Renee M. Williams

Systematic Review of the Role of Occupational Health and Safety Interventions in the Prevention of Upper Extremity Musculoskeletal Symptoms, Signs, Disorders, Injuries, Claims and Lost Time

Background Little is known about the most effective occupational health and safety (OHS) interventions to reduce upper extremity musculoskeletal disorders (MSDs) and injuries. Methods A systematic review used a best evidence synthesis approach to address the question: “do occupational health and safety interventions have an effect on upper extremity musculoskeletal symptoms, signs, disorders, injuries, claims and lost time?” Results The search identified 36 studies of sufficient methodological quality to be included in data extraction and evidence synthesis. Overall, a mixed level of evidence was found for OHS interventions. Levels of evidence for interventions associated with positive effects were: Moderate evidence for arm supports; and Limited evidence for ergonomics training plus workstation adjustments, new chair and rest breaks. Levels of evidence for interventions associated with “no effect” were: Strong evidence for workstation adjustment alone; Moderate evidence for biofeedback training and job stress management training; and Limited evidence for cognitive behavioral training. No interventions were associated with “negative effects”. Conclusion It is difficult to make strong evidenced-based recommendations about what practitioners should do to prevent or manage upper extremity MSDs. There is a paucity of high quality OHS interventions evaluating upper extremity MSDs and none focused on traumatic injury outcomes or workplace mandated pre-placement screening exams. We recommend that worksites not engage in OHS activities that include only workstation adjustments. However, when combined with ergonomics training, there is limited evidence that workstation adjustments are beneficial. A practice to consider is using arm supports to reduce upper extremity MSDs.

Effectiveness of workplace rehabilitation interventions in the treatment of work-related low back pain: a systematic review

Purpose. A systematic review was conducted to evaluate the effectiveness of workplace rehabilitation interventions for injured workers with low back pain (LBP). Method. MEDLINE, CINAHL (Cumulative Index to Nursing and Allied Health Literature), EMBASE, and AMED (Allied and Complementary Medicine) were searched from 1982 to 2005 for peer-reviewed studies of rehabilitation interventions that were provided at the workplace to workers with musculoskeletal work-related LBP. Methodological quality appraisal and data extraction were conducted by five reviewers. Results. Of a total of 1,224 articles that were identified by the search, 15 articles, consisting of 10 studies, were of sufficient quality to be included in the review. The best evidence was that clinical interventions with occupational interventions as well as early return to work/modified work interventions were effective in returning workers to work faster, reducing pain and disability, and decreasing the rate of back injuries. Ergonomic interventions also were found to be effective workplace interventions. Conclusion. The need for further research in this area is necessary to reduce the burden of back pain on employees and their families, employers, and the health care system.

A Randomized Controlled Trial of Transcutaneous Electrical Nerve Stimulation (codetron) to Determine Its Benefits in a Rehabilitation Program for Acute Occupational Low Back Pain

The authors report the results of a randomized controlled trial to examine the effectiveness of transcutaneous electrical nerve stimulation (TENS/CODETRON) when added to a standard exercise program for industrial workers with acute low back pain (LBP). Fifty-eight work-injured patients with LBP of 3-10 weeks duration were randomized into two groups that received actual or placebo stimulation in combination with the exercise regimen. The groups were compared on the primary outcome measures of disability, pain, and return to work. No significant differences between the experimental and placebo groups were discovered on any of the measured outcomes. Exercise alone, when continued over 4 weeks, reduced disability and pain scores significantly. Under the experimental conditions of this trial, no additional benefits of TENS/CODETRON were detected when added to an active exercise regimen.

Critical thinking and learning styles of students in a problem-based, master's entry-level physical therapy program

The purpose of this study was to compare critical thinking ability and critical thinking disposition of physical therapy students in year 1 and year 2 of an entry-level Masters program, and determine the association between critical thinking and preferred learning styles. Fifty year 1 and 44 year 2 students were tested for critical thinking ability on the California Critical Thinking Skills Test (CCTST), critical thinking disposition on the California Critical Thinking Disposition Inventory (CCTDI), and learning style on the Kolb Learning Style Inventory (LSI). Repeat testing of the critical thinking tests was done 8 months later. Two-way repeated measures analyses of variance (ANOVA) were used to compare students between years and times. Associations between variables were determined by means of Pearsons or Spearmans correlations. The mean scores of the CCTST (year 1: 20.7 ± 3.96, year 2: 20.2 ± 3.08) and total CCTDI (year 1: 314.6 ± 22.57, year 2: 315.2 ± 23.37) were not significantly different between years, and did not change over time. The ANOVA revealed significant effects for three subscales of the CCTDI: truth-seeking—year 2 greater than year 1, self-confidence—significant time effect, and systematicity—significant year × group interaction effect. None of the CCTDI scores was significantly correlated with CCTST. Critical thinking scores were not different among the four LSI categories. LSI scores did not predict change in critical thinking. Masters entry-level physical therapy students did not have major changes in their critical thinking ability or disposition during the program.

