Fisioterapia na avaliação e prevenção de riscos ergonômicos em trabalhadores de um setor financeiro

É freqüente a sobrecarga musculoesquelética em trabalhadores, resultando no aumento da prevalência de distúrbios osteomusculares relacionados ao trabalho (DORT). Visando a saúde do trabalhador, e para reduzir o índice de afastamento, deve-se enfatizar a prevenção desses distúrbios. Os objetivos deste estudo foram analisar a ergonomia de um setor financeiro e as posturas dos funcionários durante as tarefas e propor soluções para minimizar os riscos ergonômicos. A análise foi feita mediante três instrumentos de observação simples - avaliação rápida de membros superiores RULA (sigla em inglês de rapid upper limb assessment), checklist de Couto e análise ergonômica focada na atividade - e aplicação do questionário SF-36 aos funcionários. Verificou-se a presença de fator biomecânico de moderada importância, com risco de DORT improvável, porém possível; em outro instrumento, os resultados indicam que o ambiente de trabalho está próximo do ideal. Em análise mais detalhada, as posturas de trabalho foram classificadas como as piores possíveis, requerendo mudanças imediatas. No SF-36 os escores foram elevados, sugerindo qualidade de vida adequada. Assim, embora o ambiente de trabalho se apresente adequado, o uso incorreto dos equipamentos, a má distribuição e forma incorreta de realização das tarefas ocasiona riscos ergonômicos. Visando minimizar estes, são propostas estratégias de intervenção preventiva, sugerindo-se ações específicas nos domínios que apontaram maiores riscos ergonômicos.

Virtual reality in paediatric rehabilitation: a review

OBJECTIVE

To provide a narrative review of studies regarding the outcomes of Virtual Reality (VR)-based treatment and rehabilitation programmes within the paediatric population.

METHODS

Studies related to the use of VR across a number of paediatric areas (e.g. cerebral palsy, autism, foetal alcohol syndrome and attention deficits) were identified and summarized.

RESULTS

Outcomes from the studies reviewed provide preliminary support for the use of VR.

CONCLUSION

VR may be an effective treatment method for specific disorders, although the generalizability of this literature is hindered by several methodological limitations, such as small samples and the absence of appropriate control participants.

Approaches to vocational rehabilitation after traumatic brain injury: a review of the evidence

BACKGROUND

Return to work after traumatic brain injury (TBI) is an important outcome but frequently problematic to achieve. Vocational rehabilitation is commonly recommended as a means of facilitating return to work after TBI. However, there are several different approaches to vocational rehabilitation after TBI and little guidance regarding how to identify the best option for a particular context.

OBJECTIVES

To (1) identify approaches most commonly underpinning vocational interventions in TBI and (2) evaluate the evidence for effectiveness, strengths and weaknesses, and application of each approach for the TBI population.

METHODS

Principles of systematic review were used for searching and critiquing articles. Findings are expressed as descriptive synthesis owing to heterogeneity of designs and outcome measures.

RESULTS

Three broad categories of vocational rehabilitation for people with TBI were identified on the basis of models that underpin them-program-based vocational rehabilitation, supported employment, and case coordinated. The characteristics, similarities, differences, and applications of each approach are described, as are their strengths and limitations.

CONCLUSIONS

There is little clear evidence to suggest what should be considered the "best practice" approach to vocational rehabilitation.

Disability prevention and communication among workers, physicians, employers, and insurers—current models and opportunities for improvement

PURPOSE

To review prevailing models of disability management and prevention with respect to communication, and to suggest alternative approaches.

METHOD

Review of selected articles.

RESULTS

Effective disability management and return to work strategies have been the focus of an increasing number of intervention programmes and associated research studies, spanning a variety of worker populations and provider and business perspectives. Although primary and secondary disability prevention approaches have addressed theoretical basis, methods and costs, few identify communication as a key factor influencing disability outcomes. Four prevailing models of disability management and prevention (medical model, physical rehabilitation model, job-match model, and managed care model) are identified. The medical model emphasizes the physician's role to define functional limitations and job restrictions. In the physical rehabilitation model, rehabilitation professionals communicate the importance of exercise and muscle reconditioning for resuming normal work activities. The job-match model relies on the ability of employers to accurately communicate physical job requirements. The managed care model focuses on dissemination of acceptable standards for medical treatment and duration of work absence, and interventions by case managers when these standards are exceeded. Despite contrary evidence for many health impairments, these models share a common assumption that medical disability outcomes are highly predictable and unaffected by either individual or contextual factors. As a result, communication is often authoritative and unidirectional, with workers and employers in a passive role.

CONCLUSION

Improvements in communication may be responsible for successes across a variety of new interventions. Communication-based interventions may further improve disability outcomes, reduce adversarial relationships, and prove cost-effective; however, controlled trials are needed.

Is there a relationship between light touch-pressure sensation and functional hand ability?

