Presentation
Risk of Occupational Injuries Among Rural Rehabilitation Clinicians
Event Type
Oral Presentations
TimeThursday, June 9th3:30pm - 4:00pm EDT
Location
DescriptionApproximately 247,700 Physical Therapists (PTs) were employed in the United States in 2018, and is expected to grow by ~22% by 2028 (Bureau of Labor Statistics [BLS], 2020). Current estimates suggest that the number of Occupational Therapists (OTs) jobs (around 133,000) will grow by ~18% by 2028, which is much faster than most other occupations (Bureau of Labor Statistics [BLS], 2020). Due to the nature of this occupation, PTs and OTs frequently perform a series of patient-specific therapeutic activities that often require bending/ twisting, kneeling/squatting, awkward postures, static postures, heavy lifting and repetitive tasks, to treat patients with severe pain or injuries. Most PTs and OTs experience work-related musculoskeletal disorders (WMSDs) due to this work routine (Campo & Darragh; Amy R. Darragh, Campo, & King, 2012; Amy R. Darragh, Huddleston, & King, 2009; McCrory et al., 2014). Rehabilitation professionals are prone to experience more WMSDs in inpatient settings (i.e., free-standing rehabilitation hospitals, rehabilitation units in general hospitals, long-term acute care hospitals, skilled nursing facilities).
As the philosophy of patient-centered care has been adopted nation-wide by healthcare facilities, the risk to rehabilitation clinicians’ health and safety must be estimated and mitigated. Although there are numerous safe patient handling devices available, therapists are hesitant to use these devices specifically for patients’ rehabilitation activities (A. R. Darragh et al., 2013; Audrey Nelson, Harwood, Tracey, & Dunn, 2008). Thus, the objective of this study was to identify factors which caused or contributed to WMSDs for clinicians specifically working in rehabilitation settings (e.g., acute care, inpatient rehabilitation, long-term care, outpatient therapy) and use of patient handling equipment.
Methods
A multifaceted survey containing both quantitative and qualitative questions was conducted of PTs, OTs and therapy assistants working at a rural community hospital. The study was approved by the Montana State University Institutional Review Board (IRB). All clinicians provided informed consent and were 18 years old or older.
Information on general workload, work-related pain/discomfort, patient handling, clinical experience and demographic information were gathered using both a scripted interview questionnaire and a semi-scripted post-interview discussion. The survey contained five different sections and took approximately 20 minutes to complete. A total of twenty-seven (27) rehabilitation professionals participated in this study.
Results
Twenty-seven (27) surveys were collected from 18 PTs, 6 OTs and 3 other therapy assistants from a single rural, community hospital. PTs’ average clinical experience (13.2 years) and rehabilitation experience (14.7 years) were much longer than the experience of the OTs and assistants. More female rehabilitation clinicians participated in the study. There were 16 (59.3%) participants who worked over 8 hours per workday.
On average, heavy lifting, physically fatiguing activities, static and awkward postures were performed over 20% of the hours worked per workday. Bending or twisting, repetitive tasks and kneeling or squatting were each performed over 30% of a workday according to the clinicians, especially bending or twisting which was performed 38% per day.
Sixty-three percent (63%) reported work-related musculoskeletal pain/discomfort within the past 12 months. Half (50%) of the pain/discomfort experienced by PTs and OTs was in the upper extremity (shoulder, elbow, wrist/hand and thumb), 35% in the torso (neck, upper back, mid back and lower back), and only 15% from the lower extremity (hip/thigh, knee and ankle/foot). However, the most severe pain/discomfort was reported in the upper extremity (23.5%) and torso (58.8%). Participants most often experienced pain/discomfort bilaterally (>50%), especially for the torso region. Disproportional pain/discomfort was experienced on the right side of the body, possibly due to a large proportion of right-hand dominance.
