Work-related musculoskeletal disorders in physical therapists: a prospective cohort study with 1-year follow-up

Treatment of a patient with post-natal chronic calf pain utilizing instrument-assisted soft tissue mobilization: a case study

Musculoskeletal pain is commonly reported by pre- and postnatal women, with the most common complaint being low back pain. However, lower leg pain is also frequently reported by women particularly in the third trimester. The purpose of the case study is to illustrate how instrument-assisted soft tissue mobilization (ISTM) can be used to treat a patient with a 2-year history of chronic calf pain. The subject was a 35-year-old female who developed calf pain during the last trimester of her pregnancy following severe lower leg edema. The calf pain was present for the 2 years following delivery and was described as a dull ache, typically aggravated by direct pressure on the calf, prolonged standing, and stairs. An X-ray, magnetic resonance imaging (MRI) with contrast, and ultrasound Doppler study prior to referral ruled out tumors, vascular, lymphatic, or skeletal bone abnormalities. However, her MRI did show a dense superficial venous tissue asymmetry in the same location of her symptoms. Impairments were minimal; the only asymmetrical objective findings were calf length, strength, and soft tissue restrictions detected on palpation. After nine treatments incorporating an ISTM approach, soft tissue mobility, pain, calf strength, and lower extremity functional scale score all improved and her symptoms were abolished.

Work-Related Injuries in Canadian Occupational Therapy Practice

Background. No studies investigate work-related injuries experienced by Canadian occupational therapists.Purpose. To identify the nature and prevalence of work-related injuries, impact of practice context, cultural and structural factors that influence response to these injuries, and strategies used to manage return-to-work after injury.Methods. Members of the Canadian Association of Occupational Therapists were sent an electronic survey in June 2009.Findings. Over half of the 600 respondents reported at least one injury episode. Patient-handling and equipment-related incidents accounted for the largest proportion of injuries. Almost one-third of respondents reported being threatened at work or experiencing workplace violence.Implications. Injured occupational therapists tended to minimize the extent and impact of their injuries by underreporting incidents and continuing to work after injury. These behaviours may contribute to a failure to recognize the reality of work-related injuries in occupational therapy practice and thereby limit the development of profession-specific, risk-minimization strategies.

Work-related activities associated with injury in occupational and physical therapists

OBJECTIVE

The purpose of this study was to examine work activities associated with work-related injury (WRI) in occupational and physical therapy.

PARTICIPANTS

1,158 occupational and physical therapists in Wisconsin responded to a mailed survey, from a total of 3,297 OTs and PTs randomly selected from the State licensure list.

METHODS

The study used a cross-sectional, survey design. Participants reported information about WRI they sustained between 2004 and 2006, including the activities they were performing when injured. Investigators analyzed 248 injury incidents using qualitative and quantitative analysis.

RESULTS

Data were examined across OT and PT practice in general, and also by practice area. Manual therapy and transfers/lifts were associated with 54% of all injuries. Other activities associated with injury were distinct to practice area, for example: floor work in pediatrics; functional activities in acute care; patient falls in skilled nursing facilities; and motor vehicle activities in home care.

CONCLUSIONS

Injury prevention activities must address transfers and manual therapy, but also must examine setting-specific activities influenced by environment and patient population.

Patient Handling Methods Taught in Occupational Therapy Curricula

Sixteen of 100 full-time occupational therapists are injured while performing manual patient handling techniques. We developed a Theory of Planned Behavior self-report questionnaire to determine what educators teach and the behavioral constructs that best predict intention to change curriculum content. Traditional manual patient handling and safe patient handling methods were investigated. The results showed that both methods are taught in most programs; however, only 22% stated that they teach safe patient handling as the standard of practice. Stepwise regression analysis demonstrated that attitude and perceived behavioral control are the best predictors of intention to continue teaching manual transfers as the standard; however, normative belief and attitude best predict intention to teach safe patient handling as the standard. Knowing these predictors will assist in developing strategies to promote a paradigm shift in the way patient transfers are taught.

