Background: RTW after work-related injuries is a multifactorial process. Factors affecting clinicians to make RTW-recommendations for patients with WRSEI have not been studied in the literature. Purpose: We investigated the associations between group of factors chosen from different domains (Personal/Environmental) and clinicians’ RTW-recommendations for patients with WRSEI. Methods: Study design was cross-sectional. Data were collected from self-reported surveys and clinical charts of 130 adult workers (not working at the time of visit and referred to WSIB-Shoulder & Elbow Specialty Clinic-Toronto) with chronic (≥6-months) injuries. Results: Population mean age was 43.5-years. 52% were female. The average time-since-injury was 20.4-months (45%>12-months). 70% received RTW-recommendations (regular/modified-job). 30% received a No-RTW-recommendation. 42% had education≥college-level. 18% had heavy (>20kg) job-demands. Higher MCS-scores had a significant association (p=0.0003) with clinicians’ RTW-recommendations. Conclusion: In patients with chronic WRSEI(s), poor general health-status and high disability, workers with better mental-health were more likely to receive a RTW-recommendation by clinicians.

Background: RTW after work-related injuries is a multifactorial process. Factors affecting clinicians to make RTW-recommendations for patients with WRSEI have not been studied in the literature. Purpose: We investigated the associations between group of factors chosen from different domains (Personal/Environmental) and clinicians’ RTW-recommendations for patients with WRSEI. Methods: Study design was cross-sectional. Data were collected from self-reported surveys and clinical charts of 130 adult workers (not working at the time of visit and referred to WSIB-Shoulder & Elbow Specialty Clinic-Toronto) with chronic (≥6-months) injuries. Results: Population mean age was 43.5-years. 52% were female. The average time-since-injury was 20.4-months (45%>12-months). 70% received RTW-recommendations (regular/modified-job). 30% received a No-RTW-recommendation. 42% had education≥college-level. 18% had heavy (>20kg) job-demands. Higher MCS-scores had a significant association (p=0.0003) with clinicians’ RTW-recommendations. Conclusion: In patients with chronic WRSEI(s), poor general health-status and high disability, workers with better mental-health were more likely to receive a RTW-recommendation by clinicians.

