Work-Relted Musculoskeletl Injuries nd Disorders Among Occuptionl nd Physicl Therpists Amy R. Drrgh, Wendy Huddleston, Phyllis King KEY WORDS ccidents, occuptionl moving nd lifting ptients musculoskeletl diseses occuptionl therpy work Occuptionl therpists re t risk of work-relted injuries (WRIs) becuse of the demnding nture of their work. However, informtion bout WRIs nd musculoskeletl disorders mong occuptionl therpists is limited. For comprison, reserch indictes tht up to 9% of physicl therpists experience work-relted musculoskeletl disorders (WMSDs) nd pin. The purpose of this study ws to gther new informtion bout the prevlence, severity, nd chrcteristics of work-relted musculoskeletl symptoms nd injuries mong occuptionl therpists nd to compre this informtion with physicl therpists in the stte of Wisconsin. Investigtors miled surveys to 3,297 rndomly selected physicl nd occuptionl therpists living in Wisconsin. Results indicted 2006 nnul incidence rte of 6.5 injuries per 00 full-time workers mong occuptionl therpists nd 6.9 injuries per 00 full-time workers mong physicl therpists, rte similr to workers employed in hevy mnufcturing. Occuptionl therpists nd physicl therpists fce similr nd significnt risks of injury nd WMSDs. Drrgh, A. R., Huddleston, W., & King, P. (2009). Work-relted musculoskeletl injuries nd disorders mong occuptionl nd physicl therpists. Americn Journl of Occuptionl Therpy, 63, 35 362. Amy R. Drrgh, R, PhD, is Assistnt Professor, Division of Occuptionl Therpy, School of Allied Medicl Professions, The Ohio Stte University, Atwell Hll, 406G, 453 West 0th Avenue, Columbus, OH 4320 262; Drrgh.6@osu.edu Wendy Huddleston,, PhD, OCS, is Assistnt Professor, Deprtment of Humn Movement Sciences, University of Wisconsin Milwukee. Phyllis King, PhD,, FAA, is Associte Den/Professor, College of Helth Sciences, Deprtment of Occuptionl Therpy, University of Wisconsin Milwukee. Work-relted musculoskeletl disorders (WMSDs) mong nursing personnel re well documented (Hignett, 996). Interventions promoting sfe ptient hndling techniques mong nursing personnel hve decresed injury incidence, severity, nd cost (Collins, Wolf, Bell, & Evnoff, 2004; Engkvist, 2006; Grg & Owen, 992; Miller, Engst, Tte, & Yssi, 2006). Physicl therpists nd occuptionl therpists move nd hndle ptients differently from nursing personnel. They use ptient hndling nd trnsfer trining s wy to restore function nd improve independence. Both disciplines receive trining from their professionl curricul in self-protection while performing these techniques. Mny therpists lso receive eduction in ergonomics s prt of their cdemic trining nd serve in the role of occuptionl helth provider for other employees in their plces of work. Despite this level of trining nd expertise, evidence indictes tht these clinicins re t risk for musculoskeletl injuries ssocited with ptient hndling (Bork et l., 996; Cmpo, Weiser, Koenig, & Nordin, 2008; Cromie, Robertson, & Best, 2000; Holder et l., 999; Molumphy, Unger, Jensen, & Lopopolo, 985; Scholey & Hir, 989; West & Grdner, 200). Although evidence on injury risk in physicl therpists exists, injury prevlence nd incidence rtes mong occuptionl therpists re less well understood. Among physicl therpists, prospective cohort study (Cmpo et l., 2008) found -yer incidence of 20.7% for WMSDs in ny body region mong rndomly selected, ntionl smple of 882 physicl therpists. The study reported tht therpists who trnsferred ptients 6 to 0 times per dy hd odds of WMSDs tht were 2.4 times higher thn those of therpists who did not trnsfer ptients. Therpists who The Americn Journl of Occuptionl Therpy 35 Downloded From: http://jot.ot.org/pdfccess.shx?url=/dt/journls/jot/930072/ on 2/0/207 Terms of Use: http://aa.org/terms
repositioned ptients more thn 0 times per dy hd odds of low bck WMSDs tht were 2.6 times higher thn those of therpists who did not reposition ptients. Dt from the Bureu of Lbor Sttistics (BLS; 2004) reveled similr trends: In 2004, 59% of injuries to physicl therpists were cused by ptient cre ctivities. Among the respondents, 62% of physicl therpists nd 56% of physicl therpy ssistnts reported n injury to the low bck. Other studies of physicl therpists hve exmined injuries, pin, work hbits, nd the effects of WMSDs on job performnce (Bork et l., 996; Cromie et l., 2000; Cromie, Robertson, & Best, 2002; Holder et l., 999; Mierzejewski & Kumr, 997; Molumphy et l., 985; Scholey & Hir, 989; West & Grdner, 200). Holder et l. (999) reported tht s mny s 32% of physicl therpists reported sustining work-relted injury (WRI) in the pst 2 yers. Two other studies found tht between 29% nd 45% of physicl therpists reported low bck pin (Bork et l., 996; Molumphy et l., 985). Studies in Gret Britin, Cnd, nd Austrli ll reported tht 35% to 57% of therpists experienced low bck pin (Cromie et l., 2000; Mierzejewski & Kumr, 997; Scholey & Hir, 989; West & Grdner, 200). Cromie et l. (2000) discovered tht in 6 physicl therpists moved within or left the profession becuse of WMSDs (Cromie et l., 2000). Similr ptterns of injury exist for occuptionl therpy prctitioners. Alnser (2007) reported tht pproximtely 23% of occuptionl therpists nd 23% of certified occuptionl therpy ssistnts (CAs) reported WRI. Occuptionl therpists reported the low bck s the most frequently injured body prt, nd CAs reported injuries to the wrists, hnds, nd knees. Hignett (200) reported tht occuptionl therpists in cute cre identified ptient hndling s risk fctor for injury. According to the BLS (2004), ptient cre ctivities (ptient lifting in prticulr) were responsible for 