Thirty percent (30%) of respondents reported that a lift team was only available within their work environment. Eighteen participants (72%) could find mechanical lifting devices in the workplace. On average, 60% were mobile floor lifts, 47% overhead lifts, 17.3% therapeutic lifts, and 47% non-mechanical lifting aids. Only 31.5% of the participants were completely confident to use any of the lifting devices. For the mechanical lifting devices, 80.8% had initial training, 61.5% had annual training, and 56% had refresher training within their work area.
Most participants reported their most severe pain/discomfort within the last year lasted 24 hours or less (41.2%), occurred once every 2-3 months and was of moderate severity on the 10-point pain scale (47.1%). Over 94% of participants chose to continue working with their pain/ discomfort. More than half (52.9%) took pain relieving medication, and 58.8% of altered patients’ treatments or practices in order to accommodate their pain/discomfort. Less than half of the clinicians (41.2%) sought treatment or consulted a healthcare provider. Only 5.9% took sick leave during their injury.
The availability of mechanical lifts (full body/dependent mobile floor lifts, bariatric overhead lifts, and adjustable table/chair therapeutic lifts) were significantly associated with pain/ discomfort. When these lift devices were not available, a significant increase of work-related musculoskeletal pain/discomfort was observed among the rehabilitation clinicians. All 5 male clinicians’ experienced WMSDs while 58.8 % of female clinicians experienced WMSDs. Rehabilitation clinicians with higher BMIs were more prone to WMSDs (p=0.001).
Discussion
Around 74% of the participants delivered “hands-on” care to patients more than half of the workday. Some work environments are without lifting devices, especially therapeutic lifting devices. The availability of mechanical lifting devices (mobile, overhead and therapeutic lifts) had a negative association with the risk of WMSDs. Accordantly, mechanical lifting devices can have a positive influence on the WMSDs prevention for PTs and OTs. However, these lift devices are often thought to be obstacles for patients to regain independence, which makes many professionals hesitant to use them (Audrey Nelson et al., 2008). More evidence has shown that safe patient handling equipment/devices and new technology can help reduce pain/discomfort for medical professionals (Mayeda-Letourneau, 2014; A. Nelson & Baptiste; Audrey Nelson, Fragala, & Menzel, 2003). However, these lifting devices need to be designed to fit the needs of a range of healthcare professionals and promote positive patient outcomes (McCrory et al., 2014). Rehabilitation clinicians should select lifting devices that can help them maintain neutral postures and reduce back/torso strain. Only a small proportion of PTs and OTs were completely confident using lifting devices. Annual and refresher training were not regularly offered. Since PTs’ and OTs’ patients are changing and technology is evolving, instructions and training on lifting devices should be updated frequently. More annual and refresher training will ensure confidence and may help with incorporation of lifting devices in practice. Routine occupation risk education and mitigation should be provided at least annually.
As the philosophy of patient-centered care has been adopted nation-wide by healthcare facilities, the risk to rehabilitation clinicians’ health and safety must be estimated and mitigated. Although there are numerous safe patient handling devices available, therapists are hesitant to use these devices specifically for patients’ rehabilitation activities (A. R. Darragh et al., 2013; Audrey Nelson, Harwood, Tracey, & Dunn, 2008). Thus, the objective of this study was to identify factors which caused or contributed to WMSDs for clinicians specifically working in rehabilitation settings (e.g., acute care, inpatient rehabilitation, long-term care, outpatient therapy) and use of patient handling equipment.
Methods
A multifaceted survey containing both quantitative and qualitative questions was conducted of PTs, OTs and therapy assistants working at a rural community hospital. The study was approved by the Montana State University Institutional Review Board (IRB). All clinicians provided informed consent and were 18 years old or older.
Information on general workload, work-related pain/discomfort, patient handling, clinical experience and demographic information were gathered using both a scripted interview questionnaire and a semi-scripted post-interview discussion. The survey contained five different sections and took approximately 20 minutes to complete. A total of twenty-seven (27) rehabilitation professionals participated in this study.
