Evaluation of CBF. Centrum for belastningsskadeforskning Hogskolan i Gavle, Sweden. Final report Q S'~ Evaluator:

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1 Evaluation of CBF Centrum for belastningsskadeforskning Hogskolan i Gavle, Sweden Final report I Evaluator: Q S'~ G!1 lse a Sj0gaar.( - d Professor Odense, Denmark,

2 Evaluation of CBF Centrum för belastningsskadeforskning Högskolan i Gävle, Sweden Final report Evaluator: Gisela Sjøgaard Professor Odense, Denmark, with minor technical revisions of

3 1 Introduction Appointment of evaluator Background for the evaluation Procedure Abbreviations Evaluation of CBF till Research and development Education Interplay with the local society ( tredje uppgiften ) Discussion of activities Setting the stage Research and development Education Interplay with the society Organization Conclusions & Recommendations General conclusions Research and development Education Interplay with worklife and community interests Organization & location of CBF

4 1 Introduction 1.1 Appointment of evaluator The board of CBF appointed one evaluator in December 2007: Gisela Sjøgaard Professor and Head of Research Unit Institute of Sports Science and Clinical Biomechanics University of Southern Denmark Campusvej 55 DK-5230 Odense M Denmark 1.2 Background for the evaluation A previous in depth evaluation was conducted in 2005 by Rolf Westgaard and Gisela Sjøgaard and in part by Gunnar Grimby. The present evaluation is a follow-up on that evaluation and will not replicate the detailed reference frame given by then. The reason is that within the last 3 year period only minor changes have occurred in this landscape except for the dramatic decision in Sweden to close down ALI (Arbetslivsinstitutet). The political decision was made in 2006 with an effective deadline This aspect will be explicitly considered in some relationships below. The purpose of this evaluation was: Based on decision by the board CBF on 4/9, 2007 the purpose was to call for an evaluation less extensive than that delivered in This second evaluation should more specifically be a follow-up of activities in relation to styrdokumentet for CBF:s verksamhet efter 2005 as of 16/1, 2006 and revised 25/8, The board of CBF decided to rely on only one evaluator, preferably one of the two previous evaluators in (for more detail see enclosure 1) 1.3 Procedure The appointment was accepted by Gisela Sjøgaard Material was delivered from CBF to GS (enclosure 2) An update on the collaborations

5 and subsequently updated (enclosure 6) Site visit at CBF in Gävle Site visit at CBF in Umeå Program and participants (see enclosure 3) from Gisela Sjøgaard to Svend Erik Mathiassen and Mats Djupsjöbacka with a draft resume of the interviews in Gävle and Umeå which was, on behalf of both, accepted by MD on (enclosure 3) Preliminary report on Evaluation of CBF send by to Mats Djupsjöbacka with 6 enclosures Comments on preliminary report by Mats Djupsjöbacka and Svend Erik Mathiassen received by including detailed document on employed researchers during the evaluation period (enclosure 7) Additionally reference will be made to the following enclosures that have been produced: Enclosure 4: Journals in which CBF has published with impact factor, IF Enclosure 5: Number of citations and h-index for CBF key-researchers 1.4 Abbreviations AC Albert Crenshaw ALI Arbejdslivsinstituttet ANS Autonomic nervous system BSC Belastningsskadecentrum CNS Central nervous system CBF Centrum för Belastningsskadeforskning EL Eugene Lyskov GS Gisela Sjøgaard HiG Högskolan i Gävle IF Impact factor MBB Margareta Barnekow Bergkvist MD Mats Djupsjöbacka MSD Musculoskeletal disorders SEK Svenske kroner SEM Svend Erik Mathiassen UmU Umeå University WMSD Work-related musculoskeletal disorders 4

6 2 Evaluation of CBF till This chapter will evaluate the past 3 years and 3 months which implies that a major part of the material for 2005 enclosed in the first evaluation is also enclosed here. This overlap is seen as an advantage to see the evaluation procedures as a continuum. 2.1 Research and development Scientific production Lists of peer reviewed publications for as of are presented. In 2008 additionally10 papers are in press and 7 were submitted. In all 15 researchers and 10 doctoral students are mentioned by name and their CV s included (flik 15). However, many of them have not been employed for the full period Care seems to have been taken, to mainly include their publications during their employment period at CBF. However, publications are included also that have not been conducted during their employment at CBF but during previous employments. Further, some studies do not deal specifically with topics related to MSD but to e.g. cancer or stroke and myocardial infarction. In the dynamic scientific society this is a known challenge in every evaluation. Thus the below numerical assessments should be taken with the necessary precautions. The following summary comments are made with reference to enclosure 4: Papers published 2005 Thirty publications are listed. One paper is published in Arbete och Hälsa, which is peer reviewed but not considered an international journal. The 29 publications are published in 22 international journals. Three journals were neither recorded on PubMed, Web of Sci nor Soc Sci: Human Physiology (journal started in 2004 and for this reason not yet recorded in Web of Sci), Prehospital and Disaster Medicine and New Solutions.... In total 26 publications were available in international ISI-listed journals of respectable quality (ISI citation index impact factors, IF, ranging from 0.6 to 2.6), with three outliers: Int J Epidemiology (5.1), Human Genetics (3.9), and Eur J Pain (3.7). These journals are clearly leading in their field. In total 17 publications were published in journals with IF > 2, among these Exp Brain Res with 6 publications. Categorization of papers by topic: Neurophysiology 9 Muscle physiology/morphology 4 5