00% of ll occuptionl therpist injuries where the source ws known nd where time wy from work ws recorded. Ptient lifting ccounted for 7% of injuries to occuptionl therpists, nd injuries to the trunk, including bck nd shoulder, ccounted for 75% of injuries to occuptionl therpists (BLS, 2004). Clinicl culture in occuptionl therpy nd physicl therpy prctice my ffect complince with sfe ptient hndling methods nd increse the risk of WRIs nd WMSDs. In study of physicl therpists in Austrli, sustining n injury ws seen s unlikely becuse of the knowledge, bilities, nd perceived level of fitness physicl therpist possesses; if n injury did occur, it ws seen s the fult of the therpist (Cromie et l., 2002). In qulittive study of occuptionl therpists nd CAs, Alnser (2007) reported tht occuptionl therpists with WRIs blmed themselves for the injury nd experienced nger (towrd others nd self), depression, nd occuptionl limittions. Such beliefs my interfere with therpists using equipment to protect themselves from injury. Therpists lso re less likely to seek cre, tke time off work, or file workers compenstion clim becuse of the bility to self-tret, to recognize erly symptoms of n injury, nd to ccess clinicl collegues (Wldrop, 2004). They lso my self-tret symptoms, use collegues to pply physicl gents, nd self-prescribe exercise nd tretment progrms (Glover, McGregor, Sullivn, & Hgue, 2005; Wldrop, 2004). In summry, occuptionl nd physicl therpists represent popultion t risk of musculoskeletl injury during ptient hndling tht hs the potentil to underreport nd self-tret WRIs nd work-relted disorders. The purpose of the current study ws to describe the prevlence, incidence, nd chrcteristics of work-relted musculoskeletl injuries nd disorders mong occuptionl therpists; to compre these results with referent group of physicl therpists; nd to identify the effect of injury on work prctices. Method Prticipnts Potentil prticipnts for this study included ll licensed occuptionl nd physicl therpists who resided in Wisconsin. CAs nd physicl therpy ssistnts were not included in the study. Prticipnts were rndomly selected from list of ll licensed therpists living in the stte. Using rndom number tble, reserchers selected 50% of ll occuptionl therpists nd 50% of ll physicl therpists. Therpists who were retired or who hd not prcticed in ny of the 3 yers included in the survey were excluded. In ll, the reserchers miled 3,297 surveys to,436 occuptionl therpists nd,86 physicl therpists. Physicl therpists were chosen s referent group becuse they work in similr environments nd with similr ptients to those of occuptionl therpists. Current dt were vilble bout WRIs nd work-relted disorders mong physicl therpists (Cmpo et l., 2008), nd comprison of findings from this study to published reserch cn strengthen its externl vlidity. Reserch Design A cross-sectionl design ws used for this study. The primry vribles of interest included self-reported WRIs, selfreported musculoskeletl symptoms, nd WMSDs; chrcteristics of symptoms nd disorders; re of prctice; prctice 352 My/June 2009, Volume 63, Number 3 Downloded From: http://jot.ot.org/pdfccess.shx?url=/dt/journls/jot/930072/ on 2/0/207 Terms of Use: http://aa.org/terms
setting; tretment of the injury; symptom or disorder; nd position or prctice chnge. Instrumenttion. We developed survey using two published instruments previously used with physicl therpists. The first, designed by Holder et l. (999), ws used to identify self-reported injuries mong physicl therpists. The second, designed by Cmpo et l. (2008), ws used to identify nd describe WMSDs. For the current study, the reserchers dpted nd combined both surveys to gther more complete picture of the experiences of the prticipnts. The literture hs identified the reporting of injury mong therpists s poor nd noted tht therpists often self-tret nd seek tretment from collegues (Wldrop, 2004). Becuse of concern tht therpists my not consider their symptoms musculoskeletl injury or disorder, the reserchers creted n instrument tht combined elements of both. The survey consisted of three prts: Section A, bsic demogrphic nd work history informtion; Section B, self-report of work-relted musculoskeletl injuries sustined in ech of the pst 3 yers (2004, 2005, 2006); nd Section C, questions bout musculoskeletl symptoms experienced the prior yer, including frequency, durtion, nd severity. Reserchers used stringent cse definition of WMSD, bsed on the work of Cmpo et l. (2008), to identify therpists who reported no injuries but who experienced pin. The definition ws designed to identify WMSDs serious enough to cuse problems t work but to void symptoms tht were minor complints. The definition identified person s hving WMSD if he or she rted pin of t lest 4 of 0 on visul nlog scle (from 0 0) tht lsted more thn week or ws present t lest once month (Cmpo et l., 2008). Prticipnts were directed to complete only Section B or C, not both. Those who reported WRI in the pst 3 yers were directed to complete Section B. Those who reported no WRIs were directed to complete Section C. The intent ws to cpture more complete informtion bout the experiences of the prticipnts with injury nd with symptoms. The survey ws developed nd piloted on five occuptionl therpists nd five physicl therpists. The survey ws then revised nd redied for dissemintion. Procedures. We miled presurvey postcrd to 3,297 potentil prticipnts in Wisconsin. One week lter, they were sent cover letter; demogrphic informtion pge; questionnire; nd stmped, self-ddressed envelope. All responses were confidentil, nd no personl