Work-related musculoskeletal disorders among physical therapists: an online survey

Purpose: To evaluate the rates and characteristics of musculoskeletal disorders (MSDs) in physical therapists (PTs) according to their specialty and setting. Method: Participants completed an online questionnaire including 15 demographic questions, 7 work-related and 8 injury-related questions for 9 different body parts. Results: Complete responses were obtained from 121 PTs; 96% reported MSD symptoms during the previous 12 months, 64% affecting at least 3 body parts. The body parts with the highest prevalence of symptoms were the low back (66%) and the neck (61%). For PTs specialized in acute care, geriatrics and pediatrics, the body part most commonly affected was the low back, while for PTs specialized in orthopedics and neurology, the body part most commonly affected was the neck. Regarding work settings, the low back was the most commonly affected for PTs working in skilled nursing facilities, outpatient clinics and hospitals, and the neck in PTs working in academic and home health settings. Conclusions: MSDs are common among PTs; the body parts most often affected were the low back and neck. The prevalence and body parts affected varied by practice setting and specialty area. The findings can help informing the design of evidence-based rehabilitation, prevention, training and educational programs.

• Implications for Rehabilitation

• Rehabilitation of injured physical therapists needs to address the symptoms of the multiple body parts that are usually affected (e.g. back, wrists and hands).

• Rehabilitation of injured physical therapists needs to take into consideration their job demands, practice setting and specialty area.

• The findings can inform the design of rehabilitation, prevention, training and educational programs for physical therapists.

     

Work-related musculoskeletal disorders in physical therapists: prevalence, severity, risks, and responses

BACKGROUND AND PURPOSE: Physical therapists are at risk for work-related musculoskeletal disorders (WMSDs). Little is known of how therapists respond or of what actions they take to prevent injury. The purpose of this study was to investigate the prevalence and severity of WMSDs in physical therapists, contributing risk factors, and their responses to injury. SUBJECTS: As part of a larger study, a systematic sample of 1 in 4 therapists on a state register (n=824) was surveyed. METHODS: An 8-page questionnaire was mailed to each subject. Questions investigated musculoskeletal symptoms, specialty areas, tasks and job-related risk factors, injury prevention strategies, and responses to injury. RESULTS: Lifetime prevalence of WMSDs was 91%, and 1 in 6 physical therapists moved within or left the profession as a result of WMSDs. Younger therapists reported a higher prevalence of WMSDs in most body areas. Use of mobilization and manipulation techniques was related to increased prevalence of thumb symptoms. Risk factors pertaining to workload were related to a higher prevalence of neck and upper-limb symptoms, and postural risk factors were related to a higher prevalence of spinal symptoms. CONCLUSION AND DISCUSSION: Strategies used to reduce work-related injury in industry may also apply to physical therapists. Increased risk of thumb symptoms associated with mobilization techniques suggests that further research is needed to establish recommendations for practice. The issues for therapists who move within or leave the profession are unknown, and further research is needed to better understand their needs and experiences.     

Work-related musculoskeletal disorders and the culture of physical therapy

BACKGROUND AND PURPOSE: Knowledge, skills, relationships, and attitudes of caring and working hard are all thought to be valued by physical therapists. This article explores how physical therapists see themselves, in light of some of these values, when they experience work-related musculoskeletal disorders (WMSDs). The article also explores the ways in which these values may compete with each other, and it suggests how this may contribute to the onset of WMSDs and to therapists' behavior following a WMSD. SUBJECTS AND METHODS: Eighteen therapists who had made a career change after a WMSD participated in interviews that were designed to gain insight into the attitudes and beliefs of therapists who had had a WMSD. RESULTS: Participants did not anticipate WMSDs, and they typically believed their physical therapy knowledge and skills would have prevented WMSDs from occurring. They saw themselves as knowledgeable and caring and indicated that these characteristics were highly valued by the profession. Their need to demonstrate these attributes sometimes resulted in behaviors that contributed to the development of their WMSDs and made them worse after their onset. DISCUSSION AND CONCLUSION: The cultural values of physical therapists may make it difficult for them to do their jobs in a way that minimizes the risk of WMSDs. The study identified a potential conflict between the therapists' need to (1) demonstrate their ability to work hard and care for their patients and (2) appear knowledgeable and skilled by remaining injury free.     