7 Applied research 2 Ergonomics/Epidemiology 8 Other 4 To this adds 4 PhD theses, 1 book and 2 book chapters. Three of the PhD theses deal with neurophysiological aspects and one culture and media aspects Papers published 2006 Twenty publications are listed. One is in Arbeta och Hälsa and one in Professional safety, which leaves 18 publications in 14 different ISI-listed journals. Their IF ranges from 0.6 to 1.9, which results in none of the papers to be included in the list journals with IF > 2. Categorization of papers by topic: Neurophysiology 3 Muscle physiology/morphology 4 Applied research 5 Ergonomics/Epidemiology 3 Other 3 To this adds 3 PhD theses and 1 book chapter. Two of the PhD theses deal with neurophysiological aspects and one with culture and media aspects Papers published 2007 Sixteen publications are listed for One is published in FTF Arbejdsmiljö and one in Svensk Rehabilitering, which leaves 14 publications in 9 different ISI-listed journals. Their IF ranges from 0.2 to 3.7 with 6 papers in journals with IF > 2. An interesting new research area is introduced on Vision and eyestrain. Categorization of papers by topic: Neurophysiology 2 Muscle physiology/morphology 2 Applied research 3 Ergonomics/Epidemiology 2 Vision/eyestrain 4 Other 1 To this adds 2 PhD theses and 1 book: Ergonomi - för ett gott arbete. One of the PhD theses deal with muscle physiological aspects and one with medical aspects. 6

8 Papers published 2008 In total 6 papers are listed as published. One is published in Int J Circumpolar Health, which leaves 5 in ISI-listed journals with IF ranging from 0.9 to 2.0. Additionally 10 papers are in press of which 8 are in ISI-listed journals. Their IF range from 0.6 to 1.9. In addition to the journals in enclosure 4, papers are in press in the journals: ApplCogPsy 1.2, Ergonomics 1.4, JEK 1.3, and NordJPsy 0.7. Thus, as a minimum for 2008 there will be 14 publications in ISI-listed journals with one having an IF > 2. Categorization of papers by topic: Neurophysiology 3 Muscle physiology/morphology 1 Applied research 2 Ergonomics/Epidemiology 4 Vision/eyestrain 1 Other (not belastningsskador) 3 Additionally two book chapters are listed to be in press. Finally, during the site visit in Gävle, SEM mentioned that a book on Arbetslivsfysiologi will be published in 2008, a book that he and other researchers from the occupational physiology/ergonomics area are co-authoring General comments The classification of papers is only approximate as several of the papers can be categorized in different ways. Studies of proprioception may concern basic physiological mechanisms, but proprioception is now used as a diagnostic tool and a basis for treatment. These papers may alternatively be considered neurophysiological studies or contributing to methods development. When in doubt about categorization, the category applied research is preferred. The ISI citation index is a good indicator of quality in a comparison of different journals within a research field, but should be used with caution as it depends on publishing tradition for the type of research, time-to-print, popularity of journals as a publishing medium and several factors other than scientific quality. Research fields where journals tend to have high-value citation indexes include biotechnology, genetics, some areas of neuroscience and clinical studies. In contrast, leading ergonomic journals are ISI listed with relatively low citation indexes, usually less than 1. Some respected journals with high manuscript rejection ratios have citation indexes below 0.5. The move in research profile of CBF from more basic neurophysiology towards more applied and ergonomic 7

