ergonomics in rehabilitation phd katiacosta-black dec 2008

8/14/2019 Ergonomics in rehabilitation Phd Katiacosta-black Dec 2008

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Ergonomics in the rehabilitation of low

back disability cases: t owards developmentof an evaluation framework that fosters teamcollaboration

Ktia M. Costa BlackDecember 12 th 2008


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ErgonomicsOccupationalRehabilitation

Main

Disciplines

RehabilitationErgonomics

Industrial EngineeringOccupational Psychology

Qualitative Research

Program Evaluation Research


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P resentation P lanI. Introduction

What is the problem? What is known about the problem? Why is there a problem? What is unknown about the problem?

II. Research Objectives Primary objective Key assumptions

Secondary objectives

III. Methodology & Results Study 1 Study 2 Study 3

IV. Final Results The framework

V. Discussion Remarks on each study General discussion Limitations of the framework Conclusion

Recommendations for future research


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I . Introduction

What is the problem?What is known about the problem?Why is there a problem?What is unknown about the problem?


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W hat is the problem ?

Facts about LBD:Affects 80% of population;5-9% with persistent problem = $;

More than 1% of lost GNP, mostly fromback disability;Main cause of worker compensationclaims;

100+ associated factors.

LBD is a complex phenomenon and must be consideredfrom a transdisciplinary perspective (Schultz et al 2007 )


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W hat is know n about the problem?

Success factors:Early return-to-work;Proactive disability management;Close link to the workplace;Involve all stakeholders in the RTW process;Apply ergonomics to rehabilitation.

Workplace centered rehabilitation programs arerecognized as effective in reducing the economic

and human costs of LBD

Workplace centered rehabilitation programs arerecognized as effective in reducing the economic

and human costs of LBD

Halpern 1993Baril et al 2003

Loisel & Durand 2003Franche et al 2005


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PREVICAP: an exemple

Loisel et al 1998;Durand et al 2003

Evidence-Based (EB) programUses an interdisciplinary/inter-organizational approachPlaces the rehab process in the workplace

PREVICAP interventionControl group


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W hy is there a problem?

1. Disability and RTW

2. Work as rehabilitation

3. Ergonomics

REVIEW OF CONCEPTS


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1. Disability and RTW

Biomedicalmodel

Forensicmodel

Socialmodel

Psychosocialmodel

Economicmodel

Schultz et al 2008

IOM model

Ecologicalmodel

ICF


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PAST TODAYsimplistic view

Biomedicalmodel

Forensicmodel

Socialmodel

Psychosocial

model

Economic

model

IOM model

Ecologicalmodel

ICF

1. Disability and RTW (cont.)

A comprehension continuum?

Transdisciplinary model

FUTURE

comprehensive view


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Change in focus based on best evidenceFrom

rehabilitating people in order to return them to w orkto

returning people to w ork in order to rehabilitate them

2. Work as rehabilitation

Inclusion of workplace actors in the RTW process;Stakeholders demands of proof of effective serviceprovision (beyond traditional health care).


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What does it really mean?Ergon work and nomos principles of laws

3. Ergonomics: Meaning

This science of work, understood as work in the comprehensive andintegral sense , not merely its part that is physical labour or toil, butphysical, aesthetic, rational, and moral work. Jastrebowski, 1857.

Ergonomics is the design and engineering of human-machinesystems for the purpose of enhancing human performance.

Dempsey 2000


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PhysicalCognitivePsychicSocial

EmotionalHUMAN

Technological systemBuild environmentWorkplace

MachineTool

TECHNOLOGYWorkplace systemWork organizationJobs

TasksWork methodsActions

ORGANIZATION

Balance

3. Ergonomics: Scope


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W hat is unknow n about the problem?

Rehabilitation ergonomics for LBD:

The process, criteria and procedures used forergonomic evaluations are unknown


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I I .Research Objectives

Primary objective

Key assumptionsSecondary objectives

b


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P rimary objective

To develop a framework forassisting ergonomists in theprocess of work evaluations for LBD

cases

P i (Li i )


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P remises (Lit. review )To consider a system-based model to describing work;To use a practice-to-research approach;

AssessmentWorker worksite

Goal planning

Plan execution

C o n

t i n u o u s

f e e

d b a c

k

R e - a s s e s s m e n

t &

n e c e s s a r y

r e - a

d j u s t m e n

t o

f g o a l s

Williams 1987

To use Interdisciplinary teamwork model.