PURPOSE

To investigate and compare the level of light touch-pressure sensation as tested via the Semmes Weinstein monofilament (SWM) test with the level of functional hand ability.

METHODS

Twenty-seven persons with isolated sensory deficit due to leprosy and 31 healthy controls were tested in the Occupational Therapy department of a hospital for patients with Hansen's disease. Palmar light touch thresholds were determined by SMW testing. Functional hand ability was tested via the Jebsen-Taylor Hand Function Test (JTHFT) and the Functional Dexterity Test (FDT). All participants were measured by manual muscle testing (MMT) to exclude any motor impairment. Data analysis compared sensory thresholds and level of functional hand ability between the two groups and examined the relationship between the variables.

RESULTS

In the group with sensory deficit, the sensory thresholds were significantly higher than in the control group. Significant correlations were found between the sensory thresholds measured by the SWM test and the FDT and JTHFT scores, with higher correlations found for tasks entailing manipulation of small objects.

CONCLUSIONS

The findings support the existence of a relationship between sensory light touch thresholds tested by the Semmes Weinstein monofilaments (SWMs) and hand function. However, the SWM test alone is not sufficient as an indicator of hand function and must therefore be supplemented with other hand function tests.

Interactive virtual environment training for safe street crossing of right hemisphere stroke patients with Unilateral Spatial Neglect

PURPOSE

The goal of this study was to determine whether non immersive interactive virtual environments are an effective medium for training individuals who suffer from Unilateral Spatial Neglect (USN) as a result of a right hemisphere stroke, and to compare it to a standard computer visual scanning training.

METHOD

Participants included 19 patients with right hemisphere stroke in two groups, 11 in an experimental group were given computer desktop-based Virtual Reality (VR) street crossing training and 8 in a control group who were given computer based visual scanning tasks, both for a total of twelve sessions, 9 hours total, over four weeks. Measures included: 1. Standard USN assessments, paper and pencil and ADL checklist; 2. Test on the VR street program; and 3. Actual street crossing videotaped. Testing was performed pre and post intervention.

RESULTS

The VR group achieved on the USN measures results that equaled those achieved by the control group treated with conventional visual scanning tasks. They improved more on the VR test and they did better on some measures of the real street crossing.

CONCLUSIONS

Despite several limitations in this study the present results support the effectiveness of the VR street program in the treatment of participants with USN, and further development of the program.

Fall hazard control observed on residential construction sites

BACKGROUND

Falls are a leading cause of mortality and morbidity in the construction industry. This study measured fall hazards at residential construction sites.

METHODS

Trained carpenters administered the St. Louis Audit of Fall Risks and interviewed carpenters. The prevalence of fall prevention practices meeting safety criteria was counted and correlations explored.

RESULTS

We identified a high prevalence of fall hazards at the 197 residential sites audited. Roof sheathing met safety criteria most consistently (81%) and truss setting least consistently (28%). Use of personal fall arrest and monitoring of unguarded floor openings were rare. Safer performance on several scales was correlated. Construction sites of large-sized contractors were generally safer than smaller contractors. Apprentice carpenters were less familiar with their employers' fall prevention plan than experienced workers.

CONCLUSIONS

Safety could be improved with consistent use of recognized fall prevention practices at residential construction sites.

Weaving Color Lines: Race, Ethnicity, and the Work of Leadership in Social Change Organizations

For social change organizations working to address intractable social problems throughou the US tackling race may not only be unavoidable, it may also represent away to fully engage stakeholders in social change work. We argue that illuminating the relationship between race and leaders hip can advance our understanding of how social change leadership happens in practice. We build upon scholarship that emphasizes the ways in which seemingly essentialist, intractable racial categories are actually mutable, and the simultaneous emergence of academic research calling attention to the constructed and collective dimensions of leadership. Using a constructionist lens to analyze narratives from 22 social change organizations and building six of these as in-depth cases, we document three distinct means of understanding race, explore how they help to do the work of leadership, and suggest ways in which they seem to move their work forward.

A brief fatigue inventory of shoulder health developed by quality function deployment technique

BACKGROUND

The purpose of this study was to develop a diagnostic outcome instrument that has high reliability and low cost. The scale, called the Shoulder Fatigue Scale-30 Items (SFS-30) risk assessment, was used to determine the severity of patient neck and shoulder discomfort.

METHODS

The quality function deployment (QFD) technique was used in designing and developing a simple medical diagnostic scale with high degree of accuracy.

RESULTS

Research data can be used to divide the common causes of neck and shoulder discomfort into 6 core categories: occupation, cumulative, psychologic, diseases, diet, and sleep quality. The SFS-30 was validated by using a group of individuals who had been previously diagnosed with different levels of neck and shoulder symptoms. The SFS-30 assessment determined that 78.57% of the participants experienced a neck and shoulder discomfort level above the SFS-30 risk curve and required immediate medical attention.

