Helping workers help themselves: empowering physiotherapy clients to manage musculoskeletal problems at work

Abstract

There is increasing evidence that work is associated with positive health outcomes. Various strategies to retain or return patients to work with a musculoskeletal injury have been tested, but the role of the individual should also be considered. The worker is important to the overall success of the rehabilitation process so strategies to encourage or empower the individual to identify and solve some of their own return-to-work challenges need to be considered. The aim of this paper is to summarize the work conducted by the authors in the arena of work disability prevention and to provide practical suggestions for physiotherapists on how they can empower patients to help themselves remain at work or return to work safely and expeditiously. Empowerment of workers to attain occupational goals is discussed with suggestions on how the physiotherapist can facilitate this in their patients by: (1) encouraging workers to stay at work if at all possible; (2) making recommendations for work based on the assessed work capacity of the patient; and (3) determining the patient’s level of confidence in remaining or returning to full duties and hours given their current level of pain and disability.     

The values underlying team decision-making in work rehabilitation for musculoskeletal disorders

PURPOSE: This paper presents the results of a qualitative study on the values underlying the decision-making process of an interdisciplinary team working in a work rehabilitation facility of a Québec teaching hospital. METHODS: In order to document the values underlying the decision-making process, a single case observational study was conducted. Interdisciplinary team weekly discussions on ongoing cases of 22 workers absent from work due to musculoskeletal disorders were videotaped. All discourses were transcribed and analyzed following an inductive and iterative approach. The values identified were validated by feedback from team members. RESULTS: Ten common decision values emerged from the data: (1) team unity and credibility, (2) collaboration with stakeholders, (3) worker's internal motivation, (4) worker's adherence to the program, (5) worker's reactivation, (6) single message, (7) reassurance, (8) graded intervention, (9) pain management and (10) return to work as a therapy. The analysis of these values led to the design of a model describing interrelations between them. CONCLUSIONS: This study throws light on some mechanisms underlying the decisions made by the team and determining its action. This improves understanding of the actions taken by an interdisciplinary team in work rehabilitation and may facilitate knowledge transfer in the training of other teams.     

The values underlying team decision-making in work rehabilitation for musculoskeletal disorders

Purpose.?This paper presents the results of a qualitative study on the values underlying the decision-making process of an interdisciplinary team working in a work rehabilitation facility of a Québec teaching hospital.

Methods.?In order to document the values underlying the decision-making process, a single case observational study was conducted. Interdisciplinary team weekly discussions on ongoing cases of 22 workers absent from work due to musculoskeletal disorders were videotaped. All discourses were transcribed and analyzed following an inductive and iterative approach. The values identified were validated by feedback from team members.

Results.?Ten common decision values emerged from the data: (1) team unity and credibility, (2) collaboration with stakeholders, (3) worker's internal motivation, (4) worker's adherence to the program, (5) worker's reactivation, (6) single message, (7) reassurance, (8) graded intervention, (9) pain management and (10) return to work as a therapy. The analysis of these values led to the design of a model describing interrelations between them.

Conclusions.?This study throws light on some mechanisms underlying the decisions made by the team and determining its action. This improves understanding of the actions taken by an interdisciplinary team in work rehabilitation and may facilitate knowledge transfer in the training of other teams.     

Boron workers in China: exploring work and lifestyle factors related to boron exposure.

This article describes the lifestyle patterns of boron mining and processing workers (N=936) and a comparison group (N=251) in northeast China, and explores relationships between boron exposure and reproductive health. An English version of an interview guide addressing areas of work and lifestyle relevant to boron exposure and metabolism was developed by an occupational health research team, translated to Chinese, and translated back, for clarity. Modifications incorporated suggestions from a local community advisory board and boron industry workers; the translation-back translation process was reapplied, and cultural and semantic equivalence was attained. Results from the interviews showed more than 64% of workers and comparison group participants smoked tobacco and more than 92% reported exposure to environmental tobacco smoke. Boron workers and the comparison group varied in their food intake and alcohol consumption, but not in their smoking habits. Thirty-four percent of boron workers reported eating in the contaminated work area. Nearly all boron workers (99%) showered or bathed after work, although approximately 10% redressed in their contaminated clothes. Reproductive health outcomes were explored, including delayed pregnancy, multiple births, spontaneous miscarriages, induced abortions, stillbirths, and an unusual ratio of male to female offspring. Implications for occupational health nurses and recommendations for future research are provided.     

Sleep disorders in shift workers and life-style related disease

With Japanese social change toward a 24-hour society, a substantial proportion (ca. 27%) of workers is engaged in shift work schedules. It is known that shift workers may occasionally show a complaint of insomnia and/or excessive sleepiness. Thus, circadian rhythm sleep disorder, shift work type(shift work disorder), seems to be prevalent in our society. In shift work disorder, there is a complaint of insomnia or excessive sleepiness that is temporally associated with a recurring work schedule that overlaps the usual time of sleep. Complication may include gastrointestinal symptoms and life-style disease. The present paper overviews evidence on the relationship between shift work disorder and life-style related disease.     

