Special issue on work-related injuries and illnesses and the role of occupational therapy: implications of a systematic literature review for practice, research, education, and policy

A novel passive shoulder exoskeleton for assisting overhead work

Shoulder exoskeletons (SEs) can assist the shoulder joint of workers during overhead work and are usually passive for good portability. However, current passive SEs face the challenge that their torque generators are often attached to the human arm, which adds a significant amount of weight to the user's arms, resulting in additional energy consumption of the user. In this paper, we present a novel passive SE whose torque generator is attached to the user's back and assists the shoulder joint through Bowden cables. Our approach greatly reduces the weight on the user's arms and can accommodate complex shoulder joint movements with simple and lightweight mechanical structure based on Bowden cables. In addition, to match the nonlinear torque requirements of the shoulder joint, a unique spring-cam mechanism is proposed as the torque generator. To verify the effectiveness of the device, we conducted a usability test based on muscle activations of 10 healthy subjects. When assisting overhead work, the SE significantly reduced the mean and maximum electromyography signals of the shoulder-related muscles by up to 25%. The proposed SE contributes to further research on passive SE design to improve usability, especially in terms of reducing weight on human arms.

Supporting workers with lower back injuries to return to work: a meta-ethnography

Introduction

Lower back injuries can prevent people from engaging in the occupation of work, which is considered to be beneficial to physical and mental wellbeing. Return-to-work programmes aim to support people to re-engage with work; however, the success of these can be varied. The aim of this review was to explore what factors facilitated a return to work for those in employment, and what the factors may be in preventing others from making a successful return to work.

Method

A systematic search of the literature identified 10 qualitative research studies, and a meta-ethnographic approach was then used to critique and synthesise the findings to provide a line of argument.

Findings

Interrogation of the selected studies brought about three third-order interpretations as follows: enabling injured workers to return to work safely; challenging negative assumptions; overcoming organisational barriers.

Conclusion

The study supports previous findings that emphasise consideration of wider organisational and psychosocial factors relating to supporting people to return to work, rather than focusing solely on the injured worker. Suggestions are made for the modification of current work practices, the need for a strength-based approach to rehabilitation and for occupational therapists who might work with people living with back pain.

Enabling Work: Occupational Therapy Interventions for Persons with Occupational Injuries and Diseases: A Scoping Review

Purpose This review aims to map the scope of published research on occupational therapy (OT) interventions and pertinent work and work-related outcomes for persons with occupational injuries and diseases. Methods The scoping review adapted Arksey and O'Malley's framework. Six electronic databases were searched. Ancestral search was also done on five systematic reviews. The search was conducted from September 2015 to October 2015. Interventions and outcomes were coded using the International Classification of Functioning, Disability and Health Core Set for Vocational Rehabilitation to plot trends. Results Forty-six articles were included in the review. The top five intervention approaches included: acquiring skills (12.27%), health services, systems, and policies (10.43%), products and technology for employment (9.20%), handling stress and other psychological demands (7.98%), and apprenticeship (6.74%). The top five outcomes targeted included: remunerative employment (15.71%); sensation of pain (10.99%); emotional functions (5.76%); handling stress and other psychological demands (5.76%); economic self-sufficiency (4.71%); muscle endurance functions (4.71%); exercise tolerance functions (4.71%); undertaking multiple tasks (4.19%); acquiring, keeping, and terminating a job (4.19%); and looking after one's health (4.19%). Conclusion The trend in interventions show the use of activities and environment facilitators which are attuned to the conceptual nature of OT. Furthermore, the trend in outcomes show that there is substantial evidence that supports the use of OT to target work. This review may provide a platform for collaboration with other professionals and also help identify research directions to strengthen the evidence base for OT in work-related practice.

The Role of Functional Capacity Evaluations in Occupational Therapy Vocational Evaluations

One of the key objectives of vocational rehabilitation is to ensure that workers can perform their jobs safely, with a minimal risk for the work duties aggravating their medical problem, and with the medical problem having a minimal impact upon their work performance. Vocational evaluations can play an important role in vocational rehabilitation by determining an ill or injured worker's suitability for work. Functional capacity evaluations are a component of the vocational evaluation process, but are not comprehensive enough to address all the dynamic and complex factors that can influence an individual's work performance. The key component in any vocational evaluation is the clinical reasoning exercised by the occupational therapist, which is essential in producing credible conclusions and workplace recommendations from the information generated from an evaluation.