Prevalence,risk factors and preventive strategies in work‐related musculoskeletal disorders among Israeli physical therapists

Background and Purpose . Although physical therapists (PTs) have extensive knowledge of body mechanisms and injury prevention, work‐related musculoskeletal disorders (WRMD) are quite common in this population. The purposes of this study were: to determine the prevalence and impact of WRMD among Israeli PTs; to investigate WRMD risk factors and to identify preventive strategies used by PTs; and to compare the risk of injuries in two professional settings: rehabilitation centres (RCs) and outpatient clinics (OPCs). Method . A validated, modified Cromie questionnaire, translated into Hebrew, was distributed to the PTs at their workplaces. The relationship between WRMD symptoms and professional settings was analysed by Pearson chi‐square. The risk models were developed by logistic regression. One hundred and twelve PTs working in OPCs and RCs who defined themselves as healthy individuals were the subjects of this study. Results . Lifetime prevalence of WRMD was 83%. The highest prevalence of WRMD was in the lower back area (80%). Rehabilitation treatment was associated with an increased risk of lower back (odds ratio [OR] = 1.05) and shoulder symptoms (OR = 1.04); manual treatment was associated with an increased risk of wrist/thumb symptoms (OR = 1.11). Discussion . Work in RCs was associated with an increased prevalence of lower back/shoulder symptoms, whereas work in OPCs was associated with an increased prevalence of thumb/wrist symptoms. PT's used different strategies to reduce risk of WRMD, including altering practice technique. The respondents recommended administrative and ergonomic changes in the workplace. Conclusion . Workplace‐specific interventions to reduce WRMD in PTs should be developed and tested in future studies. Copyright © 2009 John Wiley & Sons, Ltd.     

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.     

Prevalence of musculoskeletal disorders is systematically higher in women than in men

OBJECTIVES: Many studies report a higher prevalence of musculoskeletal pain in women than in men. This paper presents an overview of sex differences in musculoskeletal pain with specific attention for: different parameters for duration of musculoskeletal pain (ie, 1-y period prevalence, point prevalence, prevalence of chronic pain, and prevalence of persistent chronic pain); and (2) different anatomic pain sites. METHODS: For the analyses, data from 2 general population-based prospective surveys (Dutch population-based Musculoskeletal Complaints and Consequences Cohort study and Monitoring Project on Risk Factors for Chronic Diseases-study) were used. The study population consisted of persons aged 25 to 64 years living in the Netherlands. Data on self-reported pain complaints were assessed by written questionnaires. RESULTS: The results of this study showed that prevalence rates of musculoskeletal pain were higher for women than for men in the Dutch general population aged 25 to 64 years on the basis of 2 population-based surveys. For musculoskeletal pain in any location, 39% of men and 45% of women reported chronic complaints. Highest female predominance was found for the hip and wrist/hand, whereas lowest and not statistically significant sex differences were found for the lower back and knee. All duration parameters of musculoskeletal pain showed a female predominance of musculoskeletal pain (1-y period prevalence, point prevalence, prevalence of chronic pain, and prevalence of persistent chronic pain). In those with persistent chronic pain, women tended to report higher severity scores. DISCUSSION: The present study shows that women have higher prevalence rates of musculoskeletal pain in most anatomic pain sites, no matter the duration of musculoskeletal pain. Future research should focus on explaining these sex differences with the ultimate goal to develop better prevention and management strategies for musculoskeletal pain in both men and women.     

Diagnosis of lower-extremity deep vein thrombosis in outpatients with musculoskeletal disorders: a national survey study of physical therapists

BACKGROUND AND PURPOSE: Prompt identification of outpatients who may have proximal lower-extremity deep vein thrombosis (PDVT) is important, in part, because of the risk of pulmonary embolism. The purposes of our study were to determine the degree of accuracy of physical therapists' estimates of the probability of PDVT in hypothetical patient vignettes and to determine whether physical therapists would contact the referring physician about the hypothetical patients' condition as recommended in published evidence. SUBJECTS AND METHODS: A survey instrument consisting of 6 vignettes was sent to a nationally representative random sample of 1,500 physical therapists. The clinical decision rule developed by Wells and colleagues served as the gold standard for PDVT probability. RESULTS: A total of 969 (65% response rate) physical therapists completed the survey. We found no evidence of nonresponse bias. For the 2 high-probability vignettes, 87% and 64% of the physical therapists underestimated the probability of PDVT. For the 2 high-probability cases, 32% and 27% of the physical therapists reported that they would not have contacted the referring physician. For the 2 moderate-probability cases, 15% and 30% of the physical therapists would not have contacted the referring physician. Therapist experience, certification status, place of practice, and region of the country did not explain the findings. DISCUSSION AND CONCLUSION: The care of outpatients who are at risk for PDVT could potentially be improved by use of the clinical decision rule developed by Wells and colleagues, although more study is warranted.     