9 research profile underlies in part the general decrease in IF of journals chosen for publication of papers by CBF during The 74 peer-reviewed papers with author affiliation to CBF during the period are published mainly in well-respected journals and in some cases, highly coveted journals for their respective research fields. Thus, the quality of the papers is very good in this respect. In addition, several books, book chapters, and conference publications are reported. Nevertheless, some comments concerning the publication record of CBF are appropriate. The number of 74 peer-reviewed papers must be evaluated relative to the number of researchers contributing as authors. The total number of authors over the 3-4 years was counted to be 145, which is of the same order of magnitude as for the previous evaluation period. According to lists delivered to the evaluator by CBF on Personalredovisning (flik 14) only a total of 22 among the authors were part or full time employed at CBF for shorter or longer periods. Further, according to flik 15, 15 of these authors are listed as forskere or doktorander at CBF. Of note is, that in all 25 individuals are listed in flik 15, but 10 of those had no publications listed, probably because they just had started in a position or were doctoral students. Also, of note is that the full year 2005 is included and for 2008 publications accepted or in press per have been included which may slightly underestimate the full 2008 publication list for the four-year period However, a slightly conservative estimate of publication per year is 74/4 = Correspondingly, a qualified estimate of the total number of researcher-years year paid by CBF during this period is 16 (and which was confirmed in a later document, enclosure 7). Thereby, the quotient Paper per research year paid by CBF is 1.15 and which compares with the value of 1.1 during the previous evaluation period. This value is in line with other institutes. An alternative way of evaluating productivity is to calculate the cost of one paper. With a budget of ~ 25 mill SEK this is approximately 1.3 mill SEK per paper from CBF, which is somewhat higher than during the last evaluation period. But certainly, these are not drastic changes and it is not known how much other institutes that are co-authoring on the papers have financed during the first and second evaluation period, respectively. In summary, the quantity of publications is still satisfactory as estimated relative to number of estimated man-month researchers as well as the full budget for CBF. As to the quality of journals the IF showed somewhat of a decrease, which is in part to be explained by the change in research profile towards areas with lower publication traditions. The individual papers still contain original and well planned studies. The remarkable discrepancy between the total number of authors on CBF-publications (~ 148) and the number of researchers paid by CBF (~ 22) witnesses about tremendous talent for collaboration with external researchers (see below). The CVs of key researchers presently employed at CBF were evaluated based on records on Web of Science and presented in enclosure 5. Below is a short summary of the findings: 8

10 Researcher Publ Total publ 3 highest cites Sum of cites h-index Svend Erik Mathiassen /8/ Mats Djupsjöbacka /6/ Margareta Barnekow Bergkvist /4/ Eugene Lyskov /6/ Albert Crenshaw /5/ In the above table the data recorded as of in the Web of Science are as follows: column Publ means all publications during the evaluation period for that researcher column Total publ means all records, irrespective of year, for that researcher, column 3 highest cites are the number of citations for the 3 most cited publications from the period , column Sum of cites accumulates all cites in the whole production of that researcher. column h-index where h is defined as the number of papers with citation number h, e.g. the h-index is 10 when an author has 10 papers published that are cited 10 times or more. For more details see: This variable is increasingly being used in evaluations as it represents a combination of publication quantity and quality in terms of impact on other research. This is an acceptable to very good publication rate for the key researchers during the evaluation period. Further, these data fully confirm their self-reported CV s. These merits of the senior staff together with the achievements of the juniors confirm that this is a solid group of researchers with good merits for a substantial period of years. In addition, there are many contributions as conference proceedings, reports, book chapters etc. Some of the papers have extensive multiple authorships (including co-authorship by several of the above listed researchers). Of note is, however, that SEM who most recently joined the group has only little co-authorship with other CBF researchers. International and national collaborations are in general positive and encouraged, but intra-research-group coauthorships are important to fully benefit from diverse scientific knowledge within the group and also show a visible profile to the scientific world. Employment of new academic staff with relevant profile for the research area of SEM will probably soon change this observation Methods development and availability (and quality) Laboratory facilities are now available in Umeå as well as Gävle. The facilities in Umeå include besides offices: 1) Proprioception lab with set-up for studying human shoulder and forearm. A quite unique set-up has been carefully developed at CBF. In this environment also the 9

11 microdialysis technique was set up to study intramuscular responses. Further, NIRS has been used in this context. 2) PC-stress or mental load set-up. A special program is used that very well simulates relevant occupational tasks and which has now been used in several studies. In addition, the Stroop test and similar stress tests are available. 3) Electrophysiological human lab, well equipped with standard techniques to monitor stress responses: HR, HR variability, BP, breathing frequency, skin resistance, EMG, plethysmography. 4) Muscle strength measures e.g. using a Biodex equipment. In this lab also a TCMS stimulator is available. 5) A lab for kinematic (FASTRAK) and kinetic (force platform) studies of postural control, arm and cervical movements. Altogether, the available methods are relevant for the research questions addressed. During the present evaluation period advantage was taken to conduct studies with those methods that carefully were established during the previous period. Thus, no major methodological break through was reported. All labs, including equipment, are easily moveable and may be established in Gävle. In addition researchers at CBF have access to methods at UmU. In particular are mentioned Departments of Social medicine and rehabilitation, Anatomy, Odontology, Psychology, and the Sport Medicine. The mechanistic research is stated to be particularly dependent on these collaborations. The core facilities in Gävle at HiG include besides offices for 10 researchers and 2 PhD students: 1) Guest researcher work places equipped with computers. 2) Meeting facilities with plans for telecommunication. 3) Plans to establish laboratory facilities in a new building. Presently, the CBF is hiring lab facilities at the Institutionen för Teknik och Byggd Miljö at HiG in Brynäs. Several lab studies have been conducted there, partly in direct cooperation with researchers at the ITB, and more are planned, e.g. for an upcoming PhD student. Further, collaboration with researchers and their lab facilities at the Universities of Uppsala and Stockholm (including Kungliga Tekniska Högskolan and Karolinska Institutet) is in progress Scientific relevance for other research Based on citation of CBF-papers by other researcher a clear relevance is documented of CBF research for other research activities internationally. Also at conferences CBF researchers are respected, well known, and interact properly with the international scientific world. 10

