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WORK: A Journal of Prevention, Assessment & Rehabilitation is an interdisciplinary, international journal which publishes high quality peer-reviewed manuscripts covering the entire scope of the occupation of work. The journal's subtitle has been deliberately laid out: The first goal is the prevention of illness, injury, and disability. When this goal is not achievable, the attention focuses on assessment to design client-centered intervention, rehabilitation, treatment, or controls that use scientific evidence to support best practice.
WORK occasionally publishes thematic issues, but in general, issues cover a wide range of topics such as ergonomic considerations with children, youth and students, the challenges facing an aging workforce, workplace violence, injury management, performing artists, ergonomic product evaluations, and the awareness of the political, cultural, and environmental determinants of health related to work.
Dr. Karen Jacobs, the founding editor, and her editorial board especially encourage the publication of research studies, clinical practice, case study reports, as well as personal narratives and critical reflections of lived work experiences (autoethnographic/autobiographic scholarship),
Sounding Board commentaries and
Speaking of Research articles which provide the foundation for better understanding research to facilitate knowledge dissemination.
Narrative Reflections on Occupational Transitions, a new column, is for persons who have successfully transitioned into, between, or out of occupations to tell their stories in a narrative form. With an internationally renowned editorial board,
WORK maintains high standards in the evaluation and publication of manuscripts. All manuscripts are reviewed expeditiously and published in a timely manner.
WORK prides itself on being an author-friendly journal.
WORK celebrates its 25th anniversary in 2015.
*WORK is affiliated with the Canadian Association of Occupational Therapists (CAOT)* *WORK is endorsed by the International Ergonomics Association (IEA)* *WORK gives out the yearly Cheryl Bennett Best Paper Award*
Abstract: BACKGROUND: A challenge facing stakeholders is the identification and translation of relevant high quality research to inform policy and practice. This study engaged academic and community stakeholders in conducting a best evidence-synthesis to identify modifiable risk and protective worker factors across health conditions impacting work-related absence. OBJECTIVES: To identify modifiable worker disability risk and protective factors across common health conditions impacting work-related absence. METHODS: We searched Medline, Embase, CINHAL, The Cochrane Library, PsycINFO,…BusinessSourceComplete, and ABI/Inform from 2000 to 2011. Quantitative, qualitative, or mixed methods systematic reviews of work-focused population were considered for inclusion. Two or more reviewers independently reviewed articles for inclusion and methodological screening. RESULTS: The search strategy, expert input and grey literature identified 2,467 unique records. One hundred and forty-two full text articles underwent comprehensive review. Twenty-four systematic reviews met eligibility criteria. Modifiable worker factors found to have consistent evidence across two or more health conditions included emotional distress, negative enduring psychology/personality factors, negative health and disability perception, decreased physical activity, lack of family support, poor general health, increased functional disability, increased pain, increased fatigue and lack of motivation to return to work. CONCLUSIONS: Systematic reviews are limited by availability of high quality studies, lack of consistency of methodological screening and reporting, and variability of outcome measures used.
Keywords: Disability prevention, risk and protective factors, occupational health
Abstract: BACKGROUND: Research suggests that health is an important determinant of re-employment. However, the association between specific physical health components, such as muscular fitness, and re-employment has not been well studied. OBJECTIVE: In a three-year follow-up of unemployed people, we investigated whether muscular fitness is associated with re-employment. METHODS: In 2002–2005, unemployed people (n=130) who were participants in active labour market policy measures were recruited to participate in a Career Health Care (CHC)…project. Data on background characteristics and muscular fitness were collected in 2002/2003 using a questionnaire and laboratory measurements. Clientship in the CHC lasted for three years, and at its end, participants' employment status was assessed by a questionnaire. Logistic regression was used to investigate the association between baseline muscular fitness (repetitive lift, sit-ups, and squats) and re-employment after three years. RESULTS: The probability of re-employment within three years significantly increased with improved performances on muscular fitness tests (lifting, sit-up, and squatting) after adjustment for age and gender. CONCLUSIONS: Unemployed people with good muscular fitness had increased probability for re-employment as compared to those with poor muscular fitness.
