Occupational Health Flashcards
Total worker Health (TWH)
the integration of worker well-being with workplace safety and health principles; supports a more holistic-centered approach to the health and safety of workers
Interventions focus on both _____________________ and __________________
work-related injury prevention factors and health promotion
Total worker health (TWH) was originally introduced by __________________ and trademarked in ____________
the National Institute of Safety and Health (NIOSH); 2011
TWH interventions that address both _______________ and ________________ reduction can improve workforce health more ___________ and ____________ than the injury prevention only
injuries and chronic disease; rapidly and effectively
Fundamentals of Total worker health: Demonstrates _______________ to worker safety,healthand well-being at all levels of the organization; ___________to eliminate or reduce safety and health hazards and promote worker well‐being; Promote and support ____________throughout program design and implementation; Ensure ____________________of workersand _______________relevant systems to advance worker well‐being
leadership commitment; design work; worker engagement; confidentiality and privacy; and integrate
According to a recent survey by Harvard University, _____% of working adults in the United States reported their job affects their _______________
40;overall health, stress levels, and family life
Worker health may be influenced directly by ____________________
exposures in the workplace and characteristics of the job, psychosocial supports or barriers of the workplace, and work-related resources andopportunities
In 2020, the average person spent _____ hours per day working and ____ minutes per day commuting on the days they worked
7.6 and 47
Workers in the _________________________, have increased the share of employed persons working from home between 23 and 40%
Financial arena, business services, and education, and health services
The dynamic nature of the characteristics, locations, and tasks of the 21st century workplace requires a flexible yet ______________ approach for occupational health professionals to design programs that ensure _____________________
Worker-centered; occupational health and safety
TWH acknowledges the direct link between occupation and health. These approaches are based on five defining elements including:
commit to worker safety and health at all levels of the organization, eliminating or reducing health hazards and promoting worker well-being, promoting and supporting worker engagement throughout program design andimplementation, ensure confidentiality and privacy of workers, integrate relevant systems to advance worker well-being
What are the 4 components of the workplace health model?
Assessment planning and management, implementation, and evaluation
OSHA defines direct costs as the costs that ________________
directly impact an employer’s workers’ compensation costs, medical costs associated with each injury, and potential legal services
The indirect costs are defined as ___________________________ which includes _________________
the costs that in-directly affect the employer’s cost and are usually secondary and more long-term; loss work time, increased absenteeism, decreased presenteeism, decreased productivity, decreased employee morale, and implementation of corrective measures
The total costs are __________________
the combination of direct and in-direct costs
Physical therapists are in a perfect position to combat WMSDs due to ___________________
their extensive training in the musculoskeletal system, pathology related to injuries, and evidence-based measures to rehabilitate injured workers back to health
Physical therapists can play an expanded role in total worker health by ____________________
utilizing their clinical skills to promote cost savings withworksite injury prevention programsdesigned to reduce injuries in the workplace and improve overall employee health
Occupational Safety and Health Act of 1970: Congress created the Occupational Safety and Health Administration (OSHA) to ensure safe and healthful working conditions for workers by __________________________
setting and enforcing standards and by providing training, outreach,educationand assistance
The OSHAAct covers most _________________ in the 50 states and certain territories under federal authority
private and public sector employers and their workers
Employers must comply with all OSHA Standards that are applicable to the hazards to their industry. They must also comply with the General Duty Clause thatstates all employers provide a work environment _____________________________
free from recognized hazards that are causing or are likely to cause death or serious physical harm
Employers with more than ____ employees are required to keep a record of serious work-related injuries and illnesses. This information helps employers, workers and OSHA evaluate the __________ and prevent ____________. The records must be maintained at the worksite for at least ______ years
10; safety of a workplace; future workplace injuries and illnesses; 5
Each February through April, employers must post a summary of the _______________________
injuries and illnesses recorded the previous year
It is imperative that physical therapists understand OSHA ___________ for the industry for which they are working. Asking to review the OSHA 300 log from the previous ___ years will glean the needed information
recordability; 3
Employers are responsible for providing _____________. In the workplace, the number and severity of WMSDs resulting from physical overexertion, and their associated costs, can be substantially reduced by _______________
a safe and healthful workplace for their workers; applying TWH principles
______________ are among the most frequently reported causes of lost or restricted work time
WMSD
According to the Bureau of Labor Statistics in 2022, WMSDs cases accounted for ________% of all worker injury and illness cases
33
In 2018, workers in private industries suffered a total of ____________ work-related injuries or illnesses
2.8 million
Liberty Mutual Insurance revealed that _______________ dollars per year are spent on overexertion injuries in 2022
19.1 billion
When working with a new company, look for ___________
trends
Healthy People 2000 /2010that proposed that 75% of employers with 50 or more workers should offer _______________ services as a benefit.
health promotion
The wellness and health promotion programs suggested by the CDC focused on 5 key elements. What are they?
