International Journal of Industrial Ergonomics 70 (2019) 107–115

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International Journal of Industrial Ergonomics

journal homepage: www.elsevier.com/locate/ergon

Risk factors for musculoskeletal injuries in airline maintenance, repair & T

overhaul
Hamed Asadia, Denny Yua,∗, John H. Mottb
a
School of Industrial Engineering, Purdue University, West Lafayette, IN, USA
b
School of Aviation and Transportation Technology, Purdue University, West Lafayette, IN, USA

A R T I C LE I N FO A B S T R A C T

Keywords: Aircraft maintenance workers are exposed to high injury rates, but risk exposures are difficult to measure and
Injury risk factors task contributors are difficult to identify due to the wide variety of parts and irregularity of jobs in this industry.
Aircraft maintenance Subjective metrics, posture assessments, and lifting analyses were collected from 235 employees from five work
Musculoskeletal disorders areas in aviation maintenance, repair and overhaul (MRO) facilities to measure ergonomic risk factors and
Exposure assessment
identify task factors contributing to poor biomechanics. Nordic Musculoskeletal Questionnaire indicated that the
low back was the most commonly reported region of the body experiencing aches, pain, and discomfort (41% of
participants), while knees were the highest (68%) in cabin maintenance, likely due to constraints in the aircraft
cabin. Rapid Entire Body Assessment (REBA) assessments showed that 57% of the jobs examined fell within the
high-risk category. Causes of poor biomechanics differed by work area, e.g., overhead work was a key con-
tributor in the engine change facility, while non-adjustable workstations were a likely contributor in cabin
maintenance and engine maintenance. The under-looked cabin maintenance, engine change, and logistic jobs
are the most pressing work areas in MRO that need ergonomic interventions.

1. Introduction Work-related musculoskeletal symptoms are frequently reported

Aircraft mechanics and avionics equipment technicians are skilled
workers who repair equipment and perform scheduled maintenance
and inspections on aircraft. In the United States, the Department of
Labour estimates that almost 5.5 million individuals are employed in
the installation, maintenance, and repair industry and that 35,820
workers are employed specifically in the scheduled air transportation
sector (Bureau of Labor Statistics, 2016c). The incidence rates of non-
fatal occupational injuries and illnesses in the air transportation sector
are especially high at 6.7 per 100 full-time workers (Bureau of Labor
Statistics, 2016b). This rate exceeds that of many other industries; it is
higher than the 4.5 per 100 incidence rate for the transportation and
warehousing sector and also higher than the rate of 3.3 per 100 across
all industries, including state and local governments (Bureau of Labor
Statistics, 2016a). In the aircraft maintenance industry, material
handling, maintenance, and repair positions are especially prevalent,
and these tasks have especially high levels of risk for musculoskeletal
injuries (The National Institute for Occupational Safety and Health
(NIOSH) 2015). For example, maintenance and repair workers experi-
ence musculoskeletal injuries such as sprains, strains and tears in 35.4%
of the total reported incidents (Bureau of Labor Statistics, 2015).
among aircraft mechanics and avionics equipment technicians. Body
regions affected include the low back, shoulders, legs and feet, neck,
arms, and hands (Chae and Kim, 2005; Kemp et al., 2010; Zungu and
Nigatu, 2015; Fajardo Rodriguez et al., 2016; Nogueira et al., 2012a,b;
Irwin and Streilein, 2015). For example, aircraft maintenance is the top
duty area for civilian worker injuries in the U.S. Air Force, resulting in
33% of all lost workdays from 1993 to 2002 (Copley et al., 2010). Other
studies have raised concern with low back pain (LBP) after observing
prevalences of 12.9%–65% among surveyed aircraft maintenance
technicians (Fajardo Rodriguez et al., 2016; Zungu and Nigatu, 2015;
Chae and Kim, 2005). Based on observations and interviews, re-
searchers have suggested potential musculoskeletal injury risk factors
include bending and working with twisted trunks (Zungu and Nigatu,
2015), lifting of aircraft parts (Kemp et al., 2010), high physical loads
(Fajardo Rodriguez et al., 2016; Zungu and Nigatu, 2015), rapid muscle
fatigue, and extended overhead activity (Irwin and Streilein, 2015).
Injury risks were not limited to only task demands; studies have also
suggested that the duration of employment (Zungu and Nigatu, 2015)
and technicians' time in the office (Fajardo Rodriguez et al., 2016) may
also be predictors for work-related musculoskeletal injuries. These
studies confirm that injuries are a concern in aviation maintenance;

