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BACKGROUND: Work-related musculoskeletal disorders (WMSD) are the leading cause of work disability. Healthcare workers (HCW) have a particularly high risk of developing these disorders. OBJECTIVE: To review the current knowledge, from an occupational therapy (OT) perspective, on interventions for upper body WMSD among HCW in close contact with clients through manual handling. METHODS: This systematic review attempted to gather experimental and observational studies published between 2008 and 2019, that discussed interventions within OT practice to prevent or treat WMSD of the upper body among HCW. The searches were conducted on CINAHL, Cochrane Library, PsycINFO, PubMed, OTSeeker, AMED and Emerald. RESULTS: Nine articles were included in the final analysis. Overall, the methodological quality of the articles was moderate. The main preventive measures used were classified according to the components of the Person-Environment-Occupation-Performance model. The identified interventions were training in ergonomics and safe patient-handling, the use of assistive devices and equipment, physical exercise, and workplace modifications. CONCLUSIONS: Findings suggest that these interventions are effective in the prevention and treatment of upper body WMSD in HCW. Furthermore, these interventions appear to be more beneficial when combined together. Researchers could also investigate the effectiveness of interventions targeting psychological factors in the prevention of WMSD.

This thesis is the culmination of a series of studies designed to improve the management of musculoskeletal (MSK) injury in an infantry training centre (ITC Catterick, UK). The overall aim of this thesis is to develop and evaluate a management strategy for MSK injury during Combat Infantryman’s Courses (CIC) training. Included is an epidemiological study of MSK injuries in the British Army (Study1), a risk factor model for MTSS (Study 2) and two randomised controlled trials (RCTs) in which the effects of prevention (Study 3) and rehabilitation interventions (Study 4) were examined. The aim of Study 1 was to quantify incidence, type and impact of the MSK injuries during military CIC training (26 weeks). Over a two year period (April 2006 -March 2008), 6608 British infantry CIC trainees completed an informed consent form to take part in this study. A prospective epidemiological study was conducted. Data for the injuries were reported according to: onset, anatomical location, diagnosis and regiment-specific incidence, week and months, impact and occupational outcome. It was clearly demonstrated that MSK injuries are a substantial burden to the British Army. Injury rate was 48.65% and overuse injury was significantly higher than acute and recurrence. Most overuse injuries occurred in the lower limb (82.34%) and were more frequent (p <0.01) in the first phase of training (Weeks 0-13). One third of the recruits (33%) were discharged prior to completion of training. A further 15% (n=991) were removed from training for further rehabilitation. Rehabilitation time ranged from 21 to 168 days and 12% of total training time was lost due to injury (equivalent to 155,403 days of training). Owing to its high severity index, medial tibial stress syndrome (MTSS) is argued to be the most impactful of these injuries despite only being second most frequent. Implications for practice and research (Study 1): MSK injuries are a significant burden to the British Army and strategies to improve prevention and treatment need to be explored. An initial focus on MTSS is warranted. In order to develop interventions for Studies 3 and 4 it is necessary to identify those risk factors for developing MTSS. The aim of Study 2 was to determine prospectively whether gait biomechanics and/or lifestyle factors can identify those at risk of developing MTSS. Again, British Infantry male recruits (n = 468) were selected for the study. Based on a review of the literature of known risk factors for MSK injury, plantar pressure variables, lifestyle factors comprising smoking habits and aerobic fitness as measured by a 1.5 mile timed-run were collected on the first day of training. A logistic regression model for membership of the MTSS and non-MTSS groups showed that an imbalance in foot pressure (heel rotation = pressure on the medial heel minus pressure on the lateral heel) was the primary risk factor for MTSS. Low aerobic fitness and smoking habit were also important, but were additive risk factors for MTSS. The logistic regression model combining all three risk factors was capable of predicting 96.9% of the non-injured group and 67.5% of the MTSS group with an overall accuracy of 87.7%. Implications for practice and research (Study 2): Foot pronation, as measure by heel rotation, is a primary risk factor for MTSS. Previous studies have shown that gait retraining can change risk factors for injury. The aim of Study 3 was to examine the effectiveness of gait retraining on reducing risk factors associated with MTSS and on reducing the incidence of MTSS during the subsequent 26 week training period. British Infantry recruits (n = 450) volunteered for the study and baseline plantar pressure variables were recorded on the first day of training. Based on the findings of Study 2, those with abnormal foot pronation at baseline (n = 134, age 20.1 ± 2.03 years; height 167 ±1.4 cm; body mass 67 ± 2.4 kg) were randomly allocated to an intervention (n = 83) or control group (n = 83). The intervention group undertook a gait retraining program which included targeted exercises three times a week and biofeedback on risk factors once per week. Both groups continued with the CIC training concurrently. Injury diagnoses over the 26 week training regimen were made by physicians who were blinded to the study. Post-measures of plantar pressure were recorded at 26 weeks. There was a significant reduction in the pronation (p <0.001) and overall difference survival function between MTSS and non-MTSS (Log rank test X2 = 6.12, p = 0.013). The absolute risk reduction was 60% in the intervention group. Implications for practice and research (Study 3): Gait retraining can reduce risk factors and incidence of MTSS injury. Based on such positive findings for the prevention of MTSS in Study 3, it was hypothesised that gait retraining may also have potential for the rehabilitation of MTSS. The aim of Study 4 was to examine the effectiveness of a gait retraining on plantar pressure variables, pain intensity and time spent in rehabilitation due to MTSS. Recruits diagnosed with MTSS but not responding to current treatment were eligible for this study (n = 66, age 20.85 ± 2.03 years; height 167 ±1.4 cm; body mass 67 ± 2.4 kg). The participants were randomly allocated to an intervention (n = 32) or control group (n = 34). In order to overcome the debilitating pain suffered by MTSS patients during exercise, the intervention group received a corticosteroid injection prior to the gait retraining programme. The control group continued with the current rehabilitation programme. There were significant improvements in terms of time to reach peak heel rotation (p<0.001), pain intensity (p<0.001) and positive occupational outcome in the intervention group (p<0.019). Implications for practice and research (Study 4): A combined corticosteroid-exercise intervention is beneficial in normalising plantar pressure, reducing rehabilitation times, pain intensity and occupational outcome of MTSS.