Characteristics of disability pensioners returning to work: An interview study among individuals with musculoskeletal disorders

Purpose. To explore adaptation patterns among disability pensioners with musculoskeletal disorders returning to work by means of the Swedish law on ‘resting disability pension’.

Method. Qualitative analyses of interviews with 17 individuals going back to work.

Results. Three adaptation patterns were identified: The Go-getter, the Realist and the Indifferent. These differed regarding influence factors, own expectations, motive, morals and mentality.

Conclusion. Several actors may support a return to work for individuals who received a disability pension due to musculoskeletal disorders. In order to succeed, however, it is essential that the disability pensioner is motivated for a reconstruction of his/her life.     

Characteristics of disability pensioners returning to work: an interview study among individuals with musculoskeletal disorders

Purpose. To explore adaptation patterns among disability pensioners with musculoskeletal disorders returning to work by means of the Swedish law on 'resting disability pension'.

Method. Qualitative analyses of interviews with 17 individuals going back to work.

Results. Three adaptation patterns were identified: The Go-getter, the Realist and the Indifferent. These differed regarding influence factors, own expectations, motive, morals and mentality.

Conclusion. Several actors may support a return to work for individuals who received a disability pension due to musculoskeletal disorders. In order to succeed, however, it is essential that the disability pensioner is motivated for a reconstruction of his/her life.     

Ultrasound therapy for musculoskeletal disorders: a systematic review.

BACKGROUND: Ultrasound therapy is used frequently to reduce pain and related disability, mainly by physiotherapists. The objective of this review was to evaluate the effectiveness of ultrasound therapy in the treatment of musculoskeletal disorders. METHODS: Published reports of randomized clinical trials investigating the effects of ultrasound therapy on pain, disability or range of motion were identified by a systematic search of MEDLINE, EMBASE and the Cochrane databases, supplemented with citation tracking. The quality of methods of all selected publications was assessed systematically by two independent and 'blinded' reviewers, using ten validity criteria. Data from the original publications were used to calculate the differences between groups for success rate, pain, disability and range of motion. Statistical pooling was performed if studies were homogeneous with respect to study populations, interventions, outcome measures and timing of follow-up. RESULTS: 38 Studies were included in the review, evaluating the effects of ultrasound therapy for lateral epicondylitis (n = 6), shoulder pain (n = 7), degenerative rheumatic disorders (n = 10), ankle distorsions (n = 4), temporomandibular pain or myofacial pain (n = 4) and a variety of other disorders (n = 7). In 11 out of 13 placebo-controlled trials with validity scores of at least five out of ten points, no evidence of clinically important or statistically significant results was found. Statistical pooling was only feasible for placebo-controlled trials on lateral epicondylitis, and produced a pooled estimate for the difference in success rate of 15% (95% confidence interval -8%-38%). CONCLUSIONS: As yet, there seems to be little evidence to support the use of ultrasound therapy in the treatment of musculoskeletal disorders. The large majority of 13 randomized placebo-controlled trials with adequate methods did not support the existence of clinically important or statistically significant differences in favour of ultrasound therapy. Nevertheless, our findings for lateral epicondylitis may warrant further investigation.     

Factors associated with generalized anxiety in workers undergoing work rehabilitation for persistent musculoskeletal pain

Abstract

Purpose: To document in workers having a work disability due to a musculoskeletal disorder (MSD), the presence and variation over time of their intolerance of uncertainty and its maintenance factors as defined in Dugas et al.’s generalized anxiety disorder (GAD) model, i.e. worries, negative problem orientation, beliefs about the usefulness of worrying, cognitive avoidance and their consequences on depressive symptoms. Methods: An observational, prospective repeated-measures design was retained. Thirty-nine workers with an MSD having caused a work absence of over three months and who were beginning a work rehabilitation program were recruited and evaluated at four moments (beginning of rehabilitation program, first hours of work exposure, 50% of regular working hours and end of rehabilitation program). Validated self-report questionnaires measuring intolerance of uncertainty and its maintenance factors were administered. Finally, the Worry and Anxiety Questionnaire measured the presence and intensity of GAD symptoms as defined in the DSM-IV-TR. Results: Fifty percent of the workers initially exhibited GAD symptoms. Concerning the variation over time, improvements were noted in all GAD-related factors during the program, particularly with the first hours of work exposure. At the end of rehabilitation, only 21% of the participants still met GAD diagnostic criteria. Conclusion: Workers with an MSD causing a work disability averaging one year in length and enrolled in a work rehabilitation program exhibited a high level of anxiety at the beginning of the work rehabilitation program. Workers perceived a usefulness in worrying and presented some intolerance of uncertainty and some cognitive avoidance strategies. According to Dugas et al.’s GAD model, the intensity of the symptoms associated with GAD development and maintenance factors was, however, not typical of a GAD.