∗
Corresponding author. School of Industrial Engineering, Purdue University, 315 N. Grant Street, West Lafayette, IN 47907, USA.
E-mail addresses: hasadi@purdue.edu (H. Asadi), dennyyu@purdue.edu (D. Yu), jhmott@purdue.edu (J.H. Mott).

https://doi.org/10.1016/j.ergon.2019.01.008
Received 12 September 2018; Received in revised form 18 January 2019; Accepted 22 January 2019
0169-8141/ © 2019 Elsevier B.V. All rights reserved.
H. Asadi et al.
however, current research primarily relies on qualitative survey
methods or only considers single jobs (a major limitation, given the
diverse set of tasks in aviation maintenance, repair and overhaul (MRO)
organizations).
To better understand the work requirements for the diverse and
irregular set of maintenance tasks performed in aviation, a systematic
approach with validated tools is needed to evaluate factors that con-
tribute to the high prevalence of injuries. This study aims to: 1) conduct
ergonomic risk assessments across all jobs performed by aircraft me-
chanics and avionics equipment technicians and 2) identify the asso-
ciated task contributions for observed risk factors.
2. Material and methods
2.1. Study participants
Participants were from one large commercial airline's full-service
Maintenance, Repair & Overhaul (MRO) organization, consisting of
almost 10,000 employees in the United States. Aircraft mechanics and
avionics technicians are the most prevalent jobs in MRO organizations.
Aircraft mechanics typically 1) diagnose mechanical and electrical
problems, 2) repair, replace, and then test components, 3) inspect
systems involved in the completed procedures, and 4) record main-
tenance actions. Avionics technicians test instruments and diagnose
their malfunctions, repair or replace the components, and maintain
equipment records (Bureau of Labor Statistics, 2018). The work areas in
MRO included:
• Engine Maintenance (EM)
• Component Maintenance (CM)
• Engine Change (EC)
• Cabin Maintenance (CB) and
• Logistics (LG).
The EM area consists of different departments repairing and pro-
cessing different parts of the aircraft and its engines, such as auxiliary
power unit (APU) inspection, blade and vane rework, engine and en-
gine component maintenance, landing gear maintenance, and plasma
spraying and plating. The employees in the engine shop disassemble
engines, where heavy lifting and awkward postures are frequently re-
quired to reach specific parts of the engines. The general repair and
processing of the parts are performed typically in maintenance work-
stations (Fig. 1a).
The CM area involves general repair and inspection of various
components including electrical accessories, fuel, hydraulic, and
pneumatic system components, and wheels and brakes (Fig. 1b).
The EC area involves engine work. The employees in EC area re-
move engines from the aircraft, attach repaired engines, and inspect the
engines and mounts. A common engine size is approximately 4.6 m
length, 3.1 m diameter, and 7264 kg weight (National Air and Space
Museum, 2004). Employees work in four-to six-person groups and fre-
quently on ladders, maintaining awkward postures to reach inside the
engine, experiencing overhead work, and fastening or loosening bolts
attaching the engines to the aircraft wings or empennage (Fig. 1c and
d).
The CB area involves general repair and inspection of the cabin
interior. Employees inspect and repair various components inside the
cabin, such as seats, seat belts, lighting, monitors, and restrooms.
Carpet change is another task in this area. This includes lifting a carpet
roll (usually as a team lift), removing old carpet while maintaining
awkward postures between the seats, and taping the floor (Fig. 2a–d).
Majority of the tasks are performed inside the aircraft.
The LG area is utilized for distributing required components to the
maintenance shops. The employees in this area receive, sort and orga-
nize, pack and ship components. This frequently requires multiple lifts,
movement of packages, and standing for prolonged periods of time
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International Journal of Industrial Ergonomics 70 (2019) 107–115
(Fig. 2e and f).
2.2. Exposure assessment
This study was reviewed by the university's institutional review
board (IRB Protocol #1803020326) and has been determined to be
exempt under Category 4 (Category 4 exempts the research from IRB
review since the information was recorded by the investigator in such a
manner that subjects cannot be identified). Prior to work site ob-
servations, email communication was sent to leads (supervisors) of each
worksite. The visits were scheduled randomly between shops and in-
cluded both day and night shifts to cover all of the jobs. For shops that
operated week-long, visits were scheduled during weekdays and
weekends for both day and night shifts. For example, EC and LG op-
erated 24 h per day, 7 days per week with three shifts.
The number of observed jobs in each work area was proportional to
the variety of jobs and tasks in that shop. For instance, the engine
change area involved teams of 4–6 employees maintaining/inspecting
engines with minor technical differences in job exposures between
groups. On the other hand, the CM area had a vast variety of depart-
ments and jobs which needed several observations to ensure capturing
these variations in job exposures.
The onsite study team was co-led by an ergonomics Ph.D. research
assistant and at least one subject matter expert from the company. The
study team leads supervised the other onsite study team members, i.e.,
graduate (masters) and undergraduate research assistants trained in
ergonomics from aviation and engineering.
On the field observation dates, the study team first met with the lead
of the section. The lead typically provided a brief tour of each of the
work stations along with an introduction of the study team to the em-
ployees. Job title, primary work tasks (up to four), and approximate
percentage work-day durations for each task were collected through
brief (5–10 min) employee interviews. Although workers' experience
can impact occupational injury risks, the primary goal of this study was
