Taking Preventative Steps

to Avoid Work Related

Injuries of the Upper

Extremity

Chelsea Lee, OTS

January 23, 2015Chelsea.Lee723@gmail.com

ASOT 2015 Vision and Action Conference

Level II FieldworkKentucky Hand and Physical Therapy (KHPT)Lexington, KY

Lee Memorial Hospital Acute RehabFt. Myers, FL

Work Related Injuries (WRI)

• Work Related Upper Extremity Disorders (WRUED)

• Upper Extremity Work Related Musculoskeletal Disorders (UE-WRMSD)

• Cumulative Trauma Disorders (CTD)

• Repetitive Strain Injuries (RSI)

• Repetitive Trauma Disorders (RTD)

• Repeated Motion Disorders (RMD)

• Overuse Syndrome

Research Question

• For individuals in the workplace, will practicing joint protection techniques using ergonomics, as compared to no intervention, significantly decrease work related upper extremity disorders?

Why should we care?

• WRIs are costing employers an estimated $1 billion per week in the United States

• Occupational therapists can drastically reduce these costs by:• Education on:

• Ergonomics• Behavioral Changes• Joint Protection Techniques

• We ALL overuse and abuse our joints…yes even YOU!

Everyday Activities

Thumb extension and abduction=stress on CMC joint

Prolonged neck flexion=stress on Atlanto-Occipital Joint

Uneven weight distribution=stress on Gleno-Humeral joint

Current Research

• Research Article 1 Darragn, A. R., Harrison, H., & Kenny S. (2008)

• Interventions: Group 1: Control Group

Group 2-Education only Group 3: Education and OT intervention

• Outcomes: Improved body positioning, body mechanics, and workstation design

• Research Article 2 McCormack, S. (2010)

• Interventions: Ergonomics and Behavioral• Outcomes: Client demonstrated improved posture

and improved behavior habits, reported decreased elbow pain with keying and mousing, and increased activity tolerance.

Current Research

• Research Article 3 Buchi, S., Bie, R.A., Ciurea, A., Kubli, R., Niedermann, K., Steurer-Stey, C., & Villiger, P. M. (2010)

• Interventions:Control Group: Conventional JP educationIntervention Group: PRISM-based JP education-consisted of standardized JP education but much more individualized and based on the PRISM tasks, the social learning, and self management. • Outcomes:Individualized, resource-oriented psycho-educational JP education (PRISM-JP) supported the acquisition and maintenance of JP behavior more successfully than C-JP.

Clinical Relevance

• Look at the person as a WHOLE, rather than just an extremity

• Saves clients time and money

• Saves employers time and money

• Educate, educate, EDUCATE• Ergonomics• Behavioral Changes• Joint Protection Techniques

Ergonomics

• Keyboards• Various keyboards available to help reduce

pain from CTDs• Correct Mouse Posture

• Relaxed Grasp• Movement distributed throughout arm

• Locations• Place items used frequently within arms reach• Stand up to retrieve items placed overhead

Behavioral Changes

• Breaks• Every 10-20 minutes stretch!

• Change positions• Every 30-60 minutes-change positions

Set a timer if needed to remember!

6 Principles of Joint Protection

• 1. Respect Pain

• 2. Balance Rest and Activity

• 3. Exercise in a Pain Free Range

• 4. Avoid Positions of Deformity

• 5. Reduce the Effort and Force

• 6. Use Larger/Stronger joints

Joint Protection Principles

Beasley, 2013, p. 459

References• Beasley, J. (2013). Arthritis.In C. Cooper (Ed.), Fundamentals of Hand Therapy: Clinical Reasoning

and Treatment Guidelines for Common Diagnoses of the Upper Extremity. (pp. 459-469). St. Louis, MO: Elsevier

• Buchi, S., Bie, R.A., Ciurea, A., Kubli, R., Niedermann, K., Steurer-Stey, C., & Villiger, P. M. (2010) Effectiveness of individual resource-oriented joint protection education in people with rheumatoid arthritis. A randomized controlled trial. Patient Education and Counseling, 82, (42-48) doi: 10.1016/j.pec.2010.02.014

• Darragn, A. R., Harrison, H., & Kenny S. (2008) Effect of an ergonomics intervention on workstations of microscope workers. American Journal of Occupational Therapy, 69, 61-69.doi: 10.5014/ajot.62.1.61

• Hammond, A., & Freeman, K. (2004). The long-term outcomes from a randomized controlled trial of an educational–behavioural joint protection programme for people with rheumatoid arthritis. Clinical Rehabilitation, 18(5), 520-528. doi:10.1191/0269215504cr766oa

• McCormack, S. (2010). Ergonomic and behavioral interventions as the primary treatment for work-related lateral epicondylitis. Work, 37(1), 81-86. doi:10.3233/WOR20101059

•  Ripat, J., Giesbrecht, E., Quanbury, A., & Kelso, S. (2010). Effectiveness of an ergonomic keyboard for typists with work related upper extremity disorders: A follow-up study. Work, 37(3), 275-283. doi: 10.3233/WOR-2010-1079

• Ripat, J., Scatlif, T., Giesbrecht, E., Quanbury, A., Friesen, M., & Kelso, S. (2006). The effect of alternate style keyboards on severity of symptoms and functional status of individuals with work related upper extremity disorders. Journal of Occupational Rehabilitation, 16, 707-718. doi:10.1007/s10926-006-9054-z.

• Soares, M. M., Jacobs, K., Levanon, Y., Gefen, A., Lerman, Y., Givon, U., & Ratzon, N. Z. (2012). Multi dimensional system for evaluating preventive program for upper extremity disorders among computer operators. Work, 41669-675. doi: 10.3233/WOR-2012-0224-669

Questions?

Chelsea.Lee723@gmail.com