Employers and policy makers can make a difference to the employment of persons with disabilities.

Purpose : The purpose of this article is to discuss what employers and policy makers can do to promote employment success for persons with disabilities. A study carried out in Rehabilitation Science at McMaster University, Ontario, Canada identified a number of themes, definitions of success and recommendations for change. Method : This article is a descriptive review of the study outcomes as well as a discussion of how the literature contributes to the position that employers and policy makers can do more to ensure that persons with disabilities achieve success in paid employment. Results : The author proposes strategies that employers and policy makers can use that have been recommended both in the study and other more recent documents. Conclusions : Despite attempts to move the employment agenda for persons with disabilities forward, the results in both North America and Europe appear to be dismally low. There is evidence to suggest that employer activity in this regard is still minimal and that policy makers are not working together to ensure that there are opportunities for this population to succeed. Professionals working in this field need to be more actively involved with both employers and policy makers in order for the environment to change in a significant way.

Psychometric Evaluation of Health-Related Work Outcome Measures For Musculoskeletal Disorders: A Systematic Review

Introduction: This systematic review evaluated the quality of psychometric properties of self-report health-related work outcome measures for patients with musculoskeletal disorders. Methods: Electronic searches of MEDLINE, EMBASE, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) between 1980 and December 2006 were conducted for peer-reviewed studies that evaluated self-report work outcome measures for patients with musculoskeletal disorders. The eligibility criteria for the papers included in the review were articles that: (1) discussed the psychometric evaluation of a self-reported health-related work outcome measure, (2) were conducted with patients who were diagnosed with musculoskeletal disorders, (3) were written as peer-reviewed full published reports, and (4) were published in English. Three pairs of reviewers used a modified rating form and evaluated the quality of the psychometric properties of the instruments described in the retrieved articles. Results: Of the 740 articles that were identified, six instruments in eight studies met the inclusion criteria. None of the instruments demonstrated satisfactory results for all properties. Overall, the highest quality ratings were given to the Functional Abilities Confidence Scale and the Occupational Role Questionnaire. Conclusions: Although validation studies of self-report health-related work outcome measures for patients with musculoskeletal disorders exist, they appear to be limited in the quality of their psychometric properties. There is a need to continue to validate health-related work outcome measures and to make them more meaningful for patients and clinicians.

Disability Management Practices in Ontario Health Care Workplaces

Background: Workplace disability management programs are important in managing injury and disability. Methods: A stratified random sample of 188 employers in health care workplaces (71 hospitals, 48 nursing homes, 42 private clinics, and 27 community clinics) completed a mailed Organizational Policies and Practices (OPP) questionnaire. The OPP asked questions about eight workplace disability management practices. This article compares disability management practices across the four types of health care workplaces. Results: A one-way analysis of variance for each of the eight practices demonstrated significant differences across facility types for all practices, except ergonomic practices. For unionized versus non-unionized workplaces, there were significant differences in all practices, except ergonomic practices. For workplaces with formal policies versus those without policies, there were significant differences in all practices, except people-oriented culture and safety diligence. Conclusion: Variations in disability management practices in health care workplaces need to be addressed to provide more effective prevention and treatment of work-related injuries and disability.

Workplace organizational policies and practices in Ontario educational facilities.

Background: Workplace organizational policies and practices (OPPs) play a pivotal role in managing injury and disability. This study identifies the workplace OPPs in Ontario’s education sector. Methods: OPPs were examined using a cross-sectional survey with 157 participants. The relationship among the type of school, workplace OPPs and injury and disability outcomes were investigated. Results: Mean subscale scores (potential range 1–5) varied from 3.1 (SD, 1.0) to 4.2 (SD, 0.6) for all schools. Private schools scored lowest on measures of disability prevention, disability management, and corporate culture. Ergonomic practices and return to work initiatives were achieved less frequently than other OPPs for all schools. Higher scores on safety diligence were associated with lower injury and disability incidence (proportion of variance explained ranged from 10 to 23%). Higher scores on people-oriented culture were associated with lower disability incidence and duration (proportion of variance explained ranged from 7 to 20%). Conclusions: Public schools engage more often in workplace OPPs than private schools. Improved achievements on safety diligence and people-oriented culture practices predict reduced injury and disability outcomes.