2 3 () 8.2 51.6 2.05.7 4.25.2 8.4 4.22.0 1.9- 31 - 53 74 41 2(%) 31.18 43.53 24.12 1.1817 20 142 101 87 1 1 193 0 0 0 17 35 127 14 7 117 50 19 8 108 60 129.50 11.17 79.33 53.16 45.79 0.53 0.53 100.00 0.00 0.00 0.00 8.81 18.13 65.80 7.25 3.63 60.62 25.91 9.84 4.26 57.45 31.91 6.38(%) 24 10 35 37 15 4 11 6 15 15 35. 4) ( ) . 17. 1. () . 2. () . 3. . 4. () () . 5. . 6. . 7. () () . 8. . 9. () . 10. . 11. . 12. . 13. . 14. . () 23(12.43) 17(9.04) 17(9.09) 11(6.08) 22(12.09) 24(13.11) 10(5.49) 26(13.98) 20(10.93) 97(51.87) 12(6.59) 10(5.46) 23(12.64) 11(6.04)- 32 - 76(41.08) 61(32.45) 56(29.95) 55(30.39) 81(44.51) 65(35.52) 40(21.98) 77(41.40) 42(22.95) 60(32.09) 20(10.99) 20(10.93) 40(21.98) 13(7.14) () . 72(38.92) 14(7.57) 9 81(43.09) 29(15.43) 6 84(44.92) 30(16.04) 7 89(49.17) 26(14.36) 13 57(31.32) 22(12.09) 12 67(36.61) 27(14.75) 11 71(39.01) 61(33.52) 12 59(31.72) 24(12.90) 8 56(30.60) 65(35.52) 11 20(10.70) 10(5.35) 7 70(38.46) 80(43.96) 12 73(39.89) 80(43.72) 11 63(34.62) 56(30.77) 12 41(22.53) 117(64.29) 12 36. 18. 1. . 2. . 3. . 4. . 5. . 6. () . 7. . 8. . 8(4.60) 44(25.29) 12(6.86) 58(33.14) 14(8.00) 59(33.71) 16(9.20) 65(37.36) 27(15.43) 89(50.86) 18(10.40) 74(42.77) 24(13.87) 91(52.60) 20(11.49) 80(45.98) 78(44.83) 87(49.71) 76(43.43) 67(38.51) 45(25.71) 66(38.15) 46(26.59) 48(27.59) 44(25.29) 18(10.29) 26(14.86) 26(14.94) 14(8.00) 15(8.67) 12(6.94) 26(14.94) 20 19 19 20 19 21 21 20 / // . (+0.4) (-9.8) . (-0.6) .(+1.1) 19. 30.0 (5.2) 64.2 (9.5) 9.8 (2.7) 9.5 (2.5) 19.3 (4.5) 30.4 (6.1) 54.4 (10.4) 9.2 (2.8) 10.6 (2.8) 19.8 (4.9)- 33 - +0.4 -9.8 -0.6 +1.1 +0.5 37. . 10 70 60 50 40 (% ) 30 20 10 0 Karasek , 51.81%35.54% . . 20. Karasek ( ) 59 12 86 9 35.54 7.23 51.81 5.42 2811. Karasek ( ) 60 50 40 (% )30 20 10 0 - 34 - 38. 21. S/T (56) (43) (44) (23) (28) 29.0 (5.4) 32.7 (7.9) 29.9 (5.5) 31.8 (5.7) 29.3 (4.8) 53.4 (10.1) 54.1 (11.5) 55.2 (7.7) 48.4 (11.0) 59.2 (11.3) 9.7 (2.7) 8.2 (2.7) 8.9 (2.5) 9.9 (3.7) 9.4 (2.9) 10.6 (2.6) 9.9 (3.0) 10.8 (2.2) 10.4 (4.1) 11.4 (2.2) 20.3 (4.8) 18.0 (4.9) 19.7 (4.0) 20.7 (7.5) 20.8 (3.7) , . , , . . 12. - 70 60 50 40 30 20 10 0 S/T- 35 - 39. 13. - , 25 20 15 10 5 0 S/T5) . /, . . .