identifiers were included in the survey. After 3-week witing period, the miling ws repeted. No surveys were opened until the second miling ws completed. Dt Anlysis. Incidence rtes nd prevlence were clculted for injuries in both professions. Annul injury prevlence ws clculted using the following formul: Prevlence = totl number of therpists with one or more injuries totl number of therpists exposed in the yer. Annul injury incidence rtes per 00 full-time workers for ll prticipnts nd for ech profession were clculted using the following formul (BLS, 2007): Injury incidence rte = (totl number of therpists injured per yer 200,000), totl number of hours worked per yer where 200,000 hr equls the equivlent of 00 employees working 40 hr per week, 50 weeks per yer. The totl number of therpists injured ws used in the numertor rther thn the totl number of injuries. Severl therpists reported multiple injuries within ech yer. Becuse we were unble to determine whether ech injury event ws seprte nd distinct or n ggrvtion of the originl injury, we coded the number of injuries dichotomously (not injured or injured). However, injuries reported by therpists over multiple yers were included, even if they reported n injury in ech of the 3 yers, for mximum of one injury per yer. Confidence intervls for the incidence rtes were estimted using the method described by Henszel, Lovelnd, nd Sirken (962) for dt following Poisson distribution for rre events. Bsic descriptive nlyses, independent smple t tests, Person chi squre, nd odds rtios were conducted () to describe the personl nd professionl fctors ssocited with injuries, pin nd discomfort, nd WMSDs; (2) to identify the reporting nd tretment-seeking behviors of therpists; nd (3) to describe the reltion between injury or WMSD nd work prctices. Work prctices include ptient tretment, time off from work, nd the proportion of occuptionl therpists nd physicl therpists who hve chnged prctice re becuse of symptoms or injuries. Prticipnts who reported multiple WRIs nswered the questions ccording to the injury tht most interfered with their work. Results Of the 3,297 surveys miled out, we received,89 responses; the response rte ws 36%. A totl of 3 respondents were excluded becuse they hd retired, decided to sty t home with their children, or not filled out the form completely. Missing dt were replced with the men vlue of the smple. One item, bord nd specilty certifictions, ws eliminted becuse of incomplete nd incorrect responses The Americn Journl of Occuptionl Therpy 353 Downloded From: http://jot.ot.org/pdfccess.shx?url=/dt/journls/jot/930072/ on 2/0/207 Terms of Use: http://aa.org/terms
(e.g., identifying Ntionl Bord for Certifiction in Occuptionl Therpy registrtion s bord certifiction). Another item, prctice re, ws modified: Acute cre nd subcute (inptient) rehbilittion were combined becuse most therpists identifying cute cre s their primry prctice re lso identified subcute rehbilittion s primry prctice re. The finl smple totled,58 nd included 477 occuptionl therpists nd 68 physicl therpists. Comprison of the Professions Bckground chrcteristics of prticipnts re presented in Tble. Occuptionl therpists nd physicl therpists were comprble in ge, body mss index (BMI), nd yers of experience. Almost ll therpists rted themselves s hving good to excellent helth (98% of occuptionl therpists nd 96% of physicl therpists). The men ge ws 43 yers, nd men BMI ws <25. Physicl therpists were more likely thn occuptionl therpists to rte their helth s excellent (n = 477 occuptionl therpists nd 68 physicl therpists for ll χ 2 ) (55% compred with 46%; χ 2 [] = 38.58, p =.000). Occuptionl therpists reported n verge of 7.4 yers of experience, nd physicl therpists reported n verge of 8 yers. A higher proportion of physicl therpists thn occuptionl therpists were mle (20%) (4.2%; χ 2 [] = 63.09, p =.000). Eductionl level differed s expected, given the eduction requirements of the disciplines. Among prticipnts, 43% of physicl therpists held grdute degrees t both the mster s nd the doctorl level, compred with 20% of occuptionl therpists (χ 2 [] = 63.72, p =.000). Occuptionl therpists nd physicl therpists worked similr number of hours per week: 33 nd 34 hr, respectively. Physicl therpists, however, spent pproximtely 2. hr per Tble. Comprison of Bckground nd Professionl Chrcteristics in Occuptionl Therpists nd Physicl Therpists (N = 58) Chrcteristic Professionl Affilition n M (SD) t df p Age 477 43.04 (9.30) 68 42.63 (0.5) 0.72 077.47 Yers of prctice 477 7.36 (9.04) 68 7.98 (0.48).076 08.282 Body mss index 477 24.57 (4.73) 68 24.43 (4.08) 0.59 926.604 Hours worked per week 477 32.93 (0.90) 68 34.06 (.7).66 56.097 Hours ptient cre per week 477 28.89 (9.74) 68 30.98 (0.48) 3.489 55.00* n Proportion Person χ 2 df p b Acdemic degree Bchelor s 477 0.799 68 0.535 Mster s 477 0.99 68 0.399 Doctorte 477 0.004 68 0.066 63.76.000* Gender Femle 477 0.958 68 0.794 Mle 477 0.042 68 0.206 63.090.000* Helth Excellent/good 477 0.985 68 0.966 Fir/poor 477 0.0 68 0.03 0.044.834 Note. = physicl therpist; = occuptionl therpist; M = men; SD = stndrd devition. p vlues obtined through independent smples t-test nlysis. b p vlues obtined through chi-squre nlysis. *Sttisticlly significnt t p.05. 354 My/June 2009, Volume 63, Number 3 Downloded From: http://jot.ot.org/pdfccess.shx?url=/dt/journls/jot/930072/ on 2/0/207 Terms of Use: http://aa.org/terms