Assessing the physiological strain of physical therapists according to work experience: A cross-sectional study

ObjectivesThis cross-sectional study aimed to assess the physiological response of physical therapists to compare the physiological workload within three groups of varying work experience and their comparative physiological responses during a 15-min recovery period.MethodsThirty therapists participated in the present study. They were divided into three groups with varying levels of work experience based on the number of years they had been in active employment: 1) Early Career (EC) group = 2–6 years); 2) Mid-Career (MC) group = 7–11 years), and 3) Late career (LC) group = over 11 years). Each group included 10 subjects comprised of both males and females. To conduct the measurements, each therapist treated one hemiplegic patient for 20 min using a passive range of motion protocol and then rested for 15 min. The maximum voluntary contraction on trapezius and deltoid muscles were tested using electromyography before and after treatment. During treatment, the muscle workload, muscle fatigue, and cardiovascular load were measured. The perceived workload was assessed using a subjective workload index (SWI) questionnaire following treatment.ResultsThe three work experience groups of physical therapists performed a similar workload. The SWI corresponded well with physiological measurement. The muscle capacity after treatment of the EC group was significantly lower than that of the MC group (p < 0.05). Notably, the right deltoid of the LC group was significantly lower than that of the MC group.ConclusionsThe physical therapists worked with a moderate, objectified workload. A 15-min rest period brought the cardiovascular load below 30% and lowered fatigue in the right deltoids. This result may indicate a musculoskeletal disorder warning signal for the physical therapists.     

Nineteen years of experience with autotransfusion for elective surgery in children: more troublesome than we expected

BACKGROUND: Under the rationale that children undergoing elective surgery are the best candidates for autologous blood donors because of their long life expectancy, aggressive donations of autologous blood, even from infants, have been reported. A number of problems are associated with the procedure, however, whereas the risks of homologous blood are very low. STUDY DESIGN AND METHODS: From 1987 through 2005, of 5792 patients referred to blood transfusion services at two Japanese university hospitals for autologous blood donations, 314 children younger than 16 years old served as subjects for assessment. RESULTS: Of 314 children, 7 were not suitable as autologous donors. In most cases this was due to uncooperative behavior. Over a follow-up period of 19 years, the authors encountered 53 cases (17.3%) of donation-related problems, and this rate was higher than the 6 percent rate recorded for adult cases (316/5305). Nine children suffered crucial complications such as vasovagal reactions, and one 14-year-old boy required a vasopressor drug. Important findings were that 6 of these were first-time donors, and the amount of blood drawn was under 10 percent of their estimated blood volume. CONCLUSION: Of 53 donation-related problems, 9 (17.0%) were accompanied by marked hypotension. Drawing autologous blood from children has become easier with advanced devices; however, lessening of anxiety and tension are essential for the safety of children's autologous blood donation programs. Aggressive donation should be avoided.     