Keywords: Health, selection, Career Health Care, unemployment
Abstract: BACKGROUND: Over the last three decades Brazil has developed a new community-based mental health policy. In this context it is important to reflect on the offers of care for users, and especially on how therapeutic projects are developed by professionals. OBJECTIVE: This study was conducted with professionals working in community-based mental health services to investigate and understand their views on the construction of therapeutic projects and compare them with the concepts and theoretical proposals…in Brazil's Mental Health Policy Guidelines and a review of the literature. PARTICIPANTS: Thirteen professionals who worked in mental health services located in three cities of the state of São Paulo, Brazil. METHODS: Semi-structured interviews were conducted between September and November of 2009 to understand the views and mechanisms adopted by professionals in developing therapeutic projects. A bibliographical review laid the foundations for the theoretical research and for strengthening the basis of the data analysis. RESULTS: The professionals views are similar to those proposed in the relevant literature and Brazil's Mental Health Policy Guidelines. However, there is a need to invest in building new models to meet the needs of the population that requires mental health services. Clearer guidelines should be established to organize services and to provide adequate, sufficient training. CONCLUSIONS: The study suggests that attention and resources should be directed to strengthening training of professionals, and especially to qualifying the organization and administration of services in order to consolidate the new model.
Keywords: Mental health services, community mental health services, technological development, occupational therapy
Abstract: BACKGROUND: Manual material handling has been attributed as a major risk to human musculoskeletal system. Workers postural stability in these tasks is influenced by holding method, time and weight being handled. OBJECTIVES: The study attempts to investigate postural balance in five different commonly adopted load handling methods amongst female volunteers. METHODS: Ten women subjects performed manual material handling tasks by lifting 9 kg load in five different ways. Lifting tasks included (1) Upfront in palms (2) on…head (3) sideways (left) (4) sideways (right) and (5) in bag at back. Normalized electromyography signals (back and leg) and center of pressure displacements parameters were investigated as measures of postural control. RESULT: An increase in the medio-lateral and anterio-posterior center of pressure displacements and activity of back muscles was reported when subjects lifted the weight directionally. CONCLUSION: There was a significant influence of load position on center of pressure displacements and muscle activity and thereby on postural stability. Keywords: Balance; center of pressure; electromyography.
Keywords: Balance, center of pressure, electromyography
Abstract: BACKGROUND: The safe maximal lift for a person is often determined during a functional capacity evaluation. This determination is based upon observation of unsafe lifting techniques, however there is limited information on specific kinematic changes that assist a therapist's clinical reasoning and determination of the safe maximal lift. OBJECTIVE: To evaluate any change in kinematics between safe minimum and safe maximum floor-to-bench lifts during the WorkHab Functional Capacity Evaluation. METHOD: Twenty-eight healthy…participants (age range 18–22 years) were digitally recorded completing the evaluation. Lumbar spine, hip, knee and ankle joint angles were measured using Dartfish Pro-suite software at the beginning (0/3), one third (1/3), two thirds (2/3) and end (3/3) of the lift in descending and ascending phases. Paired t-tests were used to compare joint angles at each point of minimum and safe maximum lifts. RESULTS: Significant changes in joint angles occurred lifting safe maximum weight compared to minimum weight. The lumbar spine was in greater flexion [4.9, 95% CI 2.1:7.7, p=0.001]; the knee joint was in less flexion descending [−4.5, 95% CI −8.1: −0.8, p=0.004 (3/3)] and ascending [−9.7, 95% CI −18.3: −1.16, p=0.027 (0/3)] and hip flexion increased at all points of the ascending phase (p⩽ 0.021). The ankle joint was in less dorsiflexion while descending [8.0, 95% CI 3.4:12.7, p=0.001(2/3); 6.7, 95% CI 4.4:9.0, p⩽0.001(3/3)] and ascending [8.9, 95% CI 6.24:11.6, p=0.001(0/3); 3.6, 95% CI 1.5:5.7, p⩽0.001(3/3)]. CONCLUSIONS: This study provides insight into kinematic changes and support observations made by the WorkHab assessor in determining a safe maximal lift during floor-to-bench lifts.