Figure. Prctice re by professionl ffilition, 2006. Note. N =,5; 7 therpists reported tht they did not work in 2006. Those who specified type of privte prctice were included in the pproprite re. For exmple, physicl therpists who indicted tht they worked in privte prctice for outptient orthopedics were included in Outptient Clinic. week more thn occuptionl therpists in direct ptient cre (t [55] = 3.48, p =.00). The primry prctice res differed between the professions (Figure ). The lrgest proportion of occuptionl therpists worked in peditrics (27.3%). Occuptionl therpists were twice s likely to work in peditrics s were physicl therpists. Peditrics ws followed by outptient rehbilittion, cute cre nd inptient rehbilittion, nd skilled nursing fcilities. Physicl therpists were twice s likely to work in outptient res s were occuptionl therpists. Almost hlf of physicl therpists (48.9%) identified outptient rehbilittion s their primry prctice re, followed by hospitl, peditrics, nd skilled nursing fcilities. Injury Prevlence nd Incidence Injury prevlence nd injury incidence rtes were clculted for occuptionl therpists nd physicl therpists who reported WRI (Tble 2). Therpists who reported tht they did not work during prticulr yer were not included in the clcultions for tht yer. Of the 477 occuptionl therpists who responded, 04 reported 90 injuries over 3 yers. Of the 68 physicl therpists who responded, 44 reported 279 injuries over 3 yers. Approximtely 6.7% of injured physicl therpists nd 3.5% of injured occuptionl therpists reported multiple injuries over the 3-yer period. The nnul injury prevlence for the therpists overll ws 0.2% in 2004, 0.5% in 2005, nd 3.5% in 2006. Therpists in generl experienced nnul injury incidence rtes (bsed on self-report of WRI) of 2.4 per 00 full-time workers in 2004, 2.9 per 00 full-time workers in 2005, nd 6.7 per 00 workers in 2006. Injury incidence rtes did not differ significntly between the disciplines (Tble 2). The rtes for injuries sustined in 2006, which rgubly were the most ccurtely reclled, were 6.5 per 00 full-time occuptionl therpists nd 6.9 per 00 fulltime physicl therpists. Among both professions, injuries to the low bck were reported by the gretest proportion of therpists (30% of occuptionl therpists nd 33% of physicl therpists). Injuries to the hnd (2% occuptionl therpist, 20% physicl therpist), shoulder (7% occuptionl therpist, 5% physicl therpist), neck (4% occuptionl therpist, 5% physicl therpist), nd wrist (4% occuptionl therpist, 4% physicl therpist) followed s the body regions most commonly identified s injured. Risk Fctors for Injury Investigtors exmined profession, gender, weight, ge, yers of experience, hours worked per week, nd ptient contct The Americn Journl of Occuptionl Therpy 355 Downloded From: http://jot.ot.org/pdfccess.shx?url=/dt/journls/jot/930072/ on 2/0/207 Terms of Use: http://aa.org/terms
Tble 2. Injury Prevlence nd Injury Incidence Rtes per 00 Full-Time Workers Among Occuptionl nd Physicl Therpists Yer Discipline N Number of Injuries Prevlence (%) Incidence 95% Confidence Intervl 2004 465 47 0. 2.8 9.5, 6.9 65 66 0.2 2. 9.5, 5.39 2005 468 53.3 4.4 0.60, 8.97 668 64 9.6.3 8.78, 4.80 2006 476 60 2.6 6.5 2.73, 2.48 675 95 4. 6.9 3.66, 20.94 2004 2006 477 60 33.5 4.6 2.44, 7.05 68 225 33.0 3.5.80, 5.40 Note. = physicl therpist; = occuptionl therpist. hours per week s potentil risk fctors for injury. Odds rtios were clculted for professionl ffilition, gender, BMI, nd ge (Tble 3). The results reveled no difference in the odds of injury between the professions. Within nd between ech profession, gender did not emerge s risk fctor for injury. To ssess weight s risk fctor, we converted BMI to dichotomous vrible. A BMI 25 ws considered overweight. The odds rtios did not support BMI s risk fctor for injury mong occuptionl therpists or physicl therpists. Age ws lso converted to dichotomous vrible, with older workers identified s those 55 yers or older. The odds rtios did not support ge s risk fctor for injury for occuptionl therpists or for physicl therpists. Risk exposure, mesured by hours of work nd ptient cre hours, ws ssocited with injury (Tble 4). Occuptionl therpists with injuries worked pproximtely 4 hr more per week thn those without injuries (t [475] = 3.8, p =.002). Physicl therpists who were injured worked pproximtely 2 hr more per week (t [29.9] = 2.04, p =.042). Injured occuptionl therpists spent pproximtely 2.6 more hours working directly with ptients thn those without injuries Tble 3. Odds Rtios for Fctors Associted With Injuries in Occuptionl nd Physicl Therpists 95% Confidence Intervl Fctor N Odds Rtio Lower Upper Profession,58.0 0.759.35 Profession Femle 477.08 0.798.46 Mle 68 2.20 0.766 6.35 Gender 477.57 0.588 4.2 68.47 0.897 2.40 Weight 477.27 0.782.63 68.06 0.699.60 Age 477.0 0.569 2. 68 0.77 0.437.34 Note. = physicl therpist; = occuptionl therpist. Odds of being n mong those with work-relted injuries, with s s referent group. (t [475] = 2.34, p =.02). Among both occuptionl therpists nd physicl therpists, experience ws not ssocited with WRI. Injury Reporting nd Tretment Behviors Another im of the study ws to evlute whether therpists tended to underreport injuries, engged in self-tretment, nd continued to work while injured (Tble 5). Results indicted tht fewer thn hlf of occuptionl therpists nd physicl therpists reported their injuries to their employers but tht the mjority of therpists sought tretment for their injuries. There ws no sttisticlly significnt difference in the proportion of mle nd femle occuptionl therpists who reported their injuries (χ 2 [] = 0.272, p =.469). Among physicl therpists, men were significntly less likely to report WRI thn women (χ 2 [] = 4.35, p =.037). Tretment vried on the bsis of whether the