The functional capacity of healthcare workers with history of severe acute respiratory distress syndrome (SARS) complicated with avascular necrosis--case report

Two years after the SARS outbreak in Hong Kong, 128 healthcare workers continued to present with musculoskeletal complaints and 38 workers were diagnosed with avascular necrosis (AVN) in different joints. 13 healthcare workers were referred to six designated Physiotherapy Departments of the Hospital Authority for a tailor-made standardized Functional Capacity Evaluation (FCE) from 2004 to 2005 on a voluntary basis. Job analysis, workers' self-perceived disability and functional capacity, non-material handling tests, and the cardiopulmonary fitness test were performed. Retrospective review of the FCE data showed that there were 17 AVN of hips, 16 AVN of knees, 3 AVN of shoulders. All patients had AVN of lower limb joints. Nearly full ranges of movement (ROM) were observed in the knees involved, but the hip range was decreased for most subjects suffering from hip AVNs. Most workers (n=12) could not complete the cardiopulmonary test due to intolerable joint pain. Six workers' self-perceived physical demands level (PDC) matched with the physical demands level identified by the FCE. 12 healthcare workers attained a sedentary physical demands level and were unable to match with their previous job demands. One staff was classified as light physical demands and managed his original duty. Four workers had returned to work at the time FCE was performed. The tailor-made FCE added information to facilitate the return-to-work planning for the staff. Four more workers returned to work with modified duties one year after the FCE.     

Unexpected barriers in return to work: lessons learned from injured worker peer support groups

Some workers who are injured at work have unexpectedly prolonged absences from work. Experiences of workers who constitute a disproportionate cost to the return-to-work system and the systemic and compliance-related barriers they encounter during the process of returning to work are reported. A qualitative interview based study was conducted with 37 members of three injured worker peer support groups in a Canadian province. Four dimensions of peer support were identified: worker experience of being misunderstood by system providers, need for advocates, social support, help with procedural complexities of the workers' compensation, and health care systems. Peer support constitutes a partial return-to-work solution for workers with injuries, but injured workers encounter an uneven playing field. Injured worker peer support group needs and activities show us that sensitivity to structural and social issues may lead to better return-to-work outcomes.     

Factors contributing to work related low back pain among personal care workers in old age

This study aims to preliminary explore the work related and individual factors that contributed to the occurrence of low back pain (LBP) that affected work activities of Personal Care Workers (PCWs). A cross-sectional study was conducted to 36 PCWs in an old age home of Hong Kong. The study is divided into three parts: 1) a questionnaire to document the workload exposure factors and the musculoskeletal symptoms survey of the PCWs, 2) work posture evaluation; and 3) an evaluation of the physical fitness and lifting capacity of the PCWs. Univariate analyses were used to explore the risk factors associated with LBP that affected work activities. The results indicated that individual physical profile and lifting capacities did not contribute to occurrence of low back pain at work. For the work demand factors, the perceived physical demands in lifting and lowering heavy objects, awkward sustain neck and back postures, loading on the back, and perceived effort of cleaning task contributed to the occurrence of LBP. For the physical environment factors, thermal stress and improper ventilation were associated with the occurrence of LBP cases. For the individual factor, LBP cases were associated with workers' self perceived muscular effort, and perceived risk of mental illness in response to work requirements.     

Physical, social and emotional function after work accidents: a medicolegal perspective

The aim of this study was to analyse social and functional consequences of work accidents in a group of workers' compensation claimants who had been referred from the National Insurance Administration for a medicolegal assessment. The injured workers were evaluated on average 3 years after their accidents. Their medical records were analysed, and each injury was scored according to the Abbreviated Injury Scale (AIS). Participants completed the Short Form Questionnaire (SF-36). Factors relating to outcome on SF-36 were analysed using univariate and multivariate methods. 191 claimants returned the SF-36 (62%), 83% of the respondents had an AIS score of less than two, 33% reported working full time. Compared to population-based norms, the respondents reported significantly reduced health on all eight scales of SF-36. Better health and function was mainly associated with a higher level of education and more serious injuries. The extent of social support in the workplace after the accident was only partly related to outcome. The importance of psychosocial factors when making injury assessments in a medicolegal setting is highlighted.     

