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PHTY2220 > L23: Occupational Factors > Flashcards

L23: Occupational Factors Flashcards

1
Q

______ is a significant determinant of health The _____ itself has an important role of the health and wellbeing of the patient

A

Work; workplace

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2
Q

______ is so prevalent but quite temporarily (won’t have a long impact on returning to work

A

Back pain

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3
Q

Most people that struggle with back pain and returning to work have it _______

A

very severe really bad

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4
Q

What are 5 LBP risk factors (not causes) in the workplace?

A
  1. Age
  2. Manual Materials Handling
  3. Frequent bending & twisting of trunk
    • Bending and twisting
  4. Whole body vibration
  5. Job dissatisfaction
    • Not causes –> odds of BP when they have these kind of activities in their workplace
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5
Q

Is there evidence that says that causal relationship that physical workload causes long term conditions

A

Lack of evidence

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6
Q

Past _____ of back pain important factor in predicting a future recurrence

A

history

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7
Q

What are 5 psychoscoial risk factors to occupational back pain?

A
  1. monotonous work
  2. perceived high workload
  3. little control over work
  4. pressure of time
  5. lack of decision-making authority
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8
Q

______ work demands account for a modest proportion of LBP (less than non-occupational factors)

A

Physical

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9
Q

______(Strong/weak/Insufficient/conflicting) evidence that sitting is not a risk factor for work-related LBP.

A

Strong

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10
Q

______(Strong/weak/Insufficient/conflicting) evidence that lack of supervisory and social support is a risk factor for work-related LBP.

A

Strong

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11
Q

______(Strong/weak/Insufficient/conflicting) evidence: frequent or prolonged periods of trunk rotation or bending for work-related LBP.

A

Conflicting

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12
Q

______(Strong/weak/Insufficient/conflicting) evidence: heavy physical work for work-related LBP.

A

Insufficient

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13
Q

______(Strong/weak/Insufficient/conflicting): awkward postures for work-related LBP.

A

Insufficient

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14
Q

______(Strong/weak/Insufficient/conflicting) job satisfaction for work-related LBP.

A

Weak

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15
Q

____ (strong/moderate/weak/no) evidence that decreasing or eliminating lifting in most workplaces alter incidence of LBP

A

no

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16
Q

____ (strong/moderate/weak/no) evidence of lumbar supports or education regarding manual handling for reducing LBP

A

no

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17
Q

____ (strong/moderate/weak/no) evidence for exercise programs in the workplace

A

moderate

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18
Q

Focussing solely on physical job factors _____ (does/does not) appear to be an effective primary preventative measure

A

does not

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19
Q

What are 5 physiotherapy management of work-related LBP?

A
  1. Measurement and demonstration of the effectiveness of treatment- Functional baseline and VAS
  2. Adoption of a biopsychosocial approach
  3. Empowering the injured person to manage their injury
  4. Implementing goals focused on optimising function, participation and return to work
    • When do you want to return to work?
    • What activities you want to be able to do at work?
    • SMART goals
  5. Base treatment on best available research evidence
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20
Q

What are 3 ways to empower the injured person to manage their injury?

A
  1. Empowering the injured person to manage their injury is a key treatment strategy incorporated in all phases of injury management.
  2. Education, setting expectations, developing self-management strategies and promoting independence from treatment.
  3. Empowerment to actively participate in activities at home, work and in the community as part of their rehabilitation
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21
Q

What are 3 treatments based on the on the best available research evidence?

A
  1. Use best available research evidence to inform decision making.
  2. Treatments with good evidence for efficacy are preferred over other treatments.
  3. Where there is good evidence that treatment lacks efficacy, it should not be used
22
Q

What are 3 reasons why measuring load matters?

A
  1. The employer or workplace would benefit from understanding the overall loading associated with tasks
  2. Loading (as well as other risk factors) may contribute to a workers symptoms
  3. Issue with prolonged lifting or loading –> need to know to modify
    • Can provide evidence to modify tasks and loading across the workday
23
Q

What are 3 ways to measure physical load associated with tasks?