Health education, supportive social and physical work environment, integration of the program into the administrative structure, assistance programs for workers, and screening programs
With Healthy People 2020, the big change is the inclusion of _____________________, consisting of ____________________
Health Risk Assessments; employers being required to offer health screenings, nutritional counseling, biometric screening, blood tests, and panel of physicians for work-related injuries/illnesses
What are the 5 main tentacles of TWH for primary prevention of WMSDs and overall health?
Post-offer functional employment exams, health coaching/wellness, functional job analyses and ergonomic modifications, education of posture, body mechanics, and lifting mechanics, and on-site MSK triaging
Transitional work programs are designed to ___________________________
facilitate an early return to work by temporarily assigning job duties that are within the physical capabilities of the injured worker
What is the intent of transitional work programs?
use real job tasks to accommodate the injured worker’s restrictions and gradually return the injured worker to their original (usual and customary) job
Transitional work programs allow employees to resume their work functions with _______________
minimal time off
Bringing injured workers back to work as soon as possible by providing modified-duty tasks or reduced hours helps the injury employee: _______________________
Experience less deconditioning, stay in the routine of working, feel productive, maintain workplace relationships, and recover from injury faster
Employer benefit from transitional work programs because it ____________________
reduces the likelihood of litigation, helps control workers’ compensation claim costs, which affect future premium, minimizes replacement costs, and maintains productivity
What percent of employers offer some form of telemedicine office visit? And how many are expected to offer this option by 2024?
8% and 25%
What percent of employers recommend the use of mobile apps for employees to manage chronic conditions? And another ________% plan on supporting these types of wellness applications by 2019
19% and 26%
OSHA website definition of ergonomics _______________ which __________________
fitting a job to a person; helps lessen muscle fatigue, increases productivity, and reduces the number and severity of WMSDs
OSHA definition of ERGONOMICS
FITTING A JOB TO A PERSON
What are the important elements of an ergonomic process?
provide management support, involve the workers, provide training, identify problems, encourage early reporting of injuries, implement solutions, and evaluate progress
A specific intervention that has become very popular in the last decade in the industrial workplaceare ______________ designed to improve _______________________
stretching programs; quality of life and reduce injuries in the workplace
What is the normal stream of events without a PT after a MSK injury?
Injury occurs, supervisor is notified, employee fills out formal paperwork regarding the injury, employee receives medical examination at a local urgent care or ED, Medications, imaging, and job restrictions are made, OSHA 300 log is filled out by employer
WHAT STEPS AFTER A MSK INJURY ARE WE TRYING TO HELP COMPANIES AVOID?
Steps 3-6: employee fills out formal paperwork regarding the injury, employee receives medical examination at a local urgent care or ED, Medications, imaging, and job restrictions are made, OSHA 300 log is filled out by employer
What are the steps when a PT is acting as on-site primary care PT?
Injury occurs, supervisor is notified, screened by physical therapist (think direct-access/primary care but on-site vs clinic), and employee can either return to work or receive appropriate external medical treatment
Why do we want to avoid sending our employees to UC or the ED and filling out the paperwork?
Supervisors/EHS are not trained in MSK assessments, Most companies don’t have a clear idea of what services are available to them, and Supervisors will automatically send to UC/ER/occupational physicians which results in OSHA recordable, worker’s compensation premium increase, decreased productivity, and loss work time by injured employee
Steps the PT takes during screening
consent signed, outcome measures, Upper/Lower quarter screening (myotomes and dermatomes), ROM/MMT, Special tests, reflexes, Red flag screening, Clinical prediction rules
What’s included in the red flag screening?
night sweats, unnecessary weight loss, visual impairments associated with a headache
Consent form needs to include the following:
potential risks, potential benefits, and alternative treatments
Just like in the clinic, we need __________, and keeping an ______________ on file is important
Informed consent; objective measure
Rotator Cuff pathology (full thickness tear) CPR
Drop Arm test (+), Infraspinatus MMT weakness, and painful arc during shoulder elevation
Shoulder impingement CPR
Hawkins-Kennedy/Empty Can Test (+), Infraspinatus MMT weakness, and painful arc during shoulder elevation
Functional Capacity Evaluation
comprehensive performance-based assessment of an individual’s physical and/or cognitive abilities to safely participate in work and other major life activities, and includes 4 major components which are: Intake interview, Medical records review, Physical examination, and Content valid functional testing
What are the 4 major components of an FCE?
