Physical therapists versus nurses in a rehabilitation hospital: comparing prevalence of work-related musculoskeletal complaints and working conditions

Work-related injury or work-related pain? A qualitative investigation of work-related pain and injury management among rehabilitation professionals1

BACKGROUND

Patient mobility tasks place rehabilitation professionals (Physical and Occupational Therapists) working in hospitals at high risk for work-related musculoskeletal disorders (WMSDs). However, when investigating engagement with a Safe Patient Handling and Mobility program (SPHM), administrative records at a level one trauma hospital showed that rehabilitation professionals reported zero work-related injuries over an eight-year period.

OBJECTIVE

As part of a qualitative study conducted to discover their unique work experiences, we explored some of the reasons that rehabilitation professionals might not report work-related injuries to their employers.

METHODS

Using a collective case study design, six focus groups were conducted with 25 members of the rehabilitation team within a level-one trauma hospital. Focus groups were recorded; transcripts were analyzed for emergent themes using first and second cycle coding procedures.

RESULTS

Participants in this study denied experiencing work-related injuries but frequently described working in pain, often attributed to patient mobility tasks. These experiences were not reported to employers. Self-management of their pain through co-worker treatment, over-the-counter medications, or informal alteration in job tasks were reported as common.

CONCLUSION

Administrative injury records may underrepresent injuries among rehabilitation professionals. This may be due to their perception of work-related pain as something different than work-related injuries, or that many of these rehabilitation professionals treat their own work-related pain and symptoms rather than report them. To get a more accurate assessment of injury frequency among rehabilitation professionals, researchers should gather information directly from the participants, and should inquire about work-related pain in addition to injury.

Physical and psychosocial work demands associated with pain and disability among skilled male Arab waiters

BACKGROUND

Physical and psychosocial demands (e.g., serving, cleaning, fulfilling orders) can lead to work-related musculoskeletal pain (WRMSP).

OBJECTIVE

To assess the prevalence of WRMSP in the upper quadrant and lower back among skilled male Arab waiters; to evaluate the disability related to WRMSP; to evaluate the association between work demands and WRMSP with related disability.

METHODS

100 skilled male Arab waiters working full-time, aged 18-60, participated in the cross-sectional study. Participants completed basic demographics and working conditions; the NDI; QuickDASH; the OswestryQ; workload, burnout, and job satisfaction at work; the adjusted NordicQ; and the TaskQ, compiled especially for this study.

RESULTS

A 12-month pain prevalence, pain frequency, and work avoidance were high: neck- 42%, 60.5%, 89.5% ; shoulders -53%, 78.2%, 94.4% ; elbows- 46%, 78.6%, 83.3% ; lower back- 45%, 44%, 78.7%, respectively. Pain prevalence in at least one site was 83% . The OswestryQ, QuickDASH, and NDI revealed mild-moderate pain and disability (14.85/50, 25.54/75, 13.74/50, respectively). Burnout score was positively associated with OswestryQ, QuickDASH, and NDI. Job satisfaction was negatively associated with 12 months of pain in the lower back, hands, arms, shoulders, and hands (NordicQ). TaskQ was positively associated with OswestryQ.

CONCLUSION

Male Arab waiters who work in physically and psychologically challenging conditions report high levels of WRMSP with a high frequency and related work avoidance. Many of them must keep their jobs as they are their families' primary or sole providers. It is possible that they are trying to prevent more severe disabilities in the future by ensuring temporary rest and pain prevention.

Effects of different bed heights on the physical burden of physiotherapists during manual therapy: an experimental study

This study aimed to determine the effect of physiotherapists' physical burden caused by different bed heights during manual therapy. Thirty-three male physiotherapists performed tasks simulating lumbar massage and passive hip abduction range-of-motion exercise (ROM) on the beds with low height (LH) and adjusted height (AH), with each task performed three times. The anterior inclination angle of the physiotherapist's trunk was measured, the surface electromyograms of the erector spinae and trapezius muscles were recorded, and perceived stress was assessed. The indexes obtained were statistically compared for different bed heights. Additionally, the lumbar disc compression force and flexion torque were estimated. The lumbar burden caused by the excessive bending and the biomechanical burden and perceived stress were stronger at LH than AH. In ROM tasks using the right hand, the muscle activity was lower at the left lumbar region at LH than at AH. At LH, the anterior inclination angle increased and the lumbar muscle activity declined as the number of tasks increased. The burden on the shoulders was not significantly different by bed heights. Our results showed that, when physiotherapists perform manual therapy, it is necessary to adjust the bed height to reduce physical burden and ensure higher quality of service.

