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A workplace education program that prevents neck and back problems, and limits reinjury

At a glance:
This study evaluated the effectiveness of Vocational
vocational
Related to work or career. Vocational rehabilitation focuses on the process of returning to the workforce.
 Oriented Medical Rehabilitation (VOMR). Aircraft maintenance workers are a high-risk group for back and neck problems, their job involves constant bending and twisting. VOMR showed good results in reducing severity of pain, days on sick leave, and in decreasing limitation of function over five years.
Perspectives:
Employee
If you work in awkward or fixed posture positions for long periods you are more likely to experience soreness in the neck or back.

This study shows that learning how to alter posture and using stretching exercises improve outcomes and prevents reinjury.

A lot of research has shown that the best way to prevent back problems or reinjury is to improve general and back fitness. This study supports these conclusions and indicates that changing posture regularly while keeping the muscles active and strong improves outcomes.

Talk to your employer about what can be done to enable changes in posture and mobility if your job requires long periods in a fixed or awkward posture.
Employer
Some employees work in awkward positions for long periods of the day. This study shows that people can be taught how to improve the situation, i.e. by learning about the difficulties of awkward postures, improving fitness, and being given the opportunity to change posture regularly.

Productivity is improved when such an education program is implemented.

Does your workplace have people doing difficult jobs for long periods? If so, involving a professional in setting up an appropriate education program and reviewing tasks can pay long-term dividends.
Treater
The best way to prevent recurrent spinal problems is to have a fit and active spine.

This study demonstrates that people can be taught to self manage, and reduce 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.
 problems. The employees in this study undertook long periods of tasks requiring an awkward posture. When they were encouraged to improve their general level of fitness and flexibility and to change posture regularly, outcomes improved and pain was reduced.

Encouraging fitness and activity is an important part of managing musculoskeletal and spinal problems.
Insurer
People who have had a problem with their back often experience a recurrence. Teaching people how to self manage carries the best chance of preventing further injuries. This study shows that even people who undertake tasks requiring an awkward posture can be shown how to manage the situation and reduce longer term problems, by changing postures and position regularly and improving fitness.
Original Article, Authors & Publication Details:
K. Holopainen1, N. Nevala2, P. Kuronen3, J. P. A. Arokoski4 (2004)

Effects of vocationally oriented medical 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.
 for aircraft maintenance personnel – A preliminary study of long-term effects with 5-Year follow-up. Journal of Occupational Rehabilitation
; 14(4):233-242

1Finnish Institute of Occupational Health, Helsinki, Finland.
2Finnish Institute of Occupational Health, Kuopio, Finland.
3Headquarters of the Finnish Air Force, Tikkakoski, Finland.
4Department of Physical and Rehabilitation Medicine, Kuopio University Hospital Kuopio, Finland.
Background, Study Objectives, How It Was Done:
Developed in Finland for workers in various industries, Vocational Oriented Medical Rehabilitation (VOMR) is a program to help people actively recover from workplace injury.

The aim of this study was to characterise poor work techniques in Finnish Air Force machinists and determine the effect of the VOMR program on their physical capacity, symptoms and perceived work ability at six months and five years after the course.

Participants:

The Finnish Air Force was chosen for this study as machinists work in uncomfortable postures for long periods and are typically not taught correct techniques for minimising strain. Twenty male air force workers were included in the study. They had worked for an average of 15 years in their profession, and had been at least 3 years in their current position. All participants had been on sick leave (less than 60 days) due to musculoskeletal symptoms (back or neck pain) in the last two years, but had no other medical condition and wanted to continue working. All of the subjects participated over the entire five year study period.

VOMR course:

The rehabilitation course consisted of physical exercises and training in how to minimise discomfort and strain
strain
Injury to a muscle in which the muscle fibres tear or become irritated as a result of overstretching or wrenching
 at work (ergonomic techniques). It aimed at teaching participants about their physical functioning, to encourage them to exercise regularly and increase their strength and flexibility whilst improving their mental and physical health.

Participants were trained in groups of 10, in two rehabilitation periods. The first for 12 days, and then for 5 days six months later. The course was taught by a team of health professionals, including a physiotherapist; psychologist; physician; physical trainer; an ergonomics
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.
 instructor; a social worker and a nurse.

Postures:

Each machinist's work postures analysed by a computer program after being videoed working the three daily tasks of working under the plane, checking the flight deck and working with the engine. By dividing the work postures into different classes and estimating the weight of the load or the amount of force used, the degree of harmfulness to the musculoskeletal system (back, neck, arms and legs) can be estimated. The degree of potential problems from the job was ranked in four categories:

1. Normal posture – no need for corrective measures

2. May cause problems dash; corrective measures needed in the near future

3. Likely to cause problems dash; corrective measures needed as soon as possible

4. Very likely to cause problems – corrective measures needed immediately

Questionnaires:


The patients completed a questionnaire one month before each rehabilitation period and five years after the completion of the rehabilitation course. They rated how severe they felt their pain was, and the level of physical and mental strain they felt at work. They were asked how many times they had visited a doctor or physiotherapist, and how many sick days they had taken due to their injury in the last six months. They were also asked how often they did vigorous exercise (e.g. jogging, cycling) in their own time and how often they took exercise breaks at work.

Measurement of physical capacity:

During each rehabilitation period the subjects' physical fitness (oxygen uptake/heart rate vs workload), strength (lifting weight/bodyweight) and flexibility (range of motion) were measured. The tests were carried out by the same health professional in both periods.
Study Findings:
Postures:
  • The machinists worked most of the time in a bent posture.
  • They worked with a twisted back:
    • 66% of the time when working under the plane.
    • 56% of the time when working on the engine.
  • Their arms were over shoulder level when working with the engine 85% of the time.
  • They were kneeling when checking the flight deck or working with the engine 45% of the time.
Most of these common work postures were problematic and needed correction (i.e. fell into categories 2-4, above), especially those used when working under the plane or with the engine.

Questionnaires:

Over the five year study period:
  • Low back pain decreased in severity
  • Neck pain decreased after six months but increased back to similar levels as before rehabilitation after five years.
  • The number of sick days the participants took decreased.
  • The number of times the participants visited a doctor/physiotherapist didn't change.
  • The amount of physical exercise the participants did in their own time didn't change.
  • The number of exercise breaks the participants took at work increased.
  • The physical and mental strain of the work decreased after six months but increased back to similar levels as before rehabilitation after five years.
Measurement of physical capacity:

Six months after the rehabilitation period:
  • The range of motion of the participants' spines increased.
  • The strength of the participants' abdominal, back, and upper arm muscles increased.
  • The participants' physical fitness did not change.
Conclusions:
This particular rehabilitation program tried to prevent disability
disability
A condition or function that leaves a person unable to do tasks that most other people can do.
 by acknowledging that the worker's physical environment and postures can contribute to the condition.

This study shows that workers can be taught the correct techniques to minimise the strain of physical work. Work techniques that have been learnt over years may be difficult to change. The postures that are possible may be limited by the workplace, as is the case for aircraft maintenance machinists. Workers in this situation were able to be taught self care and techniques specific to their workplace.

The participants reported that their pain decreased six months after rehabilitation. After five years, the severity of back pain was still less than it was prior to rehabilitation, but neck pain had increased back to a similar a level of severity.

The program encouraged the participants to exercise regularly in order to strengthen their ability to perform work tasks. While the amount of physical exercise the participants did in their own time didn't change, they were taking more exercise breaks at work five years after the program.

The number of sick days the participants took had decreased five years after the rehabilitation program, which may have been due to the participants leading a generally healthier lifestyle after the training.
References:
PubMed Abstract
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