Intake interview, Medical records review, Physical examination, and Content valid functional testing
An FCE attempts to identify ________________
an individual’s ability to safely participate in work
In instances where an individual has an _______________ that impairs his/her ability to safely participate in work, functional limitations may be present. ______________ represents what an individual can still do despite functional limitations resulting from a medically determinable impairment(s) and impairment-related symptoms
illness, medical condition, or disorder; Residual functional capacity
Functional capacity examiner
a physical therapist or occupational therapist who demonstrates evidence of education, training, and competencies specific to the design, administration, and interpretation of FCEs.
FCEs should utilize _______________________
the best available evidence when designing and performing FCE protocols and when forming conclusions about an individual’s ability to safely participate.
Functional Capacity Examiners should use a client centered approach in which __________
the examiner gathers information to understand what is currently important to the individual and to identify past work experiences that may assist in the understanding of the current issues.
A functional capacity examiner needs to have Proficiency with the FCE test process being used, and understand the process’ ____________________
underlying safety, reliability, validity and practicality
The examiner needs to employ clearly defined test endpoints during testing that include _______________________
physiological, biomechanical, and psychophysical factors
The examiner should be aware of his/her own _________________________ as there is evidence suggesting that these beliefs can impact an individual’s test results
fear-avoidant beliefs and biases
The examiner should have knowledge of ______________________, be able to utilize info contained in a job analysis to ___________________, understand essential versus marginal job functions, and under activity analysis which addresses _______________________
physical work demands, activity frequency, repetitive movements and sustained postures; design and test an individual’s functional performance of a specific job; the physical demands of an activity, the range of skills involved in its performance, and the various cultural meanings that might be ascribed to it
What laws and regulations are relevant to FCE administration and use?
Worker’s Compensation laws and regulations within the jurisdiction in which the injury occurred and/or evaluation is completed, Social Security Disability Administration criteria, Americans with Disabilities Act and Americans with Disability Amendment Act, Code of Uniform Guidelines for Employment Selection, Health Insurance Portability and Accountability Act (HIPPA), and Regulations regarding expert testimony-Federal Rules of Evidence-Daubert Standard and Frye
For an FCE, The referral source should clearly communicate the ______ of the FCE and specify any _________________
purpose; particular issues the examiner should address
If a job-specific FCE has been requested, the examiner needs detailed information regarding the ____________ whcih can be obtained from review of a job description or job analysis
physical requirements of the essential and marginal duties
Medical Records that provide background regarding the ____________ can provide helpful information to the Examiner. Records may include ____________________
individual’s mechanism of injury or illness and subsequent treatment; operative notes, recent diagnostic test reports, physician records, and occupational and physical therapy records.
Common reasons not to conduct an FCE or to cease testing include but are not limited to: _____________
No consent, language barriers, and pregnancy
Functional Capacity Examiners should design and/or utilize established functional tests that meet the following criteria: _________________
Safety, reliability, validity, practicality, and utility
What are the 2 primary types of FCEs
Job/Occupation specific FCE and any occupation FCE
Job/occupation specific FCE
The individual’s functional abilities are matched to the physical and/or cognitive demands of a specific job(s) or a specific occupation(s). The individual has usually reached MMI.
Any Occupation FCE
The individual’s functional abilities are not matched to the physical and/or cognitive demands of a specific job(s) or a specific occupation(s). Often used in long term disability claims and Social Security Disability claims, but also in workers’ compensation claims when it is known that the individual will not return to their prior job. The individual has usually reached MMI.
The Examiner is ultimately responsible for determining the amount of time necessary to design, administer, and interpret the FCE based on the complexity of the case. Common factors used to determine the amount of time necessary for an FCE include the:
Type of FCE needed (job/occupation specific or any occupation), Physical and/or cognitive demands of the job/occupation, and Chronicity and severity of the individual’s physical and cognitive impairments.
There is an allowance of up to _____ hours for an FCE over ________ days. Why might the upper end of the recommended time allowed be appropriate?
8; 1-2; Individual has chronic physical and/or cognitive impairments. Individual has reached (MMI) and permanent work restrictions are needed. Referral source requires information about an individual’s ability to safely participate in work-related activities over multiple days. The individual has reports of chronic fatigue or delayed onset pain.
Shorter testing time periods of the FCE may be appropriate in what situations?
Individual has acute to sub-acute physical and/or cognitive impairments. Individual has not reached MMI and temporary work restrictions are needed for early return to work. Baseline functional abilities are needed for participation in an advanced work rehabilitation program. To provide helpful information regarding an individual’s ability to work
FCE test components
Referral review, medical record review, informed consent, intake interview, psychological screening and comprehensive pain assessment, Systems review/Physical exam, cardiovascular respiratory abilities testing/Aerobic testing, Material handling Testing, coordination, flexibility, and postural abilities testing, other work related testing, exit interview and instructions
What is part of the referral review?
reason for referral, and relationship of individual to referral source
What is included in the medical record review?
