Amy R. Darragh

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.

Work-Related Musculoskeletal Disorders Are Associated With Impaired Presenteeism in Allied Health Care Professionals

Objective: The objective of this research was to determine the impact of work-related musculoskeletal disorders (WMSD) on presenteeism in allied health care professionals. Methods: Data were collected via postal questionnaires. Work-related musculoskeletal disorders were assessed using an established instrument and case definition. Data on presenteeism were collected with the Stanford Presenteeism Scale (13-item version). The association between WMSD and presenteeism was assessed with a Mann-Whitney U test. Results: The response rate was 76%. About 48% of therapists reported WMSD in the past 4 weeks (n = 712). Moderate WMSD were associated with higher levels of presenteeism than minor WMSD. Both work impairment and work output were affected by WMSD. Conclusions: Work-related musculoskeletal disorders may impact presenteeism in these populations. Costs associated with presenteeism due to WMDS may be substantial.

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.

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.

Therapy practice within a minimal lift environment: Perceptions of therapy staff

The purpose of this research was to explore the perceptions of occupational and physical therapy staff regarding a minimal lift policy implemented in a midwestern health system. Researchers used a qualitative focus group approach, facilitating four focus groups with 23 members of the hospital therapy staff. Transcripts of the focus groups were coded and analyzed for emergent themes. Several themes emerged from the data: Therapist risk of injury, Attitudes towards and use of equipment, Professional relationships and teamwork, and Effectiveness of minimal lift programs: barriers and supports. In general, therapists felt they were susceptible to work-related injury because of the nature of their work, environmental factors, and the actions of others. The therapists served as trainers in the minimal lift program. They trained other staff in equipment use; were resources for staff on the floors; and they used the equipment in the context of therapeutic intervention. Equipment was seen as useful primarily for the rehabilitation of low functioning or bariatric patients. Further research about the design and effect of equipment in therapy is recommended.

Effect of a Safe Patient Handling Program on Rehabilitation Outcomes

OBJECTIVE To evaluate the effect of a safe patient handling (SPH) program on rehabilitation mobility outcomes. DESIGN Retrospective cohort study. SETTING A rehabilitation unit in a hospital system. PARTICIPANTS Consecutive patients (N=1291) over a 1-year period without an SPH program in place (n=507) and consecutive patients over a 1-year period with an SPH program in place (n=784). INTERVENTIONS The SPH program consisted of administrative policies and patient handling technologies. The policies limited manual patient handling. Equipment included ceiling- and floor-based dependent lifts, sit-to-stand assists, ambulation aides, friction-reducing devices, motorized hospital beds and shower chairs, and multihandled gait belts. MAIN OUTCOME MEASURES The mobility subscale of the FIM. RESULTS Patients rehabilitated in the group with SPH achieved similar outcomes to patients rehabilitated in the group without SPH. A significant difference between groups was noted for patients with initial mobility FIM scores of 15.1 and higher after controlling for initial mobility FIM score, age, length of stay, and diagnosis. Those patients performed better with SPH. CONCLUSIONS SPH programs do not appear to inhibit recovery. Fears among therapists that the use of equipment may lead to dependence may be unfounded.

Leisure and Social Participation and Health-Related Quality of Life in Caregivers of Children with Autism

The objective of this cross-sectional study was to compare health-related quality of life (HRQoL) in mothers of children with autism spectrum disorders (ASD) with a norm-based sample. An additional aim was to examine the relationship between engagement in leisure and social occupations and HRQoL in mothers of children with ASD. Thirty-three mothers of children with ASD, between 27 and 49 years of age, participated. Study participants between the ages of 35 and 44 years reported poorer mental HRQoL than a national sample, but comparable physical HRQoL. Findings also revealed inverse correlations between participation in hobbies and community/education activities and physical HRQoL (e.g., participation in hobbies and community education/activities increased as physical HRQoL decreased). The mental HRQoL of caregivers of children with ASD is lower than that of the general population, suggesting the need for occupational therapists to include psychosocial screening and referral for this group in their practice. In addition, results suggest that the relation between participation and health is complex, warranting further investigation.

“I Cried Because I Didn't Know if I Could Take Care of Him”: Toward a Taxonomy of Interactive and Critical Health Literacy as Portrayed by Caregivers of Children with Special Health Care Needs

Although the contributions of reading ability and numeracy skills in successful navigation of health-related systems are understood, the skills that comprise interactive and critical health literacy are not fully explicit. Using a phenomenological approach and the conceptual frame of health literacy as an asset, we conducted focus group interviews with 35 caregivers of children who had significant medical needs. Caregiver quotes were coded and categorized and then compared to the Revised Blooms Taxonomy. The purpose of the analysis was to better understand the interactive and critical health literacy skills caregivers use when coordinating their childrens care. The findings support a dynamic constructivist perspective of health literacy such that caregiver skill changed relative to the childrens health conditions. In addition, a taxonomic code of cognitive and communicative skills emerged from the data. This taxonomy may be useful in developing instrumentation to measure interactive and critical health literacy as well as in identifying a potential foci of interventions aimed at improving interactive and critical health literacy.

Safe-patient-handling equipment in therapy practice: implications for rehabilitation.

OBJECTIVE To determine how safe-patient-handling (SPH) equipment is used in rehabilitation and how it affects therapists, patients, and therapy practice. METHOD We used a qualitative, instrumental case study design. Thirty-five occupational and physical therapist practitioners from three facilities participated in the study. RESULTS Therapists reported a broad range of applications for equipment (e.g., functional mobility and neuromusculoskeletal function). They reported that SPH equipment increased treatment options for therapists and increased participation options for patients, although equipment limitations exist. Three themes emerged from the analysis: choice, potential, and safety. CONCLUSION SPH equipment has therapeutic applications in rehabilitation, especially for medically complex or bariatric patients. Therapists in this study engaged in a highly individualized, complex process of decision making when selecting and using SPH devices in rehabilitation. More research to refine and test therapeutic uses is necessary.

Musculoskeletal Discomfort, Physical Demand, and Caregiving Activities in Informal Caregivers

Objectives: To characterize the burden of care and musculoskeletal discomfort associated with caring for adults with chronic physical disability among informal caregivers and to describe the most physically demanding caregiving activities and contributing factors, as perceived by informal caregivers of adults with physical disabilities. Methods: A mixed methods approach was used for the study. Forty-six informal caregivers of adults with physical disability participated. Results: Most caregivers were classified as “high burden” caregivers. They reported high levels of physical strain and musculoskeletal discomfort. Caregivers identified several activities related to mobility and self-care as the most physically demanding. Factors affecting physical demand included caregiver and care-recipeint characteristics, activity requirements, and the physical environment. Conclusion: Interventions that target high-demand caregiving activities, including all three aspects of caregiving activity performance, are necessary to support adults with disabilities in the home and their caregivers.