Prevalence of sleep disorders in school children between 11 and 15 years of age

Little is known about sleep disorders in children and adolescents that might affect physical and emotional well-being. Depending on age and size of the cohort group, and differences in questionnaires, prevalence varies between 1-43% in international studies. We examined the prevalence of symptoms characteristic of sleep disorders in school aged children with a questionnaire which allows indication of symptoms by the children themselves. METHODS: An anonymous questionnaire, based on the German Dresden questionnaire, with 22 questions concerning the main symptoms of obstructive sleep apnea syndrome (OSAS), general symptoms of para- and insomnia as well as sociodemographic data, was developed. 332 pupils (age: 11-15 y, mean: 12.75 y; median: 12 y; 56% female, 44% male) in 2 high schools in Vienna were investigated. RESULTS: 28% (n = 93/332) of the examined group reported snoring (the main symptom of OSAS) and/or insomnia (night waking almost every night) or parasomnia (nightmares, night terrors or sleepwalking almost every night). 15% (n = 14/93) of this subgroup reported snoring and para- or insomnia coincidentally. Girls were affected more frequently than boys by nocturnal awakening (79% vs. 56%, p < 0.001) and nightmares (64% vs. 52%, p < 0.01). The snoring group (21% (71/332) of all examined children) was affected more frequently by mouth dryness (16% vs. 4%, p < 0.001), pallor (7% vs. 3%, p < 0.01), night sweats (6% vs. 1%, p < 0.05) and from the following sleep disorders: nightmares (10% vs. 2%, p < 0.01), night terrors (4% vs. 1.5%, p < 0.001), sleepwalking (1.4% vs. 1%, p < 0.05) and nocturnal awakening (16% vs. 5%, p < 0.01). DISCUSSION: Almost every fifth child reports about at least one main symptom characteristic of OSAS. The statistically significant relation between symptoms of OSAS and non-organic sleep disorders shows the necessity of interdisciplinary focusing on sleep disorders. Further epidemiological studies need to be carried out in order to clarify the role of sleep anamnesis in the diagnosis and management of sleep disorders during childhood.     

Work-related beliefs about injury and physical capability for work in individuals with chronic pain

According to a fear-avoidance model of chronic pain, disability is largely determined by the erroneous belief that an increase in activity level is potentially harmful. Further, recent literature suggests that excessive fears regarding physical activities contribute to significant disability. However, the relation of changes in these fears to functional work capabilities has gone largely uninvestigated. The present study examined how changes in physical capability for work were related to changes in pain severity and fear-avoidance beliefs for general physical and work-specific activities, as well as investigating whether an interdisciplinary treatment program for chronic pain was associated with changes in these specific fears in 65 individuals with chronic pain. Results revealed that significant decreases in fear and pain levels occurred from pre- to post-treatment, in addition to increases in physical capability for work. Further, changes in work-specific fears were more important than changes in pain severity and fear of physical activity in predicting improved physical capability for work. These results expand previous research, which has found a relation between self-reported disability and fear-avoidance beliefs, by demonstrating the relation with fear of work to actual work-related behaviors.     

Work-related behaviour and experience pattern in nurses: impact on physical and mental health

Nursing is associated with high levels of emotional strain and heavy workloads. Changing working conditions raise the importance of investigating job satisfaction, stress and burnout and its consequences for nurses. The aim of the study was to investigate whether work-related behaviour and experience patterns are associated with mental and physical health status in nurses. A sample of 356 nurses in four German hospitals were interviewed using questionnaires regarding work-related behaviour and experience patterns, work stress, depression, anxiety and physical symptoms ('Work-related Behaviour and Experience Pattern'--AVEM and ERI). The main result of this study is that unhealthy work-related behaviour and experience patterns (i.e. the excessive ambitious type and the resigned type) are associated with reduced mental and physical health. Preventive, as well as intervention, strategies are needed that focus both on the individual as well as on working conditions.     

Prevalence and impact of chronic musculoskeletal ankle disorders in the community

Hiller CE, Nightingale EJ, Raymond J, Kilbreath SL, Burns J, Black DA, Refshauge KM. Prevalence and impact of chronic musculoskeletal ankle disorders in the community.ObjectiveTo determine the point prevalence of chronic musculoskeletal ankle disorders in the community.DesignCross-sectional stratified (metropolitan vs regional) random sample.SettingGeneral community.ParticipantsPopulation-based computer-aided telephone survey of people (N=2078) aged 18 to 65 years in New South Wales, Australia. Of those contacted, 751 participants provided data.InterventionsNot applicable.Main Outcome MeasuresPoint prevalence for no history of ankle injury or chronic ankle problems (no ankle problems), history of ankle injury without residual problems, and chronic ankle disorders. Chronic musculoskeletal ankle disorders due to ankle sprain, fracture, arthritis, or other disorder compared by chi-square test for the presence of pain, weakness, giving way, swelling and instability, activity limitation, and health care use in the past year.ResultsThere were 231 (30.8%) participants with no ankle problems, 342 (45.5%) with a history of ankle injury but no chronic problems, and 178 (23.7%) with chronic ankle disorders. The major component of chronic ankle disorders was musculoskeletal disorders (n=147, 19.6% of the total sample), most of which were due to ankle injury (n=117, 15.6% of the total). There was no difference among the arthritis, fracture, sprain, and other groups in the prevalence of the specific complaints, or health care use. Significantly more participants with arthritis had to limit activity than in the sprain group (Chi-square test, P=.035).ConclusionsChronic musculoskeletal ankle disorders affected almost 20% of the Australian community. The majority were due to a previous ankle injury, and most people had to limit or change their physical activity because of the ankle disorder.     