An ergonomic study on the onset of mental fatigue among the load handling workers of a central market area in Kolkata

It is a well recognized fact that manual material handling (MMH) entails enormous physical labor and associated discomfort feeling, which invariably culminate into musculoskeletal disorders. However mental fatigue, in such instances, becomes an unexplored parameter that needs definite attention during assessment of work status of MMH workers. The present study is being performed among 75 porters of a central market in Kolkata to ascertain the extent of physical and mental exhaustion among them. SF-12 health status questionnaire followed by another questionnaire involving psychosocial questions were performed among them. The analysis of both the questionnaires clearly revealed that most of the porters are under severe physical exertion as they alone carry about 120 kg load at a time and such activity is repeated at least 40 times throughout the day. They always suffer from pain and discomfort feeling at different body parts and this interferes with their normal work activity to a great extent. Moreover absenteeism means no financial return and even a day's rigourous work fetches meagre income. The inability to support family convincingly even after performing such hazardous tasks makes them feel low. Monotony, boredom, fatigue and mental trauma form an integral part of their daily work schedule.     

Workers' perspectives on self-directing mainstream return to work following acute mental illness: Reflections on partnerships

Objective: To examine barriers and facilitators influencing self-direction of return to mainstream work following acute mental illness.Participants: Five individuals who had attempted return to mainstream work following acute mental illness. Methods: In depth, semi-structured qualitative interviews with the five participants selected through purposive sampling. Results: The three main themes related to the workers' self-direction of their return to work experience were (a) worker self-management, (b) workers' 'personal' partnerships and (c) workplace partnerships. Conclusion: Personal and workplace partnerships are integral to supporting workers as they take ownership of their full potential and self-direct return to mainstream work.     

Working mothers,injury and embodied care work

In this article, we examine how mothers respond when injury interrupts maternal care, using the lens of embodied care, which we conceptualize as a form of ‘body work’. We draw on findings from a qualitative research project with two organizations in Australia that help people with injuries to return to work, examining the experiences of workers who are also mothers of dependent children. Mothers' inability to care for children during periods of injury was a significant concern for our interviewees; constraints on physical labour and physical affection were particularly troubling, indicating the importance of embodied maternal caregiving to maternal roles. Yet, while these mothers inhabited the spheres of paid work and unpaid care work simultaneously, service providers did not consider embodied care work or its relevance to injured women's ongoing needs for support. While our findings reflect the experiences of injured women, they also suggest the need for a materialist analysis of the ways that both paid work and care activities are deeply enmeshed in and through the bodies of those doing the work. Employers and service organizations still fail to recognize maternal ‘body work’, and this may be typical of social attitudes more widely.     

Mitigation of musculoskeletal problems and body discomfort of agricultural workers through educational intervention

Farming is a physically arduous occupation that places farm workers' at potential risk of musculoskeletal disorders, which has been observed to impose a greater impact on their health. Each activity in agriculture brings about certain stress and strain on bones and muscles leading to work-related musculoskeletal disorders which can lead to several permanent diseases and disabilities. The purpose of analyzing musculoskeletal problems among male and female workers engaged in agriculture was to know about the risk factors dangerous to health so that interventions can be planned for mitigating them thereby increasing the efficiency of work. Educational intervention included audio-visual aids as well as printed literature. It was hoped that awareness of these factors through dissemination of information would contribute at preventing hazards amongst farmers and their families. The results revealed that the workers reported very severe to severe pain in low back while performing agricultural activities. Weeding was the most strenuous activity for females and threshing crop for males. Training and education on MSDs through educational intervention proved that the knowledge of the farm workers could be enhanced and can help reduce risk of many musculoskeletal problems. It can be help in empowering the community and mitigate MSDs in agriculture.     

Improving work programs' delivery of information and service to workers' compensation carriers

This paper presents the results of a telephone survey of workers' compensation carriers, addressing how occupational therapy work programs can best meet these carriers' needs. Fifty percent of the market share of workers' compensation carriers in Michigan participated in the survey. Survey results indicated that workers' compensation carriers found Functional Capacity Evaluations, job analyses, and work hardening to be important work rehabilitation services. A significant portion of the respondents (88%) stated that they recognized the need for clinically successful work rehabilitation programs and indicated that if they had return to work rates for different providers, they would utilize providers that had the most successful outcome data in a specific geographical area. Occupational therapists can use these survey results to improve their services and communication with insurance to ensure that injured workers will continue to have access to the efficacious interventions occupational therapists provide in work rehabilitation.     

