Foto del docente

Roberta Bonfiglioli

Associate Professor

Department of Medical and Surgical Sciences

Academic discipline: MED/44 Occupational Medicine

Director of Second Cycle Degree of Health Professions of Prevention Sciences

Research

Keywords: Ergonomy Health care workers Musculoskeletal disorders antineoplastic drugs Occupational cancer

Research interests include:

• Investigation of the etiological relations between occupational exposures to biomechanical risk factors and neurological and musculoskeletal disorders

• Particular interest in the diagnosis of neurological and musculoskeletal disorders using traditional diagnostic techniques (ultrasound, EMG) and experimental ones (surface EMG)

• Investigation of the etiological relations between occupational risk factors in health care setting (chemical, Antineoplastic drugs, manual patient handling, ionizing radiation) and occupational disorders.

1- Investigation of the etiological relations between occupational exposures to biomechanical risk factors and neurological and musculoskeletal disorders

Since the beginning of my research activity I have developed a specific interest on the etiology of work related musculoskeletal disorders, mainly of the upper limb. I collaborated to the design and the development of epidemiological investigations in several occupational fields (health care and other services, meat industry, assembling, retail sector). I collaborated to a large longitudinal study of work related carpal tunnel syndrome lasted for 10 years in which more than 4500 workers entered the cohort. In 2015 I have started collaboration with companies from different sectors (meat processing, textile, automotive) in order to set up a surveillance system for the monitoring of musculoskeletal disorders intended to involve all employees.

  1. Bonfiglioli R, Mattioli S, Spagnolo MR, Violante FS. Course of symptoms and median nerve conduction values in workers performing repetitive jobs at risk for carpal tunnel syndrome. Occup Med (Lond). 2006 Mar;56(2):115-21
  2. Bonfiglioli R, Mattioli S, Fiorentini C, Graziosi F, Curti S, Violante FS. Relationship between repetitive work and the prevalence of carpal tunnel syndrome in part-time and full-time female supermarket cashiers: a quasi-experimental study. Int Arch Occup Environ Health. 2007 Jan;80(3):248-253
  3. Bonfiglioli R, Mattioli S, Armstrong TJ, Graziosi F, Marinelli F, Farioli A, Violante FS. Validation of the ACGIH TLV for hand activity level in the OCTOPUS cohort: a two-year longitudinal study of carpal tunnel syndrome. Scand J Work Environ Health. 2013 Mar 1;39(2):155-63
  4. Violante FS, Farioli A, Graziosi F, Marinelli F, Curti S, Armstrong TJ, Mattioli S, Bonfiglioli R. Carpal tunnel syndrome and manual work: the OCTOPUS cohort, results of a ten-year longitudinal study. Scand J Work Environ Health. 2016 Jul 1;42(4):280-90
  5. Farioli A, Curti S, Bonfiglioli R, Baldasseroni A, Spatari G, Mattioli S, Violante FS.Observed Differences between Males and Females in Surgically Treated Carpal Tunnel Syndrome Among Non-manual Workers: A Sensitivity Analysis of Findings from a Large Population Study, «ANNALS OF WORK EXPOSURES AND HEALTH», 2018, 62, pp. 505 - 5152

2-Diagnosis of neurological and musculoskeletal disorders using traditional diagnostic techniques (ultrasound, EMG) and experimental ones (surface EMG)

Work-related musculoskeletal disorders and peripheral nerve entrapments of the upper limb are characterized by a multifactorial etiology. Musculoskeletal symptoms reporting are extremely common among manual workers as well as in the general population. In order to improve the case definition I have dedicated my research interests towards the application of non-invasive diagnostic procedures not only in the clinical setting but also in epidemiological studies. These studies gave me the possibility to examine some specific issues, as for example the definition of normative values in manual workers, and to discuss the role of different parameters in the early identification of tendons or nerve impairment. In collaboration with LISiN (Laboratorio di Ingegneria del Sistema Neuromuscolare e della Riabilitazione Motoria, Politecnico di Torino) I have contributed to the application of surface EMG in the study of occupational diseases, in particular of work-related carpal tunnel syndrome.