• Implication for Rehabilitation

• A reconceptualization of the problem in terms of reducing the work disability rather than reducing pain may constitute a promising avenue to reduce anxiety symptoms.

• Future studies should look at the specific impact of work exposure, not only on pain symptoms but also on worries.

• The high level of anxiety and the reported worries by workers stresses the importance of studying the hypothesis of a workplace phobia in order to improve clinical practice guidelines.

     

Musician health and safety: Preventing playing-related musculoskeletal disorders.

Musicians are exposed to high-risk musculoskeletal activities such as repetition, hours of exposure, and awkward postures when playing instruments. These activities may result in playing-related musculoskeletal disorders. Musicians often work part-time or seasonally or are self-employed. Thus, they may be uninsured or underinsured and may delay seeking care for these painful and potentially disabling conditions. Prevention of playing-related musculoskeletal disorders includes identification of both intrinsic (e.g., musician strength and flexibility) and extrinsic (e.g., musician posture while playing an instrument) factors involved in the interface between musicians and their instruments and the playing environment (e.g., rest breaks or hours of practice). Student occupational health nurse practitioners in this pilot project performed outreach and comprehensive screening and treatment for a small group of musicians diagnosed as having playing-related musculoskeletal disorders. Tendon and nerve gliding exercises were a key component of the treatment plan.     

Suggestions for preventing musculoskeletal disorders in home healthcare workers. Part 2: lift and transfer assistance for non-weight-bearing home care patients

Home healthcare (HHC) is one of the fastest-growing professions, currently employing more than 1 million workers in the United States. Unfortunately, these workers sustain an exceptionally high rate of musculoskeletal disorders. This is the second article in a two-part series providing information and suggestions for preventing overexertion that can lead to such disorders.     

Association of musculoskeletal disorders and workload with work schedule and job satisfaction among emergency nurses

BackgroundThe emergency department is a highly demanding work environment, considered by high workload and stress. The impact of work-related factors on musculoskeletal disorders (MSDs) in emergency nurses (ENs) are not yet well understood. We investigated the association of MSDs and workload with work schedule (permanent day and night work) and job satisfaction in ENs.MethodData were collected through a questionnaire including individual and work-related factors, workload (National Aeronautics and Space Administration-Task Load Index [NASA-TLX]) and MSDs (Standardized Nordic Questionnaire) from 380 ENs in five hospitals.ResultsThe findings revealed that work schedule and job satisfaction levels were significantly associated with the MSDs in different body regions. Work schedule was significantly related to physical demand, performance, frustration, and overall workload, whereas it was not to the mental and temporal demands and effort. Job satisfaction level was negatively associated with mental demand and frustration. A high prevalence of musculoskeletal problems, particularly in knees, upper back, lower back, neck and shoulders were found.ConclusionMSDs are highly prevalent among ENs involved in night work and with low job satisfaction levels. The results are discussed in terms of their implications for emergency hospital nurses. The findings can help to better understand the working conditions and emphasize the need for ergonomic interventions in order to reduce MSDs and workload. Also, the study findings highlight the importance of mental aspects of workload in this occupational group.     

Suggestions for preventing musculoskeletal disorders in home healthcare workers. Part 1: lift and transfer assistance for partially weight-bearing home care patients

Home healthcare is one of the fastest-growing professions, currently employing more than 1 million workers in the United States. Unfortunately, these workers sustain an exceptionally high rate of musculoskeletal disorders. This is the first article in a two-part series providing information and suggestions for preventing overexertion that can lead to such disorders.     

Treatment of chikungunya musculoskeletal disorders: a systematic review

Introduction: Chikungunya virus is amongst the fastest expanding vector transmissible diseases in recent years and has been causing massive epidemics in Africa, Asia, Latin America and the Caribbean. Despite human infection by this virus being first described in the 1950s, there is a lack of adequate therapeutic evaluations to guide evidence-based recommendations. The current guidelines rely heavily in specialists’ opinion and experience instead of using higher rated evidence.

Areas covered: A systematic review of the literature was performed- not restricted to clinical trials – reporting the therapeutic response against this infection with the intent to gather the best evidence of the treatment options against musculoskeletal disorders following chikungunya fever. The 15 studies included in the analysis were categorized considering the initiation of treatment during the acute, subacute and chronic phase.

Expert commentary: This review demonstrates the complexity of chikungunya fever and difficulty of therapeutic management. This review found no current evidence-based treatment recommendations for the musculoskeletal disorders following chikungunya fever. To provide an optimal treatment that prevents perpetuation or progression of chikungunya infection to a potentially destructive and permanent condition without causing more harm is an aim that must be pursued by researchers and health professionals working with this disease.