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Ergonomic intervention for employed persons with rheumatic conditions
Abstract
Prior articles in this series on employment and arthritis have documented the major impact arthritis and other rheumatic conditions have on employment. As expected, physically demanding job tasks, including hand use, are substantial risk factors for work limitation. Computer use has been increasing. People with arthritis may choose occupations involving extensive computer use to avoid occupations with other physical demands. But studies show many people with arthritis conditions have difficulty using computers.Ergonomic assessment and implementation helps relieve the physical and other demands of jobs. The Ergonomic Assessment Tool for Arthritis (EATA) is specifically for people with arthritis conditions. Since the EATA can be conducted off worksite, it is feasible to use with workers not wishing to disclose their condition to their employer. Available research supports the effectiveness of ergonomic intervention as a viable method to reduce work limitation for persons with arthritis. Some workers will need additional vocational intervention to remain employed long term. However, ergonomic intervention is a useful first step, as it promotes awareness of arthritis effects on work activities. Assisting workers with arthritis or other rheumatic conditions to use ergonomics to enhance their ability to work well should be an important aspect of managing these conditions.
... Overall, systematic literature reviews focus on the effectiveness of rehabilitation and RTW programs including an EI component (Elders et al. 2000, Goodman et al. 2012, Shaw et al. 2008, Varatharajan et al. 2014, Verhagen et al. 2013. They also investigate the evidence in regard to the effectiveness of workplace-based strategies intervention of in preventing prolonged work disability and supporting sustainable return to work (Burton et al. 2009, Franche et al. 2005, Williams et al. 2007 or describe precisely the EI (Allaire et al. 2013, Bourmaud & Retaux 2012, Faucett & McCarthy 2003. ...
... In the studies reviewed, ergonomic assessments predominantly include the evaluation and diminishing of physical risks according to the functional capacities of the worker returning to work (Allaire et al. 2013, Baldwin et al. 2012, Calvo-Cerrada et al. 2012, Chetty 2010, Fabrizio 2009, Grayson et al. 2005, Lincoln et al. 2002, Povlsen 2012, Shaw et al. 2001, Sherrod et al. 2013. Some authors broaden their analyses from job risk factor evaluation to other aspects of work -such worker's skills, teamwork, equipment, organisation (Anema et al. 2004, Anema et al. 2003, Faucett & McCarthy 2003, Loisel et al. 2001. ...
... They also seem suitable when identifying ergonomic risk factors and determining potential solutions and appropriate adjustments (Allaire et al. 2013, Baldwin et al. 2012, Calvo-Cerada et al. 2012, or (Allaire et al. 2013, Chetty 2010, Sherrod et al. 2013. ...
The objective of this paper is to provide an overview of the use of ergonomic intervention (EI) in rehabilitation programs for workers with compensated work related musculoskeletal disorders (WRMSDs), aimed to achieve sustainable return-to-work (RTW). Groups of terms allow searching 10 databases. Thirty-one articles were selected. Recurrent themes were identified and content analyzed to describe the EI. The results support the effectiveness of the rehabilitation programs with ergonomic component in achieving sustainable RTW for workers with WRMSDs. However, the content of EIs and the way to conduct it differ according to the definition of ergonomics and the approach used. The management of the RTW process seems still be challenging in terms of training the major actors in how to better modify work and workplace. A comprehensive ergonomic framework seems needed to guide rehabilitation professionals in using ergonomics to improve the RTW sustainability by ergonomic changes and modifications in the workplace.
... Several interventions may be implemented in workplaces to promote ergonomics and reduce the stress of physically demanding tasks. For example, employees with arthritis or other rheumatic diseases who benefit from work-based assistance in to use of ergonomics have seen their work efficiency improved and their work-related disability reduced [44]. ...