Work-Related, Non-Specific Low Back Pain among Physiotherapists in France: Prevalence and Biomechanical and Psychosocial Risk Factors, as a Function of Practice Pattern

BACKGROUND

Physiotherapists worldwide experience lower back pain (LBP). Up to 80% of physiotherapists report having experienced an episode of LBP at some point in their career, and LBP is the most common musculoskeletal disorder in this profession. In France, the prevalence of LBP among physiotherapists and associated work-related risk factors have not previously been studied.

OBJECTIVE

To determine whether the risk of work-related non-specific LBP among French physiotherapists depends on practice pattern.

METHOD

A link to an online self-questionnaire was sent to French physiotherapists. The various practice patterns were compared with regard to the prevalence of LBP, the total number of days with LBP during the previous 12 months, and the degree of exposure to biomechanical, psychosocial and organisational risk factors.

RESULTS

Among the 604 physiotherapists included in the study, the prevalence of work-related, non-specific LBP in the previous 12 months was 40.4%. The prevalence was significantly greater among physiotherapists working in geriatrics (p = 0.033) and significantly lower in sports medicine (p = 0.010). Differences in exposure to risk factors were also found.

CONCLUSIONS

The risk of non-specific LBP among French physiotherapists appears to depend on the mode of practice. All the various dimensions of risk must be taken into account. The present study could serve as a basis for more targeted research on the most exposed practices.

Neck Disability Index Detects Higher Neck-Related Disability Levels among Physiotherapists and Family Medicine Specialists than among Dentists

BACKGROUND

Healthcare workers who are in physical contact with patients are prone to work-related musculoskeletal disorders (WMSDs). Much is known about the prevalence of neck pain, but the extent of disability associated with neck pain among physical therapists (PTs), dentists, and family medicine specialists (FMs) is unknown.

METHODS

The prevalence of neck pain and Neck Disability Index (NDI) data were collected from 239 PTs, 103 FMs, 113 dentists, and 112 controls from June to August 2022.

RESULTS

The highest prevalence of neck pain was found in FMs (58.3%), followed by dentists (50.4%), PTs (48.5%) and controls (34.8%). The NDI% in PTs and FMs had higher values than controls: 14.6 ± 12.4, p = 0.02 for PTs, 14.9 ± 12.4, p = 0.01 for FMs vs. 10.1 ± 10.1 controls. The dentist group did not differ from controls (11.9 ± 10.2, p = 0.13). Mild, moderate, or severe forms of disability were more common in medical professionals than in controls (44.2%, 9.5%, and 1.5% vs. 37.5%, 7%, and 0%). Dentists were the youngest group with high functionality and the lowest degree of disability, comparable to the control population. Gender or age had no effect on NDI scores in this population. FMs, who represented the oldest group, showed age dependency (eleven years older in higher disability groups). Gender had no effect on NDI. In PTs, females predominated in all disability categories and PTs became five years older with increasing disability level.

CONCLUSION

By using NDI in assessing neck-related WMSDs, we can detect medical professionals prone to more serious disability and potentially plan preventive actions.

Occupational injuries and patient lift usage among physical rehabilitation therapists

BACKGROUND

Physical therapists (PTs) and physical therapist assistants (PTAs) are at high risk for work-related musculoskeletal pain and discomfort.

OBJECTIVE

Determine the prevalence and exposure risk factors for work-related injuries (WRIs) among rehabilitation PTs and PTAs.

METHODS

A cross-sectional research survey was conducted among 170 PTs and 67 PTAs at 51 free-standing rehabilitation hospitals and rehabilitation units embedded in general hospitals in the Midwestern states of Iowa, Kansas, Missouri and Nebraska. The prevalence of WRIs and significant risk factors for developing WRIs were determined for PTs and PTAs.

RESULTS

The 1-year prevalence of WRIs among PTs and PTAs working in physical rehabilitation was 29.5%. Multifaceted causes were identified including frequently bending/twisting, over-exerting force during patient handling activities, inadequate lifting devices, and lack of ongoing training for mechanical lifting device usage.

CONCLUSIONS

Equipment usage barriers point to a critical need for technology creation, research, and education to advance worker safety while simultaneously enhancing patient outcomes.

Prevalence of Musculo-skeletal Discomfort and Level of Functional Limitations among Physiotherapists in Karachi City

Introduction: Musculoskeletal discomfort is one of the most prevalent muscular pain condition hindering normal activities reported by physical therapists and health care professionals generally engaged in handling and mobilizing patients. The study was conducted to find the prevalence of musculoskeletal discomfort and level of functional limitations in physiotherapists. Method: This research was questionnaire based cross sectional study conducted in Karachi city from January to April 2019.Data collection was completed from registered physical therapists employed in different institutions. Two questionnaires were filled by the physiotherapists. Questionnaire 01, including thirteen questions on functional activities of daily life which are potentially related to functional areas of Neck Disability Index (NDI). Questionnaire 02 was based on 1987 version of Nordic musculoskeletal questionnaire. Results: Participation of 80 physical therapists in the study.75% was directly involved with patient handling and 25% were teachers. A total of 35% therapists reported 7 days symptoms prevalence with a higher prevalence in cervical (77.1%), lower back (68.6%) and upper back (51.4%).Similarly 65% workers showed previous 12 month symptoms with higher prevalence in neck (72.3%). Gender prevalence of 7days and 12 months was high in female therapist. Conclusion: It has been concluded that 12 month prevalence of musculoskeletal discomfort was 65%, whereas 7 days was 35% and level of functional limitation from activities was insignificant. Keywords: Epidemiology, musculoskeletal discomfort, Severity, Physical therapy,

