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Medical Factors
An ergonomics program can reduce the incidence of arm pain

At a glance:
Work related conditions that cause discomfort, disability
disability
A condition or function that leaves a person unable to do tasks that most other people can do.
 or pain in the joints, muscles, tendons or other tissues
tissue
Collection of cells that perform a similar function. e.g. epithelium (skin), connective tissue (blood, bone), muscle
 of the arm, shoulder or hand, can be caused by things like repetitive motions, uncomfortable postures or forceful physical efforts.

This study describes a work based program that:

- Encouraged employees to report their injuries early
- Provided comprehensive medical care
- Undertook regular workplace assessments and job analyses to eliminate hazards

After seven years the program decreased musculoskeletal
musculoskeletal
Involving the muscles and the skeleton. This term includes the limbs, neck, shoulders and back. 'Musculoskeletal problem' refers to many different conditions that can affect the tendons, muscles and related structures.
 disorders by 80% and almost eliminated the need for surgery for musculoskeletal conditions.
Perspectives:
Employee
This study demonstrated that workplace management of arm problems can make a significant difference. Some arm problems result from specific conditions, such as inflammation of a tendon, carpal tunnel syndrome.
Carpal Tunnel Syndrome
A condition characterized by pain and numbness in the hand and sometimes the forearm. It is caused by pressure on the nerve which connects the arm to the hand (through the carpal tunnel) and gives sensation to the hand, thumb and three fingers
 tendonitis
tendonitis
Painful inflammation of a tendon. Tendonitis is often described by the body part affected, such as Achilles tendonitis.
 or tear at the shoulder. Other conditions are non-specific - that is, the pain is more generalised.

Dealing with the problem early can help. In this study the employees and their supervisor, as well as health professionals, examined the work duties and environment, identified problems, and agreed to modify any issues that were contributing to the problems.

Body aches and pains are common. If you consider your problem is persistent and bothersome it is worth reporting it promptly. Modifications to the job can often be made to prevent the problem becoming more troublesome.
Employer
Arm problems were a major issue in Australia in the 80s. While arm problems at work are now less common in Australia, they have become a more substantial problem in Europe and North America over the last 10 years.

Medical treatment is of limited benefit for non-specific upper limb
upper limb
arm
 problems. Employers can make a significant difference and often have a greater the impact on the employee's recovery than medical treatment.

This study indicates that early management of conditions reduces the harm they cause. Work in collaboration with your employees and health professionals to identify problems early, identify factors that are contributing to the problem, and reduce risks. Evaluating the ergonomics of the job can help prevent injuries occurring, and modifying workplace activities can prevent worsening of upper limb conditions.

Supervisors can be taught basic ergonomics so that they are aware risks and can prevent problems. Specialised help can be obtained through rehabilitation
rehabilitation
The process of helping a person back to their former abilities and quality of life (or as close as possible) after injury or a medical condition.
 providers or other health professionals with training in ergonomics.

Improving employees' sense of job control and identifying and dealing with workplace stress can also reduce the incidence of musculoskeletal conditions.
Treater
Medical treatment is of little benefit in managing non-specific arm pain. While hands-on treatment such as physiotherapy can help symptoms temporarily, addressing workplace issues is more successful in the long term.

To help reduce ongoing arm pain:

Review the ergonomics or layout of the job
Identify workplace stress or other workplace issues that maybe contributing to the problem
The employee should have positive relations at work, feel productive in the job and a have sense of job control

There is no evidence that avoiding or limiting activity helps the problem in the medium to long term.
Insurer
Non-specific arm pain or upper limb problems can be challenging to manage. This study shows that workplace initiatives can help prevent and manage upper limb problems.

The employer can often have a greater impact on their employee's recovery than medical treatment. A basic understanding of ergonomics will help the employer to reduce injuries, and if needed a rehabilitation provider can review the workstation.