Kinematic and electromyographic analyses of normal and device-assisted sit-to-stand transfers

Mechanical sit-to-stand devices assist patient transfers and help protect against work-related injuries in rehabilitation environments. However, observational differences between patient's movements within devices compared to normal sit-to-stand transfers deter clinician use. This study compared kinematics and muscle demands during sit-to-stand transfers with no device (ND), and device-assisted during which participants exerted no effort (DA-NE) and best effort (DA-BE). Coefficient of multiple correlations (CMCs) compared kinematic profiles during each device-assisted condition to ND. Compared to DA-NE, CMCs were higher during DA-BE at the hip, knee, and ankle. However, DA-BE values were lower than DA-NE at the trunk and pelvis due to the device's mechanical constraints. In general, all joints' final DA-NE postures were more flexed than other conditions. Electromyographic was significantly lower during DA-NE compared to ND for all muscles except lateral hamstring, and during DA-BE compared to ND for gluteus maximus, gastrocnemius, and soleus. Verbal encouragement (DA-BE) significantly increased medial hamstring, vastus lateralis, gastrocnemius, soleus and tibialis anterior activation compared to DA-NE. In conclusion, device-assisted sit-to-stand movements differed from normal sit-to-stand patterns. Verbally encouraging best effort during device-assisted transfers elevated select lower extremity muscle activation and led to greater similarity in hip, knee and ankle movement profiles. However, trunk and pelvis profiles declined.

Psychosocial work stressors as antecedents of musculoskeletal problems: a systematic review and meta-analysis of stability-adjusted longitudinal studies

Although the relationship between psychosocial workplace conditions and musculoskeletal problems has been extensively studied, the causal impact of psychosocial workplace factors in the development of musculoskeletal problems remains unclear. The purpose of the present study was to conduct a systematic review of baseline-adjusted prospective longitudinal studies estimating the lagged effect of psychosocial risk factors on musculoskeletal problems in industrialized work settings. A literature review was conducted by searching the MEDLINE, EMBASE, and PsychINFO databases dated until August 2009. The authors classified studies into categories of psychological work stressors and musculoskeletal problems. Available effect sizes were converted to odds ratios (OR). ORs were then pooled for each stressor-problem relationship using a random-effects model. Additionally, the possibility of publication bias was assessed with the Duval and Tweedie nonparametric "trim and fill" procedure. In total, 50 primary studies fulfilled inclusion criteria. Within these studies at least five effect sizes were available for 23 of the 45 possible psychosocial work stress-musculoskeletal problems relationships, leaving 9 psychosocial variables and four musculoskeletal problem areas for analyses. Of these 23 relationships, pooled OR estimates were positive and significant ranging from 1.15 to 1.66 with the largest pooled OR estimating the relationship between highly monotonous work and lower back pain. The lagged effect of low social support on lower limb problems was the only effect size for which the statistical test for bias was significant. Most psychosocial stressors had small but significant lagged effects on the development of musculoskeletal problems. Thus, organizational interventions to minimize these stressors may be promising in reducing one risk factor for the development of employee musculoskeletal problems.

A questionnaire of musculoskeletal injuries associated with manual patient lifting in occupational therapy practitioners in the state of ohio

ABSTRACT The purpose of this study is to investigate the prevalence and type of musculoskeletal injury due to patient handling as well as to ascertain current safe patient handling practices in occupational therapy within the state of Ohio. A questionnaire focusing on safe patient handling issues was e-mailed to 1,113 occupational therapy practitioners in the state of Ohio, with an overall response rate of 26%. Sixty-four percent indicated they were required to transfer patients manually. Of these respondents, 8% indicated receiving an injury, 11% missed days away from work in connection with sustaining an injury, and 12% considered leaving the profession early due to patient handling concerns. The study demonstrated that this sample of occupational therapy practitioners was exposed to occupationally based high-risk situations regarding patient handling with moderate to high incidence rates for musculoskeletal injuries. Additional research is needed to ascertain the status of safe patient handling among occupational therapy practitioners nationwide.