to assess as many jobs and workers as possible to get a big picture view
of occupational health risks in this industry. Thus, the assessments in
the present study were based on the workers' availability on the day of
observation and was not specifically sampled for. After the interview,
the employees resumed their work, and the study team used ergonomic
data collection tools to determine risk exposure. Following each ob-
servation day, study teams debriefed on the collected data.
2.3. Assessment tools
Subjective metrics, posture assessments, and lifting analyses were
collected for each employee as appropriate (i.e., lifting analysis was
performed only if a job required lifting).
Instruments for collecting subjective metrics were adapted from the
Nordic Musculoskeletal Questionnaire (NMQ) and National Aeronautics
and Space Administration Task Load Index (NASA-TLX) (Kuorinka
et al., 1987; Hart and Staveland, 1988). Specifically, the first three
questions of the NMQ were used in the interviews, i.e., whether the
employee:
1 experienced trouble in last 12 months,
2 was prevented from engaging in normal activities, and
3 visited physicians for any trouble experienced.
Musculoskeletal fatigue scores were reported by participants using a
10-point scale (0 = no fatigue, 10 = worst imaginable fatigue) for the
body-part regions: head and neck, back, right and left arm, and low
extremity. The workers were asked to rate their body-part fatigue scores
at the end of the work day. “No fatigue” was explained as feeling
completely relaxed after enough rest and without any discomforts,
pains, or symptoms and “worst imaginable fatigue” was explained as
experience of being so tired that you cannot complete a simple task.
H. Asadi et al.
Fig. 1. Working environment in various areas including (a) repairing in EM, (b) machining in CM, (c) repairing engine in EC, (d) lifting jet engine in EC.
Five out of six subscales from the NASA-TLX questionnaire were
collected (i.e., effort, mental, physical, temporal demands, and frus-
tration level). The performance subscale was not collected, as some
employees found the question not applicable for this safety critical
work environment. All self-report metrics were collected from each
worker during the interviews as time allowed.
Observer-based tools were used by the study team members in real-
time during on-site work observation and, when required, confirmed
with video recordings captured during the observations. Posture as-
sessments were performed using the Rapid Entire Body Assessment
(REBA) tool (Hignett and McAtamney, 2000). The REBA score was a
combination of two sub-scales: REBA A (neck, trunk and legs) and
REBA B (upper and lower arms and wrist). The REBA was applied to
every task observed in the field. For tasks reported by the worker that
were not observed in the field, REBA scores were either not collected or
the observed employee briefly switched tasks to demonstrate the task
requirements.
The revised National Institute for Occupational Safety and Health
(NIOSH) lifting equation was used to evaluate tasks that involved lifting
(Waters et al., 1993). Study team members estimated the variables for
each task following the same protocol used for the REBA analysis. Al-
though accuracy is a known issue for observer-based assessment tools,
steps were taken to improve reliability. For example, observers were
trained by the same faculty, received consistent definitions and case
examples, provided measuring tape to use if needed, and supervised by
ergonomics and aviation subject matter experts. In addition, the NIOSH
lifting guide was designed to facilitate observation-based analysis, and
the accuracy of the measurements for trained non-ergonomist partici-
pants showed sufficient reliability (Waters et al., 1998). Finally, the
structure of the work environment also faciliated the assessemnts. The
maintenance workshops typically consist of carts and shelves which are
helpful in measuring the horizontal and vertical distances. Object
weights were also typically known from the packages labels and tech-
nical specifications.
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International Journal of Industrial Ergonomics 70 (2019) 107–115
2.4. Data analysis
The output for each NMQ question was binary, i.e., whether the
employee reported any or no issues. Although the NMQ included nine
body parts, any reported pain regardless of body region was considered
as a positive response for that question. The percentage of positive re-
sponses was reported.
Musculoskeletal fatigue scores were averaged across the employees
and reported by body part regions for each work area. The NASA-TLX
score for each worker was calculated by averaging the subscales to-
gether (Hart, 2006). NASA-TLX scores were averaged across employees
and reported by work area.
The REBA scores were calculated for each task. The maximum score
among tasks was used as the REBA score for the observed participant
(Sunwook Kim, Nussbaum, and Jia, 2011) and averaged across em-
ployees for each work area.
The subjective surveys, NIOSH lifting indices, and REBA scores of
employees in different work areas were compared using a linear mixed-
effects model with a significance level of 0.05. The Q-Q plots were
generated for the original variables to ensure the normal distribution of
data before performing linear mixed-effects model. The REBA workload
scores are composed of multiple sub-scales. To determine whether these
sub-scales differed statistically, a linear mixed-effects model was used.
This model allowed comparison of the REBA subscales (REBA A vs.
REBA B), while accounting for the repeated measurements made on the
same employees. For REBA, the subscales (REBA A and REBA B) were
considered as fixed effects in the model.
3. Results
A total of 235 employees and 624 tasks were assessed in this study
over a period of six months. Employees were categorized by work areas
as follows: CB (25 observed subjects with 72 tasks), CM (102 subjects
with 257 tasks), EC (14 subjects with 45 tasks), EM (78 observed with
192 tasks), and LG (16 subjects with 58 tasks) areas (Table 1).
H. Asadi et al. International Journal of Industrial Ergonomics 70 (2019) 107–115