A
  1. Ask the worker ‘how much effort is required to perform X task’ use Borg Scale 6 – 20 or modified Borg
  2. Form an ‘Estimate’
    • When an object/body limb is held away from the body by 30 cm, the force on the back is increased x 5 times.
    • When the object/limb is held away from the body by 60 cm the force is x 10 times that if it was held close to the body.
  3. Utah Back compressive force calculator
24
Q

What is the Borg’s rating of perceived exertion?

A

Quick and easy way to get a measure of load/exertion

25
Q

How to measure load with an estimate? Scenario: When an object/body limb is held away from the body by 30 cm, the force on the back is increased x 5 times. When the object/limb is held away from the body by 60 cm the force is x 10 times that if it was held close to the body. Considering an average weight of the Koala is approximately 10kg,

A

then the force on the back whilst holding it (30 - 60cm away) would relate to 50-100 kg

26
Q

What does the Utah Calculator look like when measuring load?

A

Modify by halving the time holding koala, the weight of the koala, the length the arm is at away from the body when holding the koala

27
Q

What do Australia statistics in terms of returning back to work show?

A

1/3 go back cause they feel recover

2/3 go back due to other reasons (not always a bad thing)

28
Q

Why is returning to work critical?

A

If a person is off work for:

  • 20 days, the chance of ever getting back to work is 70%
  • 45 days, the chance of ever getting back to work is 50%
  • 70 days, the chance of ever getting back to work is 35%

Earlier you go back –> high rate of staying at work long term

29
Q

What are 5 prognostic factors for RTW in workers with LBP?

A
  1. Recovery expectations
  2. Health-care provider actions
  3. Patient reported level of disability
  4. Workplace support
  5. Presence of radiating pain
30
Q

What are 7 steps to taken when initially seeing a patient who is off work and has LBP?

A
  1. Some patient’s will need time off work – consider ability to modify tasks, commuting, ability to work from home and their condition (how severe and irritable)
  2. Encourage the patient to talk to their employer and return to work
    • Physiotherapists can give medical certificates –> do not need to specify reasons coordinator
  3. Develop a return to work plan on DAY ONE
  4. As first contact practitioner – physiotherapists can give a worker a sick leave certificate (these are legally recognised)
  5. However, the patient will need to see their GP to make a workcover claim
  6. Take EVERY opportunity to work together with patient, employer and other health professionals involved
  7. There is STRONG evidence that contact by a healthcare provider with the workplace significantly reduces work disability duration
    • Develop plan between employee and employer = better outcomes
31
Q

What are 6 key messages to how to relay the importance of RTW with the LBP patient?

A
  1. work is important for physical and mental health
  2. staying active is better for back health and recovery and rest can be harmful
  3. you DON’T have to be 100% fit or pain free to RTW
  4. there is no evidence of predictable harm or returning to normal activity
  5. when workers have access to modified/suitable/alternate duties, they recover faster and RTW faster
  6. it is helpful to be talk to your employer about your recovery
32
Q

_____ is important for physical and mental health

A

work

33
Q

______ (staying active/rest)is better for back health and recovery and ______ (staying active/rest) can be harmful

A

staying active; rest

34
Q

You ____(do/don’t) have to be 100% fit or pain free to RTW

A

DON’T

35
Q

There _____ (is/is not) evidence of predictable harm or returning to normal activity

A

no

36
Q

when workers have access to modified/suitable/alternate duties, they recover ____ (faster/slower) and RTW ____ (faster/slower)

A

faster

37
Q

It is helpful to be talk to your _____ about your recovery

A

employer

38
Q

What are 3 primary prevention of occupational LBP (before occurence)?

A
  1. Determining safe and unsafe tasks
  2. Training and screening techniques
  3. Providing policies and equipment to reduce physical demands
39
Q

How can determining safe and unsafe tasks be a primary prevention strategy for BP?

A
  • There is still no universally accepted method of determining safe lifting capacity for workers.
  • Many workplaces use a maximum lifting weight of 23 kg if the object is within 18 cm in front of the body
40
Q

How can training and screening techniques be a primary prevention strategy for BP?