Keywords: Kinematics, lifting, work capacity evaluation
Abstract: BACKGROUND: The term "professional dance" comprises various dance styles. There are no studies which investigated work related traumatic injuries with regard to five different dance styles. OBJECTIVE: To define dance-style related differences of traumatic injuries. METHODS: The basis for the evaluation were the occupational injuries of professional dancers of six theaters (n=1339; f: n=658, m: n=681) and one State Ballet School (n=612; f:n=421, m: n=191). RESULTS: Independent of the dance style, the lower extremity…(leg and hip) is the most frequently injured anatomical region (p< 0.001). The more dancers move away from the classical dance technique, the more traumatic head/neck injuries increase (p<0.001). Injury patterns and injured structures also show differences subject to dance styles (p< 0.001). In classical dance the most commonly sustained injuries are due to intrinsic factors with the significance of extrinsic factors increasing the more dancers diverge from defined classical dance techniques. CONCLUSION: The results shown in the study clarify the enormous dance-style related differences in traumatic injuries sustained by dancers. These differences support the development of dance-style related injury prevention measures and suggest further investigations with the focus being placed on the influence of organizational structures (e.g. number of performances) as well as on the working environments.
Keywords: Traumatic injuries, professional dance, extrinsic/intrinsic factors
Abstract: BACKGROUND: Electrical coffeepots are commonly used in professional and residential environments. Their instruction manuals are related to issues that involve the user's safety and ability to operate the machine correctly. To provide the best product performance to the user, one must indicate or inform the correct usability, to turn the interaction easier. OBJECTIVE: This research proposes to investigate the instruction manuals of the electrical coffeepots. METHODS: Four coffee pot instruction manuals were analyzed in…relation to the complexity through the heuristic evaluation. For that, eight experts of the Graphic Design were chosen to answer twenty four questions with the aim of analyzing: images; texts; layout development; information and warnings. RESULTS: This study shows the results of the 04 (four) items analyzed: a) images; b) texts; c) layout development; d) information and warnings, together with the suggestions of improvements for each manual. CONCLUSIONS: It is believed that the methodological procedures for the application of the heuristic evaluation have facilitated the diagnosis of fragilities and barriers that the users find during the interaction with electrical coffeepot manuals.
Abstract: BACKGROUND: Nutritional aspects are important for the prevention of diseases and disorders, and few studies have focused on the relationship between risk of work injury and nutritional variables. OBJECTIVE: This study aimed to verify whether nutritional variables constitute risk factors for work-related accidents. PARTICIPANTS: 1,422 industrial workers (600 cases plus 822 controls). METHODS: A case-control study was carried out in an industrial city in south-east Brazil. A multiple logistic regression model was…adjusted using work-related accidents as the response variable and nutritional variables as predictors. The associations were assessed by Odds Ratio (OR), with a p-value < 0.05. RESULTS: 47.29% of the workers were overweight or obese. Protective factors for work-related accidents were (a) attending formal education for an above average number of years (OR=0.91, p< 0.0001) and (b) eating a traditional dinner (OR=0.67, p=0.0087). Risks factors were (a) hard physical effort in the workplace (OR=1.37, p< 0.0001), (b) having lunch in the workplace (OR=1.57, p<0.0001) and (c) receiving government benefits in the form of food stamps (OR=1.39, p=0.0350) or food baskets (OR=1.30, p=0.0414). CONCLUSION: Our findings suggest an association between nutritional variables and work-related accidents. This indicates the need, during the formulation of policies for these kinds of government benefits, to include nutrition aspects in order to minimize work-related accidents risks.
Abstract: BACKGROUND: Mechanical installation workers experience work-related musculoskeletal disorders (WMSDs) at high rates. OBJECTIVES: (1) Quantify the ergonomic demands during HVAC installation, (2) identify the tasks and task parameters that generated extreme ergonomic demands, and (3) propose improvements to reduce the WMSDs among mechanical workers. METHOD: The study focused on installation of rectangular ductwork components using ladders, and analyzed five operations by two mechanical contractors. Using continuous time observational assessment, the videotaped operations were analyzed along…two dimensions: (1) the production tasks and durations, and (2) the ergonomic demands for four body regions (neck, arms/shoulders, back, and knees). The analysis identified tasks with low portion of productive time and high portion of extreme postures, and task parameters that generated extreme postures. RESULTS: Duct alignment was the task with the highest portion of extreme postures. The position of the ladder (angle and distance from the duct) was a task parameter that strongly influenced the extreme postures for back, neck and shoulders. Other contributing factors included the difficulty to reach the hand tools when working on the ladder, the congestion of components in the ceiling, and the space between the duct and the ceiling. CONCLUSIONS: The identified tasks and factors provide directions for improvement.