CONCLUSION

The QFD technique can improve the accuracy and reliability of an assessment outcome instrument. This is mainly because the QFD technique is effective in prioritizing and assigning weight to the items in the scale. This research successfully developed a reliable risk assessment scale to diagnose neck and shoulder symptoms using QFD technique. This scale was proven to have high accuracy and closely represents reality.

Developing biologically-based assessment tools for physical therapy management of neck pain

SYNOPSIS

Neck pain is a common and episodic condition that is treated using a spectrum of interventions known to be moderately effective but is associated with a significant incidence of chronic pain. Recently, there has been increased focus on defining biological aspects of neck pain. Studies have indicated that neurophysiological, biomechanical, and motor control abnormalities are present and may be useful either in prognosis or classification. We review some of these findings in the context of our own work defining biological markers that may form the basis for clinical tests that can be used for prognosis, classification, or outcome evaluation in patients with neck pain. We have identified abnormalities in neurophysiology using quantitative sensory testing (vibration, touch, and current perception) and response to cold provocation that are related to neck disability. We have identified altered muscle biochemistry by measuring circulating muscle proteins in a lumbar surgery model and are now applying those methods to whiplash injury. We have incorporated capnography into treatment to address central physiological changes present in some patients by monitoring and training CO2 levels. We have developed an innovative new test, the Neck Walk Index, that captures abnormal control of head movement during slow gait as a means of differentiating patients with neck pain from either unaffected controls or individuals with other pathologies. We have used time-varying 3-dimensional joint orientation kinematics to assess deficits in motor control during an upper extremity reach task, the results showing that poor coordination and control of the shoulder girdle leads to shoulder guarding and inconsistencies in elbow joint movement. Despite some promising early results, future research is needed to determine how these measures help clinicians to diagnose, evaluate, and forecast future outcome for patients who present with neck pain.

LEVEL OF EVIDENCE

Diagnosis, level 5.

Cervical motion assessment using virtual reality

STUDY DESIGN

Repeated measures of cervical motion in asymptomatic subjects.

OBJECTIVES

To introduce a virtual reality (VR)-based assessment of cervical range of motion (ROM); to establish inter and intratester reliability of the VR-based assessment in comparison with conventional assessment in asymptomatic individuals; and to evaluate the effect of a single VR session on cervical ROM.

SUMMARY OF BACKGROUND DATA

Cervical ROM and clinical issues related to neck pain is frequently studied. A wide variety of methods is available for evaluation of cervical motion. To date, most methods rely on voluntary responses to an assessor's instructions. However, in day-to-day life, head movement is generally an involuntary response to multiple stimuli. Therefore, there is a need for a more functional assessment method, using sensory stimuli to elicit spontaneous neck motion. VR attributes may provide a methodology for achieving this goal.

METHODS

A novel method was developed for cervical motion assessment utilizing an electromagnetic tracking system and a VR game scenario displayed via a head mounted device. Thirty asymptomatic participants were assessed by both conventional and VR-based methods. Inter and intratester repeatability analyses were performed. The effect of a single VR session on ROM was evaluated.

RESULTS

Both assessments showed non-biased results between tests and between testers (P > 0.1). Full-cycle repeatability coefficients ranged between 15.0 degrees and 29.2 degrees with smaller values for rotation and for the VR assessment. A single VR session significantly increased ROM, with largest effect found in the rotation direction.

CONCLUSION

Inter and intratester reliability was supported for both the VR-based and the conventional methods. Results suggest better repeatability for the VR method, with rotation being more precise than flexion/extension. A single VR session was found to be effective in increasing cervical motion, possibly due to its motivating effect.

A systematic review of patient acceptance of consumer health information technology

A systematic literature review was performed to identify variables promoting consumer health information technology (CHIT) acceptance among patients. The electronic bibliographic databases Web of Science, Business Source Elite, CINAHL, Communication and Mass Media Complete, MEDLINE, PsycArticles, and PsycInfo were searched. A cited reference search of articles meeting the inclusion criteria was also conducted to reduce misses. Fifty-two articles met the selection criteria. Among them, 94 different variables were tested for associations with acceptance. Most of those tested (71%) were patient factors, including sociodemographic characteristics, health- and treatment-related variables, and prior experience or exposure to computer/health technology. Only ten variables were related to human-technology interaction; 16 were organizational factors; and one was related to the environment. In total, 62 (66%) were found to predict acceptance in at least one study. Existing literature focused largely on patient-related factors. No studies examined the impact of social and task factors on acceptance, and few tested the effects of organizational or environmental factors on acceptance. Future research guided by technology acceptance theories should fill those gaps to improve our understanding of patient CHIT acceptance, which in turn could lead to better CHIT design and implementation.