Work injury rehabilitation in Guangzhou: 380 case cohort study

Work injury rehabilitation is a new concept in Mainland China. In 2001, the first work injury rehabilitation centre was established in Guangzhou under the management of the Guanghzhou Bureau of Labour and Security. This paper reviews the profile of a cohort of workers with injuries who received rehabilitation services at this centre. The changes in the physical capacity, daily function, and quality of life of the workers with injuries before and after the treatment services were also reviewed. A total of 380 were extracted from the database which occupied 79% of the total patient population admitted to the centre between 2003 to 2004. The assessment results suggested that workers with injuries showed increases in physical capacity in terms of the range of motion, muscle strength and walking tolerance. The daily functioning by using Barthel Index was also improved. Quality of life assessed with the WHOQOL also demonstrated an increase in the physical and psychological domains. Work injury rehabilitation in Guangzhou is at its infancy stage. The cooperation between the rehabilitation centre, employers and workers is of the utmost importance for a successful return to work outcome. The workers' compensation and rehabilitation policy also dictates the future of success of the rehabilitation services.     

A return to work program for injured workers: a reassignment model

The current workers' compensation system does not encourage permanently restricted workers who are disabled due to work related injuries to return to work. Workers are often labeled permanently disabled and are released from their positions with their employers. However, according to the Americans with Disabilities Act of 1990, these individuals may be qualified to return to productive employment. This paper will describe a Reassignment Model for occupational therapy supported by the rehabilitation frame of reference. This Model presents reassignment to a vacant position as a reasonable accommodation to return injured workers to productive employment. A case study will illustrate the successful implementation of the model. The potential benefits of using this Model will be described for clients, society, employers, and the occupational therapy profession.     

Will Australian workers' compensation insurance management get better soon?

A study of Australian experience in the state of New South Wales (NSW) suggests that private sector underwriting of workers' compensation insurance risk plus insurer competition on premium price may put downward pressure on benefits for injured workers, inhibit rehabilitation, and cause related cost increases for taxpayers and employers. Insurer underwriting also increases workers' compensation administrative costs and means an unnecessary loss of investment income for government and industry. An emerging and better alternative for the Australian community is for government and industry to underwrite a national workers' compensation scheme and to fix premium and benefit requirements which are competitively administered by insurers. In such a regulatory environment insurer inability to compete on premium price should promote competition to provide effective services to help employers prevent injury, assist rehabilitation and contain cost. National standards are necessary to enable widespread dissemination of comparable, reliable information on the outcome of health, rehabilitation, dispute resolution and return to work services. This is required to assess the competitive performance of service providers in order to ensure effective operation of the market to achieve scheme objectives. Holistic, multi-skilled and objective rehabilitation professionals are needed who can clearly demonstrate the effectiveness of their actions in assisting injury prevention, worker rehabilitation, and safe return to work across a range of industry contexts.     

Occupational-psychosocial perceptions influencing return to work and functional performance of injured workers

Much has been done to identify psychosocial factors influencing risk of vocational injury and prolonged disability. The purpose of this paper is to enhance the ability of injured workers to return to their prior worker role through the identification of the influencing psychosocial perceptions. Psychosocial perceptions may assist in the identification of negative or counterproductive factors that hinder the rehabilitative process. Identifying perceptions are individual centered and focused on the views of injured workers as they proceed through the transition in life following injury. Occupational therapists play a key role in the rehabilitative process of injured workers through enhancing the person-job-environment fit [4].     

Health,wellness, and workplace experiences of lesbian,gay, and bisexual social workers

Abstract

Using data from an online survey of 6,112 licensed social workers in 13?U.S. states, rates of reported behavioral health problems and service utilization, physical health problems, adverse childhood experiences, workplace stress, and compassion satisfaction were compared between heterosexual male, heterosexual female, gay/bisexual male, and lesbian/bisexual female respondents. Sexual minority workers reported far higher rates of mental health problems and service utilization, higher rates of physical problems, more frequent reporting of adverse childhood experiences, with no differences found between groups regarding workplace stress and compassion satisfaction. Minority stress theory and historical trauma are used as frameworks to conceptualize the findings.     