S d bj i


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Secondary objectives

Study I:To explore/describe the work environment issues asdiscussed by an interdisciplinary team engaged in the

rehabilitation/RTW process of individuals with for LBD;

Study II:

To explore the content of ergonomic evaluationfor LBD cases within a work rehabilitation context; and

Study III:To evaluate the applicability of ergonomicmethods to the rehabilitation/RTW of LBD.

I


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I n summary

Development of the evaluation framework

Process Content Tools

Study 3Ergonomistsperspective

Study 2Ergonomistsperspective

Study 1Interdisciplinary

perspective

Literature review- What to evaluate?- How to evaluate?


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I I I .Methodology & Results

Study 1Study 2Study 3

St d 1: Methods


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Study 1: Methods

Design: Multiple case-study;Study setting: PREVICAP program;Sample: rigorous case selection to assure heterogeneity(Stake 1994).

The team:- team coordinator;- psychologist;

- kinesiologist;- General practitioner;- Occupational therapist;- ergonomist.

Study 1: Methods (cont )


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Study 1: Methods (cont.)

Design: Multiple case-study;Study setting: PREVICAP program;Sample: rigorous case selection to assure heterogeneity(Stake 1994);Analysis: verbatim of relevant cases was analyzedusing a qualitative content analysis.

Quality assurance process for validating the content

of issues discussed in the team:

STEP 2. Individual-expert consultation.

STEP 1. Expertpanel/TRIAGE method

(Gervis 1996)



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Cases selected for content analysis:- Total: 10 workers (all employed);- Job tittles: bricklayer; railroad maintenance

worker, lumber lift operator, crane driver,office clerk, clerk-manager, saleswoman, welder,bus driver and day labor-mason;

- Ages: 31 to 58 yrs old;- Gender: 8 males and 2 females;


Results: Study 1


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Results: Study 1

A classification scheme of the interdisciplinaryfactors in the person-environment interfacebased on real-life situations. Interdisciplinary

perspective

Work factorsCONTENT

Study 2: Methods
http://classification%20scheme.jpg/


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Study 2: MethodsQualitative method: exploratory and descriptive;12 ergonomists working in rehab facilities in Montrealwhich include a team approach were recruited;5 agreed to participate;

DESS = post-graduate professional degree



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Analysis approach was a two-step content analysis

2. Deductive thematicanalysis

(Landry 2003)

1. Expert consensusNGT method

(Gill & Delbecq 1982)

Data gathering & analysis

consensus on w ork factors converged intothe elements

of the Work Compatibility Model (WCM)



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Work Compatibility (WC) as an integrator of work energizers(WE) and work demands (WD).

(Abdallah et al 2004)


Results: Study 2


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Results: Study 2

- Business type- Companys size- Corporate culture- Job content- Level of job rotation- Production demands- Etc.

- Workplace receptivity- Relationship with peers- Employer acceptanceof ergo intervention- Etc.

Work Compatibility Model

(Genaidy et al 2002, 2005, 2007, 2008)

Results: Study 2 (cont )
http://wcm%20and%20consensus.jpg/


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No factors

No factors

- Level of physical fatigue- Perceived effort- Perceived mentaldemands- Physical capacity

- Level of task difficulty- Pace of task performance- Work related stress

Hypothesis generated: this data might be obtained by

another professional in the team

Results: Study 2 (cont.)



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Ergonomic evaluation PROCESS- Challenges encountered in practice:1. Source of data on work system =

multi-professional integration2. Source of the request (e.g. legal

implications);

3. Status: when away from work it isnecessary a flexible methodologyand use of various sources of data.

Ergonomists consensus

PROCESS

CONTENT

Study 3: Methods


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Study 3: Methods

Literature review and expert consultation ;Experts: ergonomists from Quebec working as acollaborative member of a rehabilitation in a team.

Use of a structured questionnaire survey : open andclose-ended questions;Questionnaire content: questions on tools features,

familiarity and usage of tools in the field;

Data analysis:- open-ended questions: thematic content analysis;- closed-ended questions: defined scores for

each feature and content analyzed.



