Despite a decreasing trend during the last 2-4 years, musculoskeletal disorders are still — followed closely by mental ailments — the dominating cause of reported occupational ill-health in Sweden (129).
With few exceptions, this applies also to the other member countries in the OECD (94), and work-related musculoskeletal disorders has been identified as a prominent issue to European public health (28). Considerable proportions of the Swedish work-force report strenuous physical work conditions, such as extensive manual handling or short-cycle repetitive work tasks (130), which are strongly suspected to be associated with increased risks of disorders (45, 122). Strenuous physical and mental loads often occur together in working life (65), and they interact in generating bodily disorders as shown in epidemiologic studies (72), in consistence with basic neurophysiology (69). Some trends in working life, e.g. an increased need for elderly care, and a continued specialization of companies, suggest that several “classical" risk factors for musculoskeletal disorders will still be prominent in the future.
At the same time, an increasing concern is raised that other sectors in working life develop towards offering too little physical load to the workers. A European expert forecast on emerging occupational risks (27) classified lack of physical activity as the foremost concern, followed by factors pertaining to “classical" exposures like awkward postures and repetitive movements. Prolonged inactivity leads to increased risks for an abundance of ailments, including some related to motor performance and physical capacity (99, 126). In this case, working life offers a potential arena for improving musculoskeletal health and well-being by providing beneficial patterns of (increased) physical load (15). A similar concept applies to work-site rehabilitation programs for individuals with musculoskeletal disorders (25). Neither of these options has been thoroughly investigated. In a wider sense, current Swedish policy emphasizes the prospects of a good work environment in creating competitive enterprises, in addition to better health for individuals and decreased public expenses (127).
Resolving a public health issue of this complexity requires a research agenda spanning from basic issues concerning mechanisms explaining why disorders appear, persist and recuperate via applied studies of principles for preventing ill-health, treating sufferers and promoting health, to investigations of how to succeed in changing the behaviour of individuals and organisations (143, 144). A research strategy this wide is generally supported for some public health issues like neurologic diseases and diabetes (36), but it is equally warranted with respect to musculoskeletal disorders.
This outlines the profile of the present R&D centre.
The research of the centre focuses on musculoskeletal issues, mental loads being addressed to the extent that they have an effect on musculoskeletal health, performance and well-being. The centre addresses eight R&D programs, each of them being a stabilization, succession and extension of current R&D at the University of Gävle and its partners. The programs include controlled physiologic studies of mechanisms (program I), studies of relationships between key exposures in working life and their effects on short- and long-term outcomes (programs II, III), extending into life beyond work (program IV), predictors at the individual and worksite level for future musculoskeletal health (programs III, V), development of effective methods for assessing work load (program VI), principles for implementing changes of the work environment in companies (program VII), and new procedures for early classification and rehabilitation of patients with musculoskeletal disorders (program VIII). While described independently, these programs have several common denominators, including overlapping research questions (e.g. the effect of load variation in programs I and III), joint study populations and experimental set-ups (e.g. programs I, III, V and VII), and common standardized measurement methods (e.g. for assessing exposure variation in programs II, III, IV and VI). Also, results produced by one program at an early stage can be used by another program in a later phase, as illustrated by the progression from developing basic knowledge on combinations of physical and mental loads in program IV to investigating procedures for implementing interventions based on this knowledge in program VII.
All programs are headed by a senior principal investigator (PI) from the CBF and involve additional researchers from the CBF and the University of Gävle (UoG) as stated. The listed external partner institutions (Ext) have all agreed to invest resources in a co-operation within the framework of a FAS-centre, and parts of a possible FAS grant can be allocated to joint initiatives, e.g. shared positions. In a particular program, one contact representative is stated for each external partner, but in several cases more researchers from that partner institution are involved. The research issues to which these partners will contribute are indicated for each program. Besides the mentioned partners, all programs will involve national and international partners in the established network of CBF, in line with the CBF policy of allocating internal resources to co-operations, including visiting researchers.
Each program presents a number of R&D issues, including a crude time line for their realization. A thorough research effort on each and all of these issues would, altogether, require far more resources than available for the centre within a 10-year time frame, even when adding internal funding from the University and external funding from the present FAS grant. Thus, in case of a positive response from FAS, mutual discussions should be undertaken so as to identify which issues to prioritize above others. Also, the suggested allocation of funding between the eight programs described in the “economy" enclosure can be revisited according to discussions between FAS and the University. Additional funding will be pursued for research issues not covered by the present grant.
In addition to the described R&D and the dissemination of its results according to the communication plan, the centre will take a national responsibility — in accordance with the strategic plans of the University — for co-operative and strategic discussions with other R&D groups within the area. These discussions will, in continuation of earlier initiatives, include efforts to establish a national network supporting joint education of PhD students (Swedish: “forskarskola").