Abstract: BACKGROUND: One hundred and sixty million office workers (knowledge workers) in the U.S. and 2/3 of the developed countries use computers on a daily basis. OBJECTIVE: Investigate the effectiveness of ergonomic and diversified chiropractic care for the reduction of pain, discomfort and impaired productivity in knowledge workers presenting with neck and upper extremity musculoskeletal complaints. METHODS: A one-year prospective case series (n=5 applying ergonomic job task analyses and ongoing surveillance at baseline,…8 weeks, 16 weeks and one-year for musculoskeletal discomfort (CMDQ and VAS, quality of life (Rand SF-36, productivity and forward head posture (FHP). RESULTS: CMDQ and VAS scores decreased by 45% (neck) and 80% (upper extremities); productivity increased from 65% to 100%; physical functioning, role physical and role emotional improved for 4 of 5 subjects; body pain and general health improved for 3 of 5. Average FHP changed from 1-inch (baseline) to 1/4-inch (16-weeks) to 1/2-inch (one year). CONCLUSIONS: Effectiveness of this intervention for the reduction of risks depended upon the subject's adoption of safe workstyle behaviors and postures. A transtheoretical model (TTM) for behavior change is discussed as a possible methodology to enhance the adoption of safer work habits.
Abstract: BACKGROUND: The prevalence of chronic diseases and disabilities are higher in older adults, which is one of the key factors of rising health care costs. Health care stakeholders wish older adults to take more control of their health to delay the onset of age-related disabilities and chronic diseases. Engaging older adults in their health care decision making would cut down health care costs and prepare a health care system to be more sustainable. OBJECTIVE: We used the Human-Centered…Design approach to propose a prototype that more effectively engages older adults in their health care decision-making. METHODS: Four participants from four different countries – Taiwan, USA, Austria, and Germany; and two facilitators from the USA participated in this study. The participants interviewed a total of four subjects in their respective countries. This study used the Human-Centered Design approach, which embraced three main phases – observation, identification, and ideation. Each phase involved brainstorming, voting, and consensus among participants. RESULTS: This study derived 14 insights, 20 categories, 4 themes, a conceptual framework, some potential solutions, and a prototype. CONCLUSIONS: This study showed that older adults could be engaged in their health care decision-making by offering them health care products and services that were user-friendly and technology enabled. A 'gradual change management plan' could assist older adults to adopt technologies more effectively. The health care products and services should be centered on the needs of older adults. Moreover, the possibilities of older adults maintaining control over their own health may rely on proper timing, a personal approach, right products, and services.
Keywords: Aging, product design, services, technology, health care cost
Abstract: BACKGROUND: Stability during standing is achieved by a complex process which involves the performance of various systems. Using a force plate for analysing the stability for a period of one minute has been reported exclusively by many investigators. Most of people stand for a long period of time when chatting with somebody, doing a job and when waiting in a queue. However nobody has analysed the stability during quiet standing for a prolonged standing (5 minutes).…OBJECTIVE: The main aim of this research study was to analyse the performance of the subjects regarding stability for a period of 5 minutes. METHOD: A group of 40 normal subjects from the staff and students of Rehabilitation Faculty of Isfahan University of Medical Sciences were recruited in this research project. They were asked to stand on the force plate (Kistler) for a period of 5 minutes. They were instructed to look straight ahead and with their head erect and their arms at their sides in a comfortable position. The excursions of the COP sway in both planes were measured for all 20 seconds periods of data collection. RESULTS: The results of this research study showed that stability analysing based on the sway of the COP, while the test was collected for one minute, is not recommended. There is a significant difference between the excursions of the COP during the first to fifth minutes. The stability of the subject was optimum in the third and fourth minutes of standing. CONCLUSION: Using the COP sway, based on the first minute of standing, is neither a good representative of the more stable position nor the unstable position. It is recommended to discuss the stability of subjects based on their ability to return from an unstable position to a more stable position.