- 36 - 40. 22. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 / ( ) ( ) 9(4.95) 29(15.93) 94(51.65) 7(3.89) 14(7.78) 106(58.89) 8(4.47) 24(13.41) 119(66.48) 7(3.98) 33(18.75) 106(60.23) 5(2.79) 10(5.59) 69(38.55) 30(16.67) 48(26.67) 64(35.56) 2(1.12) 10(5.62) 114(64.04) 5(2.82) 104(58.76) 1(0.59) 4(2.35) 132(77.65) 2(1.18) 5(2.96) 122(72.19) 4(2.45) 25(15.34) 114(69.94) 1(0.67) 3(2.01) 114(76.51) 1(0.65) 106(68.39) 2(1.29) 120(77.42) 3(1.95) 1(0.65) 139(90.26) 1(0.65) 1(0.65) 151(97.42) 2(1.31) 145(94.77) 6(3.95) 105(69.08) 2(1.45) 2(1.45) 133(96.38) 41(22.53) 9(4.95) 12 50(27.78) 3(1.67) 14 26(14.53) 2(1.12) 15 28(15.91) 2(1.14) 18 73(40.78) 22(12.29) 15 34(18.89) 4(2.22) 14 43(24.16) 9(5.06) 16 60(33.90) 8(4.52) 17 28(16.47) 5(2.94) 24 34(20.12) 6(3.55) 25 20(12.27) 31 26(17.45) 5(3.36) 45 44(28.39) 4(2.58) 39 33(21.29) 39 10(6.49) 1(0.65) 40 2(1.29) 39 6(3.92) 41 40(26.32) 1(0.66) 42 1(0.72) 56 , , S/T. 23. S/T (56) (43) (44) (23) (28) 16.9 17.8 17.9 15.9 16.3 17.1 (2.9) 23.6 22.7 22.0 22.1 22.5 22.8 (2.2) 9.0 3.0 9.2 3.0 9.1 3.0 9.3 3.1 9.2 3.0 9.1 (0.7) 3.0 (0.3)- 37 - 5.7 5.8 5.9 5.7 5.7 5.8 (0.5) 58.3 58.4 57.7 55.7 56.9 57.7 (4.0) 41. 6) . 1 (NIOSH))77.32%, 36.60%,))3( 17.01%.11( 1(NIOSH2(1 1 , )) ( . 24. ( ) : % / / / / 1 81 (41.75) 110 (56.70) 47 (24.23) 79 (40.72) 86 (44.33) 79 (40.72) 150 (77.32) 2 17 (8.76) 41 (21.13) 13 (6.70) 27 (13.92) 35 (18.04) 25 (12.89) 71 (36.60) 3 4 (2.06) 17 (8.76) 4 (2.06) 13 (6.70) 15 (7.73) 12 (6.19) 33 (17.01) 4 4 (2.06) 16 (8.25) 4 (2.06) 10 (5.15) 11 (5.67) 9 (4.64) 28 (14.43)14. ( )807 7 .3 270 60 50 (% )3 6 .640 301 7 .0 1201 4 .4 310 0 1 2 3- 38 - 4 42. 15. - 1 2(%) 1 260 50 40 (% )30 20 10 0/ / / / , S/T, , , . 25. ( )% S/T (56) (43) (44) (23) (28) 1 47 (83.93) 35 (81.40) 33 (75.00) 19 (82.61) 16 (57.14) 2 20 (35.71) 21 (48.84) 14 (31.82) 7 (30.43) 9 (32.14) 3 8 (14.29) 10 (23.26) 8 (18.18) 3 (13.04) 4 (14.29) 4 7 (12.50) 8 (18.60) 7 (15.91) 3 (13.04) 3 (10.71) , . , .- 39 - 43. 26. 7) / 61 71 17 3 72 59 12 5 41 49 55 70 14 4 66 57 9 13(%) 40.13 46.71 11.18 1.97 48.65 39.86 8.11 3.38 28.28 33.79 37.93 79.55 15.91 4.55 45.52 39.31 6.21 8.97(%) 42 46 49 106 49 . (NIOSH2(1 , )) . . 