Objectives The study aims to analyze the patterns and determinants of sick leaves (SL) associated with the most common rheumatological diseases and estimate the associated productivity loss cost (PLC). Method A retrospective study reviewed all SLs that were issued from a rheumatology outpatient clinic between 2016 and 2019 for the following diagnoses: low back pain (LBP), knee osteoarthritis (OA), rheumatoid arthritis (RA), and disc disorders. The duration of each sick leave was captured and analyzed by patients' age category, gender, and diagnosis. The human capital method was used to estimate the PLC. Result One thousand and two SLs have been issued during the study period, for a cumulative 4,649 days. The majority of the patients were female (86.3%), and the mean (SD) age was 42.01 (10.71) years. SL durations ranged from 2 to 14 days. The most frequent diagnosis was RA (34.3%), followed by LBP (30.1%). Disc disorder, knee OA, and RA were independently associated with 2.01 (p=0.014), 9.07 (p<0.001), and 7.75 (p<0.001) odd ratios for long SL (≥7 days), by reference to LBP. The average PLC was estimated at $235.29 per day of sick leave, for a total cumulative cost of $235,755.30. Conclusion Rheumatological diseases are responsible for approximately 4.5 days of SL prescribing per day in our clinic, with an average yearly cost of $58,938.83. Monitoring the pattern of sick leave and identifying the interplay between their cofactors are essential to developing a comprehensive approach to enable evidence-based clinical practices along with advancements in work-based protective measures and policies.
... Z upoštevanjem ergonomskih načel vplivamo na fizične, kognitivne, psihosocialne in druge zahteve aktivnosti, kar omogoča učinkovitejšo izvedbo okupacij. Ergonomske prilagoditve zmanjšujejo pojav bolečine, poškodb in povečajo produktivnost (Allaire idr., 2013). Pri uporabnikih z okvarami zgornjih udov sta edukacija in prilagojena uporaba zgornjega uda enako ali bolj pomembni kot fizične adaptacije s prilagojenimi pripomočki (Meals in Koenigsberg, 2015). ...
Sindrom zapestnega prehoda je utesnitvena nevropatija. Povzroči jo mehanski dinamični pritisk živca na določenem mestu. Ob zgodnjem diagnosticiranju se težave odpravljajo s pomočjo konzervativnega zdravljenja. Med učinkovite delovnoterapevtskeintervencije spadajo: edukacija uporabnika o pravilni uporabi zgornjega uda med izvajanjem aktivnosti, spoznavanje ergonomskih načel in prilagoditev ter uporaba nočne opornice za zapestje. Članek predstavlja splošen pregled informacij, pomembnih tekom rehabilitacije sindroma zapestnega prehoda. Namen je bil ugotoviti, pri katerih dnevnih aktivnostih imajo uporabniki s sindromom zapestnega prehoda največ težav, ter jih seznaniti s pravilno rabo zgornjega uda in prilagojenim izvajanjem dnevnih aktivnosti. Na Univerzitetnem rehabilitacijskem inštitutu – Soča smo tekom ustaljene obravnave dodali edukacijski pristop. Izdelali smo navodila za prilagojeno uporabo zgornjega uda pri vsakodnevnih aktivnostih. Za preverjanje upoštevanja navodil smo izdelali vprašalnik upoštevanja navodil za preprečevanje simptomov sindroma zapestnega prehoda.
... 127 Studies support the effectiveness of ergonomic intervention as a viable method to reduce work limitation among employed persons with arthritis, though the generalizability of various types of interventions continues to be investigated. 126 Data are lacking regarding the determination as to whether a worker who perceives work limitations from musculoskeletal conditions, such as arthritis, attempts to achieve relief through use of opioid prescription. ...
Objective:
Prescription opioid and benzodiazepine drug use, which has risen significantly, can affect worker health. Exploration of the scientific literature assessed (1) interrelationships of such drug use, occupational risk factors, and illness and injury, and (2) occupational and personal risk factor combinations that can affect their use.
Methods:
The scientific literature from 2000 to 2015 was searched to determine any interrelationships.
Results:
Evidence for eight conceptual models emerged based on the search yield of 133 articles. These models summarize interrelationships among prescription opioid and benzodiazepine use with occupational injury and illness. Factors associated with the use of these drugs included fatigue, impaired cognition, falls, motor vehicle crashes, and the use of multiple providers.
Conclusion:
Prescription opioid and benzodiazepine drugs may be both a personal risk factor for work-related injury and a consequence of workplace exposures.
