Risk factors for musculoskeletal disorders in an obstetrician-gynecologist and orthopedic surgeon.

BACKGROUND: Orthopedic and obstetrician-gynecologist (OB/GYN) surgeons have risks for musculoskeletal disorders (MSD) during work in the operating room (OR). Risks for MSD have not been identified as a result of work outside the OR or during non-work tasks. OBJECTIVE: The purpose of the study was to determine risk factors for MSD in an orthopedic and OB/GYN surgeon. METHODS: A case study format and mixed method design were used to gather data by using the Rapid Upper Limb Assessment (RULA) to measure MSD risks in the OR; the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) to measure surgeons' upper extremity disability; observation of surgeon office hours; and semi-structured interviews to gather qualitative data. RESULTS: Both surgeons had risks for MSD during occupational performance outside of work, with some risks similar to those experienced at work. Both surgeons had MSD risks during work inside and outside the OR. Both surgeons experienced MSD symptoms exacerbated by work and non-work tasks. CONCLUSIONS: Identifying and reducing MSD risk should include a comprehensive analysis of occupational performance for orthopedic and OB/GYN surgeons.

Outcomes of a pilates-based intervention for individuals with lateral epicondylosis: A pilot study.

BACKGROUND: Core stability and flexibility, features of Pilates exercise, can reduce loads to the upper extremities. Reducing loads is essential to improve symptoms for individuals with lateral epicondylosis. Although Pilates exercise has gained popularity in healthy populations, it has not been studied for individuals with lateral epicondylosis. OBJECTIVE: The purpose of this study was to determine if adding Pilates-based intervention to standard occupational therapy intervention improved outcomes as measured by the Patient-Rated Tennis Elbow Evaluation (PRTEE) more than standard intervention for individuals with lateral epicondylosis. METHODS: Participants (N= 17) were randomized to the standard intervention group or Pilates-based intervention group. All participants received standard intervention. The Pilates-based intervention group additionally completed abdominal strengthening, postural correction, and flexibility. RESULTS: For both groups, paired t-tests showed significantly improved PRTEE scores, 38.1 for the Pilates-based intervention group, and 22.9 for the standard intervention group. Paired t-test showed significantly improved provocative grip strength and pain for both groups. Independent t-tests showed no significant difference between groups in improved scores of PRTEE, pain, and provocative grip. CONCLUSIONS: Although the Pilates-based intervention group showed greater improvement in PRTEE outcome, provocative grip, and pain, scores were not significantly better than those of the standard intervention group, warranting further research.

Comparing responsiveness of the quick disabilities of the arm, shoulder, and hand and the upper limb functional index.

OBJECTIVE: The purpose of this study was to measure clinical change in persons with upper extremity (UE) musculoskeletal conditions and to determine if the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) or the Upper Limb Functional Index (ULFI) was a more responsive outcome tool. The objective was to select one tool that was responsive and practical for the occupational therapy (OT) setting. PARTICIPANTS: Participants were patients (N=27) who had musculoskeletal conditions, were age 18 years or older, and received outpatient OT. METHODS: Participants received standard OT treatment for UE musculoskeletal conditions, completing the ULFI and QuickDASH at evaluation and discharge. RESULTS: Paired t-tests showed significant change of 25.1 points in the QuickDASH and 23.6 points in the ULFI. Work module showed significant change of 26.2 points. CONCLUSIONS: The QuickDASH was a more responsive tool compared to the ULFI. Participants made significant improvements in work performance as measured by the QuickDASH Work Module. Large effect sizes and standardized response means of the QuickDASH and the ULFI change scores showed both tools were responsive outcome measures for individuals with musculoskeletal conditions. Although the QuickDASH was more responsive, therapists preferred the ULFI as an efficient outcome measure with client-centered goals.

The meaning of work for two high school seniors.

The workplace is increasingly serving as an important context for the development of work behaviors, interpersonal skills, and values for high school students. A lack of qualitative studies regarding the meaning of the subjective aspects of work for teens is evident. The purpose of this research study was to understand the meaning of work for two high school seniors through qualitative inquiry. The researchers interviewed two participants in a conference room to maintain privacy. Interviews were audio taped, transcribed verbatim, and returned to the interviewees for member check. The researchers analyzed transcriptions, coded for identification of themes, and shared them with the participants to ensure accuracy. The meaning of work for both participants included themes of gaining financial freedom, learning job-specific skills, learning the general work skill of time management, sacrificing and rearranging leisure time spent with friends and family, and helping to define choices related to future work and co-workers. The meaning of work for the participant who owned his own business included additional themes of improving interpersonal communication, marketing, budgeting, taking initiative and responsibility, prioritizing, organizing, and decision-making, all required to develop and expand a successful business.

The meaning of work in the US for two Latino immigrants from Colombia and Mexico.

UNLABELLED: The purpose of this study was to understand the meaning of work for two Latino adults working in US industry. METHOD: Two adults from Latin countries who worked in industry participated in a qualitative research design during which data were gathered through interviews, observations, and record reviews. RESULTS: Workers adapted to the language barrier by limiting socialization at work and during leisure, learning only the English needed to perform the job, and maintaining traditional spiritual and leisure activities outside of work. The financial rewards of working temporarily in the US supported their goals to further their vocations in their home countries. CONCLUSION: Occupational therapists must provide services that recognize the uniqueness of Latino workers who must adapt to challenges in performing work and maintaining valued occupations outside of work.

Challenges for the older academic in balancing work and wellness.