12 The change in research profile towards more ergonomic and applied research in concert with styrdokumentet - has resulted in less basic neuro-physiological publications. This kind of research has been intensively referred to by other research groups, and is now a solid ground knowledge at CBF. It is to be seen to which extent the present research will be relevant for other researchers because there always is a delay from publication to citation. However, as seen from the extensive collaboration (see below) CBF research at present influences other research groups by methods as well as concepts. This is a very good pointer on the relevance of the scientific expertise at CBF. As pointed out by CBF researchers their research priorities comply with conclusions drawn by an international evaluation group concerning recommended future priorities for Swedish research on work-related musculoskeletal disorders (Wegman, D.H., Burdorf, A., Oldershaw, P., Schulte-Fortkamp, B., Viikari-Juntura, E., International evaluation of Swedish work environment research. Scand J Work Environ Health 33 Suppl 1, 32-45), citation: Research on exposure assessment modelling and related risk modelling needs to be strengthened. This includes research on exposure variability, which factors determine exposure patterns, and how this knowledge is applied in the design, conduct and interpretation of epidemiological studies and workplace interventions. More systematic intervention studies are needed. There is a major need for development of scientific methods for determining the efficacy and effectiveness of interventions. It is also recommended to pay more attention to the use of appropriate study designs and methods for exposure and outcome assessment in intervention studies along with economic evaluation techniques. Interdisciplinarity is likely to be important in achieving this objective. Research is needed on methods and strategies for the implementation of new scientific knowledge Applied relevance: occupational or work-related Relatively more publications are now related to workplace activities that have direct applied relevance. Further the ongoing and upcoming projects show clear trends to be more applicable in relation MSD in general and at work in particular. This is fully in concert with the propositions in the CBF board styrodokument. 11

13 2.2 Education Basic In this section on basic education all teaching below doctoral school level (see below) is included. The amount of basic education given by CBF is not large but new activities were reported since the first evaluation. The main delivery is still one course for physiotherapists post graduating: Arbetsfysiologi, ergonomi och rehabilitering. The extent is 30 points (corresponding to 20 study weeks) during each of the years 2005, 2006, 2007, and The course is run physically alternating in Umeå and Gävle with telecommunication when requested. The number of participants has increased from ~15 to 20 participants according to MBB. In the first evaluation it was stated that this course generated an income of SEK 472k to CBF, and which has increased to SEK in 2008 In addition in line with the first evaluation, a 5-point course in physical ergonomics was given in 2006 as part of a 40 point master program. New initiatives since 2005 is to mention: 1) Physical ergonomics (fristående 7.5 point) with start in ) Master course in medical science in collaboration with Department of nursing and sociology at HiG, 30 study points with start in ) Master program in Arbetshälsovetenskap (120 ECTS) is under development in cooperation with the Department of pedagogic, didactics and psychology and the Department of mathematics, nature and computer sciences at HiG. An application to qualify for examination authority for the degree of master in the scentific area Arbetshälsovetenskap is planned to be sent to Högskoleverket 15/10, This is probably essential for HiG to receive merits in academic educations in Sweden Research, Doctoral School CBF has many PhD students associated to the center. Per a list was presented of all PhD students enrolled 2006 (3), 2007 (6), and 2008 (8 of whom 4 are not officially enrolled yet). These were CBF financed for %. To this adds 5 PhD students who defended their thesis in In all, 18 individual PhD students were listed in which the scientific staff of CBF contributed to their supervision. This is somewhat lower than in the preceding evaluations period with 30 PhD students. Joint mentorship is now seen between a number of CBF senior researches for several PhD s. This is considered a very positive trend as to bridge the quite complementary research areas of CBF. Ten PhD theses were defended and accepted during the second evaluation period (see 9 PhD theses 12

14 mentioned in section above and including the defense in May 2008, see below). The increase of PhD students per year from is taken as a very positive development in the new CBF area. In all this is a significant contribution to production of PhD s in Sweden considering the size of the center. One PhD student participated in an interview, and who was very satisfied with the scientific atmosphere. Although probably not representing all, it was stated that PhD s at CBF received more assistance that generally seen at UmU. However, it seemed very convincing that a positive development had occurred since Of note is, that among the 5 PhD students to become enrolled in 2008 at CBF, 2 PhD students will be mainly working in Umeå and 3 PhD students in Gävle. The specific details for all students working on their PhD in 2008 are (according to information from MD on additional to Flik_16): Jonas Sandlund, Umeå, defended thesis in May 2008 Jenny Hadrevi, Umeå, enrolled 2004 Ulric Röijezon, Alfta (presently working at distance from Piteå), enrolled 2006 Per Liv, Umeå, enrolled 2006 David Hallman, Gävle, enrolled 2008 Mahmoud Rezagholi, Gävle, enrolled 2008 Thomas Rudolfsson, Umeå, enrolled 2008 Guilherme Elcadi, Umeå, enrolled 2008 Student not appointed yet (but to be enrolled 2008), Gävle External This section includes teaching performed at several other educational institutions, such as 1) UmU, in particular at Avd. för Sjukgymnastik and Idrottsmedicin 2) Kungliga Tekniska Högskolan, Stockholm 3) Uppsala University 4) National Institute of Working Life (till medio 2007) 5) Professional organizations, e.g. Arbetsmiljöverket This is clearly positive and highly relevant, but is difficult to evaluate without more information on content and quantity. 13