... In addition to these domains on the WES, the WES-RC includes items that could be barriers to work, but are not workplacebased, e.g., commuting problems, stairs at home, and family responsibilities, as well as items that related specifically to rheumatic conditions such as light-ing [13]. These types of items can be problematic for people with rheumatological and musculoskeletal conditions and could impact work abilities [16,17]. ...
Background:
People with arthritis are at risk of work disability. Job accommodation and educational programs delivered before imminent work loss can minimize work disability, yet are not currently being widely implemented. The Work-It Study is a randomized controlled trial testing the efficacy of a problem solving program delivered by physical and occupational therapy practitioners to prevent work loss over a two-year period among people with arthritis and rheumatological conditions.
Objective:
The purpose of this paper is to describe the protocol of the randomized controlled trial, and describe the baseline characteristics of the subjects and their work outcomes.
Methods:
287 participants were recruited from the Boston area in Massachusetts, USA. Eligible participants were aged between 21-65, self-reported a physicians' diagnosis of arthritis, rheumatic condition, or chronic back pain, reported "a concern about working now or in the near future due to your health", worked at least 15 hours a week, had plans to continue working, and worked or lived in Massachusetts. Subjects were recruited through community sources and rheumatology offices. Participants in the experimental group received a structured interview and an education and resource packet, while participants in the control received the resource packet only. The baseline characteristics and work related outcomes of the participants were analyzed.
Conclusions:
To our knowledge, the Work-It Study is the largest and most diverse randomized controlled trial to date aiming to identify and problem solve work-related barriers, promote advocacy, and foster work disability knowledge among people with chronic disabling musculoskeletal conditions. Despite advances in medical management of arthritis and other rheumatological and musculoskeletal conditions, many people still have concerns about their ability to remain employed and are seeking strategies to help them sustain employment.
Study design
Invited Clinical Commentary
Background
Arthritis is one of the most frequently reported causes of disability in the United States and the prevalence is expected to increase in the coming decades. While many rheumatic diseases involve hand impairments, most are systemic and involve more than the musculoskeletal system. Functional and work disability are high and people would benefit from the services of occupational and physical therapists.
Purpose of study
This paper reviews concepts of self-management, and symptoms that contribute to limitations and restrictions to participation in daily life in people with rheumatic diseases and suggests roles for hand therapists beyond the immediate hand impairments.
Methods
The impact of selected rheumatic diseases on functional and work disability are reviewed along with strategies for symptom management and self-management. Upper extremity impairments of selected rheumatic diseases are also discussed.
Results
The role for hand therapists in evaluating and addressing the complex needs of persons with rheumatic diseases, including less common diseases, is discussed. Outcome measures for fatigue, muscle involvement, ergonomics and computer use, and work disability are introduced. Finally, strategies for self-management and prevention of work and functional disability, along with symptom management for fatigue and pain are presented.
Conclusion
Hand therapists can play a vital role in chronic rheumatic disease management to improve self-management and increase participation in meaningful activities. Patients, primary care and rheumatology providers need to be educated about the scope of services occupational and physical therapists provide beyond the hand impairments.
Background:
Rheumatoid arthritis (RA) is one of the leading causes of work disability in the United States. Ergonomic interventions offer an individualized treatment approach, and when used in conjunction with pharmacological treatment interventions, may improve work outcomes and improve the overall quality of life for individuals with RA.
Objective:
To identify the current body of evidence regarding the effectiveness of ergonomic interventions in reducing work activity limitations in adults with RA.
Methods:
A systematic review was conducted to identify articles of ergonomic interventions targeting working adults with RA. The CONsolidated Standards of Reporting Trials (CONSORT) checklist and Non-Pharmacological Treatment (NPT) Extension evaluated the reporting quality of each randomized controlled trial (RCT), and the Grading of Recommendation Assessment, Development, and Evaluation (GRADE) evaluated the quality of the evidence.
Results:
Six studies were identified and reviewed for the quality of their reporting on evidence related to work activity limitations. Sixty-six percent of the items on the CONSORT checklist were fully reported by all studies and analysis through the GRADE framework demonstrated moderate confidence that the reported effects of ergonomic interventions on work activity limitations in the studies are accurate. This review revealed varied results for the effectiveness of ergonomic interventions on work activity limitations and at-work productivity.