Mechanism of injury, Individual’s response to treatment to date, Objective diagnostic tests, Surgeries, and Other relevant claims/medical history
What is included in informed consent of the FCE test?
Include risk for injury, exacerbation of symptoms, or possibility of soreness in response to testing. Include the exam procedures that will help to reduce that risk. Discuss release of FCE information. Describe the FCE testing process e. Address individual’s concerns
What is included in the psychosocial screening and comprehensive pain assessment?
Use of evidence-based psychosocial/psychometric screens, Observation of the individual’s pain behavior throughout the FCE examination, Measurement of the individual’s physiological responses following acute episodes of increased pain, Use of a pain scale with functional descriptors, and Pain diagram.
What is included in the systems review/physical examination?
Cardio/respiratory, integumentary, musculoskeletal, neuromuscular, and cognitive
What is included in the material handling testing?
Ability to exert force to lift, push, pull, or carry objects; Lifting/lowering, carrying, pushing/pulling, and grasping/pinching
Coordination, Flexibility, and postural abilities testing should include ______________________ and includes ____________________
sustained and/or repeated observations of the ability to assume, maintain, and exit positions consistent with work including those defined by the DOL/DOT; Dynamic flexibility, gross body equilibrium, manual dexterity tasks
Dynamic flexibility
the ability to quickly and repeatedly bend, stretch, twist, or reach out with your body, arms, and/or legs
Gross body equilibrium
The ability to keep or regain your body balance or stay upright when in an unstable position
Common physical demand activities as reported by the dictionary of occupational titles includes: ________________
sitting, standing, walking, crawling, bending, twisting, pulling, crouching, reaching, and handling
Cognitive testing may be included dependent on symptoms and may include
Cognitive factors, perceptual/sensory factors, communicative factors, behavioral factors, and psycho-emotional factors
Intake interview
An interview which includes questions about current, recent, and past levels of pain and function provides insight into the nature, severity, and irritability of the individual’s condition; information from this interview can be used to develop the sequencing and rate of progression of test components, and helps the examiner target specific response to monitor
In the psychosocial/pain assessment, it’s important to include not just pain questionnaires, but also ________ and ___________ assessments such as ___________________
Fear avoidance, psychosocial; NDI, FABQ, Oswestry, Tampa Scale of kinesiophobia, DASH/Quick DASH, PHQ-2
When an individual reports an acute increase in pain during the FCE, the physiological responses monitored could include _________________________
inc HR, inc BP, inc RR, diaphoresis, and pupil dilation
Aerobic response to work demands is an important factor in determining an individual’s ability to perform __________. Results of testing should be reported such that they relate to __________ and avoid reporting results that compare to ___________ values
sustained work activity; work demands; age related normative
The preferred method for reporting aerobic capacity is in ___________
METs
Material handling Testing administration: Lifting/Lowering
should be tested progressively beginning with weights expected to be easily managed and in a manner that includes maximum opportunity for control. The vertical lift height should be noted.
Material handling Testing administration: carrying
should be tested progressively beginning with weights expected to be easily managed and in a manner that includes maximum opportunity for control. Carrying can be tested unilaterally or bimanually and should be conducted to best provide information needed by the referral source.
Material handling Testing administration: pushing/pulling
common vocational demands and can encompass moving a number of objects including hospital beds and stretchers, pallet jacks, hand trucks, crates, doors, ropes, and wire
Material handling Testing administration: grasping/pinching
The use of the hands for producing force in grasping and pinching are essential to functioning in most work environments. Assessment of the ability to produce force for grasping and pinching should be measured in accordance with standard protocols.
Work tasks require the worker to possess dynamic flexibility, extent flexibility, and gross body equilibrium to complete occupational tasks including:
Sitting, Standing, Walking, Climbing, Balancing, Stooping, Kneeling, Crouching, Crawling, Reaching, and Handling
Examiner interpretation of test data requires triangulation of multiple data sets in order to provide meaningful and useful information to the requestor. The 3 primary areas of consideration include a determination of the individual’s:
Performance or Effort level, Effect of pain and other symptoms on test performance, and Residual functional capacity including functional abilities and functional limitations.
For predicting an individual’s ability to safely perform work-related activities over an 8-hour period, their % Max HR should be what for 8 hours? 1 hour? 20 minutes? 5 minutes?
33, 50, 70, 85