Dans nos pays industrialisés, les comportements sédentaires entrainent des enjeux de santé pour de nombreux travailleurs, les exigences physiques de leur travail étant désormais insuffisantes. Afin de répondre à cette problématique, la recherche s’intéresse aux bureaux actifs (poste de travail debout, avec pédalier ou avec tapis roulant) qui comparativement au poste de travail conventionnel permettent aux travailleurs d’augmenter l’apport d’activité physique au travail et ainsi, réduire le temps sédentaire quotidien. Lorsqu’ils sont comparés au poste conventionnel (assis), les bureaux actifs ont des effets sur des biomarqueurs physiologiques et biomécaniques liés à l’amélioration de la santé. En plus, ils offrent quelques avantages sur la productivité et le bien-être au travail des travailleurs. Malgré l’accumulation des connaissances sur les bureaux actifs, les différences entre bureaux actifs sont toujours méconnues. Ce mémoire s’adresse donc à la compréhension et à la comparaison entre les types de bureaux actifs, plus précisément à leurs impacts sur le temps sédentaire au travail, leurs effets sur les biomarqueurs physiologiques et biomécaniques et à leurs effets sur la productivité et le bien-être au travail. Pour ce faire, les résultats et la discussion sont développés autour d’un article de revue systématique (Dupont et al., 2019) et d’un article issu d’une recherche expérimentale soumis en octobre 2019. Dans un premier temps, les avantages associés à chaque type de poste de travail actif (debout, avec pédalier ou avec tapis roulant) ne sont pas équivalents. En effet, les postes avec pédalier et avec tapis roulant semblent apporter de plus grands changements physiologiques à court terme que les postes de travail debout et pourraient potentiellement améliorer la santé. De plus, les postes debout, avec pédalier et avec tapis roulants semblent tous présenter des avantages de productivité à court terme, toutefois les postes avec tapis roulants réduisent les performances des tâches faites à l’aide de clavier et de souris d’ordinateur. Dans un deuxième temps, à court terme (2 semaines), l’introduction d’un poste debout et d’un poste à pédalier dans leur bureau permet aux travailleurs d’accumuler en moyenne 132 minutes de temps actif (ex. travail fait avec poste debout et/ou avec poste avec pédalier) par jour, ce qui représente 46 % du temps total passé dans leur espace de travail personnel. Ce faisant, les travailleurs réduisent de moitié leur temps assis au travail en fractionnant le temps assis en courtes périodes de 30 minutes. Basé sur nos résultats, l’ajout de deux postes de travail actif à même le bureau d’un travailleur permet de diminuer le temps sédentaire au travail. / In our industrialized countries, sedentary behaviours lead to health issues for many workers, as the physical demands of their work are now insufficient. To answer this problem, the research focuses on active workstations (standing, with pedals or treadmill workstations) which compared to the conventional workstation allow workers to increase physical load at work and thus, reduce daily sedentary time. When compared to the conventional (sit) workstation, active workstations have effects on physiological and biomechanical biomarkers related to better health. Also, they offer some advantages over workers’ productivity and wellbeing at work. Despite the accumulation of knowledge about active workstations, the differences between active workstations are still unknown. This thesis is aimed at understanding and comparison between active workstation types, specifically their impacts on sedentary time at work, their effects on physiological and biomechanical biomarkers and their effects on productivity and well-being at work. The results and the discussion are developed around a systematic review article (Dupont et al., 2019) and an article from an experimental research submitted in October 2019. First of all, the benefits associated with each type of active workstation (i.e. standing, cycling, treadmill) may not be equivalent. Cycling and treadmill workstations appear to provide greater short-term physiologic changes than standing workstations that could potentially lead to better health. Cycling, treadmill and standing workstations appear to show short-term productivity benefits, while treadmill workstations reduce the performance of computer-related work. Secondly, in the short term (2 weeks), the introduction of a standing workstation and a pedal workstation in their office allows workers to accumulate an average of 132 minutes of active time (i.e. work done with standing and/or cycling workstations) per day, which represents 46% of the total time spent in their personal workspace. As a result, workers reduce their total desk-sitting time by half and sat on average 30 minutes per sedentary bout. Based on our findings, adding two active workstations to an office worker’s helps reduce sedentary time at work.