Abstract: BACKGROUND: Previous studies have shown that surgical team members' attitudes about safety and teamwork in the operating theatre may play a role in patient safety. OBJECTIVE: The aim of this study was to assess attitudes about teamwork and safety among Italian surgeons and operating room nurses. METHODS: Fifty-five surgeons and 48 operating room nurses working in operating theatres at one hospital in Italy completed the Operating Room Management Attitudes Questionnaire (ORMAQ). RESULTS:…Results showed several discrepancies in attitudes about teamwork and safety between surgeons and operating room nurses. Surgeons had more positive views on the quality of surgical leadership, communication, teamwork, and organizational climate in the theatre than operating room nurses. Operating room nurses reported that safety rules and procedures were more frequently disregarded than the surgeons. CONCLUSIONS: The results are only partially aligned with previous ORMAQ surveys of surgical teams in other countries. The differences emphasize the influence of national culture, as well as the particular healthcare system. This study shows discrepancies on many aspects in attitudes to teamwork and safety between surgeons and operating room nurses. The findings support implementation and use of team interventions and human factor training. Finally, attitude surveys provide a method for assessing safety culture in surgery, for evaluating the effectiveness of training initiatives, and for collecting data for a hospital's quality assurance programme.
Keywords: Leadership, patient safety, surgery, human factors
Abstract: BACKGROUND: Playing-related musculoskeletal disorders (PRMDs) are common in musicians and interfere with the ability to play an instrument at the accustomed level. There is limited research into injuries affecting folk musicians. OBJECTIVE: To explore the Irish traditional musicians' experience of PRMDs. METHODS: Focus group interviews were conducted in 2011 and 2012, in two venues in Ireland. Data were recorded and transcribed verbatim. Data collection ended when no new findings emerged from the…analysis of interviews. The inclusion criteria were: males or females aged 18 and above, and who taught or played Irish traditional music on any instrument. The data were analysed using the interpretative phenomenological method. RESULTS: All participants (n=22) believed there was a link between playing music and musculoskeletal problems. The main body areas affected were the back, shoulders, arms and hands. The main theme that emerged was: 'PRMDs are an integral part of being a traditional musician', and that the musical experience was generally prioritised over the health of the musician. There were sub-themes of 'fear' and 'stresses that contributed to PRMDs'. CONCLUSIONS: PRMDs are an occupational hazard for Irish musicians. There is an awareness of PRMDs, but changes (technique, environment) may threaten identity.
Keywords: Injury, disability, pain, folk music, work, leisure
Abstract: BACKGROUND: Work-related musculoskeletal disorders (WMSDs) remain a major occupational health problem, despite decades of research, outreach, and intervention. OBJECTIVE: The aim of this study is to promote early identification and prevention of WMSDs by developing education and outreach materials grounded in interview data collected from workers that have recently filed for workers compensation (WC) for WMSDs. PROCEDURES: We conducted semi-structured telephone interviews with WC claimants (n=66) from high risk industries identified through…the use of a Prevention Index (PI) in Washington state with WMSDs of the back, shoulder, hand/wrist, or knee. RESULTS: Perceptions regarding the degree of exposure to WMSD risk factors, the social construction of pain, and the potential to implement injury-prevention measures varied widely. Many workers dismissed their injuries as the result of "fluke" or "freak" occurrences and framed their exposure to risk factors for WMSDs as either inevitable or "just part of the job." CONCLUSIONS: Workers in high-risk industries for WMSDs described their work conditions in ways that suggested: (1) a lack of awareness of the potential for developing a WMSD, (2) a view of work-related pain as normal, and/or (3) a pattern of self-blame for WMSD onset. A paradigm that either asserts the inevitability of WMSDs or dismisses potential control measures presents both a significant barrier to injury prevention efforts as well as a major opportunity for future occupational health research.