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Content analyzed (Shoaf et al 1998):1. Environment elements2. Physical workload

3. Mental workload4. Social elements5. Organizational elements

6. Individual capacities7. Human-task interactions

y ( )Analysis of utility and content

Utility features analyzed (toppriority):

1. Recommended for rehab/RTW

2. Adapted to various workplace3. Easy data collection & analysis4. Meaningful data5. Reliable6. Valid

Results : Study 3


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St e p 3 : analysis of utility and content

yLiterature review

Not used by at least3 participants (10)

67 methods(65 identified via review process and 2 from pilot interviews)

Recommendedfor rehab/RTW (18)

Not recommendedfor rehab/RTW (49)

Used by at least 3participants (8)

Used by at least 3participants (5)

Not used by at least3 participants (34)

Step 1

Step 2



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y ( )

23 ergonomic tools were analyzed in terms ofthe utility features and content .On utility features: the AET, Borg RPE, F-JAS, JCQ, JDQ, OWAS, Snooks tables andWRFQ showed potential applicability forrehabilitation;On domains covered: the AET, F-JAS, JDQand WRFQ are the most comprehensivetools.Responses from ergonomists:

- need flexible tools;- sometimes use their own method instead ofa formal tool;

- etc.

Applicabilityof tools

TOOLS

CONTENT


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I V.Final results

Framework

Ergonomic evaluation framework for LBD


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g

Criteria

Methods

Adapted tovarious

workplace

Easy datacollect. &

analysis

Meaningfuldata

Reliable Valid Totalscore

Dictionary of Occupational Titles (DOT) 2 n/a 0 1 1 4Job Content Questionnaire (JCQ) 2 1 1 2 2 8Job Demands Analysis (JDA) 2 ? ? 0 0 2Job Description Questionnaire (JDQ) 1 2 1 2 1 7Position Analysis Questionnaire (PAQ) 2 0 1 2 2 7

I D E N T I F I C A T I O N O F

P R O B L E M

P H A S E

Work Role Functioning Questionnaire(WRFQ)

2 1 2 2 2 9

AET job analysis method 2 1 1 2 2 8Borg Rated Perceived Exertion (RPE) 2 2 1 2 2 9Fleishman Job Analysis Survey (F-JAS) 2 1 1 2 2 8

B O T H

OVAKO Working posture Analyzing System(OWAS)

2 1 1 2 1 7

Biomechanical model of lifting tasks 0 1 0 0 1 2Lifting Guidelines for people with LBDisorders

0 1 2 0 1 4

Lumbar Motion Monitor (LMM) 1 0 1 1 1 4NIOSH lifting equation 0 2 0 2 2 6Organizational Policies and Practices (OPP) 2 1 2 2 2 8Rodgers Muscle Fatigue Assessment (MFA) 1 1 1 0 1 4Snooks tables 1 1 1 2 2 7

I N - D

E P T H

A N A L Y S I S

P H A S E

3D (2D) Static Strength Prediction Program 1 1 1 0 1 4

Decision-treePlan of action

Decision-matrixUse of formal methods

WorksheetMulti-professional

Integration of data

Steps 1 to 4: I nvestigation phase


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Emphasis on data

exchangeFormalizing theinterdisciplinary

data exchangeprocess

Decision matrix

on tools

Steps 5 to 7: I nterpretation phase


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Emphasis on dataexchange

Engaging keystakeholders inthe process

Steps 8 & 9: I ntervention phase


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Engaging keystakeholders in

the process


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V. Discussion

Remarks of each study

General discussionLimitations of the frameworkConclusionRecommendations for future research

General discussion


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Regarding the proposed framework:

- Provides a basis for formulating a more work-orientedrehabilitation plan , according to an interdisciplinaryapproach;

- Decision-tree format is easy to use, case-sensitive andflexible in selecting formal methods applicable to rehab; and- It integrates an ergonomics perspective in the rehabilitation

process.

Regarding this research:- It clarified terms and definitions regarding work factors from

practice-to-research;- It built blocks of information which can contribute towards the

development of a transdisciplinary vision of the disability

problem.

Main limitations of the framew ork


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Main limitations of the framew ork

Its important that usersbecome familiar with tools

and have the tools in thedecision-matrix;Up until now the format is not

user friendly and too timeconsuming;More research is needed on

ergonomic factors.

and remember that.


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The information obtained by the ergonomist is butone piece of the disability assessment puzzle!

Conclusion


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The framework allows for an improved capacity toassign priorities for ergonomic intervention forLBD;

It also facilitates information-sharing regardingworker-work environment interactions within arehabilitation ergonomics context.

Recommendations for future


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research

It is necessary to validate theframework in practice.

Thank you


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ergonomics in rehabilitation phd katiacosta-black dec 2008

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