A 13-Year Cohort Study of Musculoskeletal Disorders Treated in an Autoplant, On-site Physiotherapy Clinic
Tóm tắt
Introduction The purpose of this study was to describe the rate and distribution of treatment visits provided in an on-site, automotive plant, physiotherapy clinic over a 13-year period. Method A retrospective cohort study was conducted using data collected at an on-site physiotherapy clinic (1990–2002, 65,977 visits; n = 2,636 workers). Results The average age of workers was 43 ± 9 years; most remained at work (85%) when treated. Disorders most commonly affected the shoulder, lumbar, and cervical regions; the median number of visits for these was 7, 6, and 5, respectively. Elbow disorders occurred commonly only for work-related complaints and required a median of eight visits. Rate of utilization was higher for women, with 47% of the plant’s female workers attending physiotherapy in 1 year. Women had higher rates of cervical spine (12 vs. 22%) and wrist (5 vs. 10%) disorders. The two most common causes of injury reported by workers with an industrial injury were “frank injury arising out of normal employment” (51%) and “gradual onset/no frank injury” (37%). The diagnosis most often reported by the physiotherapist after initial assessment was “strain” which was similar for both industrial (43%) and non-industrial (49%) injuries. The six main departments in this automotive plant account for 93% of all industrial injuries reported. Final Assembly accounted for the largest number and highest rate of injury, although shift variability was noted in utilization rates (13 vs. 26%), despite the same tasks, shift schedules, and demographics. Although there was no control group, the number of visits to discharge was lower than reported in the literature for off-site physical therapy; there was a large reduction in claims (441–275) following introduction of the clinic and reduced duration/costs of lost time were identified by the employer as a rationale to continue and enhance the service over time. Conclusions On-site physiotherapy services can provide early, cost-effective management of WRMSD in the automotive sector. Service utilization reflects the influence of gender, job task, and shift-dynamics on rates and location of WRMSD.
Tài liệu tham khảo
Workplace Safety and Insurance Board of Ontario. Injury Analysis of Allowed First Time Claims for Automotive Sector for Accident Year 2001.
Punnett L, Gold J, Katz JN, Gore R, Wegman DH. Ergonomic stressors and upper extremity musculoskeletal disorders in automobile manufacturing: a one year follow up study. Occup Environ Med 2004;61:668–74.
Silverstein BA, Fine LJ, Armstrong TJ. Hand wrist cumulative trauma disorders in industry. Brit J Ind Med 1986;43:779–84.
Bureau of Labor of Statistics. Bureau of Labor Statistics: News, United States Department of Labor. 1999;99–102.
Punnett L, Wegman DH. Work-related musculoskeletal disorders: the epidemiologic evidence and the debate. J Electromyogr Kines 2004;14:13–23.
Musculoskeletal Disorders and Workplace Factors. 1997; DHHS (NIOSH) Publication N0. 97–141.
Silverstein B, Welp E, Nelson N, Kalat J. Claims incidence of work-related disorders of the upper extremities: Washington State, 1987 Through 1995. Am J Public Health 1998;88:1827–33.
Webster BS, Snook SH. The cost of 1989 workers compensation low-back-pain claims. Spine 1994;19:1111–6.
Shannon HS, Lowe GS. How many injured workers do not file claims for workers’ compensation benefits? Am J Ind Med 2002;42:467–73.
Munir F, Yarker J, Haslam C, Long H, Leka S, Griffiths A, Cox S. Work factors related to psychological and health-related distress among employees with chronic illnesses. J Occup Rehabil 2007;17:259–77.
Allen H, Hubbard D, Sullivan S. The burden of pain on employee health and productivity at a major provider of business services. J Occup Environ Med 2005;47:658–70.
Meerding WJ, IJzelenberg W, Koopmanschap MA, Severens JL, Burdorf A. Health problems lead to considerable productivity loss at work among workers with high physical load jobs. J Clin Epidemiol 2005;58:517–23.
Tanaka S, Wild DK, Cameron LL, Freund E. Association of occupational and non-occupational risk factors with the prevalence of self-reported carpal tunnel syndrome in a national survey of the working population. Am J Ind Med 1997;32:550–6.
Hales TR, Bernard BP. Epidemiology of work-related musculoskeletal disorders. Orthop Clin N Am 1996;27:679–709.
Nathan PA, Keniston RC, Lockwood RS, Meadows KD. Tobacco, caffeine, alcohol, and carpal tunnel syndrome in American industry—a cross-sectional study of 1464 workers. J Occup Environ Med 1996;38:290–8.
Baldwin ML. Reducing the costs of work-related musculoskeletal disorders: targeting strategies to chronic disability cases. J Electromyogr Kinesiol 2004;14:33–41.
Staal JB, Hlobil H, van Tulder MW, Waddell G, Burton AK, Koes BW, van Mechelen W. Occupational health guidelines for the management of low back pain: an international comparison. Occup Environ Med 2003;60:618–26.
Arnetz BB, Sjogren B, Rydehn B, Meisel R. Early workplace intervention for employees with musculoskeletal-related absenteeism: a prospective controlled intervention study. J Occup Environ Med 2003;45:499–506.
Hashemi L, Webster BS, Clancy EA, Courtney TK. Length of disability and cost of work-related musculoskeletal disorders of the upper extremity. J Occup Environ Med 1998;40:261–9.
Heering L. Posture in industry. I. Basic principles of physical therapy in industry. Physiotherapy 1953;39:297–8.
Wiig L. My work as a physical therapist in industry. Physiotherapy 1954;40:291–4.
Grayzel EF, Finegan AM, Ponchak RE. The value of in-house physical therapy. J Occup Environ Med 1997;39:344–6.
Linz DH, Shepherd CD, Ford LF, Ringley LL, Klekamp J, Duncan JM. Effectiveness of occupational medicine center-based physical therapy. J Occup Environ Med 2002;44:48–53.
Scruby DJ, Denham S, Larkin GN. Economic impact of on-site physical therapy. J Occup Environ Med 2001;43:670–1.
Cheng MS, Amick III BC, Watkins MP, Rhea CD. Employer, physical therapist, and employee outcomes in the management of work-related upper extremity disorders. J Occup Rehabil 2002;12:257–67.
Hochanadel CD, Conrad DE. Evolution of an on-site industrial physical therapy program. J Occup Med 1993;35:1011–6.
Portney LG, Watkins MP. Foundations of clinical research: applications to practice. Upper Saddle River NJ: Prentice Hall Health; 2000.
Welch LS, Goldenhar LM, Hunting KL. Women in construction: occupational health and working conditions. J Am Med Womens Assoc 2000;55:89–92.
Berkley KJ. Sex differences in pain. Behav Brain Sci 1997;20:371–80.
Punnett L, Bergqvist U. Musculoskeletal disorders in visual display unit work: gender and work demands. Occup Med 1999;14:113–24, iv.
Riley III JL, Robinson ME, Wise EA, Myers CD,Fillingim RB. Sex differences in the perception of noxious experimental stimuli: a meta-analysis. Pain 1998;74:181–7.
McGeary DD, Mayer TG, Gatchel RJ, Anagnostis C,Proctor TJ. Gender-related differences in treatment outcomes for patients with musculoskeletal disorders. Spine J 2003;3:197–203.