27. (1) 1 () 39.0 8.0 50.6 1.5 5.7 4.0 38.3 8.6 53.3 2.7 5.8 4.6 p-value 0.6065 0.4883 0.0511 0.1147 0.7163 0.0287 2.12 . - 40 - 44. 0.34 . / / / 4.14, 3.39 . , / . 28. (2) N 37 142 101 89 52 141 124 69 116 72/ / / / /95% 1.49430.6838-3.26502.12071.1643-3.86270.33650.1747-0.64814.13792.2094-7.74983.38791.8178-6.3142 , , . . , . 29. 29.8 54.7 9.7 10.5 20.3 31.3 53.9 8.3 10.7 19.0p-value 0.1261 0.6375 0.0016 0.6951 0.1005 , . - 41 - 45. 1.2 . 2.1 . , . 30. 16.7 22.5 9.1 3.0 5.8 56.9 17.9 23.2 9.2 3.1 5.7 59.0p-value 0.0103 0.0702 0.3080 0.1858 0.8324 0.005716. ( 2)5960 505840 57 30 56 20 5510540 S/T- 42 - 46. 3. 1) /(L)2004/ / / 2/3//,6 28 27/2.6h1. : () , , () . , .2. RULA (1~2: , 3~4: , 5~6: , 7: ) : () (b)(c) 0~61~41~51~31~90~10~31~134 43 34 42 26 6118 8twist (a), (a+b+c) (1)+ (2)+ (1)(2)(3)1~6 1~6 1~2 1~90~10~3 1~13 1~7341511(3) 77 7 , , () ,, 15 - 43 - 47. 3. ( ) 1. . 2. , , . 3. . 4. .4. 1. , , , , . 2. , . 3. . 4. , . . 5. .5. 1(3) . 2(3~6) . 3(6~12) . .- 44 - 48. 20046 28///(L)1/266/6.3h1. : () (16) . G-Tex .2. RULA (1~2: , 3~4: , 5~6: , 7: ) : () twist (a)(b)(c) 0~61~41~51~31~90~10~3634296342912 (1)+ , (a+b+c) 1~13 (2)+ (1)(2)(3)(3)1~61~61~21~90~10~31~136519121212 121~77 7 , , ,, - 45 -15 49. 3. ( ) 1. . 2. . 3. . 4. .4. 1. . 2. . 3. . 4. . 5. .5. 1(3) . 2(3~6) 3(6~12) . 1. (15) . 2. .- 46 - 50. 20046 28///(L)/8/ , 66/6.3/h1. : () (4) (2) . . .2. JSI (3: , 4~7: , 7 : : () 1~130.5~3.00.5~3.01~31~20.25~1.563.03.02.01.01.5/ 7 162 ANSI (0~9: , 10~15: , 16 : ,) 0~30~30~30~31330/ 0~120~1216 12625 , - 47 - 51. , 2525151515 202~30 2~3010% 5% 3% 3% 20% 5% 20% 15%3. ( ) 1. 15~20KG . 2. . 3. , . 4. . 5. . 6. . 7. . 8. , , 9. .4. 1. . 2. . 3. . 4. . 5. . 6. . 7. . 8. - 48 - 52. 5. 1(3) . . 2(3~6) . 3(6~12) . . .- 49 - 53. 20046 28///(L)/1/2016/192h1. : ( ) (12~16kg) 1~3m .2. JSI (3: , 4~7: , 7 : : () 1~130.5~3.00.5~3.01~31~20.25~1.591.51.52.01.01.5/ 7 60.75 TLV (1 , ) 1 2 C192 -9kg12~16kg1.33~1.78 ANSI (0~9: , 10~15: , 16 : ,) 0~30~30~30~33303/ - 50 -0~120~1216 10625 54. , , ,, 25 20%3. ( ) 1. (12~16KG) 192 . 2. . 3. .4. 1. 1 . 2. .5. 1(3) 2(3~6) . 3(6~12) 1 2 . .- 51 -