Fig. 2. Working environment in CB and LG areas are illustrated, where (a) overhead view of CB, (b) repairing chair in CB, (c) carpet change in CB, (d) inspecting life
vests in CB, (e) packaging in LG, (f) lifting package in LG.

Table 1 Employees and tasks observed were proportional to task variation, task
Sample size for each metric by work area, Engine Maintenance (EM), requirements, and employee population.
Component Maintenance (CM), Engine Change (EC), Cabin Maintenance (CB),
Logistics (LG).
3.1. Worker questionnaires
Area Employees Tasks Questionnaires REBAa Lifting Analysis
Of the 235 observed participants, 196 employees were interviewed.
CB 25 72 25 25 3
CM 102 257 79 102 31 The other 39 employees were observed but not interviewed either due
EC 14 45 14 14 3 to employee time-constraints or to minimize workflow interruptions.
EM 78 192 61 78 35
LG 16 58 15 16 13
Total 235 624 194 235 85
3.1.1. Nordic Musculoskeletal Questionnaire
Results of the NMQ are summarized below for the five observed
a
Rapid Entire Body Assessment (REBA). work areas (Fig. 3). Work areas CB, EC, and LG reported 22%–37%
higher prevalence of pain than that reported by EM and CM
(p < 0.05). For the “experience of trouble (such as ache, pain, dis-
comfort, numbness in different parts of the body)” question on the
NMQ, low back problems were reported by 41% of employees (Table 2,
total line). In addition, over a quarter of surveyed employees reported
aches and pain for the upper extremities, e.g., shoulders and wrist/
hands (Table 2, total line).

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H. Asadi et al. International Journal of Industrial Ergonomics 70 (2019) 107–115

* Cabin Maintenance Engine Change

Cabin Maintenance 10 Logistics Component Maintenance
100% Engine Maintenance
Engine Change *
*
Logistics

Average Musculoskeletal Fatigue (scale: 0 (No

Component Maintenance

Fatigue) - 10 (Worst Imaginable Fatigue))

80% 8
Engine Maintenance *
Positive Responses

60% 6

40% 4

20% 2

0% 0
Experience of trouble Prevented from normal Visited physician for the Head and Neck Back Right Arm Left Arm Lower Extremity
(such as ache, pain, activities (e.g. job, experienced condition
discomfort, numbness) housework, hobbies) Fig. 4. Average musculoskeletal fatigue for observed jobs with breakdown of 25
during the last 12 months because of experienced
trouble in CM, 79 in EC, 14 in EC, 62 in EC, and 16 in LG areas. *Indicates p < 0.01
(Error bars represent the standard deviation).
Fig. 3. NMQ responses for observed jobs in work area. *Indicates p < 0.05.

10 *

Average Workload (scale: 0 (very low) - 10

3.1.2. Musculoskeletal fatigue
A total of 192 musculoskeletal fatigue scores were collected, and the **
8
average value for each body region was calculated for each work area
(Fig. 4). Fatigue in the back and lower extremities were reported to be

