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Work-Related Musculoskeletal Disorders in Physical Therapists: A Prospective Cohort Study With 1-Year Follow-up

Background: Work-related musculoskeletal disorders (WMSDs) have a significant impact on physical therapists, but few studies have addressed the issue. Research is needed to determine the scope of the problem and the effects of specific risk factors. Objectives: The objectives of this study were: (1) to determine the 1-year incidence rate of WMSDs in physical therapists and (2) to determine the effects of specific risk factors. Design: This was a prospective cohort study with 1-year follow-up. Methods: Subjects were randomly selected American Physical Therapy Association members (N=882). Exposure assessment included demographic data, physical risk factors, job strain, and specific physical therapy tasks. The primary outcome was WMSDs, with a severity rating of at least 4/10 and present at least once a month or lasting longer than a week. Results: The response rate to the baseline questionnaire was 67%. Ninety-three percent of the subjects who responded to the baseline questionnaire responded to the follow-up questionnaire. The 1-year incidence rate of WMSDs was 20.7%. Factors that increased the risk for WMSDs included patient transfers, patient repositioning, bent or twisted postures, joint mobilization, soft tissue work, and job strain. Limitations: The primary limitation of this study was the number of therapists who had a change in their job situation during the follow-up year. Conclusions: Work-related musculoskeletal disorders are prevalent in physical therapists. Physical therapy exposures, patient handling, and manual therapy, in particular, increase the risk for WMSDs.

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.

Work-related musculoskeletal disorders in female Swedish physical therapists with more than 15 years of job experience: Prevalence and associations with work exposures

The objective of this study was to determine the prevalence of and risk factors for work-related musculoskeletal disorders (WRMDs) in female physiotherapists with more than 15 years of job experience. A self-administered postal questionnaire was sent to 203 female physiotherapists with more than 15 years of job experience. Unconditional logistic regression was used to study the association between job exposures and the risk for WRMDs. The questionnaire was returned by 131 physiotherapists (64.5%). Of 99 subjects who answered specific questions about WRMDs, 52 (53.5%) were affected by WRMDs in at least one body part. Regions most affected were the hand/wrist (n=31; 58.5%) and the lower back (n=30; 56.5%). For hand/wrist pain, associations were found with: orthopedic manual therapy techniques (adjusted odds ratio [OR]=3.90; 95% confidence interval [CI]=1.2–13.1); working in awkward or cramped positions (OR=4.96; 95% CI=1.3–18.7); and high psychological job demands (OR=4.34; 95% CI=1.2–15.0). For lower back pain, associations were found with: working in awkward or cramped positions (adjusted OR=6.37; 95% CI=1.6–24.7); and kneeling or squatting (adjusted OR=4.76; 95% CI=1.4–15.9). More than half of the respondents reported WRMDs. General physical and psychosocial work-related exposures, as well as specific therapy tasks, were strongly associated with WRMDs. Larger, longitudinal studies are needed to determine the direction of causality.

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.

Changes in functional independence measure ratings associated with a safe patient handling and movement program.

&NA; Safe patient handling and movement (SPHM) programs are effective in reducing healthcare worker injuries. However, the perception among rehabilitation personnel that SPHM equipment promotes patient dependence and adversely affects functional outcomes is one barrier to implementing successful programs. This barrier is particularly evident in acute inpatient rehabilitation facilities, where functional independence is the primary goal. The purpose of this retrospective cohort study was to evaluate this perception. Functional Independence Measure (FIM) ratings were collected from 94 patients with a diagnosis of stroke. Forty‐seven patients were admitted 1 year prior to implementation of the SPHM program (Group 1), and 47 were admitted to the facility over a period of 1 year (Group 2) 18 months after program implementation. Group 2 obtained equal or better discharge mobility FIM ratings than Group 1, who received care without the SPHM equipment. This study suggests that SPHM programs do not impede functional outcomes in stroke patients.

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.