Le diagnostic de l'asthme professionnel (AP) est toujours un défi. Le test de provocation bronchique spécifique (TPS), comme une méthode de diagnostic de référence, n’est pas aisément accessible. Cette étude diagnostique rétrospective vise à évaluer des outils diagnostiques actuels et à développer des scores cliniques pour AP (définis comme ayant le résultat positif en TPS). Les données concernant les travailleurs soupçonnés d'avoir de l’AP qui, d’une part, ont été exposés aux agents de haut-poids-moléculaire élevé (HPM) (n=139) et à bas-poids-moléculaire (BPM) (n=285), et d’autre part, ont travaillé encore un mois avant de l’évaluation de TPS. Par ailleurs, les modèles de régression logistique sont développés dans chaque groupe d'exposition. Ainsi, concernant des tests objectifs, les valeurs de différents tests distinctifs sont ajoutées aux caractéristiques cliniques, et enfin, le résultat a été évalué. Les modèles ont été testés pour l’exactitude, et pour la validation interne par la procédure bootstrapping. Suite à cela, les modèles finaux sont traduits en scores cliniques et le score total est stratifié en groupes à risque. Chez les travailleurs exposés à des agents BPM, si le test de la méthacholine est fait isolément, le modèle prédictif n'a pas montré de meilleures valeurs diagnostiques que le test de provocation. Cependant, dans le groupe HPM, le modèle final, y compris le sexe, l'âge> 40 ans, la durée des symptômes ≥1 an, la rhinoconjonctivite, l'utilisation de corticostéroïdes inhalés, le test de provocation à la méthacholine, et le test de la piqûre épidermique spécifique, avait un bon calibrage et une validation interne raisonnable. Par ailleurs, la catégorie de sujets avec une probabilité élevée d’avoir AP avait une meilleure spécificité et une meilleure valeur prédite positive par rapport à la combinaison de test de provocation à la méthacholine et de la piqûre épidermique spécifique dans la détection de l'AP, cependant n'avait pas de signification statistique. En conclusion, ce modèle quantifie la probabilité individuelle d'AP. Dans les centres où l'accès à TPS est difficile ou impossible, notre modèle serait utile dans le diagnostic d’OA, néanmoins, la validation externe du modèle reste nécessaire. Mots-clés : asthme professionnel, modèle diagnostique, prévention, score clinique. / The diagnosis of occupational asthma (OA) is challenging since the use of specific inhalation challenge (SIC) as the reference test is not widely accessible. This retrospective diagnostic study is aimed to evaluate current diagnostic tools and to develop clinical scores for OA (defined as positive SIC). Data from workers with suspected OA who were exposed to high-molecular-weight (HMW) (n=139) and low-molecular-weight (LMW) agents (n=285) and still working one month before the SIC were evaluated. Logistic regression models were developed in each exposure group. The added values of different objective tests to clinical and exposure characteristics were evaluated. The models were tested for accuracy, and, validated internally by the bootstrapping procedure. The final models were translated into clinical score and the sum scores were stratified into risk groups. In workers exposed to LMW agents, the predictive model did not perform better diagnostically than the methacholine challenge test alone. In the HMW group, the final model including sex, age >40 years, symptom duration ≥1 year, rhinoconjunctivitis, inhaled corticosteroid use, the methacholine challenge test, and specific SPT had a good accuracy and reasonable internal validation. The high probability category of the predictive model had a better specificity and positive predicted value compared to the combination of methacholine challenge test and specific SPT in detecting OA but did not reach the statistical significance. Our results suggest that this model could quantify an individual’s probability of OA. This model emphasizes the necessity of performing both tests in order to have a more accurate diagnosis in workers exposed to HMW agents. In centers where access to SIC is difficult or impossible, our model might be of benefit in diagnosing OA. Nevertheless, external validation of the model is necessary. Key words: occupational asthma, diagnostic model, prevention, clinical score.

L'étude vise à évaluer l'exposition professionnelle au bruit des travailleurs d'une plateforme gazière en Algérie et à mettre en évidence des déterminants influençant cette exposition. Des groupes d'exposition homogène (GEH) ont été constitués sur la base de ressemblances quant à l'exposition au bruit, aux titres d'emploi et aux lieux de travail. Deux stratégies d'échantillonnage ont été suivies, la première selon la norme internationale ISO 9612 : 2009 et la seconde selon la stratégie aléatoire de l'AIHA. Pour les deux approches, les niveaux de bruit (Lex, 8h, niveaux d'exposition au bruit pondéré (A) ajustés à une journée de travail de 8 heures) des opérateurs et des superviseurs étaient généralement > 85 dB(A) alors que pour les techniciens-tableau, les niveaux de bruit (Lex, 8h) étaient en tout temps < 85 dB(A). Pour les trois GEH du titre d'emploi des maintenanciers, il y a eu régulièrement des dépassements de la valeur de référence. Plusieurs travailleurs oeuvrant sur les plateformes gazières sont exposés à des niveaux importants de bruit et sont à risque de développer des problèmes auditifs. / The study aims to evaluate workers'noise exposure from an onshore gas platform in Algeria, and to emphasize the determinants influencing the exposure. Exposure groups were formed based on their work category and job location. Two sampling strategies were followed. The first was according to the international standard ISO 9612: 2009, and the second, according to the AIHA random strategy. For both strategies, the noise level (Lex, 8h, levels of exposure to noise ratio (A) for a working day of 8-hour) for operators and supervisors was usually > 85 dB(A) whereas the noise level for the technicians exposed in the distributed control system (DCS) was < 85 dB(A) at all times. The three HEG belonging to the maintenance technician group regularly exceeded the reference value of 85 dB(A). We concluded that employees working on the gas platform are exposed to significant noise level, and are at risk of developing hearing problems