It is equally important to address any workplace interpersonal issues. People do better when they feel they are contributing and are productive. Whilst pain levels may be improved in the short term by restricting arm activity, longer term management requires the individual to be working in a role that is meaningful and productive. Industrial relations issues can make the problem worse, and employees may benefit from specialised help to resolve the issues.
Original Article, Authors & Publication Details:
E. J. Bernacki1, J. A. Guidera1, J. A. Schaefer1, R. A. Lavin1 and S. P. Tsai2 (1999).

An Ergonomics Program Designed to Reduce the Incidence of Upper Extremity
extremity
arm (upper extremity) or leg (lower extremity)
 Work Related Musculoskeletal Disorders.
Journal of Occupational & Environmental Medicine 41(12): 1032-1041.

1 Johns Hopkins School of Medicine
2The University of Texas Health Science Center, Houston, Texas
Background, Study Objectives, How It Was Done:
“Work-related upper-limb musculoskeletal disorders' involve discomfort, impairment, disability or persistent pain in joints, muscles, tendons or other soft tissues in the shoulder, arm or hand.

There is evidence that work-related musculoskeletal disorders are more common in jobs that involve repetitive motions, localised stress, awkward positions, vibrations, and forceful physical efforts. Industries such as meat packing, frozen foods, carpentry and logging have high rates of these injuries. They can also be caused by typing, repetitive tool use, or repetitive moving of objects.

Ways in which employers are trying to decrease the occurrence of work-related musculoskeletal injuries include:

Formal programs to identify injuries
Fitting the job to the worker (e.g. by changing the layout of the workspace)
Gradually accommodating the worker to the job
Keeping workers well informed

This study investigated a program that was initiated in 1992, which aims to decrease upper-limb work-related musculoskeletal disorders. The program is in operation in Maryland in the US, in a large teaching hospital and university. The researchers monitored the number of upper-limb work-related musculoskeletal injuries that occurred in the first 7 years after the program was introduced (1992 - 1998).

The program aims to

Identify and treat work-related musculoskeletal injuries
Prevent new injuries occurring
Prevent existing injuries from getting worse.

It involves:

1. Early response to the injury
2. Changes to compensation policies
3. Medical assessments and treatment
4. Workplace assessment
5. Job analysis and
6. Changes to the workspace to eliminate risks

A summary of the different strategies is given below.

Responding to injury:

All employees with a work-related injury are directed to report immediately to an on-campus Occupational Injury Clinic for evaluation and treatment.

The clinics are staffed by occupational health nurses and occupational physicians, and provide case management services and regularly meet to discuss cases.

Where necessary, specialised care is provided by a team of doctors qualified in occupational medicine, orthopaedics, neurosurgery and physical rehabilitation.

A second group of case-managers, safety professionals, human resources workers and compensation representatives meets once per month to plan a return-to-work strategy for each worker on sick leave.

Workers' compensation program:

The costs of managing the medical condition in the early stages were covered straight away, without needing to ask the insurer about liability to accept the condition. With this approach delays were avoided. Liability was sorted out after the condition and the workplace were better understood.

Workplace assessment:

Workplace assessments were used routinely. They were used to identify and correct workplace risks to prevent further injuries. The assessment included a review for repetitive movements, stresses, trauma, forceful efforts, awkward positions and dangerous environmental conditions. The worker was involved in the assessment and a report of the workplace assessment was given to the worker's supervisor.

30 days after the supervisor receives the report, there was a telephone follow-up to check whether changes have been made or were in process and to check on the condition of the employee.

Medical assessments and treatment:

All injured employees were referred to a physician or an orthopaedic surgeon for a definitive diagnosis.
diagnosis
The process of identifying a medical condition or disease by its symptoms, the findings from a medical examination, and from the results of various diagnostic procedures.
 The assessment included review of medical, social and psychological
psychological
Refers to a person's perceptions, thought processes, emotions, personality and behaviour. Psychologists can treat mental health problems.
 factors than can influence health.