Workplace interventions for preventing work disability

BACKGROUND

Work disability has serious consequences for all stakeholders and society. Workplace interventions are considered appropriate to facilitate return to work by reducing barriers to return to work, involving the collaboration of key stakeholders.

OBJECTIVES

To determine the effectiveness of workplace interventions compared to usual care or clinical interventions on work-related outcomes and health outcomes; and to evaluate whether the effects differ when applied to musculoskeletal disorders, mental health problems, or other health conditions.

SEARCH STRATEGY

We searched the Cochrane Occupational Health Field Trials Register, CENTRAL, MEDLINE and EMBASE (EMBASE.com), and PsycINFO databases (to November 2007).

SELECTION CRITERIA

We included randomized controlled trials of workplace interventions aimed at return to work for workers where absence from work because of sickness was reported as a continuous outcome.

DATA COLLECTION AND ANALYSIS

Two authors independently extracted data and assessed risk of bias of the studies. Meta-analysis and qualitative analysis (using GRADE levels of evidence) were performed.

MAIN RESULTS

We included six randomized controlled trials (749 workers): three on low back pain, one on upper-extremity disorders, one on musculoskeletal disorders, and one on adjustment disorders. Five studies were rated as having low risk of bias for the sickness absence outcome. The results of this review show that there is moderate-quality evidence to support the use of workplace interventions to reduce sickness absence among workers with musculoskeletal disorders when compared to usual care. However, workplace interventions were not effective to improve health outcomes among workers with musculoskeletal disorders. The lack of studies made it impossible to investigate the effectiveness of workplace interventions among workers with mental health problems and other health conditions. A comparison of a workplace intervention with a clinical intervention, in one study only, yielded similar results for sickness absence and symptoms for workers with mental health problems.

AUTHORS' CONCLUSIONS

As a result of the few available studies, no convincing conclusions can be formulated about the effectiveness of workplace interventions on work-related outcomes and health outcomes regardless of the type of work disability. The pooled data for the musculoskeletal disorders subgroup indicated that workplace interventions are effective in the reduction of sickness absence, but they are not effective in improving health outcomes. The evidence from the subgroup analysis on musculoskeletal disorders was rated as moderate-quality evidence. Unfortunately, conclusions cannot be drawn on the effectiveness of these interventions for mental health problems and other health conditions due to a lack of studies.

Improving physical fitness of individuals with intellectual and developmental disability through a Virtual Reality Intervention Program

Individuals with intellectual and developmental disabilities (IDD) are in need of effective physical fitness training programs. The aim was to test the effectiveness of a Virtual Reality (VR)-based exercise program in improving the physical fitness of adults with IDD. A research group (N=30; mean age=52.3+/-5.8 years; moderate IDD level) was matched for age, IDD level and functional abilities with a control group (N=30, mean age=54.3+/-5.4 years). A 5-6 week fitness program consisting of two 30 min sessions per week included game-like exercises provided by the Sony PlayStation II EyeToy VR system. Changes in physical fitness were monitored by the Energy Expenditure Index (EEI), the modified 12 min walk/run and the Total Heart Beat Index (THBI). Significant (p<0.05) improvements in physical fitness were demonstrated for the research group in comparison to the control group for the Modified Cooper test and the THBI but not for the EEI test. The EEI, Modified Cooper and THBI tests were found feasible to evaluate physical fitness levels and change of individuals with IDD under clinical conditions. VR technology intervention was suitable for adults with IDD and resulted in significant improvements in the physical fitness levels of the participants.

Priming Media Stereotypes Reduces Support for Social Welfare Policies: The Mediating Role of Empathy

Two experiments involving White participants tested the influence of media-based priming of Black stereotypes on support for government policy that assisted Black versus White persons-in-need. Experiment 1 showed that priming the “Black criminal” stereotype through exposure to photographs of Blacks looting after Hurricane Katrina reduced policy support for Black evacuees-in-need but did not influence support responses toward White evacuees-in-need. Experiment 2 showed that priming the “promiscuous Black female” stereotype through exposure to sexual rap music reduced policy support for a Black pregnant woman-in-need but did not influence support responses toward a White pregnant woman-in-need. Further tests of mediated moderation demonstrated that in both experiments, the interactive influence of priming Black stereotypes and race of persons-in-need on policy support was mediated by empathic responding.

Effectiveness of vocational rehabilitation intervention on the return to work and employment of persons with multiple sclerosis

BACKGROUND

Multiple sclerosis is a neurological disease that frequently affects adults of working age, resulting in a range of physical, cognitive and psychosocial deficits that impact on workforce participation. Although, the literature supports vocational rehabilitation (VR) approaches in persons with multiple sclerosis (pwMS), the evidence for its effectiveness is yet to be established.

OBJECTIVES

To evaluate the effectiveness of VR programs compared to alternative programs or care as usual on return to work, workability and employment in pwMS; to evaluate the cost effectiveness of these programs.