15 2.3 Interplay with the local society ( tredje uppgiften ) CBF has developed a comprehensive communication strategy. This includes their vision, core values and is specified for both internal and external communication. The internal includes CBF, HiG, CBF-styrelse, and collaborators in the local environments. The external include the funding agencies, the political system, business world, trade unions, and the press. An action-plan for is presented. According to CBF-styrelsen s Styrdokument an informatör (i.e. an information and communication officer) should be engaged in 2006 and this request was fulfilled Occupational relations A list with 8 specific company contacts is presented including private and public companies. These contacts are of a more permanent character and include activities as: Educational, informational, collaborative (with exchange of personnel). The focus is on rehabilitation, evaluation, and occupational health. In this context also the initiative Ergopriset is to be mentioned, witnessing about creative initiatives to engage companies to implement the existing research knowledge to improve working life Public relations CBF researchers have frequently contact with the press media to give expert comments. They even have presented pressmeddelanden e.g. in relation to PhD defences. A leaflet in a clear way presents CBF research and development. The homepage for CBF is well organized and easy to use. The three research areas are nicely presented. More information on the background for the choice of these three core areas could be presented together with the interplay between them. The homepage is still in progress, e.g. the full list of publications is not yet available (in the English version) and in the Swedish version it is not easy to differentiate e.g. between full scientific papers, applied publications and abstracts. By and large the homepage is very useful and frequently updated 14

16 3 Discussion of activities Setting the stage Musculoskeletal pain prevails in the society and is still linked to working conditions. A detailed analysis of the state of art was presented in the evaluation of BSC in 2005 and will not be fully updated here. This is because the problem per se has not been solved and the state of art not drastically changed. One major change has occurred, however, in Sweden which is the close down of ALI, as effectuated medio The loss of knowledge in the area of WMSD is dramatic for the Swedish society. International research is still intense but the absorption of this knowledge into the Swedish society is now seriously hampered because of a limited number of national experts to attract this knowledge. In the long run this condition will impair working conditions and health of the employees unless other bodies of expertise are established. CBF and its expansion is the obvious choice. There is a trend in occupational research to move towards symptom treatment and neglecting scientific evidence for the underlying mechanisms. E.g. in Denmark and other European countries there is a political focus to bring down sick leave per se. There are many ways to do this in the short run. Special bonus agreement on group or individual level will acutely bring down sick leave. At the same time however, presenteism may decrease, a term which is used to describe the productivity during working time. In the long run, therefore, the gain of decreased sick leave may be lost in simultaneously decreased presenteism. Already now voices of concern are heard from e.g. trade unions. Decreased sick leave and simultaneous increased presenteism is only likely to occur when work site interventions are based on sound scientific knowledge. CBF has an even more important role in Sweden now than at the 2005 evaluation in order to fill in the gap after ALI on the MSD area. 3.2 Research and development Research priorities for CBF are presented in Styrdokument för verksamheten under perioden , approved by the CBF board This styrdokument is very specific regarding research profile, quantity, resources, dissemination of research etc. In the following the performance of CBF will be evaluated in relation to this document. Further, discussion will be based on this document and the actual performance of CBF. 15

17 3.2.1 Priorities scientifically and significant relevance The vision is in 2010 to see CBF as a centre of excellence on WMSD. Research at the center should take off from real working life conditions and science back to society is a focal delivery by CBF. Geographically, the base for CBF should be in Gävle and Umeå with collaboration with relevant universities. CBF should continue the research strategy presented during the evaluation in 2005, e.g. research on MSD focusing on three themes: 1) Physiological and psychological mechanisms in musculoskeletal disorders 2) Interventions to prevent musculoskeletal disorders in the workplace 3) Rehabilitation of musculoskeletal disorders For each of the three themes leadership responsibilities have been delegated to one senior researcher within CBF. Criteria for approving research projects include work life relevance, scientific interest, established competence within CBF or collaborating partners and, preferably, an element of external funding. A vision is to give priority to research that is: - problem based - work-related - interdisciplinary - of high scientific quality - conspicuous - collaborative The three themes of research have been well perused fully in line with the strategic plans. However, the interaction between themes is limited. To legitimate CBF as one center in the future the interdisciplinary activities must become much more visible. This will be a unique contribution that CBF can deliver to the scientific world. Due to the lack of this interaction so far, each theme is briefly evaluated separately below Mechanisms Physiological and psychological mechanisms underlying the development of WMSD has developed research in a logical continuation of CBF in The activities are supervised by EL. In depth studies include muscle metabolism and adaptation on the molecular level. Furthermore, neurophysiology, motor control, and stress-related research are continued and in some cases extended by new collaborations e.g. with the experimental pain researchers in Denmark. A new area of vision/eyestrain has been included due to recruitment of new academic staff member. 16