Work related musculoskeletal disorders amongst therapists in physically demanding roles: qualitative analysis of risk factors and strategies for prevention

Background

Physiotherapy and occupational therapy are two professions at high risk of work related musculoskeletal disorders (WRMD). This investigation aimed to identify risk factors for WRMD as perceived by the health professionals working in these roles (Aim 1), as well as current and future strategies they perceive will allow them to continue to work in physically demanding clinical roles (Aim 2).

Methods

A two phase exploratory investigation was undertaken. The first phase included a survey administered via a web based platform with qualitative open response items. The second phase involved four focus group sessions which explored topics obtained from the survey. Thematic analysis of qualitative data from the survey and focus groups was undertaken.

Results

Overall 112 (34.3%) of invited health professionals completed the survey; 66 (58.9%) were physiotherapists and 46 (41.1%) were occupational therapists. Twenty-four health professionals participated in one of four focus groups. The risk factors most frequently perceived by health professionals included: work postures and movements, lifting or carrying, patient related factors and repetitive tasks. The six primary themes for strategies to allow therapists to continue to work in physically demanding clinical roles included: organisational strategies, workload or work allocation, work practices, work environment and equipment, physical condition and capacity, and education and training.

Conclusions

Risk factors as well as current and potential strategies for reducing WRMD amongst these health professionals working in clinically demanding roles have been identified and discussed. Further investigation regarding the relative effectiveness of these strategies is warranted.

Increased prevalence of low back pain among physiotherapy students compared to medical students

Some studies have demonstrated that physiotherapists have a high prevalence of low back pain (LBP). The association between physiotherapy students, who are potentially exposed to the same LBP occupational risks as graduates, and LBP has never been demonstrated. The objective of the study is to evaluate the association between undergraduate physiotherapy study and LBP. The study design includes a cross-sectional study. A questionnaire-based study was carried out with physiotherapy and medical students. LBP was measured as lifetime, 1-year and point prevalence. Bivariate and multivariate analyses were performed to find the factors associated with LBP. Bivariate analyses were also performed to assess differences between LBP characteristics in the two courses. 77.9% of the students had LBP at some point in their lives, 66.8% in the last year and 14.4% of them reported they were suffering from LBP at the moment of answering the questionnaire. Physiotherapy students reported a higher prevalence of LBP when compared with the medical students in all measures. In the logistic regression model, physiotherapy students (A-OR 2.51; 95% CI 1.35-4.67; p = 0.003), and being exposed to the undergraduate study for more than four semesters (A-OR 2.55; 95% CI 1.43-4.55; p = 0.001) were independently associated with LBP. There were no differences between the courses concerning pain intensity and disability. As it was a cross-sectional study, we were not able to observe accurately if there is an increasing incidence of LBP during the course. Also, we did not intend to identify which activities in the course were associated with the development of LBP. This study clearly demonstrated an association between undergraduate physiotherapy study and LBP. The length of course exposure is also associated with LBP.

Prevalence, characteristics, and impacts of work-related musculoskeletal disorders: a survey among physical therapists in the State of Kuwait

Background

Physical therapists working in the State of Kuwait are at risk of work-related musculoskeletal disorders (WMSDs). However, prevalence rates and risk factors are not well documented. The objective of this study was to determine the prevalence, characteristics, and impacts of WMSDs among physical therapists in the State of Kuwait.

Methods

A self-administered questionnaire was distributed to 350 physical therapists. The questionnaire gathered demographic data as well as information on occurrence of musculoskeletal complaints in the previous 12 months. Descriptive statistics, frequency, and Chi-square analyses were used.

Results

The response rate to the questionnaire was 63% (222/350). Of the 212 responders included in the study, the one-year prevalence of WMSDs was 47.6%, with lower back complaints as the most common (32%). This was followed by neck (21%), upper back (19%), shoulder (13%), hand/wrist (11%), knee (11%), ankle/foot (6%), elbow (4%), and hip/thigh (3%) complaints. The frequency of WMSDs was not gender related (except lower back, neck, and shoulder complaints) nor was it related to age (except lower back complaints), working venues (except hand/wrist), working hours, area of specialty, or exercise. WMSDs' impact on work was minor.