Preparation of physical therapists to work with handicapped infants and their families: current status and training needs

The purposes of this study were to determine the current status of physical therapists' preparation to work with handicapped and at-risk infants and their families and to identify needs for infant- and family-focused training materials and curricula. Results of a telephone survey of 73 physical therapy programs and a follow-up mail survey of 14 physical therapy programs with infancy specialization options are presented. Students in entry-level programs and postprofessional master's degree programs with infancy specializations commonly received instruction in infancy-related topics. Many students received minimal or no exposure to family-related content. Family assessment and intervention were identified as the areas of highest priority for development of training materials and curricula. The results of this study provide direction for the design of infant- and family-focused training materials and curricula in physical therapy.     

Prevalence of musculoskeletal symptoms in hospital nurse technicians and licensed practical nurses: associations with demographic factors

Objective

: This cross-sectional study aimed at analyzing: 1. the main musculoskeletal symptoms (MSS) presented by hospital nursing workers and; 2. personal, occupational, and health factors related to MSS among them.

Method

: Two questionnaires were filled in by 245 nurse technicians (NTs) and licensed practical nurses (LPNs) (response rate 95%) associated with direct patient care sectors from a hospital. These questionnaires were: the standardized version of the Nordic Musculoskeletal Questionnaire (NMQ) and one including questions on 15 demographic independent variables potentially related to outcomes from the NMQ. Univariate analyses and binary logistic regression analyses were performed to identify which variables would explain the occurrence of MSS in different body regions.

Results:

The low back (57%), shoulder (52%), and neck (48%) were identified as the most affected regions. The logistic regression analysis showed that low back symptoms in the last 12 months were significantly associated with LPN activities (OR=2.36; CI=1.24-4.5) and previous sick leave due to MSS (OR=5.97; CI=1.2-29.1). Smoking was significantly associated with symptoms in the low back (OR=2.77; CI=1.13-6.8) and thoracic spine (OR=2.37; CI=1.04-5.40). Physical exercise showed a protective effect on the cervical spine (OR=0.42; CI=0.23-0.77). Previous sick leave was significantly associated with pain in the knees (OR=4.24; CI=1.33-13.5) and in the upper limbs (OR=5.36; CI=1.07-26.7).

Conclusions:

The nursing workers who were evaluated presented a high prevalence of MSS. Previous history of sick leave was strongly associated with the presence of symptoms in various body regions. These results indicate the need for preventive programs in the hospital environment in order to control more severe MSS in nursing professionals.     

Work-related stress,job satisfaction,and quality of work life among cardiovascular nurses in Italy: Structural equation modeling

AimTo investigate the simultaneous effects of work-related stress and job satisfaction on cardiovascular nurses' quality of work life.BackgroundPrior research has investigated nurses' work-related stress, job satisfaction, and quality of work life as separate aspects and not in specific nursing settings, such as cardiovascular wards. Cardiovascular care settings can be particularly stressful for nurses, who are often faced with distress, depression and patients and caregivers' physical and psychological exhaustion.MethodsA multicenter cross-sectional study was conducted among 1126 cardiovascular nurses from 10 hospitals in Italy. Work-related stress, job satisfaction, and quality of work life were measured using valid and reliable questionnaires. Structural equation modeling was performed.ResultsNurses working in critical cardiac care units experienced more stress than their colleagues working in other cardiac units. Nurses working in cardiac outpatient clinics reported lower quality of work life than those working in other cardiac settings. There was a negative relationship between work-related stress and nurses' quality of work life, which was partially mediated by job satisfaction, indicating that stress generated by the work environment negatively affect nurses' quality of work life by reducing their job satisfaction.ConclusionCardiovascular nurses' quality of work life is negatively affected by work-related stress. The work-related stress is mediated through job satisfaction. Nurse managers should maximize nurses' job satisfaction by providing comfort at work, supporting professional development opportunities, sharing organizational objectives, and actively listening and addressing nurses' concerns. When cardiovascular nurses' quality of work life is elevated, patients' care quality and outcomes are improved.