Claim Costs, Musculoskeletal Health, and Work Exposure in Physical Therapists, Occupational Therapists, Physical Therapist Assistants, and Occupational Therapist Assistants: A Comparison Among Long-Term Care Jobs

BACKGROUND

Patient/resident-handling tasks are physically demanding and associated with musculoskeletal disorders (MSDs) among nursing personnel. The routine performance of such tasks by physical therapists and occupational therapists during treatment can cause similar problems.

OBJECTIVE

This study characterized the magnitude of MSDs and the risk factors for MSDs in physical therapists, occupational therapists, physical therapist assistants, and occupational therapist assistants (collectively called "therapy personnel" for this study) and compared them with those of other nursing home workers, especially nursing staff.

DESIGN

This was a cross-sectional study.

METHODS

Workers' compensation claim (WCC) data from 1 year of experience in a long-term care company were used to compute claim rates by body region, nature, and cause of injury, and the costs per case and per full-time-equivalent employee. Data regarding musculoskeletal symptoms, use of patient/resident-lifting equipment, and perceived physical and psychological job demands were obtained from a concurrent cross-sectional survey of workers from 24 long-term care facilities.

RESULTS

About 80% of the WCCs were related to musculoskeletal incidents in nursing aides and therapy personnel. WCC costs paid per case for therapy personnel were more than twice those for nursing staff for both ergonomic and resident-handling incidents. Prevalence of low back pain in therapy personnel was the same as in nursing aides (48%) but involved more chronic, milder pain. About half of therapy personnel reported "never" or "rarely" using patient/resident-lifting equipment. Therapy personnel, nursing aides, and housekeeping/dietary/maintenance personnel reported the highest physical job demands.

LIMITATIONS

Causal inference cannot be determined due to the cross-sectional nature of the survey data. Study findings are relevant only to therapy work in long-term care settings because exposures vary in other health care settings (hospitals, outpatient, and others).

CONCLUSIONS

MSD prevalence and claim costs in therapy personnel are high enough to deserve more attention. The low use of patient/resident-lifting equipment in therapy could increase the risk for MSDs. Future studies with comprehensive ergonomic analysis of therapist tasks and recommendations to reduce injuries are warranted.

Evaluation of body posture in nursing students

OBJECTIVE

To investigate the body posture of nursing students before and after clinical practice.

METHOD

The study was developed in two stages. Initially the body posture of students of the 2nd, 4th, 6th, and 8th periods were assessed through photogrammetry. All images were analyzed in a random and masked manner with CorporisPro® 3.1.3 software. Three evaluations were performed for each angle and then the mean value was calculated. Two years later, when the 4th period students had developed their clinical internships, their body posture was again evaluated.

RESULTS

The total sample consisted of 112 students. Comparison of their posture with the normality pattern showed that all the angles presented significant differences (p< 0.00), except for the angle of the Thales triangle. Reassessment of these students evidenced significant differences in the angles of the acromioclavicular joint (p=0.03), knee flexion (p< 0.00) and in the tibiotarsal angle (p< 0.00).

CONCLUSION

All the students presented alterations when compared to the normality values. The segments that presented significant differences between before and after practice were the acromioclavicular angle, knee flexion, and tibiotarsal angle; the latter two were in the rolling position.

OBJETIVO

Investigar a postura dos estudantes de enfermagem antes e após a prática clínica.

MÉTODO

O estudo foi desenvolvido em duas etapas, inicialmente com estudantes (2º, 4°, 6° e 8º períodos) tiveram sua postural corporal avaliada por meio da fotogrametria. Todas as imagens foram analisadas, de maneira aleatória e mascarada, por meio do software CorporisPro® 3.1.3. Foram realizadas três avaliações para cada ângulo e calculada a média. Dois anos depois, quando os estudantes do 4º período desenvolveram os estágios clínicos, foram novamente avaliados quanto à postura corporal.

RESULTADOS

A amostra total foi composta por 112 estudantes. Comparando-se os estudantes com o padrão de normalidade, todos os ângulos apresentaram diferença significativa (p< 0,00), com exceção do ângulo triângulo de Tales. Reavaliando os mesmos estudantes, houve diferença significativa nos ângulos da articulação acromioclavicular (p=0,03), da flexão de joelhos (p< 0,00) e no ângulo tibiotársico (p< 0,00).