Conclusions

WMSDs among physical therapists in Kuwait were common, with lower back and neck affected most. Lower back and neck WMSDs were related to the participant's demographics. Hand/wrist WMSDs were related to work settings. Further research is needed to investigate the effect of risk factors as physical load, psychosocial load, and general health status on prevalence musculoskeletal disorders.

Impact of work-related pain on physical therapists and occupational therapists

BACKGROUND

Physical therapists and occupational therapists experience high rates of work-related pain. Although most therapists continue to work through this pain, it interferes with work and alters therapists' work habits. However, the effects on productivity, quality of patient care, and therapists' quality of life and long-term career plans are unknown.

OBJECTIVES

The purpose of this study was to determine the impact of working with work-related pain on physical therapists and occupational therapists.

DESIGN

Multiple methods were used in this study. It was primarily a phenomenological study.

METHODS

A phenomenological approach was used to explore the meaning of work-related pain in therapists. Focus group interviews were used as the method of data collection. A questionnaire was used to supplement the qualitative analysis.

RESULTS

Nineteen therapists participated in 4 focus groups ranging from 2 to 7 participants each. The participants noted substantial effects of work-related pain at work, at home, and in their career plans. All of the therapists were concerned about their potential clinical longevity. The professional culture complicated these effects by forcing therapists into a professional ideal.

CONCLUSIONS

Work-related pain affects therapists in several personal and professional domains. It also may affect career plans. Strategies to reduce the risk of injury and physical loading of jobs are needed.

Work-related musculoskeletal disorders and injuries: differences among older and younger occupational and physical therapists

INTRODUCTION

Occupational and physical therapists are at significant risk of work-related musculoskeletal disorders and injuries. As the therapy workforce ages, and shortages of therapists are predicted, it is important to evaluate differences in injuries and injury behaviors between older and younger therapists.

METHODS

Half of all occupational and physical therapists practicing in Wisconsin were randomly selected for a cross sectional study examining the relationship between aging and characteristics of self-reported work injuries and musculoskeletal symptoms.

RESULTS

Data from a sample of 1,158 therapists revealed older workers to have similar injury incidence rates, however, days away from work due to injury were higher among older workers. Overall, older and younger therapists were more similar than different, especially in regards to work behaviors. Older therapists tended to report more severe pain symptoms than younger therapists and were two and a half times more likely to report that they changed jobs due to their pain symptoms.

CONCLUSIONS

Older and younger therapists have similar work-related injury experiences. Older workers may be more vulnerable to lost work time and may experience more severe pain symptoms. Many interventions exist to prevent work-related injuries to therapists and more guidance in the best way to integrate these interventions (e.g., mechanical lift devices) into therapy practice is needed.

Job strain in physical therapists

BACKGROUND

Job stress has been associated with poor outcomes. In focus groups and small-sample surveys, physical therapists have reported high levels of job stress. Studies of job stress in physical therapy with larger samples are needed.

OBJECTIVE

The purposes of this study were: (1) to determine the levels of psychological job demands and job control reported by physical therapists in a national sample, (2) to compare those levels with national norms, and (3) to determine whether high demands, low control, or a combination of both (job strain) increases the risk for turnover or work-related pain.

DESIGN

This was a prospective cohort study with a 1-year follow-up period.

METHODS

Participants were randomly selected members of the American Physical Therapy Association (n=882). Exposure assessments included the Job Content Questionnaire (JCQ), a commonly used instrument for evaluation of the psychosocial work environment. Outcomes included job turnover and work-related musculoskeletal disorders.

RESULTS

Compared with national averages, the physical therapists reported moderate job demands and high levels of job control. About 16% of the therapists reported changing jobs during follow-up. Risk factors for turnover included high job demands, low job control, job strain, female sex, and younger age. More than one half of the therapists reported work-related pain. Risk factors for work-related pain included low job control and job strain.

LIMITATIONS

The JCQ measures only limited dimensions of the psychosocial work environment. All data were self-reported and subject to associated bias.

CONCLUSIONS

Physical therapists' views of their work environments were positive, including moderate levels of demands and high levels of control. Those therapists with high levels of demands and low levels of control, however, were at increased risk for both turnover and work-related pain. Physical therapists should consider the psychosocial work environment, along with other factors, when choosing a job.