SEARCH STRATEGY

Electronic searches included: Cochrane Central Register of Controlled Trials "CENTRAL" 2008 issue 3, MEDLINE (PubMed) (1966- 2008), EMBASE (1988- 2008), CINAHL (1982- 2008), PEDro (1990- 2008), the Cochrane Rehabilitation and Related Therapies Field trials Register and the National Health Service National Research Register.

SELECTION CRITERIA

Randomized and controlled clinical trials, including before - after controlled trials, that compare VR rehabilitation with alternative intervention such as standard or a lesser form of intervention or waitlist controls.

DATA COLLECTION AND ANALYSIS

Two reviewers selected trials and rated their methodological quality independently. A 'best evidence' synthesis was performed, based on methodological quality. Trials were grouped in terms of type and setting of VR programs.

MAIN RESULTS

Two trials (one RCT and one CCT) (total 80 participants) met the review criteria. Both trials scored poorly on the methodological quality assessment. There was 'insufficient evidence' for VR programs for (a)'competitive employment', in altering rates of job retention, changes in employment, improvement in rates of re-entry into the labour force; (b) for altering 'work ability' by improving participants' confidence in the accommodation request process, or employability maturity or job seeking activity. No evidence could be assimilated for changes in proportions of persons in supported employment or on disability pensions, nor for cost-effectiveness.

AUTHORS' CONCLUSIONS

There was inconclusive evidence to support VR for pwMS. However, the review highlights some of the challenges in providing VR for pwMS. Clinicians need to be aware of vocational issues, and to understand and manage barriers for maintaining employment. Proactive and timely VR programs should incorporate practical solutions to deal with work disability, workplace accommodation and educate employers, and the wider community. Liaison with policy makers is imperative for government initiatives that encourage work focused VR programs. Future research in VR should focus on improving methodological and scientific rigour of clinical trials; on the development of appropriate and valid outcome measures; and on cost effectiveness of VR programs.

Characteristics of sick-listing cases that physicians consider problematic--analyses of written case reports

OBJECTIVE

The aim was to discern common characteristics in the sick-listing cases that physicians in general practice and occupational health services find problematic.

DESIGN

Descriptive categorization within a narrative theoretical framework.

SETTING

Sickness-insurance course for physicians in general practice and occupational health services.

SUBJECTS

A total of 195 case reports written by 195 physicians. Main outcome measures. Categories of features regarding medical, work, and social situation as well as medical interventions.

RESULTS

Beside age and sex, the following information was often provided: family situation, stressful life events, occupation, problem at work, considerations concerning diagnoses, medical investigations, treatments, and vocational rehabilitation measures. Two-thirds of the patients had been sickness absent for more than a year. The most common type of case reports concerned women, employed in non-qualified nursing occupations, and sick listed due to mental disorders. The most common measures taken by the physicians were referrals to psychotherapy and/or physiotherapy, and prescribing antidepressants (SSRI). Facts about alcohol habits were rarely provided in the cases.

CONCLUSIONS

Some of the circumstances, such as prolonged sick-listing, are likely to be more or less inevitable in problematic sick-listing cases. Other circumstances, such as stress-full life events, more closely reflect what the reporting physicians find problematic. The categories identified can be regarded as markers of problematic sick-listing cases in general practice and occupational health service.

Development of the St. Louis audit of fall risks at residential construction sites

We describe the development and pilot testing of the St. Louis Assessment of Fall Risks, a worksite audit to assess fall prevention safety practices on residential construction sites. Surveillance data and feedback from carpenters and safety instructors regarding work tasks associated with falls from heights were used to develop the audit instrument. The audit focuses on the framing process, including general safety climate/housekeeping, floor joist/sub-floor installation, walking surfaces/edges, wall openings, truss setting, roof sheathing, ladders, scaffolds, and personal fall arrest equipment. The audit was tested at sixteen residential construction sites, documenting excellent inter-rater reliability (kappa = 0.93). Results suggest that the audit has good face and content validity and is a reliable instrument for measuring fall safety risks at residential construction sites. It is practical, easy, and safe to administer, making it a potentially useful instrument for field research as well as regular safety monitoring by foremen and crew.

Can a transitional work grant program in a workers' compensation system reduce cost and facilitate return to work?