injury ws reported to the employer. Among therpists who reported their injuries, 9% of occuptionl therpists nd 87% of physicl therpists sought tretment. Most occuptionl therpists sought tretment from physicin or chiroprctor (7%) or treted the injury themselves (50%). A substntil proportion sought tretment from collegue (27%). Physicl therpists who reported their injuries were s likely s occuptionl therpists to seek tretment from physicin or chiroprctor (63%), occuptionl therpist or physicl therpist (37%), collegue (29%), nd to tret themselves (52%). Occuptionl therpists who reported their injury were.5 times s likely to seek tretment for the injury s those who did not report n injury (χ 2 [] =.3, p =.00), lthough mong physicl therpists, reporting behvior ws less strongly ssocited with seeking tretment (χ 2 [] = 2.98, p =.084). Therpists who did not report injuries, however, lso obtined tretment for their injuries. In fct, 30% of occuptionl therpists nd 37% of physicl therpists who did not report WRI to their employer received tretment 356 My/June 2009, Volume 63, Number 3 Downloded From: http://jot.ot.org/pdfccess.shx?url=/dt/journls/jot/930072/ on 2/0/207 Terms of Use: http://aa.org/terms
Tble 4. Assocition Between Bckground Chrcteristics nd Work-Relted Injury Without Injury With Injury Fctor N M (SD) M (SD) t df p Experience (yers) 477 68 7. (9.) 8.3 (0.40) 8.3 (8.74) 6.8 (0.68).73.48 475 679.242.39 Hours worked per week 477 68 32. (0.73) 33.7 (2.26) 35.9 (.04) 35.6 (9.26) 3.79 2.044 475 292.002*.042* Ptient cre hours per week 477 68 28.3 (0.06) 30.7 (0.92) 30.9 (8.24) 32. (8.55) 2.336.704 475 278.020*.089 Note. = physicl therpist; = occuptionl therpist; M = men; SD = stndrd devition. p vlues obtined through independent smples, two-tiled t test. *Sttisticlly significnt t p.05. from physicin or chiroprctor nd 60% of occuptionl therpists nd 75% of physicl therpists self-treted. Effect of Injury on Work Prctices Almost ll occuptionl therpists nd physicl therpists who reported WRI stted they continued to work while they were injured (Tble 5). Most ltered their work hbits becuse of the injury nd reported tht clinicl prctice excerbted their symptoms. Few reported tht they limited ptient contct time becuse of the injury, nd only 6% of occuptionl therpists nd physicl therpists reported tht they missed hlf-dy of work or more becuse of their injuries. Approximtely 28% of the therpists either considered chnging jobs or hd chnged jobs becuse of their injuries. No sttisticlly significnt differences were found within ech profession in the proportion of mle therpists nd femle therpists on ny of these vribles. Work-Relted Musculoskeletl Symptoms nd Disorders Of the 373 occuptionl therpists who did not report WRI, 43% reported work-relted musculoskeletl symptoms (Tble 6). The nnul prevlence of symptoms mong the 537 physicl therpists who did not report n injury ws 49%. Of those who reported symptoms, totl of 53 therpists met the criteri for WMSD. The 2-month prevlence of WMSD ws 8% for occuptionl therpists nd 6% for physicl therpists. Tble 5. Work Prctices nd Culturl Fctors Among Occuptionl nd Physicl Therpists With Work-Relted Injuries Proportion Culturl Fctors nd Work Prctices Person χ 2 df p Reported injury to workplce 0.44 (44/0) 0.38 (54/42) 0.752.386 Sought tretment 0.74 (75/0) 0.8 (5/42).07.30 MD/DC / Clinic Collegue Self-tret 0.46 (48/04) 0.30 (3/04) 0.22 (23/04) 0.54 (56/04) 0.38 (55/44) 0.23 (33/44) 0.26 (37/44) 0.66 (95/44) Missed t lest hlf-dy of work 0.30 (30/0) 0.26 (38/44) 0.325.569 Worked while injured 0.96 (96/00) 0.95 (36/43) 0.6.36 Altered work hbits 0.74 (74/00) 0.73 (04/43) 0.049.472 Limited ptient contct time 0.4 (4/00) 0. (5/43) 0.095.337 Clinicl prctice excerbtes symptoms 0.64 (63/99) 0.6 (86/4) 0.73.390 Considered chnging jobs 0.20 (20/00) 0.2 (30/43).457.483 Chnged jobs becuse of injury 0.08 (8/00) 0.08 (2/43).443.483 Note. = physicl therpist; = occuptionl therpist; MD = medicl doctor; DC = chiroprctor. p vlues obtined through Person χ 2 test of ssocition..575.498 0.422 3.729.209.22.56.053 The Americn Journl of Occuptionl Therpy 357 Downloded From: http://jot.ot.org/pdfccess.shx?url=/dt/journls/jot/930072/ on 2/0/207 Terms of Use: http://aa.org/terms
Tble 6. Pin nd Work-Relted Musculoskeletl Disorders (WMSDs) Prevlence nd Associted Fctors Among Occuptionl Therpists nd Physicl Therpists (n = 90) Fctor n No Pin or Discomfort Pin Prevlence WMSD Prevlence Person χ 2 (WMSD) df p 373 0.43 (60/373) 0.8 (67/373) 537 0.49 (264/537) 0.6 (86/537) 0.578.447 No WMSD With WMSD Fctor (mong those with pin/discomfort) n M (SD) M (SD) t df p b Experience (yers) Hours worked/week Ptient cre hours/week 373 537 373 537 373 537 7.47 (9.36) 8.45 (0.43) 3.38 (.35) 33.37 (.44) 27.25 (0.43) 3.65 (.39) 6.9 (9.50) 7.7 (0.26) 32.4 (0.57) 33.6 (0.73) 30. (8.39) 30.2 (9.7) 6.4 (8.24) 8.9 (0.75) 34.0 (8.62) 34.4 (7.00) 29.4 (0.67) 3.4 (.68) Note. = physicl therpist; = occuptionl therpist; M = men; SD = stndrd devition. p vlues obtined through Person χ 2 test of ssocition, comprison of proportion of WMSD mong s nd s. b p vlues obtined through independent smples, two-tiled t test, comprison of WMSD to those with no pin or discomfort. *Sttisticlly significnt t p.05. 