OBJECTIVE: The objective of this study was to describe the risks for the development of MSDs in older academics. METHOD: Four older academics needed modification of their offices to reduce symptoms of MSDs. In order to improve their occupational performance, data were gathered through interviews and observations, facilitating selection of interventions responsive to their unique client factors, physical contexts, and the organizational environment. RESULTS: Older academics did not perceive risks for the development of MSDs in work that was sedentary. Their routines included few health and wellness behaviors in a culture rewarding excessive work, facilitating commitment to the organization, and understating the importance of health and wellness to the academic community. CONCLUSIONS: Occupational therapists must reframe sedentary work as physically demanding and potentially risky for the development of MSDs, and must recognize the organizational influences on the work of academics. Prolonging work life might likely result from modifications in the physical context and from the academic adopting healthy lifestyle routines within multiple environments.

Partnering with management to implement ergonomics in the industrial setting.

UNLABELLED: The purpose of this study was to describe the collaboration among occupational therapy graduate students, faculty, and managers of an industrial organization in developing safety-training materials for workers. METHOD: Three managers from an industrial organization sought collaboration from the School of Occupational Therapy. The occupational therapy faculty developed fieldwork experiences and implemented a qualitative research study where data were gathered through interviews, observations, key events, artifacts, and immersion in the field. RESULTS: Changing workers' behaviors required influence from an organizational level, including manager support and role modeling, safety committee involvement, and a strong presence of occupational therapy in the organizational environment. CONCLUSION: Occupational therapists who provide safety training in industrial settings must become partners with workers and managers, and immerse themselves in the organization to plan strategies that compliment the culture. Occupational therapists' interventions for safety training should match the needs and values of the managers.

Experience of cumulative trauma disorders on life roles of worker and family member: a case study of a married couple.

The prevalence of diagnosed cumulative trauma disorders (CTD) within the workforce comes at a high price for employers burdened with financial losses from missed work and worker's compensation costs. Research has focused primarily on the impact of CTD on the worker role within the workplace, overlooking the impact on roles across multiple environments [24,35,54]. Furthermore, the influence of CTD on life roles of a spouse has not been examined. This single case study illustrated the experience of CTD within a marital relationship through the use of grounded theory. Results indicated that adaptations to CTD symptoms were least altering to the established routines and roles of the couple. With progression of symptoms, the spouse without symptoms was relied on more heavily for adaptations to manage pain. The results of this study indicate that occupational therapists must examine the client's valued roles and incorporate the family into intervention strategies.

Occupational therapists working in hand therapy: the practice of holism in a cost containment environment.

OBJECTIVE: Occupational therapists specializing in hand therapy are challenged to provide care that reflects foundational concepts of occupation and holism. The researchers investigated cost containment influences on occupational therapists specializing in hand therapy to determine how therapists provide holistic care within cost containment constraints. METHOD: Five hand therapists were chosen based on selection criteria of hand therapy and holistic care practice. Using a grounded theory approach, the researchers gathered data via interviews and clinical observations. Data were analyzed through open, axial, and selective coding, and critiqued by an expert panel for emerging theory and concepts. RESULTS: Occupational therapists developed new skills or refined existing skill through adapting, educating, and strategizing in response to environmental demands. Tenets of the occupational adaptation model matched the strategies used by the participants. CONCLUSION: Occupational therapists specializing in hand therapy adapted to cost containment constraints by modifying professional settings and skills, educating multiple consumers, and implementing innovative interventions.

Identifying meaning and perceived level of satisfaction within the context of work.

OBJECTIVE: The primary objectives of this study were to identify sources of meaning for individuals within the context of a work environment, and to compare varied sources of meaning for individuals with high and low work satisfaction levels. METHOD: Participants were chosen based on satisfaction levels in employment, full-time employment status within an organization for at least one year, and diversity in the work setting. Data were gathered through a series of interviews and observations of the participants' workplaces. A comparative analysis of transcribed interviews was conducted by the researchers and with an expert occupational therapy faculty panel. From these analyses, the researchers developed work narratives for a mechanical engineer, a high school teacher, an employee of mechanical services, and a career service counselor. RESULTS: Emerging themes from the work narratives indicated that the various meanings employees found in work had an effect on their perceived levels of job satisfaction. Participants conveyed that organization identification, financial benefits, independent decision-making, reciprocal respect, opportunities for creativity, and maintaining significant relationships outside of work enhanced meaning and satisfaction. CONCLUSIONS: The worker role is a significant source of an individual's identity, meaning, and satisfaction in life. Professionals in various fields can work with employers to develop meaningful work environments for increased job satisfaction, greater motivation for work, increased productivity, and decreased employee turnover.

The inter-rater reliability and validity of self-report of risk factors for cumulative trauma disorders within the hand therapist population - a pilot study.

OBJECTIVES: This study examined the validity of hand therapists' self-report of cumulative trauma disorder (CTD) risk factors by comparing the self-report to observations performed by the raters. Inter-rater reliability was also analyzed between the raters who observed the hand therapists. STUDY DESIGN: Two raters simultaneously observed each hand therapist during a splinting task at a therapy facility. Following this task, the raters and the hand therapist independently completed an identical assessment tool. Thirteen therapists were observed and a total of six raters observed the therapists. Responses from two categories of the self-assessment, "posture" and "mechanical stress", were compared. Percentage of agreement was calculated by dividing the number of like responses by the total number of possible responses for each category. RESULTS: Overall inter-rater reliability was 72%, significantly above the accepted minimum standard of 60-70%, and validity was 39%, significantly below the accepted minimum. CONCLUSION: The high percentage of inter-rater reliability established consistency and accuracy among the raters in their observations. However, the low percentage of validity should prompt hand therapists to investigate the accuracy of a patient's self-report before relying on it for treatment.