(very high))
higher than other body regions. Head and neck fatigue for CB was 1.9 6
points higher than CM and EM (p < 0.01). Additionally, back fatigue
for CB, EC and LG is 1.9–3.1 points higher than EM and CM (p < 0.01).
4
No statistical differences were observed for right and left arm fatigue
between areas. Lower extremity fatigue for maintenance jobs (e.g., CM
and EM) was 2.4–3.3 points less than that in engine change (EC) and 2
logistic (LG) jobs (p < 0.01).
0
Cabin Engine Logistics Component Engine
3.1.3. Workload Maintenance Change Maintenance Maintenance
The NASA-TLX questionnaire was used to collect data from 192
employees (Fig. 5). In general, effort, mental and physical demands Fig. 5. Average aggregated workload scores for observed jobs with breakdown
were reported to be higher than temporal demand and frustration le- of 25 in CM, 79 in EC, 14 in EC, 62 in EC, and 16 in LG areas *Indicates
p < 0.05 and **Indicates p < 0.001 (Error bars represent the standard de-
vels. Similar to the trend observed in fatigue questionnaires, employees
viation).
in EC and LG reported 3.0 to 3.3 points higher workload than EM and
CM (p < 0.001). In addition, reported workload in CB is 1.8 and 1.9
points higher than EM and CM (p < 0.05). No statistical differences were 1.5–1.8 points greater than REBA B scores (p < 0.05) (see Fig. 6).
were observed between EM and CM.
3.3. NIOSH
3.2. REBA
Lifting was observed in 85 of the 624 tasks, and a NIOSH lifting
A total of 235 REBA analyses were collected, and the mean scores analysis was subsequently performed for those tasks (Fig. 7). Lifts
for jobs were calculated for each work area (Fig. 6). The final REBA performed with assistive equipment or hoists (the majority of lifts in CB
score for all observed areas was 8.3±2.6. As defined in REBA (Hignett and EC) were not included in the lifting analysis. Team lifts and one-
and McAtamney, 2000), a final score exceeding a value of 8 was clas- handed lifts were also excluded from this analysis. The object weights
sified as “high-risk”, and 57% of the observed jobs fell within this ca- for the lifting tasks assessed by NIOSH lifting equation varied from 10
tegory. The CB and EC areas had REBA scores that were 2.6–3.2 points to 80 pounds (with the average of 29.6 pounds and 12.2 standard de-
higher than those in the EM and CM areas (p < 0.001). The LG had viation). The average NIOSH lifting index across all work areas was
REBA scores that were 2.0 and 2.2 higher than EM and CM (p < 0.01). 1.8±0.7 (Fig. 7). Seventy tasks (82.4% of observed lifts) had a lifting
Final REBA scores were not significantly different between CM and EM. index greater than one and five tasks (5.9%) had a lifting index ex-
For CB, EC, and LG, REBA A scores that represent upper-body exposures ceeding three. The median NIOSH lifting index for CB and EC were 2.3

Table 2
The prevalence of trouble experience in different parts of the body. The reported percentage is [number of cases with reported trouble]/[total number of ques-
tionnaires in each area], Engine Maintenance (EM), Component Maintenance (CM), Engine Change (EC), Cabin Maintenance (CB), Logistics (LG).
Area Questionnaires Neck (%) Shoulders (%) Upper Back (%) Elbows (%) Wrist/Hands (%) Lower Back (%) Hips/Thighs (%) Knees (%) Ankles/Feet (%)

CB 25 40 40 56 12 44 64 8 68 20
CM 79 19 18 15 13 23 27 4 8 10
EC 14 43 57 43 29 64 71 21 43 21
EM 61 13 30 5 16 21 31 5 11 21
LG 15 47 67 60 7 40 87 33 33 53
Total 194 24 31 23 14 29 41 8 21 19

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16
**

REBA Score
Average REBA Scores for Observed Jobs in

14
**
12 *

13
13
14
13

12

13
12

12
13
12

12
Different Areas

10

Removing pump (while standing on the

Under the seat inspection and repairing
Assembling and disassembling of seats
Emergency vest case repair (under the
8

Screwing/Unscrewing engine bolts

6

Using borescope (while sitting)

4

Job with high ergonomic risk/discomfort scores in observed areas, Engine Maintenance (EM), Component Maintenance (CM), Engine Change (EC), Cabin Maintenance (CB), Logistics (LG).

Disassembling engine parts

Unloading/lifting packages
Repairing/Processing parts
2

Lifting/loading fixtures
Carpet Replacement
0

Task Description
REBA A Score REBA B Score REBA Score
Cabin Maintenance Engine Change Logistics Component Maintenance Engine Maintenance

Fig. 6. Average REBA final score, REBA A and REBA B for observed jobs for 25

ladder)
in CM, 102 in EC, 14 in EC, 78 in EC, and 16 in LG areas *Indicates p < 0.05

seat)
and **Indicates p < 0.001 (Error bars represent the standard deviation).