Conclusion:
The results of this review indicate a need for further investigation. Future studies should focus on reviewing specific ergonomic interventions to determine the dosage needed to see results in reducing work activity limitations for working adults with RA.
The purpose of this study was to analyze the factors contributing to musculoskeletal disorders (MSDs) among 439 workers in an MDF furniture factory using questionnaires and the risk assessment form of the EATA (Ergonomic Assessment Tool for Arthritis) technique to assess aspects of the workstations and working postures of jobs.
With regard to factors that affected MSDs, it was found that workers older than 50 were having knee symptoms: their adjusted Odd Ratio, aOR [95% confidence interval (CI)] was 18.49 [1.51, 226.40]. Those who had been working for 1–2 years were having neck pain symptoms: aOR [95% CI] 12.01 [1.82, 79.43].
The recommendation of this study is that health monitoring be provided for workers who have pain in various parts of their bodies, especially those who have been working for 6–10 years, and those who are over 50 years old with knee pain.
Keywords: musculoskeletal disorder, furniture factory, Thailand
Inflammatory arthritis (IA) is a leading cause of work disability, especially for those with jobs involving repetitive, hand-intensive or manual work. Ergonomic interventions may mediate against job loss. Our objective was to identify desirable features of an ergonomic tool for use in providing job accommodation for people with IA, and to evaluate a selection of ergonomic and rehabilitation tools against these features. Eight desirable features were compared across 16 assessment tools. None of the tools met all the pre-determined features. Ergonomic assessment tools should incorporate objective assessment of risk factors together with subjective perceptions of symptom aggravation, and identify risk factors that may not currently be causing problems, but may increase risk of aggravation or injury in the future. To accommodate the needs of people with IA, the tool should allow for evaluation of risks and generation of solutions without a worksite visit in situations where the client does not want to disclose their illness. Finally, an assessment tool needs to be applicable to a wide range of worksites, easy to use, valid, and reliable. Against these criteria, it appears that there is a lack of appropriate ergonomic assessment tools for use in people with IA.
Many people with arthritis become work disabled, but little is known about (a) the types of work barriers they experience and (b) their use of job accommodations. Our objectives were to describe work barriers and use of accommodations and to examine factors associated with accommodation use in persons with arthritis at risk for work disability. Barrier assessment was conducted using the Work Experience Survey. Factors associated with accommodation use were analyzed by logistic regression. The overwhelming majority of the 121 participants (98%) reported having one or more barriers, and 68% reported 10 or more barriers; 38% used an accommodation. Greater functional limitations and self-efficacy for accommodation request were each associated with accommodation use. Even though these employed persons with arthritis faced multiple barriers at work, only a small number used any form of job accommodation.
Background
Prolonged sitting has been associated with musculoskeletal dysfunction. For desk workers, workstation modifications frequently address the work surface and chair. Chairs which can prevent abnormal strain of the neuromuscular system may aid in preventing musculo-skeletal pain and discomfort. Anecdotally, adjustability of the seat height and the seat pan depth to match the anthropometrics of the user is the most commonly recommended intervention. Within the constraints of the current economic climate, employers demand evidence for the benefits attributed to an investment in altering workstations, however this evidence-base is currently unclear both in terms of the strength of the evidence and the nature of the chair features. The purpose of this study was to evaluate the evidence for the effectiveness of chair interventions in reducing workplace musculoskeletal symptoms.
Methods
Pubmed, Cinahl, Pedro, ProQuest, SCOPUS and PhysioFocus were searched. ‘Ergonomic intervention’, ‘chair’, ‘musculoskeletal symptoms’, ‘ergonomics’, ‘seated work’ were used in all the databases. Articles were included if they investigated the influence of chair modifications as an intervention; participants were in predominantly seated occupations; employed a pre/post design (with or without control or randomising) and if the outcome measure included neuro-musculoskeletal comfort and/or postural alignment. The risk of bias was assessed using a tool based on The Cochrane Handbook.
