Evaluation of the preventive tool G 46 of the German Social Accident Insurance with regard to effectivity and practicability – first step: cross-sectional analysis

Project No. FF-FP 0293


completed 07/2012


Back pain is a major health concern and economic problem. With the DGUV 46 tool for Occupational Medical Examinations regarding strain on the musculoskeletal system, there is an instrument designed for secondary prevention of back pain. The present study investigated the effectiveness and practicability of the G 46 – as a tool which has been developed by experts – according to the criteria of evidence‐based medicine and wanted to identify potential improvement opportunities and implications for strengthening the method in the practical implementation.


The G 46 was carried out comprehensively comprising a study sample of 410 industrial mechanists from a total of eleven metal working companies. In addition to the classic G 46 anamnesis, a complete clinical examination of all study participants according to the Focus method® was performed by trained occupational physicians. Furthermore, a differentiated risk assessment was carried out for categorized work activities by measuring physical and psychosocial exposure factors at work. The physical risk assessment was based on the ambulatory measurement system CUELA, the psychosocial risk assessment on the Instrument for Stress‐Oriented Task Analysis (ISTA). Moreover, both physicians and employees were surveyed about their experience with the practical implementation of the G 46.


Overall, the analysis of the physical exposure factors shows that on average the industrial mechanics in the present sample are exposed to relatively low musculoskeletal stress (exception: trunk inclination). However, regardless of their causation – the high prevalence of back pain symptoms and functional abnormalities underline the need for appropriate prevention tools. The study provided a supplement for the detection of relevant psychosocial risk factors at work. Moreover, a clarification of the selection criteria for cumulative trunk flexed postures could be developed. Evidence of U‐shaped dose‐effect relationships for different loads provided evidence for individual counseling in the context of occupational health prevention. Overall, the results of the present study indicate that in practice the content of the examination as well as the stepwise approach of the G 46 are useful and applicable.

Last Update:

17 Sep 2015


Financed by:
  • Deutsche Gesetzliche Unfallversicherung e.V. (DGUV)
Research institution(s):
  • Institut für Arbeitsschutz der Deutschen Gesetzlichen Unfallversicherung (IFA)
  • Berufsgenossenschaft Metall Nord Süd
  • BAD GmbH

metal working

Type of hazard:



ergonomics, musculoskeletal disorders (except cancer), occupational medical prevention

Description, key words:

G 46 occupational medical prophylaxis, risk assessment of physical and mental stresses, musculoskeletal system, milling machine operator, metalworking industry, G 46

Further information

  • see also: Project IFA4196
  • Final report: IFA Report 3/2015 (in German, summary in English)
  • Handlungsanleitung für die arbeitsmedizinische Vorsorge nach dem Berufsgenossenschaftlichen Grundsatz G 46
    (DGUV Information 240-460, so far: BGI/GUV-I 504-46 ) (in German)