• Prolonged awkward postures during maintenance and inspection

on ladder and prolonged holding and overhead postures

engine components while standing on

postures for reaching the engine components during

4.0

3.5

floor carpet during cabin carpet replacement

3.0
Average Lifting Index

2.5

lifting of engine components (> 40lbs)

the rolled stock of replacement carpet
2.0

Work demands leading to poor biomechanics

1.5

• Lifting heavy components (> 40lbs)

1.0

• Prolonged hours of standing

0.5

• Pulling/pushing/holding
0.0

lifting tasks
maintenance process
Cabin Engine Logistics Component Engine
Maintenance Change Maintenance Maintenance

Fig. 7. Average NIOSH lifting index for CB(n = 3), CM(n = 31), EC(n = 3), EM

the ladder

• Awkward
• Working

• Multiple
(n = 35), LG(n = 13) (Error bars represent the standard deviation).
• Pulling
• Lifting

• Heavy
and 1.5, respectively. The lifting index was not statistically different
across the areas examined.
of aircraft components

3.4. Top factors leading to poor biomechanics

parts (working

parts (moving, lifting, pushing, pulling,

The top factors leading to poor biomechanics were identified by

reviewing the jobs with high risk scores and also by reviewing the
parts

notes, videos and talking to subject matter experts/ergonomic re-

packages
• Assembling/Disassembling/Moving

searchers on identifying the task contributors. The top factors observed

• Moving/Lifting/Testing/Welding
cabin parts
Job description and involved tasks

leading to poor biomechanics are described and summarized for each

• Assembly/Repair/Disassembly

work area (Table 3). These leading factors represent key opportunities
• Unloading/Sorting/Typing
• Lifting/Scanning/Pushing
Seats/Flooring

for future interventions to improve the work environments of the air-

• Installing/Removing
• Carpet Replacement

craft mechanics and avionics equipment technicians.

mainly on ladder)
change

4. Discussion
• Replacing
holding)
• Remove

• Engine

Aircraft mechanics and avionics equipment technicians experience

high rates of workplace injuries, but injury risk exposures have not been
systematically measured across the various jobs/tasks performed in this
industry. Previous works on MRO workers have several limitations, e.g.,
reliance on worker self-report surveys (Chae and Kim, 2005; Fajardo
Rodriguez et al., 2016; Zungu and Nigatu, 2015; Nogueira et al.,
AMT (Aircraft Maintenance

2012a,b), data from safety reports (Kemp et al., 2010), or physical

AMT, General Mechanics

AMT, General Mechanics

examinations (Nogueira et al., 2012a,b). Another limitation of previous

Logistics Attendant

work is the focus on a small subset of jobs in MRO (Irwin and Streilein,
2015). No studies have measured ergonomic risks across all jobs in
Technician)