Although previous research has shown returning the injured worker to work as soon as possible is important to the long-term prospects of the worker remaining in the work force, there is limited economic support for implementing such programs. Thus, the purpose of this case control study was to determine the cost savings of the implementation of a Transitional Work Grant (TWG) program, which consisted of several components including job analyses, education, communication and transitional work (TW). Companies that enrolled in the TWG program were matched to nonparticipating companies (NTW) based on employer size, type of industry, number of overall claims, and number of claims with > 7 days lost time (LT claims) submitted the year prior to enrollment. The study analyzed economic data: number of claims, number of LT claims, indemnity costs, medical costs, and days lost (days away from the workplace). An additional outcome was the ratio of LT claims (> 7 days lost work) to medical only (MO) claims (LT/MO ratio). Overall, participation in the TWG program was associated with decreased indemnity cost and decreased LT/MO ratio. However, effectiveness of the program varied by employer size and industry. In terms of the state of Ohio, these costs translate into substantial savings: more than $2.3 million per year. Although the cost savings and reduction in lost time claims is encouraging, the true benefit of TW has yet to be completely quantified. Future work must account for other potential co-factors and programs that could also contribute to the savings as well as document further the indirect benefits associated with a TWG program, such as improved employee morale and increased productivity and product quality that could be four times greater than the direct savings. In summary, programs such as this one adopted by several companies in Ohio can reduce the cost burden of injuries.

Individualized assessment of driving fitness for older individuals with health, disability, and age-related concerns

OBJECTIVE

Driver licensing agencies are faced with an increasing population of drivers who are seeking to maintain driving privileges whilst coping with functional changes associated with health, disability, or aging-related issues. Some of these changes impact upon the motor, sensory, and cognitive capacities essential for safe motor vehicle operation. The driver assessment process, as provided by occupational therapists and other professionals trained in the techniques of driver rehabilitation, can provide objective data to identify driver strengths and limitations and options available to increase mobility independence via consideration of adaptive mobility equipment, vehicle choice, driver training, or alternative transportation if necessary. This article provides an overview of the driver rehabilitation specialist's assessment and training process, with an analysis of the key issues related to this form of assessment and the need for further research.

RESULTS/DISCUSSION

The basic driver rehabilitation process is outlined including examples of common deficits, assessment considerations, and intervention approaches. The clinical and on-road assessment procedures are described, with illustrations of the reasoning process that leads to a determination of the person's overall driving competence and rehabilitation recommendations. A review of the literature is provided that examines the currently available documentation that supports this assessment and rehabilitation process.

CONCLUSION

The article concludes with a review of current literature that examines the claim that detailed clinical and on-road assessment, as provided by driver rehabilitation specialists, is currently the best method for assisting drivers with complex health, disability, or aging-related issues to resume or retain driving privileges.

The effects of a 1-year physical exercise programme on development of fatigue during a simulated ambulance work task

The aim of the study was to evaluate the effects of individually prescribed physical exercise programmes on development of fatigue during the carrying of a loaded stretcher up and down the stairs. Nineteen ambulance personnel performed the training for 1 year. Testing occurred before and after 1 year of the training. Both the training group (n = 19) and the control group (n = 15) were assessed for physical capacity and lactate concentration in blood and ratings of perceived exertion during carrying a stretcher on the stairs. When comparisons were made between those who had been training three times/week for 1 year and the control group, lactate concentration was significantly decreased. In conclusion, markers of fatigue during stretcher carrying can be reduced by the use of individually prescribed physical exercise programmes.

Glatiramer acetate versus interferon beta-1a for subcutaneous administration: comparison of outcomes among multiple sclerosis patients

INTRODUCTION

We compared the outcomes of multiple sclerosis (MS) patients treated with either glatiramer acetate (GA) (Copaxone, Teva Pharmaceutical Industries, Israel) or interferon beta-1a for subcutaneous administration (IFN beta-1a-SC) (Rebif, Merck Serono, Switzerland).

METHODS

Data were obtained from i3's Lab Rx Database from July 2001 to June 2006. We established an 'intent-to-treat' (ITT) cohort (n=845) of patients diagnosed with MS who began therapy on either GA (n=542) or IFN beta-1a-SC (n=303) and had continuous insurance coverage from 6 months before to 24 months after the date they began taking the medication. We also created a 'continuous use' (CU) cohort (n=410) of individuals who, in addition to the criteria listed above, used either GA or IFN beta-1a-SC within 28 days of the end of the 2-year-post period. Using multivariate regressions, we examined both the 2-year total direct medical costs and the likelihood of relapse associated with the use of these two MS medications. We defined relapse as either being hospitalised with a diagnosis of MS, or being diagnosed with MS during an outpatient visit and then prescribed steroids within a 7-day period. All regressions controlled a wide range of factors that have potentially affected outcomes.

RESULTS

In the ITT cohort, patients who started therapy on GA had a significantly lower 2-year risk of relapse (5.92% versus 10.89%; P=0.0305), as well as significantly lower 2-year total medical costs (US$41,786 versus US$49,030; P=0.0002). In the CU cohort, patients who used GA also had a significantly lower 2-year risk of relapse (1.94% versus 9.09%; P=0.0049) and significantly lower total medical costs (US$45,213 versus US$57,311; P<0.0001).

CONCLUSIONS

Results indicate that, compared with the use of IFN beta-1a-SC, use of GA is associated with significantly lower probability of relapse as well as significantly lower 2-year total direct medical costs. In addition, these results are more pronounced among patients defined as continuous users.