A
  • No definitive conclusion has been reached on the clinical significance of back training (educational programs on back care, posture, body mechanics, back exercises, and how to prevent injury).
  • Pre-placement strength testing as a screening method and physical examination for back pain are controversial and ineffective
    • While it is not predictive –> just insurance that taking a fit person in to work (at the start), not taking an unfit worker
  • No investigations offer significant predictive value to screening for future back pain
41
Q

How can providing policies and equipment to reduce physical demands be a primary prevention strategy for BP?

A
  • Abdominal belts have been proven by randomized clinical trials to be ineffective at preventing back pain.
  • There is conflicting evidence regarding the efficacy of exercise interventions and the provision of manual handling equipment and training.
  • “No lift policies” are often used, particularly in hospitals.
  • There are significantly fewer back injuries and less absence from hospitals due to musculoskeletal pain/symptoms compared with non no lift sites.
42
Q

What are 3 characteristics of secondary prevention (of chronicity and recurrence of symptoms) in LBP?to

A
  1. The majority of patients (80%) in the acute phase (symptoms of back pain last 3–4 weeks) will have good prognosis even with minimal investigation and treatment.- Modification of activities at work
  2. In the sub-acute phase, if the patient is still off work, measures targeted at the physical demands of the worker’s job can be both effective and cost saving.
  3. As for patients in the chronic phase (>3 months after symptom onset) multidisciplinary approaches are most effective.
43
Q

While sitting is considered to not be a risk factor for LBP, can sedentary lifestyle lead to LBP?

A

Yes

Vast majority –> no relationship with sitting and standing

44
Q

What are the 2 guidelines that workers should initially progress towards accumulating, in those occupations which are predominantly desk based?

A
  1. 2 hours a day of standing and light activity (light walking) during working hours
  2. eventually progressing to a total accumulation of 4 hours in total per day (not at once).

For overall health guidelines

45
Q

How beneficial are standing work stations for LBP?

A

Sit-stand desks reduced total sitting time Standing more did not produce harmful effects in the studies, such as musculoskeletal pain, varicose veins, or a decrease in productivity. Can be safe and can reduce sitting time Overall reduction in LBP found Vast differences in the dosage of the sit-stand interventions

46
Q

While sitting is not a risk factor • Standing desk have reduced BP symptoms • Be comfortable as long as its at least 2 hrs to 4 hrs a day

A

A

47
Q

What are the 4 guidelines for standing workstations?

A
  1. aiming for two hours a day of standing and light activity (slow walking), eventually progressing to a total of four hours
  2. regularly breaking up sit-down work with standing using adjustable sit-stand desks or work stations
  3. avoiding long periods of standing still, which may be as harmful as long periods sitting
  4. changing posture and doing some light walking to alleviate possible pain and fatigue “seated-based work should be regularly broken up with standing-based work, the use of sit–stand desks, or the taking of short active standing breaks”. Ensure good footwear, rubber matting (anti-fatiguing mat)
48
Q

What are 4 other equipments which accompany the standing work desk?

A
  1. A sit-stand stool allows rest and change of position in standing to minimise single leg leaning (especially where the desk is not easily lowered)
  2. A soft matt reduces leg fatigue and pain
  3. A foot rest allows changes in loading
  4. Frequent changes in position is key - Before then pain comes on
49
Q

What are the 4 set up for standing workstations?

A
  1. Standing straight
  2. Elbows 90 degrees
  3. Hands/fingers at height of keyboard/mouse
  4. Top of screen at or slightly below eye level
50
Q

When the patient first starts on a standing work station, what are 2 things to remember?

A
  1. Individuals new to adopting more standing-based work could expect some musculoskeletal sensations or discomfort and some fatigue as part of the positive adaptive process.
  2. If this cannot be relieved either by an altered posture or walking for a few minutes, then the worker should rest, including sitting

Normal to have fatigue –> to make this easier = gradual progressions

PHTY2220 (31 decks)

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