CONCLUSÃO

Todos os estudantes apresentaram alterações, comparadas aos valores de normalidade. Os segmentos com diferença significativa, comparando-se antes e após a prática, foram o ângulo acromioclavicular, flexo de joelho e ângulo tibiotársico, sendo os dois últimos na posição de rolamento.

Repositioning a passive patient in bed: Choosing an ergonomically advantageous assistive device

Repositioning of passive patients in bed creates health risks to the nursing personnel. Therefore, appropriate assistive devices should be used. Our aim was to find the optimal assistive device for reducing musculoskeletal load while moving a passive patient in bed. Torso kinematic inputs evaluated by the Lumbar Motion Monitor (LMM) and perceived load (Borg scale) were measured in female nurses performing 27 patient transfers [represented by a mannequin weighing 55 (12 nurses), 65 (24 nurses) and 75 kg (12 nurses) in bed] using a regular sheet, a sliding sheet and a carrier. The lowest rates of perceived exertion were found when the sliding sheet and/or carrier were used, for all tasks (p ≤ 0.009). According to the predicted risk for Low Back Disorder (LBD) based on the LMM inputs, negligible differences between assistive devices were found. In a 75 kg mannequin, the participants were able to perform all tasks only by using a sliding sheet. Utilizing sliding sheets is an advantageous technique in comparison to traditional cotton sheets and even carriers.

Work-related musculoskeletal disorders among physical therapists: A systematic review

Physical therapists (PTs) perform demanding tasks that can lead to work-related musculoskeletal disorders (WMSD), but the rates and characteristics of WMSD among PTs are not well known. The objective of this systematic review of the literature was to integrate the information published on the prevalence, types, and risks for WMSD among PTs. Four databases were searched using combinations and synonyms for WMSD, discomfort, symptoms, and PTs. Two reviewers independently searched and screened peer-reviewed articles published in English evaluating WMSD in PTs; agreement between reviewers was evaluated. From 867 unduplicated articles, 32 were eligible and included. Up to 90% of PTs have WMSD during their careers; 50% experience WMSD within 5 years of practice. Low back was the body part most commonly affected. Female PTs and PTs working in hospitals have higher prevalence of WMSD. WMSD are associated with PTs' age, gender, specialty and job tasks. Performing manual therapy, lifting and transferring patients are tasks commonly associated with PTs' developing WMSD. The body parts affected differed by specialty and tasks. The findings presented in this review are useful to inform future research, quality improvement, and educational programs to reduce the rates of WMSD among PTs.

Prevention of Nurses’ Work-Related Musculoskeletal Disorders Resulting From Repositioning Patients in Bed

Repositioning patients in bed to promote comfort and prevent impairments caused by continuously lying in a prone position is a task frequently performed by nurses and nursing assistants. Repositioning is a high-risk activity, frequently causing occupational injuries. These occupational injuries are attributed to excessive physical demands on nurses due to patients’ weight and awkward nurse postures. During repositioning, risk of injury can be lowered by reducing friction between the patient and the bed. Hence, certain friction-reducing devices have been developed to reduce the manual force required to move patients. Nevertheless, further research is needed to evaluate the potential effectiveness of these devices. Therefore, the aim of this review was to present current research about the risk factors, prevention strategies, and assistive devices that could reduce work-related musculoskeletal disorders caused by repositioning patients in bed.

Comparisons of musculoskeletal disorders among ten different medical professions in Taiwan: a nationwide, population-based study

Objective

Medical personnel are at risk of musculoskeletal disorders but little is known whether the risk of musculoskeletal disorders were different among various medical professions. Therefore, this study compared the risk of musculoskeletal disorders among personnel of 10 different medical professions in Taiwan using a nationwide health claims database.

Methods

Data from the 2000–2010 Taiwan National Health Insurance Research Database were used to identify personnel of 10 different medical professions. Diagnoses based on the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) were used to identify eight different musculoskeletal disorders that occurred after the license issuance date. Cox proportional hazards model was used to compare the risk of eight musculoskeletal disorders among the 10 different medical professions using dentists as the reference category.

Results

A total of 7,820 medical personnel were included in the analysis. Using dentists as the reference category, physical therapists showed a significantly higher risk of all eight musculoskeletal disorders (ranging from 1.59 [p = 0.032] in sprains and strains of other and unspecified parts of back to 2.93 [p < 0.001] in spondylosis and allied disorders).

Conclusions

Compared with dentists, a profession that already known to suffer from high rates of work-related musculoskeletal disorders, physical therapists, registered nurses, and doctors of Chinese medicine showed an even higher risk of musculoskeletal disorders.