0.368 0.402 2.007 0.642.45 0.50 278 357 44 357 278 357.73.688.047*.52.48.60 WMSDs of the low bck were identified by the gretest proportion of occuptionl therpists nd physicl therpists (49% occuptionl therpists, 4% physicl therpists). WMSDs of the neck (39% occuptionl therpists, 35% physicl therpists), hnd (30% occuptionl therpists, 28% physicl therpists), shoulder (27% occuptionl therpists, 24% physicl therpists), nd upper bck (22% occuptionl therpists, 28% physicl therpists) were the other body regions most often identified by therpists with WMSD. Risk Fctors for Work-Relted Musculoskeletl Symptoms nd Disorders We evluted BMI, ge, nd gender s potentil risk fctors ssocited with pin nd WMSD (Tble 7). BMI >25 ws risk fctor for WMSD mong occuptionl therpists (odds rtio [OR] = 2.47; 95% confidence intervl [CI] =.26, 4.84) but not physicl therpists. Age 55 yers lso emerged s risk fctor for WMSD mong occuptionl therpists. The odds of being 55 yers old were 3.46 times s high mong respondents with WMSD s mong those without (95% CI =.4, 0.49). Too few mle occuptionl therpists responded to evlute the effect of gender on WMSD. Among physicl therpists, the odds of being femle were.85 times s high mong those with WMSD s mong those without WMSD, lthough the confidence intervl mkes tht finding questionble (95% CI = 0.895, 3.83). The odds of being n occuptionl therpist, s opposed to physicl therpist, were.49 times s high mong those with WMSD s mong those without, nd gin the confidence intervl mkes the finding difficult to confirm (95% CI = 0.994, 2.24). Experience, work hours, nd direct ptient cre hours were lso ssessed s potentil risk fctors (Tble 6). Among occuptionl therpists, those with pin or discomfort spent more hours in ptient cre per week thn those without (t [37] = 2.434, p =.05). There were no sttisticlly significnt differences in yers of prctice or hours worked per week mong those with pin nd those without. When we evluted occuptionl therpists who met the criteri for WMSD, those with WMSDs worked pproximtely 2. hr more per week thn those without ny symptoms (t [44] = 2.007, p =.047). The hours in ptient cre did not differ between occuptionl therpists with WMSD nd occuptionl therpists without pin or discomfort. There were no sttisticlly significnt differences in the yers of experience, hours worked per week, nd ptient contct hours per week Tble 7. Odds Rtios for Fctors Associted With Work-Relted Musculoskeletl Disorders (WMSDs) in Occuptionl nd Physicl Therpists 95% Confidence Intervl Fctor N Odds Rtio Lower Upper Profession.49 0.994 2.24 Gender b 264.85 0.895 3.83 Weight 60 2.47.260 4.84 264 0.8 0.460.4 Age 60 3.46.40 0.49 264.3 0.637 2.69 Note. = occuptionl therpist; = physicl therpist. Odds of being n mong those with WMSD, with s referent group. b Unble to compute becuse 0 men filed to meet cse definition. 358 My/June 2009, Volume 63, Number 3 Downloded From: http://jot.ot.org/pdfccess.shx?url=/dt/journls/jot/930072/ on 2/0/207 Terms of Use: http://aa.org/terms
mong physicl therpists with pin nd without nd mong those who met the cse definition of WMSD nd those who did not. WMSD Reporting nd Treting Behviors According to Wldrop (2004), physicl therpists tend to underreport their symptoms; therefore, reporting behviors were ssessed for this cohort of occuptionl therpists nd physicl therpists (Tble 8). Among occuptionl therpists, 22% of those with WMSDs reported their symptoms to their employer, compred with 8% of physicl therpists with WMSDs. Occuptionl therpists with WMSDs were more likely to report their symptoms thn those with milder pin. However, this ws not true for physicl therpists. The sme proportion reported their symptoms (8%), regrdless of severity. Of note is tht 70% of occuptionl therpists with WMSDs nd 57% of physicl therpists with WMSDs sought tretment for their symptoms, even though few reported them to the employer. Although most occuptionl therpists nd physicl therpists with WMSDs self-treted (60% of occuptionl therpists nd 43% of physicl therpists), 34% of occuptionl therpists nd 22% of physicl therpists sought tretment from physicin or chiroprctor, nd mny sought tretment from more thn one professionl. WMSD Effects on Work Prctices Meeting the cse definition of WMSD ppered to be n importnt fctor in work behviors in both physicl therpists nd occuptionl therpists. Physicl therpists nd occuptionl therpists were more likely to seek tretment, see physicin, lter their work hbits, nd consider chnging jobs if they met the cse definition of WMSD (Tble 8). In fct, 25% of occuptionl therpists with WMSDs nd 35% of physicl therpists with WMSDs reported tht they were considering chnging or hd chnged jobs becuse of the WMSD. These therpists lso were more likely to report tht pin interfered with work nd tht prctice excerbted their pin or discomfort. Physicl therpists with WMSD were more likely to limit their ptient contct time becuse of their symptoms thn those without WMSD. Given these findings, it is importnt to note tht most physicl therpists nd occuptionl therpists with WMSD worked while experiencing pin or discomfort, nd very few indicted tht they missed work becuse of the WMSD. Discussion The results of this study indicte tht occuptionl therpists nd physicl therpists re t similr nd significnt risk of WRI nd of developing WMSDs. As point of comprison, the 2006 injury rte of lmost 7 per 00 full-time workers is similr to the 2006 incidence rtes for non cly refrctory mnufcturing (6.9), motor home mnufcturing (6.8), iron foundry work (5.), nd light truck mnufcturing (4.6) (BLS, 2006). The nnul prevlence of injuries, symptoms, nd WMSDs found in this study is similr to those found in other studies (Alnser, 2007; Cmpo et l., 2008; Holder et l., 999). The combined findings of these studies indicte tht work-relted injuries nd disorders mong occuptionl nd physicl therpists pose significnt popultion helth problem. Severl personl chrcteristics were ssocited with