airline maintenance operations, e.g., logistics and cabin maintenance

Job Title

jobs have been frequently overlooked. Although the diversity of tasks

AMT

and jobs performed in the industry makes it challenging to quantify

ergonomic risks and implement effective mitigation strategies, the
Table 3

Area

findings in this study examined all jobs and tasks to measure the pre-
CM

EM
CB

LG
EC

valence of musculoskeletal pain/fatigue and identify task contributors

112
H. Asadi et al.
to poor biomechanics. These key task contributors are highlighted as
opportunities for improving working conditions.
4.1. Workers discomforts
Five major work areas were identified within the aviation main-
tenance industry, and the prevalence of musculoskeletal symptoms
differed significantly by work areas (Fig. 4). In the CB, EC, and LG work
areas, 88–93% of employees reported experiencing musculoskeletal
symptoms during the last 12 months (Fig. 3).
Similar to other studies on injuries in aircraft maintenance techni-
cians (Nogueira et al., 2012a,b; Fajardo Rodriguez et al., 2016; Zungu
and Nigatu, 2015; Chae and Kim, 2005), the current study observed
that the low back was the most commonly reported body region ex-
periencing aches, pain, and discomfort (41% of participants, Table 2).
The overall prevalence of low back symptoms was within the range
published previously, but the 41% prevalence in the present study is
lower than the 65% reported by Fajardo Rodriguez et al., 2016 (Fajardo
Rodriguez et al., 2016). A potential explanation for the discrepancy is
the more limited subset set of jobs examined in the previous work.
Specifically, when focusing on workers in EC and LG work areas, the
low back symptoms exceeded the previously published range at 71%
and 87%, respectively (Table 2). This suggests that the impact of
musculoskeletal injuries in MRO operations is even higher than what is
current studies have estimated when other MRO work areas are con-
sidered.
Specific tasks requirements in LG may explain the increased reports
of pain among these workers. Unlike the other maintenance work areas,
workers in LG primarily perform multiple lifting tasks as distribution of
parts is a key focus of their work. These frequent lifts are known con-
tributors to low back pain (Kelsey et al., 1990; Riihimäki, 1991). In
addition, workers in LG were also observed standing for prolonged
hours that may contribute to LBP. A review study (Coenen et al., 2017)
showed that low back symptoms can occur after 71 min of standing.
Logistics personnel in the current study worked 8- to 10-h shifts each
day. Even though these employees were given two 30-min breaks
during their shifts, the total time of standing (in combination with
lifting) likely exceeds the proposed threshold for developing muscu-
loskeletal symptoms due to standing (Coenen et al., 2017). Interven-
tions to prevent standing-related musculoskeletal symptoms which
could be used in LG include breaking up the standing by intermittent
sitting (Gallagher et al., 2014) and applying certain shoe or floor con-
ditions (Y.-H. Lin et al., 2012a; b). However, shoe-floor interventions
have generally shown only moderate effects on reducing symptoms so
far (Gallagher et al., 2014; Y. H. Lin et al., 2012a; b). In addition, these
interventions do not eliminate the standing exposure.
4.2. Awkward postures
The REBA analysis across the five work areas indicates 57% of the
observed jobs fell within the high-risk category, with REBA final scores
of 10.7±1.3 and 10.5±2.2 for the EC and CB areas, respectively.
Although low back pain was reported in CB, the body part experi-
encing the highest prevalence of pain (68%) was actually the knees,
followed by the back, wrists, shoulders, and neck. The unique bio-
mechanical exposures that contributed to these symptoms were the
constraints and obstructions from working inside the aircraft cabin.
These constraints required workers to perform tasks frequently on their
knees, assume awkward postures, and experience contact stresses
(Fig. 2a–d). For example, many tasks in CB required employees to as-
sume non-neutral postures due to the limited work spaces between
cabin seats on the aircraft and overhead posture while working on the
cabins' overhead bins and cables (Fig. 2a and d), and posture assess-
ments scores reflected this increased risk for injuries
(REBA = 10.4±2.8) (Fig. 6). Since overhead work impacts ergonomic
postures and strength capability, this further increase injury risks (Yu
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International Journal of Industrial Ergonomics 70 (2019) 107–115
et al., 2018). In addition to posture risk factors, the carpet change task
was observed to be especially demanding in CB area. Workers were
observed repetitively pulling with high force while on their knees to
remove the carpet (Fig. 1C). This task was also reported by CB em-
ployees as one of the most high-effort tasks. Conclusions from these
observations (task is of high injury risk) paralleled self-report data,
where mean musculoskeletal fatigue was higher in the head, neck, and
arms for CB than in other work areas. It is important to note that the
hand tools could be facilitate carpet removing task in cabin main-
tenance (Kadefors et al., 1993; Aptel et al., 2002; Jain et al., 2018).
The key task contributor to the high REBA scores in EC was over-
head work. Workers in EC were required to stand on ladders and sustain
prolonged overhead postures to access aircraft engines, which are
mounted well above ground level. Also, the tight spaces within the
engine cowl was another important risk factor in this area (Fig. 2c and
d). Within this space, EC workers had to reach within and exert pull or
push forces to install engine bolts. Interventions (e.g., supports, safety
belts, and adjustable ladders) may be needed to reduce overhead and
awkward postures.
4.3. Modification of lifting tasks
Revised NIOSH lifting assessments similarly indicated that lifting
tasks in CB and LG lifts were concerns for injuries, with indices of
2.4±1.0 and 1.9±0.9, respectively. The horizontal multiplier (0.56
average value) was especially problematic in comparison to other
multipliers, suggesting ergonomic interventions focusing on bringing
the load closer to the worker through workstation design may help
reduce injuries. However, it is important to note that some of the ob-
served lifting tasks could not be analysed with the NIOSH lifting as-
sessment, since they occurred while employees were lifting with one-
hand, seated, working in restricted work spaces, and/or carrying
