Prosthetists' and Orthotists' experience of their work and workspace - characterising the physical and organisational environment: Focus group findings

Work-related musculoskeletal pain in prosthetists and orthotists: a comparison between Australia and other countries

BACKGROUND

Musculoskeletal pain (MSP) is a substantial societal and personal burden resulting in loss of employment and reduced productivity. Prosthetics and orthotics professionals working in Australia have previously reported a high prevalence of MSP; however, little is known about the prosthetic and orthotic communities in other countries.

OBJECTIVES

To explore the prevalence and range of workplace exposures associated with MSP in a convenience sample of the international prosthetic and orthotic profession.

STUDY DESIGN

A cross-sectional study using a convenience sample was conducted with prosthetists and orthotists worldwide.

METHODS

Prosthetists and orthotists were invited to participate in a survey to explore work-related factors associated with MSP. Bivariate and regression modelling was used to examine associations between self-reported demographic and workplace characteristics including job satisfaction, work-life balance, and physical and psychosocial hazards.

RESULTS

Seventy-six percent of respondents (n = 173) reported MSP in the previous 6 months. However, MSP was associated with different factors in Australia compared with other countries. Among Australia-based prosthetists and orthotists, MSP was associated with sex, physical hazards, and psychosocial hazards. For the international sample, MSP was only associated with length of employment.

CONCLUSIONS

Three-quarters of all respondents reported having MSP. Differences in associations between MSP and other factors by respondents' geographical location suggest the need for context-specific identification of hazards to enable the development of targeted and contextually appropriate prevention strategies.

Reflections and future directions for psychological science in Prosthetics and Orthotics International

In the inaugural edition of Prosthetics and Orthotics International in 1977, Dr Sidney Fishman identified the Psychological Sciences as one of six indispensable areas of skill and knowledge in professional prosthetic-orthotic practice. Since then, there have been substantial changes and developments in the complexity and capabilities of assistive technologies, greater emphasis on understanding the relationships between people and enabling technologies, growing recognition of the importance of the contexts and environments that support their use, and changes in both health care services and the professional development of prosthetists and orthotists. The aim of this narrative review is to reflect on the role of Prosthetics and Orthotics International in shaping the evolving understanding of psychology in prosthetics and orthotics. There remains considerable potential and opportunity for the development and application of psychology in addressing the challenges of disability globally. However, a broad interpretation and application of the principles of rehabilitation psychology are needed if we are to meaningfully incorporate psychological science into the knowledge that informs prosthetic and orthotic practice.

An exploratory qualitative study of health professional perspectives on clinical outcomes in UK orthotic practice

Background

Despite potential savings to the National Health Service, the collection of data on outcomes of NHS orthotic services is patchy. Indeed, several reports into orthotic services in the UK have reported a lack of data relating to outcomes of care and highlighted the need to routinely measure outcomes to demonstrate efficacy of services. Whilst a previous study provided an overview of the use of outcome measures in orthotic practice and identified some barriers to their use, further questions emerged. Hence, this qualitative study aimed to explore orthotists’ opinions and personal experiences on the influences on outcomes, how appropriate and relevant outcomes can be measured and also how barriers to the use of outcome measures can be overcome.

Methods

Following a review of the literature, an initial advisory group informed semi-structured questions. These were used to create dialogue in a focus group of 12 orthotists. Data from the focus group was transcribed verbatim and analysed using thematic analysis, creating themes and subthemes for discussion.

Results

The setting of realistic and agreed goals through managing expectations, compromise and patient education/information were seen as factors that could inform and improve outcomes. Barriers to the collection of outcome measures were associated with inadequate technology to manage the data, lack of time to complete them, lack of training in them and difficulties selecting appropriate outcome measures for patients with complex problems managed by different health professionals. The participants discussed ways of addressing these barriers, such as the use of ‘snapshots’ and delegation of data collection.

Conclusions

This study has revealed that measuring outcomes is considered to be an important activity. In order to achieve good outcomes, it is important to address patient expectations, discuss and establish joint goals for care at the outset and inform and include patients in the decision-making process. The identified barriers to measuring outcomes can be overcome with the solutions revealed by these participants. Hence, this study has contributed to current knowledge which has relevance for clinical practice and may provide the theoretical basis for future research.