WMSD, including weight nd ge for occuptionl therpists nd being femle for physicl therpists. These fctors hve been supported by other studies (Cmpo et l., 2008). Hours worked per week nd ptient cre hours were lso ssocited with injury nd WMSD. This finding is likely the result of incresed exposure nd, potentilly, ftigue. The culture of occuptionl nd physicl therpists my be plcing therpists t risk. Similr to the findings of Wldrop (2004), fewer thn hlf of therpists in this study reported their injuries to their employers, nd <25% reported their WMSDs. The clinicl culture of helth cre providers is one in which ltruism is vlued, so dmitting n injury cused by ptient cre is difficult. Both respondents with injuries nd those with WMSDs hd symptoms tht were excerbted by clinicl prctice; they worked while in pin nd reported tht their conditions interfered with work, but few limited ptient contct time or missed work. This reluctnce to identify n injury my be why so mny therpists who indicted they hd not sustined ny WRIs described musculoskeletl symptoms severe enough tht they met our definition of WMSD. Therpists with WMSDs were less likely to report their WMSD thn those with WRI were but more likely to stte tht prctice excerbted their symptoms nd just s likely to work in pin nd lter work hbits. Of prticulr concern is tht 53% of occuptionl therpists with WMSD or injury nd 65% of physicl therpists with WMSD or injury reported tht they were considering chnging or hd chnged jobs becuse of their injury or WMSD. We do not know wht proportion would leve the profession rther thn chnge prctice re. Even so, this finding deserves serious ttention given the projected need for therpists (BLS, 2004) nd the potentil loss of experienced prctitioners to other prctice settings or professions. Therpists my not be reporting injury becuse they re ble to self-tret, recognize erly symptoms of n injury, nd ccess clinicl collegues (Wldrop, 2004). More thn hlf of the occuptionl therpists nd physicl therpists in this study reported tht they self-treted injuries nd WMSDs, The Americn Journl of Occuptionl Therpy 359 Downloded From: http://jot.ot.org/pdfccess.shx?url=/dt/journls/jot/930072/ on 2/0/207 Terms of Use: http://aa.org/terms
Tble 8. Culturl nd Work Prctice Fctors Among Physicl Therpists nd Occuptionl Therpists With Pin nd With Work-Relted Musculoskeletl Disorders (WMSDs) Fctor Pin (n) WMSD (n) Person χ 2 df p Reported injury to workplce 0. (0/93) 0.22 (5/67) 3.99.046* 0.08 (4/76) 0.08 (7/86) 0.003.959 Sought tretment 0.44 (4/93) 0.70 (47/67) 0.69.00* 0.32 (56/77) 0.57 (49/86) 5.49.000* Sought tretment MD/DC: MD/DC: / clinic: / clinic: 0. (0/93) 0.08 (5/78) 0.08 (7/93) 0.06 (/78) 0.34 (23/67) 0.22 (9/86) 0.22 (5/67) 0.4 (2/86) 3.22 9.65 7.25 4.4.000*.002*.007*.036* Collegue: Collegue: 0.6 (5/93) 0.0 (8/78) 0.24 (6/67) 0.23 (20/86).49 8.3.22.004* Self-tret: Self-tret: 0.38 (35/93) 0.34 (60/78) 0.60 (40/67) 0.43 (37/86) 7.62 2.7.006*.4 Missed work becuse of pin 0.02 (2/93) 0.06 (4/67).57.20 0.0 (2/78) 0.04 (3/86).75.86 Worked while in pin 0.89 (83/93) 0.97 (65/67) 3.39.066 0.92 (6/75) 0.98 (84/86) 3.23.072 Pin interfered with work 0.6 (5/93) 0.39 (26/67) 0.5.00* 0.5 (26/75) 0.33 (28/85).37.00* Altered work hbits 0.63 (58/92) 0.78 (52/67) 3.86.049* 0.53 (95/78) 0.73 (63/86) 9.54.002* Limited ptient contct time 0.07 (6/92) 0.06 (4/67) 0.020.888 0.07 (3/76) 0.5 (3/86) 0.752.049* Prctice excerbted pin 0.65 (59/9) 0.83 (55/66) 6.58.00* 0.66 (7/78) 0.87 (75/86).09.00* Considering chnging jobs 0.04 (4/9) 0.6 (/67) 6.49.0* 0.05 (8/76) 0.26 (22/86) 25.2.000* Chnged jobs becuse of injury 0.03 (3/93) 0.09 (6/67) 2.4.2 0.05 (8/75) 0.09 (8/86) 2.24.34 Note. = physicl therpist; = occuptionl therpist; MD = medicl doctor; DC = chiroprctor. p vlues obtined through independent smples, two-tiled t test. *Sttisticlly significnt t p.05. nd pproximtely one-fourth indicted they sought tretment from collegue. Therpists lso reported tht they ltered their work prctices becuse of their injury or disorder. Both occuptionl nd physicl therpists help clients nd ptients dpt their work environments to ccommodte disbility, injury, or discomfort. If they use these skills to protect themselves nd continue working, they my see no reson to report the injury. Other studies suggest tht therpists my perceive the injury s wekness on their prt becuse of their expertise in the re of ptient hndling nd movement (Cromie et l., 2002). Therpists lso ply role in preserving the occuptionl helth of their collegues. Occuptionl nd physicl therpists hve dul role within mny helth cre settings. For exmple, within the hospitl system, occuptionl therpists nd physicl therpists re often responsible for trining 360 My/June 2009, Volume 63, Number 3 Downloded From: http://jot.ot.org/pdfccess.shx?url=/dt/journls/jot/930072/ on 2/0/207 Terms of Use: http://aa.org/terms