  1. Violante FS, Bonfiglioli R, Isolani L, Raffi GB. Levels of agreement of nerve conduction studies and symptoms in workers at risk of carpal tunnel syndrome. Int Arch Occup Environ Health, 2004 Nov;77(8):552-8
  2. Violante FS, Bonfiglioli R, Graziosi F, Caso A, Isolani L, Fiorentini C, Mattioli S. Potential of ultrasonography for epidemiological study of work-related wrist tenosynovitis. Occup Environ Med. 2007 Feb;64(2):82-6
  3. Bonfiglioli R, Botter A, Calabrese M, Mussoni P, Violante FS, Merletti R. Surface electromyography features in manual workers affected by carpal tunnel syndrome. Muscle Nerve. 2012 Jun;45(6):873-82
  4. Bonfiglioli R, Mussoni P, Graziosi F, Calabrese M, Farioli A, Marinelli F, Violante FS. Effects of 90min of manual repetitive work on skin temperature and median and ulnar nerve conduction parameters: A pilot study in normal subjects. J Electromyogr Kinesiol. 2013 Feb;23(1):252-9

3- Criteria for the case definition musculoskeletal diseases in the occupational setting

Reliable classification of musculoskeletal disorders is necessary both at clinical and research level. Generally agreed criteria are needed to compare the results of a wide range of epidemiological studies, to estimate the burden and the natural history of diseases and to understand the role of causal factors; in occupational settings the case-definition adopted is also a crucial point to comprehend the dose-response relationship. For clinical purposes different case-definitions may be necessary in order to assess prognosis and treatment of these disorders. In the last 10 years I have actively promoted the debate on the lack of consensus in the classification and management both for upper limb musculoskeletal disorders and back diseases. I was involved as an organizer and a speaker in the ICOH 2006 – Pre-Congress event “Criteria for the case definition of upper limb musculoskeletal diseases in the occupational setting” yield in Bologna. I participated at the organization of round-table discussions during the following ICOH and PREMUS Conferences, which led to the formulation of the statements of the Scientific Committee on Musculoskeletal Disorders of the International Commission on Occupational Health published in 2012 (Hagbert et al., 2012).

  1. Isolani L, Bonfiglioli R, Raffi GB. Violante FS: Different case definitions to describe the prevalence of occupational carpal tunnel syndrome in meat industry workers. Int Arch Occup Environ Health, 2002, 75(4):229-234
  2. Bonfiglioli R, Mattioli S, Violante FS. Relationship between symptoms and instrumental findings in the diagnosis of upper limb work-related musculoskeletal disorders. Med Lav. 2007 Mar-Apr;98(2):118-26
  3. Violante FS, Bonfiglioli R. Criteria for the case definition of upper limb musculoskeletal diseases in the occupational setting. Editorial. Med Lav. 2007 Mar-Apr;98(2):87-8
  4. Hagberg M, Violante FS, Bonfiglioli R, Descatha A, Gold J, Evanoff B, Sluiter JK. Prevention of musculoskeletal disorders in workers: classification and health surveillance - statements of the Scientific Committee on Musculoskeletal Disorders of the International Commission on Occupational Health. BMC Musculoskeletal Disorders. 2012 Jun 21;13:109.

4- Occupational risk factors in health care setting and preventive strategies

In the healthcare setting, where I practice since 1998, I have had the opportunity to study topics related to patient care (exposure to antineoplastic drugs, patient handling, prevention of infectious diseases).

Significant was the experience as a Scientific Responsible of a Research Unit as part of a national multicenter project “Evaluation of occupational mutagenic/carcinogenic hazards in subjects exposed to antiblastic drugs” funded by the Ministry of Health (PRIN) in 2006-2007.

  1. Violante FS, Fiori M, Fiorentini C, Risi A, Garagnani G, Bonfiglioli R, Mattioli S. Associations of psychosocial and individual factors with three different categories of back disorders among nursing staff. J Occup Health, 2004, 46(2):100-108
  2. Bonfiglioli R, Vignoli M, Guglielmi D, Depolo M, Violante FS. Getting vaccinated or not getting vaccinated? Different reasons for getting vaccinated against seasonal or pandemic influenza. BMC Public Health. 2013 Dec 21;13:1221.
  3. Buschini A, Villarini M, Feretti D, Mussi F, Dominici L, Zerbini I, Moretti M, Ceretti E, Bonfiglioli R, Carrieri M, Gelatti U, Rossi C, Monarca S, Poli P. Multicentre study for the evaluation of mutagenic/carcinogenic risk in nurses exposed to antineoplastic drugs: assessment of DNA damage. Occup Environ Med. 2013 Nov;70(11):789-94
  4. Moretti M, Grollino MG, Pavanello S, Bonfiglioli R, Villarini M, Appolloni M, Carrieri M, Sabatini L, Dominici L, Stronati L, Mastrangelo G, Barbieri A, Fatigoni C, Bartolucci GB, Ceretti E, Mussi F, Monarca S. Micronuclei and chromosome aberrations in subjects occupationally exposed to antineoplastic drugs: a multicentric approach. Int Arch Occup Environ Health. 2015 Aug;88(6):683-95
  5. Musti, Muriel Assunta; Collina, Natalina; Stivanello, Elisa; Bonfiglioli, Roberta*; Giordani, Stefano; Morelli, Carla; Pandolfi, Paolo, Perceived work ability at return to work in women treated for breast cancer: A questionnaire-based study, «MEDICINA DEL LAVORO», 2018, 109, pp. 407 - 419