Abstract: BACKGROUND: Taxi drivers work long hours for low wages and report hypertension, weight gain, and musculoskeletal pain associated with the sedentary nature of their job, stressful working conditions, and poor dietary habits. They also experience a high work-related fatality rate. OBJECTIVE: The objective of this study is to examine the association of taxi drivers' health status and level of job stress with work-related injury and determine if a potential interaction exists. METHODS: A survey of 309…Los Angeles taxi drivers provides basic data on health status, job stress, and work-related injuries. We further analyzed the data using a Modified Poisson regression approach with a robust error variance to estimate the relative risk (RR) and the 95% confidence intervals (CI) of work-related injuries. Focus group results supplemented and helped interpret the quantitative data. RESULTS: The joint effect of good health and low job stress was associated with a large reduction in the incidence of injuries, consistent with the hypothesis that health status and stress levels modify each other on the risk of work-related injury. CONCLUSIONS: These results suggest that the combination of stress reduction and health management programs together with changes in the stressful conditions of the job may provide targeted avenues to prevent injuries.
Keywords: Stressors, taxi driver injuries, worker alliance, health promotion
Abstract: BACKGROUND: The anthropometric characteristics of the Turkish female population are needed for the design of safe and ergonomically efficient workplaces. OBJECTIVE: The purpose of this study was to determine the anthropometric characteristics of the Turkish female population in one region. For this purpose, 56 anthropometric parameters were measured according to ISO 7250. PARTICIPANTS: Two hundred and twenty-five Turkish women participants who were aged 18+ years were selected to participate in the study.…METHODS: The measurements were obtained with an anthropometry measuring set. Principal component analysis was used to create statistical models to draw on information from two or more databases to estimate values for a large range of anthropometric variables. A reliability analysis was carried out on survey data to ensure the internal consistency of the constructs. RESULTS: The results of this study showed that the following five factors allow for a good general description of human body shapes for the Turkish female population: "corpulence", "length of body parts", "upper body length", "length of arm" and "hip-thigh region". CONCLUSIONS: The data provided by this study can help to solve a wide range of design problems, including product ergonomics and workplace ergonomics in manufacturing.
Abstract: BACKGROUND: Home care workers are at risk of various harmful occupational exposures, health complaints and sick leave. OBJECTIVE: Identifying occupational exposures related to shoulder-neck and low back pain, and assessing the comparative importance of such exposures, for home care workers. METHODS: One hundred and thirty-eight home care workers in a large municipality in Norway participated in the study (response rate 76.2%). Questionnaire comprised a combination of standardized items and context-specific VAS scales on mental,…social, emotional and physical work demands, perceived general tension and pain in shoulder-neck and low back. RESULTS: Severe pain scores for both shoulder-neck and low back regions were common, with individual variations. All VAS measures on occupational exposures were significantly correlated with shoulder-neck pain and all except social demands were significantly correlated with low back pain. However, stronger associations were found with perceived general tension, which proved to be the strongest predictor of shoulder-neck and low back pain, indicating a mediating effect in the relationship between occupational exposures and musculoskeletal pain. CONCLUSIONS: Identifying and alleviating occupational exposures is important to ensure a healthy and sustainable work environment. Special attention should be drawn to early signs of symptoms, such as general tension, preventing further development of musculoskeletal pain.
Keywords: Musculoskeletal symptoms, psychosocial risk factors, work environment, health care
Abstract: BACKGROUND: Several risk factors for upper-extremity muscle injuries are known, including repetitive and continuous-flow assembly work. However, no study has investigated the changes in the cervical flexion-relaxation ratio (FRR) and scapular position after continuous detailed assembly work. OBJECTIVE: This study investigated the changes in the cervical FRR, trapezius muscle pain, and acromion and scapular positions after continuous detailed assembly work. METHODS: Fifteen male workers were recruited. The cervical FRR, pressure-pain threshold (PPT)…of the upper and middle trapezius muscle, and acromion and scapular positions were measured in all subjects once before and once after detailed assembly work. RESULTS: The cervical FRR after detailed assembly work was significantly decreased compared with that before detailed assembly work. The PPT of the upper and middle trapezius muscle after detailed assembly work was significantly decreased compared with that before detailed assembly work. The acromion angle after detailed assembly work was significantly decreased compared with that before detailed assembly work. The scapular inferior distance after detailed assembly was significantly increased compared with that before detailed assembly work. CONCLUSIONS: Our findings suggest that detailed assembly work may cause the absence of FRR, upper trapezius and middle trapezius pain, and scapular malalignment associated with a potential risk of neck and shoulder pain.