18 Much effort had until 2005 been invested in establishing new methods. In the following years these methods have been applied in a number of studies resulting in numerous papers and 5 PhD theses. Studies continue with focus on low-level repetitive activity and local muscle responses. Work relatedness is focused on computer mouse work. A computer mouse-use model in combination with using methods like NIRS and microdialysis is applied to reveal inflammatory substances accumulated during such work. Studies are ongoing using these methods to MSD patients, to identify what/whether substances are accumulated in painful muscles, possibly relating to the inflammatory state or serving as metabolic indicators of abnormal function. The effect of stress on proprioception has been continued to explore the combined effect of mental and physical loads on proprioception, and in particular autonomic effects on muscle spindle function and motor control in general. Also lab studies with experimental pain and stress have been conducted and are recommended to be perused in future studies. Disturbance of CNS/ANS stress regulation as an element in the pathogenesis of WMSD has been continued. Physiological examination of patients with WRMSD (neck/shoulder, low back) or stress related symptoms have been conducted to understand ways of rehabilitation. Plans are developed to apply such methods in field studies and which should be intensified Intervention for prevention The focus on ergonomic interventions for prevention of WMSD was a newly started research area within BSC by SEM in 2005 and continues to be supervised by him. This area has been substantially expanded since Importantly, also the core activities in this area are now localized in Gävle. A new academic staff member within statistics and modeling will highly strengthen the research in this area. However, the CBF academic staff members in this area are still borderline regarding critical mass and the retirement of MBB in the not too fare future implies diminished recourses for this area. SEM has extensive international collaboration which allows this to be reasonably productive but a further strengthening is important. Several papers but only one PhD thesis is reported since SEM has continued his research projects with collaborations with groups in Lund, Gothenburg, Denmark, Holland, and the USA. They have focused on the development and evaluation of methods for exposure quantification, which are integral to this research field. A particular emphasis is given to the development of cost-efficient methods for collecting and processing exposure data, using advanced statistical and microeconomics techniques. The joint consideration of workplaces from production engineering and ergonomics perspectives is another important and relevant niche. Other ongoing studies that SEM has continued at CBF include call-centers and air traffic controllers. 17

19 Prior to the arrival of SEM, BSC had been involved in studies that include workplace interventions, notably projects focusing ambulance personnel supervised by MBB. These studies have very comprehensive design, utilizing both quantitative and qualitative methods and laboratory and field measurements. These projects are in several respects rather different from the intervention research carried out by SEM, including different target groups (services vs. industry, exposure profile etc.), methods utilized and research questions asked. A real interaction between these two research lines within intervention research has not been documented at CBF. However, to be mentioned is that high priority is given to a new research line now being built up at the CBF: implementation research. As of April 2008, this research is manned with one full-time senior post-doc researcher (Katarina Wijk), who has a background in pedagogic research, and several other senior researchers are involved, including Per Lindberg, Göran Hägg (pt 25% at the CBF) and SEM. Current research issues are, e.g., pedagogical theories underpinning ergonomic intervention strategies as described in the literature, and company attitudes to ergonomics programmes as part of the strive for overall profitability. The research in this field is closely coordinated with the developmental work in the project Ergopriset Rehabilitation This research area is supervised by MD. It can be considered an application area anchored by the extensive experience at CBF with research on human proprioception. In the first evaluation period much focus was on method development, e.g. to establish and validate relevant tests. Subsequently, tests of proprioception may now be used to identify individuals at risk. Training to improve proprioception may reduce pain and improve function, as part of a rehabilitation regime, and facilitate return-to-work. At present, projects include studies of the effect of injury and pain on sensory-motor performance and the health effects of different treatment regimes for improved proprioception. CBF activities within the rehabilitation theme represent a narrow segment of the very large rehabilitation research field. Collaboration with clinical experts is ongoing within the areas of MDS, neck pain, low back pain. Importantly, at the time of the evaluation an extensive RCT was just starting, that also had attracted substantial external funding from several sources. Among the outcome measures is included sick leave and return to work. Moreover, this RCT is conducted in close collaboration with the Dept. of Community Medicine and Rehabilitation, UmU, which was mentioned as a key future collaboration partner by Gunnar Grimby in his part of the evaluation A significant fraction of publications relate to this research theme including 3 theses. A first important step has bee taken to apply methods within the rehabilitation theme in a strict epidemiological design in terms of the RCT study. Future studies should preferably be conducted also in collaboration with researchers involved in the other research themes at CBF. 18