Background: Traumatic musculoskeletal injury (TMsI) often leads to chronic pain and post-traumatic stress disorder (PTSD). This study examined factors of a modified diathesis-stress model in the development of PTSD symptoms following TMsI. Methods: 205 patients were recruited in this prospective, observational study. Within 14 days of injury, participants completed an in-hospital questionnaire investigating acute symptoms of anxiety, depression, pain, and PTSD. Results: Logistic regression identified multiple factors associated with symptoms of PSTD (p<.0001). Neuropathic pain (odds ratio[OR]=1.091, 95% confidence interval[CI] 1.020-1.168), general anxiety (OR=1.176, 95%CI 1.046-1.318), pain anxiety (OR=1.056, 95%CI 1.018-1.094), and pain catastrophizing (OR=1.168, 95%CI 1.016-1.348) were associated with acute symptoms of PTSD. Conclusions: The results support the modified diathesis-stress model indicating that neuropathic pain, general anxiety, pain anxiety, and pain catastrophizing are associated with symptoms of PTSD. Future studies should examine the influence of these acute factors on the development of chronic pain and PTSD following TMsI.

The focus of this inquiry is “New Zealand small business employers’ perspectives of the important factors in return-to-work (RTW) of an employee following a musculoskeletal injury or an illness”. Whilst worldwide there is an increasing amount of attention focused on the RTW process in large organisations, there continues to be little understanding of this phenomenon in small businesses. I chose to use a social constructivist theoretical framework drawing on grounded theory methodology to construct some understanding of the employers’ perspectives of the RTW process. Eight small business employers from Auckland and Christchurch participated in this research. Data were gathered using semi-structured interviews. Constant comparative analysis, theoretical sampling and thematic analysis were used to construct two themes from the data. The findings showed that small business employers prefer informal organisational approaches, rely on close working relationships with their staff, are generally wary of bureaucracy and often must run their businesses with limited staff and financial resources. Having an employee off work for a prolonged period of time creates a sizable gap in the staff resources that keep the business running. The employer has responsibility to fill this gap while maintaining a productive business. In the absence of formal injury management practices an ad hoc approach was taken to the RTW process. A number of the employers felt undervalued by key stakeholders, such as doctors, treatment providers, Accident Compensation Corporation and in some cases RTW co-ordinators. Health and safety was a risk all employers appeared to take seriously whereas injury management information and support seemed less of a focus. This research suggests there may be little focus on injury management in small businesses by employers and, that employers perceive greater government emphasis on injury prevention. The extent and associated costs of work disability in small businesses is as yet unknown, but it is likely to be significant. How to support and encourage the uptake of injury management in small businesses in the long term warrants further investigation. Understanding that employers may well lack injury management expertise, experience and resources requires stakeholders to make specific effort with the employer, at the workplace, to facilitate the RTW process.