ptient cre stff in good body mechnics to void injury (Drrgh, Cmpo, & Olson, in press). Reporting n injury tht they tech others to prevent could be mjor brrier. Therpists rely on good body mechnics to void injury. As these dt indicte, however, good body mechnics lone cnnot protect therpists from injury. Biomechnicl evidence confirms this finding nd hs demonstrted tht there is no sfe wy to lift dependent ptient (Mrrs, Dvis, Kirking, & Bertsche, 999). Even trnsfer tsk with light ptient who is complint results in spinl loding tht exceeds tissue thresholds (Mrrs et l., 999; Ulin et l., 997). Reserch hs demonstrted tht using sfe ptient hndling guidelines cn reduce musculoskeletl injuries nd disorders mong nursing personnel while improving ptient sfety (Collins et l., 2004; Grg & Owen, 992; Nelson & Frgl, 2004; Yssi et l., 200). Miniml-lift nd no-lift progrms hve been implemented in mny medicl fcilities, nd therpists will be expected to trin nursing personnel in the use of the equipment nd to integrte the equipment nd lifting restrictions into prctice. Although mechnicl lift devices nd other miniml-lift equipment cn protect therpists from some musculoskeletl injuries nd disorders, therpists must lso consider the best wy to fcilitte independence in their ptients while reducing the mount of unssisted hndling they perform. Limittions of the Study The current study hs severl limittions. First, s crosssectionl study tht relies on self-report, it hs the possibility of selection bis nd recll bis. The fct tht the prevlence mong physicl therpists is similr to or lower thn other studies, especilly the prospective study by Cmpo et l. (2008), improves the vlidity of these findings, but the bis remins. The response rte ws 36%, which could indicte bised smple. Future studies will ddress bis by using personlized, ddressed envelopes; incentives (such s coffee crds); nd stmps insted of bulk miling. These strtegies resulted in 93% response rte in the study of physicl therpists by Cmpo et l. (2008). Becuse the study relied on self-report of injury, we did not identify the proportion of injuries nd WMSDs tht would be considered recordble by Occuptionl Sfety nd Helth Administrtion stndrds; thus, it is possible the rtes nd prevlence could be inflted. In ddition, the survey did not include questions bout psychosocil fctors tht my contribute to WMSD nd WRI nd could therefore not include this informtion in the nlyses. This study cnnot provide informtion bout predicting injuries; it cn only exmine ssocitions between vribles. A longitudinl study to develop predictive model of injury nd WMSD in occuptionl therpists would be powerful contribution to this knowledge bse. Finlly, this study is limited to therpists in Wisconsin. Whether these therpists differ from those in other sttes is unknown, but differences could limit generlizbility. Recommendtions for Further Reserch The current study identified the scope of the problem of WRI, symptoms, nd WMSD. Further reserch is needed to identify the effects on occuptionl therpists nd physicl therpists of working injured or while in pin. The verge ge of the therpists in the current study ws pproximtely 43 yers with n verge of 7 yers of experience; 35% reported t lest one injury or WMSD within 3-yer period. If we include respondents who reported pin or discomfort, we see tht bout 60% of therpists hve experienced or re experiencing work-relted symptoms, injuries, nd disorders, nd lmost ll respondents hve worked while injured or in pin. This behvior cn result in presenteeism, phenomenon in which workers continue to work with injuries or illnesses nd experience decresed productivity or qulity of work (Pilette, 2005). Reserch on other occuptions experiencing this phenomenon demonstrtes tht presenteeism cn result in deleterious physicl nd psychosocil effects (Goetzel et l., 2004; Stewrt, Ricci, Chee, Morgnstein, & Lipton, 2003). Although therpists with injuries nd WMSDs sustin injuries severe enough tht they re in pin when they prctice, lter their work hbits nd, in some cses, limit ptient contct time, presenteeism hs not been explored. The need for occuptionl therpists nd physicl therpists is predicted to grow much fster thn tht for ll other occuptions through 204 s the popultion ges. A study of the impct of presenteeism in the proposed popultions is urgently needed (BLS, 2004). In ddition, reserch into the exposures tht plce therpists t risk is necessry to prevent injury. More detiled observtionl exposure nlyses re wrrnted. Reserch exmining the usefulness nd effects of sfe ptient hndling nd movement lgorithms nd equipment in the context of therpy must be pursued. Conclusions Occuptionl therpists nd physicl therpists re t substntil risk of WRIs nd WMSDs. Prevention of these conditions is limited by underreporting nd ltruistic behvior on the prt of the therpists. Of concern is the tendency of therpists to continue to work while in pin or with workrelted musculoskeletl injury or disorder, even while excerbting their condition. The long-term physicl nd psychosocil effects of this behvior must be explored. Finlly, therpists must mke shift wy from their relince on body mechnics lone s protection ginst injury. Occuptionl The Americn Journl of Occuptionl Therpy 36 Downloded From: http://jot.ot.org/pdfccess.shx?url=/dt/journls/jot/930072/ on 2/0/207 Terms of Use: http://aa.org/terms
therpy prctitioners must exmine the integrtion of sfe ptient hndling nd movement devices nd recommendtions into therpy. s Acknowledgments This study ws supported, in prt, by University of Wisconsin Milwukee College of Helth Sciences Stimulus for Extrmurl Enhncement nd Development grnt. References Alnser, M. Z. (2007, April). Perspectives on occuptionl musculoskeletl injuries incurred by occuptionl therpy prctitioners. Pper presented t the Americn Occuptionl Therpy Associ tion 87th Annul Conference & Expo, St. Louis, MO. Bork, B. E., Cook, T. M., Rosencrnce, J. C., Englehrdt, K. A., Thomson, M. E., Wuford, I. J., et l. (996). Work-relted musculoskeletl disorders mong physicl therpists. Physicl Therpy, 76, 827 835. Bureu of Lbor Sttistics. (2004). Tbles R9 R2: Occuption selected cse chrcteristics, 2004. Retrieved October, 2006, from www.bls.gov/iif/oshcdnew.htm#04b Bureu of Lbor Sttistics. (2006). Tble SNR0. 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