Workplace injuries in the Australian allied health workforce

Objective This study aims to identify the number, costs and reported injury mechanisms of serious injury claims for allied health professionals. Methods Using Australian Workers' Compensation injury data, the number, mechanism, and costs of injury claims were calculated for eight groups of allied health professions (chiropractors and osteopaths, speech pathologists and audiologists, occupational therapists, physiotherapists, psychologists, podiatrists, social workers and prosthetists/orthotists) between the 2000-01 and 2013-14 financial years. Workforce injury rates were calculated using the 2011 Australian Census Workforce data (denominator) and 2011 Workers' Compensation Statistics claims data (numerator). Results Across the allied health professions, 7023 serious injuries (minimum 5 days absence from work) were recorded with an associated total compensation cost of A$201970000. Fewer than 1.5% of each allied health professional group had an injury claim, with the exception of prosthetists/orthotists who had a rate of 25.9% serious injury claims (95% confidence interval 21.9-30.4). The average cost per claim varied across the allied health professions, from the lowest cost of A$19091 per injury for occupational therapists to the highest of A$48466 per claim in chiropractic and osteopathy. Body stressing followed by mental stress were the most common mechanisms of injury. Conclusions Mechanism of injury, both physical and psychosocial, were identified. Prosthetists/orthotists are at the highest risk of workplace injury of all allied health professions. This suggests the need for further investigation and development of appropriately targeted injury prevention programs for each allied health profession. What is known about this topic? Retention of allied health professionals is a significant issue, with workplace injuries identified as one contributing factor to this problem. Healthcare workers are potentially at high risk of injury as they are exposed to a range of physical and psychosocial hazards in their workplace. What does this paper add? This paper is the first to report on serious injuries, minimum 5 days absence from work, from Australian Workers' Compensation data, across a range of allied health professions. Various allied health professions were examined to identify the number, mechanism and cost of serious workplace injuries finding there is an average of 500 serious claims per year at a cost of A$14million. Prosthetists/orthotists were identified as having the highest proportion of claims per workforce population. What are the implications for practitioners? These results suggest highly varied injury rates across allied health professions. Compensation data does not enable accurate identification of causal factors. Further work is required to identify relevant causal factors so that targeted risk reduction strategies can be developed to reduce workforce injuries.

Work-related musculoskeletal injuries in prosthetists and orthotists in Australia

Objective. This study aims to determine the prevalence of work-related musculoskeletal disorders in prosthetists/orthotists working in Australia. Secondary to this, the relationship between work-related hazards and work-related musculoskeletal disorders will be examined. Methods. In 2012, a self-report survey was conducted with the prosthetist/orthotist workforce in Australia (N = 139, 56% response rate). Data on workplace physical and psychosocial hazards, job satisfaction, work-life balance and musculoskeletal discomfort were collected. Predictors of work-related musculoskeletal disorders were assessed using logistic regression analysis. Results. Prevalence of work-related musculoskeletal disorders was 80%. Gender (β = 1.31, p = 0.030), total weekly hours (β = 0.9, p < 0.010) and physical (β = 1.91, p < 0.010) and psychosocial (β = 1.28, p < 0.010) hazards were all associated with reporting of work-related musculoskeletal disorders. Females reported higher levels of work-related musculoskeletal disorder discomfort than males in all body areas. Conclusions. Work-related musculoskeletal disorders prevalence is high in prosthetists/orthotists. This suggests that focus on workplace injury prevention is required. Targeted prevention requires systematic identification and then control of all relevant workplace hazards.

Physical and environmental hazards in the prosthetics and orthotics workshop: a pilot study

Prosthetists and Orthotists (P&O) are exposed to physical hazards within the workshop environment. Concern regarding these exposures has been expressed by P&Os; however, little research has been undertaken. Exposures to noise and volatile organic compounds in amounts larger than statutorily allowed can have adverse short and long term consequences on people's health. To identify and quantify hazardous noise and chemical exposures in a typical P&O workplace. Noise and volatile organic compound testing was undertaken in 2011 and 2013. Modifications to the workshop occurred between these testing times and the impact of these changes examined. The levels of volatile organic compounds was very low in all areas in 2011 and 2013. Noise levels were high and staff require the use of PPE to prevent exposure beyond levels prescribed in the Australian Standards.

CONCLUSIONS

Occupational environmental exposures in P&O are of concern to the profession. A pilot study of one facility demonstrated that Occupational Noise exposures are high and may result in hearing loss and other adverse health outcomes. Occupational chemical exposures through volatile organic compound exposures are relatively low. Further, systematic investigation is required to develop evidence-based control strategies.