Results
Five studies were included in the review. The number of participants varied from 4 to 293 participants. Three of the five studies were Randomised Controlled Trials, one pre and post-test study was conducted and one single case, multiple baselines (ABAB) study was done. Three studies were conducted in a garment factory, one in an office environment and one with university students. All five studies found a reduction in self-reported musculoskeletal pain immediately after the intervention. Bias was introduced due to poor randomization procedures and lack of concealed allocation. Meta-analysis was not possible due to the heterogeneity of the data (differing population, intervention and outcomes across studies).
Conclusion
The findings of this review indicate a consistent trend that supports the role of a chair intervention to reduce musculoskeletal symptoms among workers who are required to sit for prolonged periods. However the amount, level and quality of the evidence are only moderate therefore we cannot make strong recommendations until further trials are conducted. The review also highlights gaps: for example in showing whether the effectiveness of a chair intervention has long-term impact, particularly with respect to musculoskeletal symptoms, as well as the recurrence of symptoms and the consequent cost of care.
Objective. To investigate physical fitness and work capacity in women with rheumatoid arthritis (RA). Methods. The 42 subjects were a subset of a prospective trial of conditioning exercise in rheumatic disease. Assignment to an exercise or nonexercise group was determined by proximity to the intervention, a 3-month supervised group exercise program. Physical fitness and work capacity were assessed at baseline, 3 months, and 12 months. Results, At baseline, subjects were deconditioned and limited in hand function, lifting ability, and lower extremity mobility. Only the exercise group improved their aerobic capacity and exercise tolerance. There were no significant changes in measured work capacity in either group. Moderate to strong correlations were found between aerobic capacity, mobility, hand function, and work capacity. Grip strength was a strong and consistent correlate of work capacity. Conclusion, Our findings suggest that physical capacity, particularly hand function, may be important in the complex phenomenon of work disability in RA.
Osteoarthritis is the most common form of arthritis, affecting millions of people in the United States. It is a complex disease whose etiology bridges biomechanics and biochemistry. Evidence is growing for the role of systemic factors (such as genetics, dietary intake, estrogen use, and bone density) and of local biomechanical factors (such as muscle weakness, obesity, and joint laxity). These risk factors are particularly important in weightbearing joints, and modifying them may present opportunities for prevention of osteoarthritis-related pain and disability. Major advances in management to reduce pain and disability are yielding a panoply of available treatments ranging from nutriceuticals to chondrocyte transplantation, new oral anti-inflammatory medications, and health education. This article is part 1 of a two-part summary of a National Institutes of Health conference. The conference brought together experts on osteoarthritis from diverse backgrounds and provided a multidisciplinary and comprehensive summary of recent advances in the prevention of osteoarthritis onset, progression, and disability. Part 1 focuses on a new understanding of what osteoarthritis is and on risk factors that predispose to disease occurrence. It concludes with a discussion of the impact of osteoarthritis on disability. Ann Intern Med. 2000;133:635-646. www.annals.org For author affiliations and current addresses, see end of text.
Objective. To study the risk factors for early work disability in systemic lupus erythematosus (SLE).
Methods. A sample of 159 SLE patients who had been employed at some time since diagnosis was drawn from a multicenter study of outcome in SLE. Disease activity, organ damage, education, income, source of health insurance, and work-related factors were measured in a standardized interview. Work disability was defined by patient self-report of not working because of SLE. The outcome measure was current work status. Seven patients were excluded from the analysis because their choice not to work was unrelated to SLE.
Results. An average of 3.4 years after diagnosis, 40% had quit work completely, and job modification was substantial. Univariate analysis (chi-square and t-test) showed that significant predictors of early work disability included having a high school education or less, receiving Medicaid or having no health insurance, having a job which required more physical strength, having an income below poverty level, and having greater disease activity at diagnosis. In multivariate models, significant predictors were education level (P = 0.0004), higher physical demands of the job (P = 0.0028), and higher disease activity at diagnosis (P = 0.0078). Race, sex, cumulative organ damage at diagnosis, and disease duration were not significant.
Conclusion. Early work disability in SLE is strongly associated with some sociodemographic factors that might be amenable to intervention.