Introduction La santé est considérée comme un idéal, un objectif et un but à atteindre; pour l'améliorer, certains ergothérapeutes utilisent les approches habilitantes. Ces dernières démontrent des résultats positifs pour la prévention des troubles musculosquelettiques (TMS). Objectif L’objectif de cette recherche est de mesurer les effets d'un programme en partenariat pour la prévention des TMS dans une pharmacie communautaire. Méthodologie Un devis mixte (quantitatif, qualitatif et descriptif) avant-après avec un groupe témoin non équivalent est utilisé. Le recrutement des participants se fait sur une base volontaire. Ceux-ci sont âgés de 18 ans et plus (groupe expérimental (n = 18) et témoin (n = 17)) et occupent trois titres d'emplois distincts. Différentes mesures via des questionnaires et des entrevues sont prises avant et après l’intervention. L’intervention, quant à elle, comprend trois rencontres élaborées à partir des concepts de l’ergonomie. Résultats En lien avec les connaissances acquises et la mobilisation, une diminution des sensations douloureuses est constatée chez les participants du groupe expérimental. De même, pour ceux-ci, une tendance à la généralisation des connaissances est notée. Conclusion Inspirée des principes de la prévention, de l’ergonomie et de l’habilitation, cette recherche, malgré ses limites, permet de mieux documenter les effets d'un programme en partenariat en entreprise de services pour la prévention des TMS. / Introduction Health is regarded as an ideal, a goal to improve and to achieve; in order to enhance it some therapists using enabling approaches. The latter show positive results for the prevention of musculoskeletal disorders (MSD's). Objective The objective of this research is to measure the effects of a partnership program in a community pharmacy for the prevention of MSD's. Methodology A mixed design (quantitative, qualitative and descriptive) before and after with a non-equivalent control group is used. Participant recruitment is done on a voluntary basis. They are aged 18 years and over (experimental group (n = 18) and control (n = 17)) and occupy three distinct job titles. Different measures through questionnaires and interviews are taken before and after the intervention. The intervention, meanwhile, includes three session developed from the concepts of ergonomics. Results Results are related to the acquired knowledge and mobilization, and there is a decreased of pain sensation is measured among the participants of the experimental group. Similarly, for these participants, a disposition or proneness to generalize knowledge is observed. Conclusion Inspired by the principles of prevention, ergonomics and empowerment, this study, despite its limitations, allows to better document the effects of a program in partnership with business services for MSD's prevention.

Caregivers injure their backs more than workers in any other industry. Efforts to reduce injuries have been on-going for decades with limited results. Mechanical lift devices have been incorporated into clinical practice over the past 30 years to reduce the risk of injury from patient lifting. Yet injury rates remain high. The use of mechanical lifts may be partly to blame. While these devices assist with lifting patients, they also introduce new activities that result in caregivers experiencing unsafe loading on the spine. We measured loads on the lower back during manoeuvres of the two most common lift types (overhead and floor) as well as during sling insertion. A new device called SlingSerterTM was evaluated for use in the clinical environment. We also investigated spine shrinkage as a measurement tool for estimating cumulative load. Caregivers worked alone and in pairs for both lift maneuvering and sling insertion activities. Overhead lift use resulted in much lower loads than floor lift use. We conclude caregivers can safely operate overhead lifts alone, while floor lift use remained unsafe even with two caregivers. Less-experienced caregivers had higher loads than more-experienced counterparts when using floor lifts. There was no corresponding effect of experience with overhead lift use and we found this to be a further benefit of overhead lifts over floor lifts. Most caregivers exceeded the safe limit for spine compression during sling insertion, though a single caregiver was at no higher risk of injury than two caregivers working together. Clinicians who tested SlingSerterTM agreed the device would be useful in clinical practice, particularly with bariatric patients and other special patient populations that are difficult to roll or turn. Finally, we investigated a novel method for estimating cumulative load based on spine shrinkage. There is growing recognition that excess cumulative load may be responsible for back injury. We found the variability in spine shrinkage was too large to estimate cumulative load directly. However, the technique may still be useful for determining the relative importance of the load from different activities to the cumulative total.