<p><font face="Arial"> <p align="left">The aim of the study was to determine the prevalence of and risk factors contributing to work-related musculoskeletal injuries amongst underground mine workers in Kitwe, Zambia.</p> </font></p>

<p><font face="Arial"> <p align="left">The aim of the study was to determine the prevalence of and risk factors contributing to work-related musculoskeletal injuries amongst underground mine workers in Kitwe, Zambia.</p> </font></p>

The focus of this inquiry is “New Zealand small business employers’ perspectives of the important factors in return-to-work (RTW) of an employee following a musculoskeletal injury or an illness”. Whilst worldwide there is an increasing amount of attention focused on the RTW process in large organisations, there continues to be little understanding of this phenomenon in small businesses. I chose to use a social constructivist theoretical framework drawing on grounded theory methodology to construct some understanding of the employers’ perspectives of the RTW process. Eight small business employers from Auckland and Christchurch participated in this research. Data were gathered using semi-structured interviews. Constant comparative analysis, theoretical sampling and thematic analysis were used to construct two themes from the data. The findings showed that small business employers prefer informal organisational approaches, rely on close working relationships with their staff, are generally wary of bureaucracy and often must run their businesses with limited staff and financial resources. Having an employee off work for a prolonged period of time creates a sizable gap in the staff resources that keep the business running. The employer has responsibility to fill this gap while maintaining a productive business. In the absence of formal injury management practices an ad hoc approach was taken to the RTW process. A number of the employers felt undervalued by key stakeholders, such as doctors, treatment providers, Accident Compensation Corporation and in some cases RTW co-ordinators. Health and safety was a risk all employers appeared to take seriously whereas injury management information and support seemed less of a focus. This research suggests there may be little focus on injury management in small businesses by employers and, that employers perceive greater government emphasis on injury prevention. The extent and associated costs of work disability in small businesses is as yet unknown, but it is likely to be significant. How to support and encourage the uptake of injury management in small businesses in the long term warrants further investigation. Understanding that employers may well lack injury management expertise, experience and resources requires stakeholders to make specific effort with the employer, at the workplace, to facilitate the RTW process.

Magister Scientiae - MSc / The aim of the study was to determine the prevalence of and risk factors contributing to work-related musculoskeletal injuries amongst underground mine workers in Kitwe, Zambia.

Background: First responders have unique and important roles. The duties performed can be dangerous, physically demanding and stressful, leading to high risks of injury and illness. Because of their unique job demands, it is important to identify aspects of the disability management process and predictors of return to work that are specific to first responders Thesis Objectives: To analyze first responder disability management claims associated with injuries and mental health issues to determine predictors of return to work and differences in the disability management claims when comparing first responders to high and low demand occupations. Methods: The claim data were obtained from a disability management company. In the first study, all first responder claims were included in the Cox proportional regression models and the log-rank tests to identify predictors of return to work. For the second study, the claims of high and low demand occupations were randomly age and sex-matched to the first responder claims. Differences in the duration of time off work, the duration of the claim, the injury and mental health diagnoses, and the duties performed when returning to work existed between first responders and the two occupation groups. Results: Musculoskeletal injuries predicted an increased likelihood of returning to work in a shorter duration of time. Medical report lag and claim lag decreased the likelihood of returning to work. First responders returned to work sooner, had shorter disability claim durations, differed in the injuries and mental health issues sustained, and were less likely to return to their pre-injury duties compared to the two occupation groups. Conclusions: Predictors of return to work specific for first responders were identified, yet the results lack generalizability. Although first responders returned to work sooner compared to the other occupations, they were more likely relegated to modified duties. / Thesis / Master of Science (MSc) / First responders perform dangerous and stressful work. They are at risk of injuries and illnesses that require time off work to recover. The goal of this dissertation is to identify features of the return to work process that are specific to first responders. The studies found that first responders with injuries like sprains and strains went back to work sooner than those with mental health issues. The study also found that sooner the injury claim was started and the medical information was received, the sooner first responders could return to work. When compared to other injured workers, first responders returned to work quicker, but were more likely to only be able to do modified work rather than their typical jobs. It is important that first responders fully recovery from injuries before they can get return to responding to emergency calls.