5- Patents

- Co-inventor (16%), Ergonomic handle for hand-held tools.  Complete filing date 3.11.2016; number 102016000110570. Acceptance date 18.3.2019. Grant number 102016000110570 Country Italy.

- Co-inventor (20%), Sensorized glove for monitoring hand force during manual work. Complete filing date 21.6.2017 number 102017000069353, Country Italy. Patent pending.

 

Research Support

Ongoing research projects

Monitoring of musculoskeletal disorders in workers employed in manual work. Role: PI

Musculoskeletal disorders are among the main health problems in manual workers involved in the handling and transport of loads. The main aim of the project is to identify higher risk tasks and personal factors that may modify the effect of exposure. The whole working population of each company will be invited to participate in order to record and monitor musculoskeletal disorders over time in exposed and non exposed workers. The project will take advantage from the collaboration and funding of companies from high-risk sectors as meat processing industry, retail sector, automotive, textile industry.

 

Completed research projects

2015- March 2017 Development of a non-invasive and easy to use model for reproducible measurement of biomechanical parameters in manual jobs characterized by handling loads tasks. In order to set up threshold limit values and to define acceptable demands for continuous or occasional exposure to biomechanical risk factors we need reliable and valid methods for risk assessment. Most of the methods commonly used are observational. Observational results have in general agreed moderately with detailed information collected from video recordings, while correspondence with technical measurements has generally been lower. The aim of the project was the development and the application in the field of non-invasive and easy to use devices for reproducible measurement of biomechanical parameters in manual jobs characterized by handling loads tasks. The multicenter study has been supported by funds from the National Institute for Insurance against Accidents at Work (INAIL) and is carried out with the collaboration of University of Milan (Prof. C. Colosio), University of Bari (Prof. L. Soleo), University of Messina (Prof G. Spatari) and University of Chieti (Prof F. Caciagli). Role: PI and National Coordinator

2000-2011 Longitudinal study of work related carpal tunnel syndrome.
Completed project, the goal was to investigate the dose-response relationship of forceful and fast manual work and the occurrence of carpal tunnel syndrome in a cohort of approximately 4,500 workers with a follow-up of 10 years. I collaborated with the Principal Investigator; my role was mainly related to the definition of criteria and recording of nerve conduction parameters.

2008 Participation as a national expert (Italy) to the study on the socio-economic impact of possible Community initiatives in the area of prevention of musculoskeletal disorders in the European Union (EU project managed by TNO Quality of Life, Amsterdam).

2006-2007 Responsible for the Local Research Unit of the national multicenter study (Prin 2005, Prot. n.2005062547) "Biological monitoring using markers of the internal dose and effect in workers exposed to antineoplastic drugs" (46.857 Euro)

2006-2007 Participation as Coordinator Researcher to the Project "Usefulness of surface electromyography in the diagnosis of Carpal tunnel syndrome and in the assessment of myoelectric parameters changes due to repetitive manual tasks", funded by ISPESL (Istituto Superiore per la Prevenzione e la Sicurezza del Lavoro) – n. B1-9/DML/04

2004-2005 Participation as Coordinator Researcher to the Project "Reference electrodiagnostic and ultrasound parameters for the diagnosis of upper limb entrapment disorders due to repetitive manual jobs funded by ISPESL (Istituto Superiore per la Prevenzione e la Sicurezza del Lavoro) – n. B92/MDL/03

2002-2003 participation to the European Project NEW: Neuromuscular assessment in the Elderly Worker

1994: Contract 94-3030-15, participation to the project The European Health and Safety Database (HASTE): extension, demonstration and dissemination, European Foundation for the Improvement of Living and Working Conditions, Dublin

1992: Contract 92-4030-25, participation to the project Systems for monitoring working conditions related to health and safety, European Foundation for the Improvement of Living and Working Conditions, Dublin