Work-related factors contributing to chronic disability in low back pain

Low back pain is a costly and incapacitating musculoskeletal disorder. Prospective studies documenting the capacity of work-related factors to predict chronicity are few in number, the methodology used is very diversified, and the results obtained diverge. The aim of the present study is to investigate the capacity of work-related objective (non-psychosocial) and psychosocial factors to predict chronic disability related to low back pain. A longitudinal prospective study with two measurement times was carried out. The sample (N = 258) consisted of workers with subacute low back pain who were on sick leave and receiving compensation from the CSST (Quebec Workers' Compensation Board). Of all the work-related variables measured, perceived stress and fears and beliefs about work were associated with return to work status at the six-month follow-up. The results obtained show the importance of considering fears and beliefs about work when identifying people in the subacute phase of low back pain who are at risk of developing chronic disability.     

Educating back-injured workers: What should we be teaching?

OBJECTIVE: The purpose of this study was to identify what information people with acute and chronic back pain, health care practitioners, employers and case managers felt should be included in an educational brochure for recently back-injured workers. STUDY DESIGN: Four focus groups were convened, each comprising several representatives from one of the four constituencies. Participants rated 32 information items regarding their inclusion in an educational brochure. Ratings were tabulated for ranking and for group comparisons. RESULTS: While consensus was strong for most information items, there were apparent differences between the groups for several items relating to work resumption, medical attention, and legal or compensation consultation. CONCLUSIONS: Perceived educational needs of back-injured workers may differ from those of their health care practitioners and from their employers or insurers. Future efforts to prevent back disability through education should include evaluation of the informational needs of injured workers.     

Low back pain in physical therapists: a cultural approach to analysis and intervention

Low back pain is one of the most prevalent work related injuries in the physical therapy profession. New graduates and therapists working in rehabilitation and acute care hospitals are at the highest risk for developing low back pain [9]. Although physical therapists are trained in maintaining proper body mechanics and preventing work related injuries, between 30% and 63% of therapists will experience low back pain at some point in their careers [2,4,9]. The culture of physical therapy is one of the primary factors contributing to this problem, with many therapists reporting that their decision to use back pain preventive strategies depends on their colleagues' use of these strategies. The authors will use Green and Kreuter's PRECEDE-PROCEED model to identify behavioral, environmental, educational and ecological factors contributing to the problem; then will propose a health promotion intervention using the social action theory at the community level to decrease work-related low back pain in physical therapists while simultaneously addressing the culture of physical therapy.     

Spinal disc hydration status during simulated stooped posture

Stooped work has been shown to be associated with the development of low back disorders, particularly those that affect the spinal intervertebral discs. Although several studies have been conducted to evaluate the effects of physical factors on disc health, little research has focused on the effect of prolonged stooped work on disc hydration- a critical component of disc health. The purpose of this study is to explore the connection between stooped work and low back pain through controlled mechanical loading and quantitative analysis of disc hydration during in vitro simulated stooped and erect loading conditions of porcine discs. The results showed that stooped postures exhibit significantly decreased overall water content relative to erect postures. Since as disc hydration forms the foundation for overall disc health and proper function, these results have implications for the injury mechanisms associated with stooped work.     

Fish harvesters with injuries' accounts of their experiences with the workers' compensation system

The workers' compensation system was established to provide fair access to compensation for workers who have experienced occupational injury and can no longer work. It was expected that such a system would reduce individual legal claims. Evidence indicates that many injured workers proceed with a variety of appeals indicating dissatisfaction with the current system. The fishing industry is extremely dangerous. The aim of this research was to explore the experience of injured fish harvesters who were making use of a compensation system. Interviews were held with a sample of injured in-shore and deep-sea fish harvesters. In general, they identified themselves strongly as hard-working people who did not deserve their injury. They also reported substantial frustration with the staff of the compensation system who they believed treated them with suspicion and disrespect. The deep-sea fish harvesters were more concerned with the amount of compensation. This dissatisfaction with the system contributed to the fish harvesters' use of the appeals procedure. The fish harvesters' complaints are discussed with reference to the concepts of distributive and procedural justice.     

Use of functional capacity evaluations in workplaces and the compensation system: a report on workers' and report users' perceptions

Until recently, little was documented about how functional capacity evaluations (FCEs) are used by employers and workers' compensation organizations. Such information was one focus of a comprehensive research study on FCEs carried out in southern Ontario, Canada, which involved representatives from the full range of groups involved in FCEs: referral sources, assessors, return-to-work specialists, third party payers and injured workers [1]. This paper shares findings from a cohort of injured workers undergoing FCEs, and explored how their FCE results were perceived and utilized by those receiving the reports. Based on study findings, we provide recommendations as to how FCEs should be requested, undertaken, reported and particularly applied to reduce work disability among injured workers.