(Waters et al., 1993). For instance, EC employees were observed car-
rying equipment weighing over 20 pounds while climbing ladders, and
CB employees were observed lifting/carrying/holding seats in re-
stricted work spaces.
The majority of the evaluated lifts (70 out of 85) had a lifting index
greater than one, but less than three. The spread of these indices over
all areas indicates moderate risk associated with lifting tasks and sug-
gests current worksite policy is preventing high risk lifts (indices > 3).
Frequent lifting tasks were observed in LG area. Here, the lifting tasks
were commonly performed in the same workspace (for example, the
worker was loading/unloading the packages while scanning the bar-
codes.). Assistive lifting equipment could prevent high risk lifts. The
current safety efforts include worker training, lift assist equipment, and
team lifts policy. However, continued monitoring is needed to de-
termine whether current policy should be revised to further lower
lifting risk indices (Liu and Boyle, 2009).
4.4. Work stations design
EM and CM areas represented a majority of workers in the MRO
operation, and the tasks they performed varied widely due to the
hundreds of thousands of different parts needed on an aircraft (Boeing,
2014). Despite the variation in work tasks, personnel in EM and CM
reported musculoskeletal pain less frequently than those in other work
areas. This may be due to differences in workstation environment.
Typically, jobs in EM and CM were performed on individual work-
stations operated by a single employee (Fig. 1a and b). This contrasted
with the lack of standard workstations for jobs in EC and CB due to the
nature of the working environment, as employees worked inside the
cabin or on the engine (Fig. 6). For example, the limited workspace in
CB due to the shape of the aircraft is a significant barrier for im-
plementing ergonomic layouts and principles as the aircraft cabin was
likely designed with passengers in mind, not maintenance workers.
However, it is critical to note that over half of the participants in EM
H. Asadi et al.
and CM still experienced musculoskeletal symptoms within the last
year, and REBA A scores highlight poor biomechanics in the upper
extremities. The observers noted the limited adjustability of current
workstations, e.g., fixed workstations, fixed workbenches that must
accommodate multiple workers on the same row, and chairs with
limited support. While changes in workstations are preferred, a tem-
porary solution might include the incorporation of microbreaks, which
has seen some success in reducing fatigue in other industries (Sooyeol
Kim, Park, and Niu, 2017; Zacher et al., 2014; Hallbeck et al., 2017;
Park et al., 2017).
4.5. Limitations and future directions
Although both subjective and quantitative observer-based metrics
collected in this study provide a general assessment of ergonomic risks
across several work areas in MRO operations, they provide only a
limited snapshot of the work demands, and longitudinal techniques are
needed to establish more causal relationships. It is important to note
that the observer-based assessments are also prone to subjective inter-
and intra-individual variability (Van Der Beek and Frings-Dresen,
1998); however, this approach allowed us to gather data from large
number of jobs/tasks present in the MRO industry. The recent work-
place assessment methods could provide more detailed assessment in
the MRO industry.
More granular assessments with tools like motion tracking, which
was previously implemented in postural analysis of aircraft painters
(Irwin and Streilein, 2015), could provide more objective measure-
ments on exact postures and how long workers remain in at-risk pos-
tures. The wearable sensors could be used to identify the risk factors for
the recognized high-risk jobs in aviation (for example, the IMUs could
be used to assess the postural variable of cabin maintenance workers or
EMGs could be used to identify high muscle activities of logistics
agents. For example, the wireless motion tracking sensors can be worn
full workdays with limited interference to the workers (Yu et al., 2017).
This can further improve our understanding of the high posture risk
observed in cabin maintenance workers. Such data could be used sub-
sequently for biomechanical modelling of a dose-response relationship.
The results showed that elevated arms were commonly observed in
CB (Fig. 2b) and EC (Fig. 1c and d) areas. Other than visual observa-
tions, the pairwise comparison of REBA subscales revealed higher REBA
A scores (represents upper-body exposures) than REBA B score in CB
and EC areas. Recent innovations in ergonomics have suggested that
passive exoskeletons may effectively reduce loads by supporting the
limbs and transferring the load. Specifically, the exoskeleton vest may
be able to support the overhead work commonly observed in the EC and
CB work areas (Kim et al., 2018a,b). On the other hand, CM is likely not
be able to fully utilize the benefits of exoskeletons since the work is
seated and is mostly bench work.
The current study was observational, and next steps could consist of
designing, implementing, and assessing the impact of interventions.
Some interventions were suggested herein, but were not applicable for
all of the areas in MRO organizations. In addition to the interventions
on workplace, equipment, and tools, the future investigation of further
macro-ergonomic and administrative solutions may be beneficial.
5. Conclusion
This study compared exposure differences between work areas by
using both subjective and observer-based assessment tools for a wide
range of jobs and tasks in a large commercial airline's full-service
Maintenance, Repair & Overhaul organization. The back, head, neck
and lower extremities were the most-affected body parts, and the
under-looked CB, EC and LG areas are the most pressing sections in
MRO that need ergonomic interventions. The commonly elevated arms
observed in CB and EC areas could be supported by passive exoskele-
tons that may effectively reduce loads by supporting the limbs and
114
International Journal of Industrial Ergonomics 70 (2019) 107–115
transferring the load. The assistive lifting equipment could prevent high
risk lifts as frequent lifting tasks were observed in LG area. Also, hand
tools could be improved to provide more maintenance friendly en-
vironment for the tasks in CB. The interventions were suggested for
various areas based on the identified work demand and exposures in
MRO.
Disclosure statement
The authors declare no conflicts of interest.
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