Professional orchestral string musicians represent a population at risk for performance-related musculoskeletal disorders (PRMD). Research literature suggests the influence of stress in the incidence of work-related and performance-related musculoskeletal disorders. The purpose of this study was to qualitatively investigate the role of holistic health (physical, mental, emotional, spiritual, and social) and stress management in the prevention of PRMDs in professional orchestral string musicians. Five musicians representing different instruments, genders, and PRMD histories were recruited and sorted from a single professional orchestra in Canada. This study combined quantitative data - in the form of basic demographic information and a Health and Well-being Assessment - with qualitative interview data. This combined data provided a focused, in-depth view of typical instances in the professional orchestral string population. The musicians reported a variety of occupational and non-occupational risk factors, as well as a range of intrinsic risk factors. They also reported a variety of PRMD prevention strategies and lifestyle behaviours. The musicians in this study provide evidence that stress may play a mediating role in PRMDs and that the management of biomechanical and psychosocial stressors through holistic health practices may positively influence the incidence, severity, and treatment of PRMDs in orchestral string musicians. This dissertation recommends that increased awareness and education in holistic health practices be encouraged for the purpose of improved PRMD prevention in professional orchestral string musicians.

Caregivers injure their backs more than workers in any other industry. Efforts to reduce injuries have been on-going for decades with limited results. Mechanical lift devices have been incorporated into clinical practice over the past 30 years to reduce the risk of injury from patient lifting. Yet injury rates remain high. The use of mechanical lifts may be partly to blame. While these devices assist with lifting patients, they also introduce new activities that result in caregivers experiencing unsafe loading on the spine. We measured loads on the lower back during manoeuvres of the two most common lift types (overhead and floor) as well as during sling insertion. A new device called SlingSerterTM was evaluated for use in the clinical environment. We also investigated spine shrinkage as a measurement tool for estimating cumulative load. Caregivers worked alone and in pairs for both lift maneuvering and sling insertion activities. Overhead lift use resulted in much lower loads than floor lift use. We conclude caregivers can safely operate overhead lifts alone, while floor lift use remained unsafe even with two caregivers. Less-experienced caregivers had higher loads than more-experienced counterparts when using floor lifts. There was no corresponding effect of experience with overhead lift use and we found this to be a further benefit of overhead lifts over floor lifts. Most caregivers exceeded the safe limit for spine compression during sling insertion, though a single caregiver was at no higher risk of injury than two caregivers working together. Clinicians who tested SlingSerterTM agreed the device would be useful in clinical practice, particularly with bariatric patients and other special patient populations that are difficult to roll or turn. Finally, we investigated a novel method for estimating cumulative load based on spine shrinkage. There is growing recognition that excess cumulative load may be responsible for back injury. We found the variability in spine shrinkage was too large to estimate cumulative load directly. However, the technique may still be useful for determining the relative importance of the load from different activities to the cumulative total.

Professional orchestral string musicians represent a population at risk for performance-related musculoskeletal disorders (PRMD). Research literature suggests the influence of stress in the incidence of work-related and performance-related musculoskeletal disorders. The purpose of this study was to qualitatively investigate the role of holistic health (physical, mental, emotional, spiritual, and social) and stress management in the prevention of PRMDs in professional orchestral string musicians. Five musicians representing different instruments, genders, and PRMD histories were recruited and sorted from a single professional orchestra in Canada. This study combined quantitative data - in the form of basic demographic information and a Health and Well-being Assessment - with qualitative interview data. This combined data provided a focused, in-depth view of typical instances in the professional orchestral string population. The musicians reported a variety of occupational and non-occupational risk factors, as well as a range of intrinsic risk factors. They also reported a variety of PRMD prevention strategies and lifestyle behaviours. The musicians in this study provide evidence that stress may play a mediating role in PRMDs and that the management of biomechanical and psychosocial stressors through holistic health practices may positively influence the incidence, severity, and treatment of PRMDs in orchestral string musicians. This dissertation recommends that increased awareness and education in holistic health practices be encouraged for the purpose of improved PRMD prevention in professional orchestral string musicians.