Phyllis M. King

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 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.

Evaluation of the impact of employee ergonomics training in industry

This study examined the effects of three different types of ergonomics training methods upon employee knowledge, attitude and behavior. Employees within intact processing lines (N = 104) were randomized into four groups, one group serving as a control group. Pre- and post-test measures were implemented. Results showed training to have a significant effect upon knowledge of ergonomics. No significant differences were noted among all four groups according to empowerment and human factors measures. Training had a significant impact upon employees job satisfaction, and the recognition and reporting of health hazards associated with their jobs.

The ergonomics of child care: conducting worksite analyses

This paper examined the ergonomics of child care at a large metropolitan, university-based child care center. A case study approach was used to describe the job analysis process and results. Center staff were involved in the identification of health risk factors by completing an ergonomics survey and responding to questions posed during the job analysis (n=36). Two occupational therapists analyzed six different rooms, accommodating different age groups of children. Specific activities were identified as stressors and/or health risk factors inherent in the jobs according to the age of the children cared for. A list of ergonomic health risk factors and recommendations was generated.

Analysis of approaches to detection of sincerity of effort through grip strength measurement

Due to a variety of psychological and/or economic reasons, the validity of grip strength measurement to assess physical characteristics, progress in rehabilitation and degree of disability is sometimes compromised by a subjects deliberate submaximal performance. This paper analyzes the reliability and validity of various approaches used to detect sincerity of effort through grip strength measurement. Studies basing methodologies on the bell-shaped curve theory, cortical control theory, analysis of force relationships, use of coefficient of variation, and EMG techniques are examined. Strengths and limitations to each approach are discussed. Implications for future research are stated.

Sensory function assessment: A pilot comparison study of touch pressure threshold with texture and tactile discrimination

The purpose of this study was to determine if a correlation exists between touch-pressure threshold testing and sensory discrimination function, specifically tactile gnosis for texture and object recognition. Twenty-nine patients diagnosed with carpal tunnel syndrome (CTS), as confirmed by electromyography or nerve conduction velocity tests, were administered three sensibility tests: the Semmes-Weinstein monofilament test, a texture discrimination test, and an object identification test. Norms were established for texture and object recognition tests using 100 subjects (50 females and 50 males) with normal touch-pressure thresholds as assessed by the Semmes-Weinstein monofilament test. The CTS patients were grouped into three categories of sensibility as determined by their performance on the Semmes-Weinstein monofilament test: normal, diminished light touch, and diminished protective sensation. Through an independent t test statistical procedure, each of the three categories mean response times for identification of textures of objects were compared with the normed response times. Accurate responses were given for identification of all textures and objects. No significant difference (p < .05) was noted in mean response times of the CTS patients with normal touch-pressure thresholds. A significant difference (p < .05) in response times by those CTS patients with diminished light touch was detected in identification in four out of six objects. Subjects with diminished protective sensation had significantly longer response times (p < .05) for identification of the textures of cork, coarse and fine sandpaper, and rubber. Significantly longer response times were recorded by the same subjects for identification of such objects as a screw and a button, and for the shapes of a square, triangle, and oval.

Work Hardening and Work Conditioning

Since their inception in the late 1970s, work-hardening and work-conditioning programs have undergone metamorphoses. They have become less distinct and now offer more diverse services. This is primarily due to the ever-changing environment of health care, and the need to adapt to new consumer needs. Insurance demands, reimbursement issues, health care service trends, the adoption of disability management practices, and employee-employer relations are just a few variables influencing the practices of work-hardening and work-conditioning programs.

Employee ergonomics training: Current limitations and suggestions for improvement

Employee ergonomics training programs are increasingly being called upon as a strategy to reduce illness and injury in the workplace. A review of the literature on ergonomics training revealed a variety of methodologies and practices. Programs varied in structure, content and method of delivery. These variances, along with a number of obstacles purported to influence the acceptance and effectiveness of training programs, reflect some of the current limitations to effective ergonomics training. This paper recommends the application of adult education principles to improve program planning and training practices.

Estimated energy expenditure of nursing assistants in long term care

UNLABELLED Ergonomic research on nursing work has focused primarily on the biomechanical analysis of patient handling tasks. Few studies have addressed the intensity of a full day of nursing work as measured by changes in heart rate and energy expenditure. OBJECTIVE A pilot study was conducted between August 2009 and May 2010 to examine the intensity of performing nursing assistant work in long term care settings and to assess the usefulness of heart rate monitoring as a measure of work intensity. The residents of the facilities were physically dependent adults. The settings had floor-based mechanical lifting devices available and no-lift policies that restricted workers from lifting. PARTICIPANTS Eight women between the ages of 19 and 54 from two facilities participated in this study. METHODS A wearable recorder allowed unobtrusive heart rate monitoring while nursing assistants worked their usual shift. Continuous heart rate monitoring for a full shift provided an estimation of energy expenditure. RESULTS The data suggest that the nursing assistants worked at a moderate level yet were within the safe work intensity level recommended by NIOSH [32]. CONCLUSIONS The information provides preliminary baseline data for nursing assistants who work with physically dependent adults using floor-based lifts in a no-lift environment.