20 3.2.3 Quantity Research quantities for CBF are specified in Styrdokument för verksamheten under perioden , approved by the CBF board A number of relevant variables are selected below for in-depth analysis from the long list of requests in the document. The following is e.g. stated: 1) The annual number of publications of scientific papers with affiliation to CBF should be 3 per employed senior fulltime researcher equivalent. In enclosure 7 the fulltime researcher equivalent per year has been calculated as 6.2 for 2005, 6.9 for 2006, 7.6 for 2007, and 2.5 for the first quarter of 2008 (~ 10 for the full year 2008). It is not fully clear if the senior fulltime researcher equivalent is considered to be: 4.2, 5.2, 5.5, and 1.3, respectively. Therefore, both denominators have been used. Given the numbers of publications in peer reviewed journals (ISI-listed journals) presented above in section the figures for the requested publication quantity are: 26/6.2 = 4.2 or for the seniors only 26/4.2 = 6.2 for 2005, 18/6.9 = 2.6 or for seniors only 18/5.2 = 3.5 for 2006, 14/7.6 = 1.8 or for seniors only 14/ 5.5 = 2.5 for 2007, and 14/10 = 1.4 or for seniors only 14/5.6 = 2.5 as a likely minimum number in There are a number of important comments in this context. First, it is not clear, on which basis a number of 3 publications per senior fulltime researcher equivalent has been requested. As mentioned in section this figure in the previous evaluation period was 1.1 (including all researchers) and compares well with that of other research institutes. Most recently in 2008 the National Research Centre for the Working Environment, NRCWE, in Denmark, was evaluated. In the report the following is stated: The average number of published scientific papers per researcher year during the the period was In the period the corresponding average is A number of 3 is therefore considered to be unrealistic high. Second, there is a delay of several years from conducting research until publication. Only because CBF includes publications with affiliations to the former BSC, with many more researchers during previous periods, the extremely high values of 4.2 and 2.6 have been attained. It is recommended that for future years the CBF board will set a more realistic number and more common denominator that allows comparison with other groups. 2) Per senior fulltime researcher equivalent a 0.35 PhD degrees should be attained. This value is not very reliable to calculate during the evaluation period with a quite discontinuous intake of PhD students. However, according to section a total number of 9 PhD theses were defended successfully during the evaluation period and one additionally in May Given ~ 16 senior fulltime researcher equivalent this results in 10/16 = 0.63 PhD degrees per senior fulltime researcher equivalent or double the requested volume by the CBF board! 19

21 3) Per senior fulltime researcher equivalent there should be mentorship for 1.5 PhD equivalent. With a total of 10 PhD students having a mentor at CBF during the evaluation period at the cut-point , and several received mentorship for 2 or more years during the period, a total of 25 PhD equivalents were estimated. With a total of ~ 16 senior fulltime researcher equivalent this results in 1.6 PhD equivalents per senior fulltime researcher equivalent and thus fully meets the request by the CBF board. 4) During the evaluation period the activities within the themes Intervention and Rehabilitation should increase relative to Mechanisms. According to enclosure 7 the fulltime researcher equivalent was for the themes Mechanisms, Intervention, and Rehabilitation : 3.53, 1.58, and 1.06 respectively in 2005 and changed to: 4.05, 1.54, and 1.98, respectively in 2007 and 1.14, 0.80, and 0.57, respectively in 2008 (first three month). These figures show a development into the intended direction but that an equal distribution of resources in terms of fulltime researcher equivalent between the themes has not yet been attained. The pattern is similar if only including what may be considered senior fulltime researcher equivalent. Importantly, the most recent enrollment of PhD s will improve the balance. 5) Resources should be used for at least 3 month of guest researchers. A significant number of guest researchers have visited CBF during the evaluation period. At the CBF homepage the names of 10 guest researchers are presented at present. According the director ( föreståndere ) a significant larger amount than 3 month has been invested in this activity every year throughout the evaluation period Collaboration An extensive list of collaboration is presented by CBF and included as enclosure 6 in this report. A short information paragraph on the research content of each collaboration is presented which witnesses about the seriousness of all collaborations listed. To summarize: 15 collaborations in Umeå These are well established over many years for most of them. Two of the collaborations however, do not related to MSD 20