Results
Twenty-seven (27) surveys were collected from 18 PTs, 6 OTs and 3 other therapy assistants from a single rural, community hospital. PTs’ average clinical experience (13.2 years) and rehabilitation experience (14.7 years) were much longer than the experience of the OTs and assistants. More female rehabilitation clinicians participated in the study. There were 16 (59.3%) participants who worked over 8 hours per workday.
On average, heavy lifting, physically fatiguing activities, static and awkward postures were performed over 20% of the hours worked per workday. Bending or twisting, repetitive tasks and kneeling or squatting were each performed over 30% of a workday according to the clinicians, especially bending or twisting which was performed 38% per day.
Sixty-three percent (63%) reported work-related musculoskeletal pain/discomfort within the past 12 months. Half (50%) of the pain/discomfort experienced by PTs and OTs was in the upper extremity (shoulder, elbow, wrist/hand and thumb), 35% in the torso (neck, upper back, mid back and lower back), and only 15% from the lower extremity (hip/thigh, knee and ankle/foot). However, the most severe pain/discomfort was reported in the upper extremity (23.5%) and torso (58.8%). Participants most often experienced pain/discomfort bilaterally (>50%), especially for the torso region. Disproportional pain/discomfort was experienced on the right side of the body, possibly due to a large proportion of right-hand dominance.
Thirty percent (30%) of respondents reported that a lift team was only available within their work environment. Eighteen participants (72%) could find mechanical lifting devices in the workplace. On average, 60% were mobile floor lifts, 47% overhead lifts, 17.3% therapeutic lifts, and 47% non-mechanical lifting aids. Only 31.5% of the participants were completely confident to use any of the lifting devices. For the mechanical lifting devices, 80.8% had initial training, 61.5% had annual training, and 56% had refresher training within their work area.
Most participants reported their most severe pain/discomfort within the last year lasted 24 hours or less (41.2%), occurred once every 2-3 months and was of moderate severity on the 10-point pain scale (47.1%). Over 94% of participants chose to continue working with their pain/ discomfort. More than half (52.9%) took pain relieving medication, and 58.8% of altered patients’ treatments or practices in order to accommodate their pain/discomfort. Less than half of the clinicians (41.2%) sought treatment or consulted a healthcare provider. Only 5.9% took sick leave during their injury.
The availability of mechanical lifts (full body/dependent mobile floor lifts, bariatric overhead lifts, and adjustable table/chair therapeutic lifts) were significantly associated with pain/ discomfort. When these lift devices were not available, a significant increase of work-related musculoskeletal pain/discomfort was observed among the rehabilitation clinicians. All 5 male clinicians’ experienced WMSDs while 58.8 % of female clinicians experienced WMSDs. Rehabilitation clinicians with higher BMIs were more prone to WMSDs (p=0.001).
Discussion
Around 74% of the participants delivered “hands-on” care to patients more than half of the workday. Some work environments are without lifting devices, especially therapeutic lifting devices. The availability of mechanical lifting devices (mobile, overhead and therapeutic lifts) had a negative association with the risk of WMSDs. Accordantly, mechanical lifting devices can have a positive influence on the WMSDs prevention for PTs and OTs. However, these lift devices are often thought to be obstacles for patients to regain independence, which makes many professionals hesitant to use them (Audrey Nelson et al., 2008). More evidence has shown that safe patient handling equipment/devices and new technology can help reduce pain/discomfort for medical professionals (Mayeda-Letourneau, 2014; A. Nelson & Baptiste; Audrey Nelson, Fragala, & Menzel, 2003). However, these lifting devices need to be designed to fit the needs of a range of healthcare professionals and promote positive patient outcomes (McCrory et al., 2014). Rehabilitation clinicians should select lifting devices that can help them maintain neutral postures and reduce back/torso strain. Only a small proportion of PTs and OTs were completely confident using lifting devices. Annual and refresher training were not regularly offered. Since PTs’ and OTs’ patients are changing and technology is evolving, instructions and training on lifting devices should be updated frequently. More annual and refresher training will ensure confidence and may help with incorporation of lifting devices in practice. Routine occupation risk education and mitigation should be provided at least annually.
Authors