Evidence based guidelines were followed to ensure high standard medical care. Referral to a group of experienced specialist occurred where appropriate.

Job analysis:

A job analysis reviewed the way a job was performed and examined any modifications needed for the person to do the job. The employee, supervisor, and relevant ergonomic
ergonomic
Designing activities and the workplace in a way to minimize discomfort. i.e. Adapting work tasks, hours, or workstation to accommodate people. An ergonomic computer workstation allows the person to work in the best position to relieve load on the muscles of the neck and arms.
 and health professionals were involved in the job analysis. On completion the job analysis findings were documented to make sure the agreement was clear. Follow up occurred if there were further problems.
Study Findings:
The researchers found:

  • The rate of upper-limb work-related musculoskeletal disorders per 1000 workers decreased by 80% over the 7-year period.
  • The number of job analyses and workplace assessments increased several-fold over this time. By the end of the program, 10% of jobs at the centre had been analysed for health risks, and steps taken to correct these problems.
  • Over the final 4 years of the study there was only 1 surgery for a work-related musculoskeletal injury. This surgery was for a long-standing condition that existed before the program was introduced.

The table below summarises the changes in the number of upper-limb musculoskeletal disorders, surgeries, job analyses and workplace assessments over the 7 years after the program was introduced.

Year Workplace assessments/job analyses performed Work-related musculoskeletal disorders Surgeries for work-related musculoskeletal disorders
1992 73 112 5
1993 97 97 8
1994 167 102 13
1995 279 56 0
1996 375 42 0
1997 584 39 1
1998 604 29 0

Conclusions:
 
This study investigated a program that aimed to identify and treat work-related musculoskeletal injuries, prevent new injuries occurring and prevent existing injuries from getting worse. The program was implemented at Johns Hopkins Hospital and University. It involved early response to the injury, changes to compensation policies, medical assessments and treatment, workplace assessments and job analysis.

The program was unique in that medical professionals, insurance representatives and loss control specialists worked together. Compensation claims were processed using medical and work-related information. Medical care was standardised and closely managed and workplace assessments eliminated hazards.

In the 7 years after the program began, work-related musculoskeletal disorders decreased by 80%. The number of musculoskeletal injuries requiring surgery was reduced to almost zero. At the same time, the number of workplace assessments and job analyses performed significantly increased.

Overall, the researchers believed that the decrease in injuries occurred due to 5 factors:

  1. Identification and treatment of long-term cases that had gone unnoticed
  2. Quick reporting of injuries. This meant that treatment could begin early and complications could be avoided.
  3. Workplace assessments for people with existing musculoskeletal injuries. This eliminated hazards and ensured the employee was placed in an appropriate job.
  4. Workplace assessments that eliminated potential risks for other employees
  5. Identification of problems that were caused by psychological or social issues
By changing the way compensation claims were handled, there was a significant increase in the number of upper-limb work-related musculoskeletal disorders that were reported. This meant that, at first, the rate of injuries appeared to increase, while in fact injuries that had been there all along were being identified. Because injuries were reported sooner, there was a decrease in the number of long-standing injuries that had developed to the point where they required surgery. In an organisation of over 17000 employees, only 1 surgery was required for a work-related skeletal disorder between 1995 and 1998.

Within the program, assessments and changes in the workplace initially focussed on resolving problems for injured employees. However the strategy was soon found to be useful for identifying risks and preventing further injury. Employees and supervisors increasingly requested assessments of their workplaces. The increase in workplace assessments corresponded with a decrease in the rates of injury.

Because the number of workplace assessments increased, there was a significant increase in the costs generated by these assessments. The decrease in the number of surgeries, however, brought considerable savings. Before the program was implemented, the organisation paid an average of about $84 000 per year for surgeries for work-related musculoskeletal conditions. In comparison, they paid an average of $23 760 per year after implementation of the program to evaluate, treat, assess and correct the workplaces of injured employees.
References:
PubMed Abstract
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