Experiences of returning to work after acquired brain injury

The purpose of this qualitative study was to explore experiences of returning to work after rehabilitation, from the viewpoint of people with acquired brain injury. A purposive sampling of eight informants was made, and data were collected through personal interviews with open questions. The data were then analysed through qualitative content analyses in five steps, resulting in four main categories of experiences: "A new person", "Stimulants and fellowship", "Understanding and support", and "To reach insight" with appurtenant sub-categories. The overarching theme was "Returning to work after acquired brain injury is a long process". The conclusion of this study is that returning to work after acquired brain injury requires motivated individuals, flexible work, accommodating labour management, and prolonged environmental support. This study also shows that the informants need support for a long period of time to reach a balance and to obtain a functional working role. In order to achieve this, client-centred rehabilitation, professional teamwork, and longer follow-up periods than those of today are required.

Computer use patterns associated with upper extremity musculoskeletal symptoms

INTRODUCTION

Over half of surveyed college students are experiencing pain they are attributing to computer use. The study objective was to evaluate the effect of computing patterns on upper extremity musculoskeletal symptoms.

METHODS

Symptom experiences and computing/break patterns were reported several times daily over three weeks for 30 undergraduate students over a semester. Two-level logistic regression models described the daily association between each computing pattern and both any and moderate or greater symptom experienced, adjusting for covariates.

RESULTS

The associations between most computing/break patterns and experiencing any symptoms were positive: total hours of computer use adjOR = 1.1 (90% CI 1.1-1.2), 1-2 breaks versus none adjOR = 1.3 (90% CI 0.9-1.9), 3-6 breaks versus none adjOR = 1.5 (90% CI 1.1-2.2), >15 min break versus none adjOR = 1.6 (90% CI 1.1-2.2), and number of stretch breaks adjOR = 1.3 (90% CI 1.1-1.5). However, breaks for less than 15 min were negatively associated with experiencing any symptoms: adjOR = 0.6 (90% CI 0.5-0.9). The associations between most computing/break patterns and experiencing moderate or greater symptoms were positive: total hours of computer use OR = 1.1 (90% CI 1.1-1.2), 1-2 breaks and 5-6 breaks versus none OR = 1.8 (90% CI 1.1-2.9), 7-8 breaks versus none OR = 2.0 (1.0-4.2), >15 min break versus none 1.8 (1.1-3.1), and number of stretch breaks OR = 1.3 (1.0-1.5).

CONCLUSION

Computing/break patterns were consistently associated with experiencing symptoms. Our findings suggest evaluating breaks with computing duration (computing patterns) is more informative than assessing computing duration alone and can be used to better design ergonomic training programs for student populations that incorporate break times.

The longitudinal relationship between job mobility, perceived organizational justice, and health

BACKGROUND

The main purpose of the present study was to examine the 2-year longitudinal and reciprocal relationship between job mobility and health and burnout. A second aim was to elucidate the effects of perceived organizational justice and turnover intentions on the relationship between job mobility (non-, internally and externally mobile), and health (SF-36) and burnout (CBI).

METHODS

The study used questionnaire data from 662 Swedish civil servants and the data were analysed with Structural Equation Modeling statistical methods.

RESULTS

The results showed that job mobility was a better predictor of health and burnout, than health and burnout were as predictors of job mobility. The predictive effects were most obvious for psychosocial health and burnout, but negligible as far as physical health was concerned. Organizational justice was found to have a direct impact on health, but not on job mobility; whereas turnover intentions had a direct effect on job mobility.

CONCLUSION

The predictive relationship between job mobility and health has practical implications for health promotive actions in different organizations.

Virtual reality as a leisure activity for young adults with physical and intellectual disabilities

Participation in leisure activities is a fundamental human right and an important factor of quality of life. Adults with intellectual disabilities (ID) and physical disabilities often experience limited opportunities to participate in leisure activities, virtual reality (VR) technologies may serve to broaden their repertoire of accessible leisure activities. Although the use of VR in rehabilitation has grown over the past decade, few applications have been reported for people with ID. Thirty-three men and women with moderate ID and severe cerebral palsy participated in the study. Each participant in the experimental group (n=17) took part in VR activity two to three times weekly for 12 weeks. Virtual games were provided via GestureTek's Gesture Xtreme video capture VR system. The VR-based activities were perceived by the participants to be enjoyable and successful. Moreover, participants demonstrated clear preferences, initiation and learning. They performed consistently and maintained a high level of interest throughout the intervention period. VR appears to provide varied and motivating opportunities for leisure activities among young adults with intellectual and physical disabilities. Its ease of use and adaptability make it a feasible option for this population.

Lumbar supports for prevention and treatment of low back pain

BACKGROUND

Lumbar supports are used in the treatment of low-back pain patients, to prevent the onset of low-back pain (primary prevention) or to prevent recurrences of a low-back pain episode (secondary prevention).