22 5 collaborations at HiG One of these collaborations concern networking on an interdisciplinary basis rather conducting an actual research project. 8 collaboration in Uppsala or Stockholm (KI, KTH) These locations are reasonably close to HiG that future collaboration with a base at HiG can be envisaged. This is considered a strong development in line with the strategic plans in styrdokumentet. 12 collaborations with other Swedish groups This in particular related to Luleå, Linköping, and Lund 4 collaborations with other Nordic countries CBF is enrolled in a large Nordic collaboration on the project: Database of methods measuring physical exposures on musculoskeletal system at work (workload). This is an ambitious initiative, chaired by Finland, to collect the existing knowledge on methods for exposure assessment and to evaluate the validity of each method. This will be a very important tool for future work to link exposure and detrimental outcome to prove or disprove possible causal relationships. Additionally two projects are conducted in collaboration with Denmark (Ålborg and Copenhagen, respectively) within the line of mechanisms. Finally, collaboration is established with researchers from Århus, Denmark, where also other research groups from Europe/USA/Canada participate to develop methods for intervention studies. 7 collaborations to other European countries In particular Holland is well represented, which is scientifically fully justified. 7 collaborations outside Europe In particular the US is well represented which also is scientifically well justified. This sums up to 56 collaborations for 15 senior scientists, which is a quite impressive activity. 3.3 Education Basic CBF has increased its educational activities at HiG, and should continue to do so. The scientific expertise of the CBF-academics fills perfectly into an educational line at GiH. However, CBF should also in the future be financially compensated for teaching since research into the three themes mechanisms, intervention, and rehabilitation can be sustained only, given that resources are not moved from research to teaching. 21

23 CBF will submit an application to qualify for masterexamenrätt at HiG according to styrdokumentet. According to information during the site visit, this CBF has taken much more responsibility for this activity that originally proposed by CBF-styre. Two researcher have during spent a significant amount of time for building up and coordinating collaboration between CBF and other sections of HiG as well as writing the particular application Research, Doctoral School A number of PhD students are supervised at CBF but a doctoral school per se has not yet been established. CBF could probably have a leading role in Sweden to organize PhD courses and other PhD activities within occupational MSDs at HiG in collaboration with the universities in Umeå, Uppsala, Stockholm, and Lund. Specifically CBF could relate to two national doctoral schools in Denmark: GRASPH (www.phdpubhealth.dk) and REPS (www.reps.ku.dk)within public health and physical activity (sports sciences), respectively. Also, CBF should further explore the possibility of establishing a doctoral school for research into occupational MSD s involving EU universities External In line with the evaluation in 2005 the educational efforts outside HiG are considerable and appear to function well, although there is not much information to base this impression on. It is difficult to be more specific concerning this aspect other than state this activity is important to ensure support and to be perceived as a national institution within occupational MSD research. 3.4 Interplay with the society CBF has engaged an informatör (i.e. an information and communication officer) in 2006 according to the strategy by the CBF board styrodokument. Further, CBF has put major effort into dissemination of research in two text books: Ergonomi för ett gott arbete (published 2007) and Bok i Arbetslivsfysiologi (to be published November 2008). CBF senior researchers have taken responsibilities and given significant contributions. CBF should maintain its activities within tredje upgiften according to the communication strategy developed. That document presents not only a framework but also specifies many activities in detail. The content is fully in concert with strategies and profile for HiG. Regular communication between CBF and HiG will ensure that the two organizations maintain the same understanding and appreciation of this task. 22

24 3.5 Organization Internal organization CBF has developed a quite large organizational structure that seems extensive to the size of the center: 15 senior researchers, 10 doctoral students, 7 technical staff members including secretary. However, academic as well as technical staff find the organization convenient and transparent. Everyone knows where to go and there is a pleasant atmosphere. It is a hierarchical structure with one director (föreståndere, MD) at the highest level. He delegates to the second level responsibilities for research and relevant resources to SEM and for personnel to personalsamordnaren. Additional a biträdande föreståndare is appointed. This year also a leader for education, MBB, was appointed. SEM delegates to the third level responsibilities for the research area mechanism to EL. Rehabilitation is delegated to MD and intervention taken care of by SEM. According to the above there are in total 6 leaders in a group of ~ 30 persons. There are three levels of leadership at present, and the third level of leaders for the three research areas should be reconsidered for two reasons: 1) This level results in dual roles in the organization for MD and SEM and 2) EL is located in Gävle while the research area mechanisms has core activities in Umeå. Also, SEM and MD in combination are scientifically fully capable to guide and coordinate all research activities at CBF Localization The major part of activities are still located in Umeå, but a significant increase of activities has been established in Gävle. This regards in particular the intervention area but also some of the mechanisms and rehabilitation activities. Fortunately, MD and SEM are in Umeå and Gävle, respectively, and top-scientific leadership thereby available at both locations. However, insufficient technical and secretary assistance is available in Gävle, and initiatives should be taken to adjust this. The physical facilities in Umeå fully suffice the CBF s activities while in Gävle there are shortcomings in terms of lab facilities. Most of the methods at CBF in Umeå can be moved to Gävle and some of the scientists are interested to join the Gävle group. This became evident at discussions during the site visit and it is recommended to have an open discussion on this issue at CBF. Interests for research activities as well as plans for lab facilities should therefore be promoted and a strategy planned for relevant sections of the mechanism and rehabilitation research to combine into the intervention research in Gävle. There is probably no need to force individuals to move to Gävle, but a constructive push is welcome. Interaction between the research areas should be promoted. However, some of the delicate activities that are conducted in collaboration with research groups at UmU 23

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