OBJECTIVES

To assess the effects of lumbar supports for prevention and treatment of non-specific low-back pain.

SEARCH STRATEGY

We updated the search in the Cochrane Central Register of Controlled Trials, PubMed, EMBASE, and CINAHL to December 2006. We also screened references given in relevant reviews and identified trials, and contacted experts to identify additional RCTs.

SELECTION CRITERIA

Randomized controlled trials that reported on any type of lumbar supports as preventive or therapeutic intervention for non-specific low-back pain.

DATA COLLECTION AND ANALYSIS

One review author generated the electronic search. Two review authors independently identified trials that met the inclusion criteria. One review author extracted data on the study population, interventions, and final results. The methodological quality and the clinical relevance were independently assessed by two review authors. Because it was not possible to perform a quantitative analysis, we performed a qualitative analysis in which the strength of evidence on the effectiveness of lumbar supports was classified as strong, moderate, limited, conflicting, or no evidence.

MAIN RESULTS

Seven preventive studies (14,437 people) and eight treatment studies (1361 people) were included in this updated review. Overall, the methodological quality of the studies was rather low. Only five of the fifteen studies met 50% or more of the internal validity items. There was moderate evidence that lumbar supports are not more effective than no intervention or training in preventing low-back pain, and conflicting evidence whether lumbar supports are effective supplements to other preventive interventions. It is still unclear if lumbar supports are more effective than no or other interventions for the treatment of low-back pain.

AUTHORS' CONCLUSIONS

There is moderate evidence that lumbar supports are not more effective than no intervention or training in preventing low-back pain, and conflicting evidence whether they are effective supplements to other preventive interventions. It remains unclear whether lumbar supports are more effective than no or other interventions for treating low-back pain. There is still a need for high quality randomized trials on the effectiveness of lumbar supports. One of the most essential issues to tackle in these future trials seems to be the realization of an adequate compliance. Special attention should be paid to different outcome measures, types of patients and types of lumbar support.

A measure of university employees' exposure to risk factors for work-related musculoskeletal disorders

This study examined the computer workstations of 50 faculty and staff at a regional comprehensive university in the southeastern United States. Data were collected using a subjective questionnaire and the observational Computer Workstation Analysis tool. The researchers found no significant differences between participants' perceptions of their risk for work-related musculoskeletal disorders (WRMDs) and observations of workstations at the worksite. The researchers recommend developing an ergonomics program delivered by occupational health team members with knowledge and skill in WRMD prevention, identification, and treatment.

Association of stability of line drawing and drawing performance

The study presents a simple method to predict the drawing performance of designers or artists by measuring the stability of their line drawings. An 8 x 3 two-way factorial design experiment with directions and phases was conducted to explore the most stable direction and phase among eight directions and three phases of line drawing. The scores of 40 participants' drawings rated by instructors were used directly as drawing performance. Correlations estimated relations of stability of the line drawing and drawing performance. Analyses showed 45 degrees was the most stable direction, whereas the least stable was 135 degrees. For each line drawing, the start was more stable than the middle and end phases. For drawing a plus sign (+), the horizontal line was more stable than the vertical line. When drawing a horizontal line, drawing rightward was more stable than drawing leftward; when drawing a vertical line, drawing downward was more stable than drawing upward. In general, drawing a multiplication sign (x) was similar to drawing a plus sign rotated counterclockwise with an angle of 45 degrees. Line-drawing stability was positively correlated with drawing performance, so line-drawing stability could be used to predict drawing performance. The stability of the least stable direction was the most powerful predictor for assessing drawing performance. All subjects were design students, were right-handed, and drew with the right hand. Persons from other fields and drawing with the nondominant hand are interesting topics for further investigation.

Responsiveness of the physical work performance evaluation, a functional capacity evaluation, in patients with low back pain

BACKGROUND AND PURPOSE

The Physical Work Performance Evaluation (PWPE) is a functional capacity evaluation. This study investigated the responsiveness of the PWPE.

METHODS

The internal and external responsiveness was tested. For the internal responsiveness, the change in the pre-/post-test PWPE scores of a group participating in a work rehabilitation program (n = 27) was compared to that of a comparison group of healthy subjects (n = 30). The external responsiveness was tested with the rehabilitation group, and the change in their PWPE scores was compared to concurrent and empirical criteria.

RESULTS

The comparison of the change in pre-/post-test PWPE scores showed that the change for the rehabilitation group was significantly different from that for the comparison group, but only for one section of the PWPE. Changes in six criteria were seen after completion of the program, but there was no significant correlation between these changes and the change in the overall PWPE score.

DISCUSSION AND CONCLUSION

The overall PWPE level of work score does not appear to have the ability to measure clinically significant changes achieved through a work rehabilitation program.