Work Assessments: A How-To

That Could Save Your Patient’s

Life (Job)

Julie J. Keysor, PhD, PT

Catherine L. Backman, PhD, OT(C) FCAOT

Nancy Baker, ScD, OTR/L

November 10th, 2010 Atlanta, GA

Part 1: The Work Experience Survey for

Persons with Rheumatic Conditions

Part 2: The Ergonomic Assessment Tool for

Arthritis

Part 3: Computer Ergonomics Assessment

Disclosure

• None

Why Care About Work?

Arthritis is the 3rd leading cause of work limitation in the US1

5% of all US employment aged adults have arthritis-attributed work limitations2

Of people with arthritis who are working, 30% report work limitations3

1Stoddard S, et al. 1998; 2MMWR 2005;54(5):119–123; 3Theis, K et al. 2007

What Can Be Done?

Medication advancements continue…

Provide people with knowledge and skills to optimize work outcomes Job accommodations

Adaptive technology

Strategies to balance physical, emotional, and social activities of work and personal life

Job Accommodation:

Target Work Barriers

What is a work barrier?

Anything that poses a

problem for employment

work that is created by or

related to health

Why Target Work Barriers?

Prevent a person from doing his/ her job

More likely scenario is person can do all or most job tasks but has difficulty doing them

Reduces job satisfaction (Roessler et al., 1995; Allaire et

al, 2000)

Reduced job satisfaction leads to work cessation

Approach:

Address Work Barriers

1) Identify work barriers

2) Prioritize work barriers

3) Develop solutions to work barriers

4) Educate and foster advocacy

= Enhanced ability to secure job

accommodations

Evidence Supporting Approach

Brief job retention intervention (3 hours) delivered by vocational rehabilitation

professionals minimized work loss and increased confidence in ability to manage

health-work problems.

Allaire et al. 2003; Allaire et al. 2005

Work Experience Survey

(WES)

Structured interview tool designed to help

people with disabilities plan accommodations

Administered face-to-face or via telephone

interview by a rehabilitation professional

Assesses health and work history Job functions, work place access

Barriers

Provides a process to generate solutions

Roessler RT, et al., 1995

WES

Liked the WES process

Good for guiding a structured interview

Good for generating solutions

Liked the “check-list” approach

WES: Challenges

#1 WES did not address all aspects of work

for persons with arthritis or rheumatic

conditions.

#2 How can the approach/intervention reach

the target population?

Development of the WES-

Persons with Rheumatic

Conditions

Goal: Modify WES to optimize fit for arthritis

Focus groups people with arthritis (N=32)

Participants primarily women

Range of arthritis conditions

Both blue/pink collar jobs and professional/

managerial jobs

Allaire S., Keysor JJ. Arthritis Rheum. 2009 Jul 15;61(7):988-95.

Results of Qualitative Study

Four new categories of barriers

Symptoms and health issues (pain, fatigue)

Energy job demands

Emotional job demands

Demands that occurred outside of the workplace, but which indirectly affected work

Revisions suggested for physical, social, and company policy job barriers

What’s Inside the WES-RC?

Demographics, health and work history

Health symptoms list

Pain

Fatigue

Sudden changes in symptoms and ability to

do things

Poor sleep/irritability

Depression/anxiety

Medication side effects

Getting Ready for Work and

Traveling To/From or for Work

Extra time needed for

dressing, preparing

breakfast

Getting children other

family members ready

Using public

transportation

Driving

Stress of getting to

work on time

Examples of items in WES-RC

Workplace Access

Parking

Walking

Stairs

Opening doors (weight and door knobs)

Using workplace facilities (bathrooms)

Examples of items in WES-RC

Physical Job Demands

Standing too long

Prolonged sitting

Getting up and down from

sitting

Lifting, pulling, pushing or

moving materials

Carrying things

Bending, kneeling,

squatting

Use computer

Being able to move

quickly

Examples of items in WES-RC

Mental Job Demands

Staying alert

Remembering

Thinking quickly

Focusing or concentrating on work activities

Planning or organizing

Examples of items in WES-RC

Time, Energy, and Emotional

Job Demands

Working regular hours

Working extra hours

Starting on work activities soon after you get to work

Work pace or scheduling issues

Meeting time or production quotas

Examples of items in WES-RC

Working Conditions and

Company Rules

Lighting

Temperature

Time constraints

Sick time

Schedule flexibility

Examples of items in WES-RC

WES-RC: Problem Prioritization and Solution Development

Review the problems identified in sections 1-7 and list the 3 most bothersome problems/barriers to employment. Then describe possible solutions to the 3 problems and resources or people who can help. Be specific. Problem/barrier #1: ____________________________ Possible solutions: ____________________________

Same for problem/barriers 2 & 3

WES: Challenges

#1 WES did not address all aspects of work

for persons with arthritis or rheumatic

conditions.

#2 How can the approach/intervention reach

the target population?

Vocational rehabilitation counselors delivered

the intervention in Allaire et al.’s trial

Difficult to diffuse approach in vocational

rehabilitation clinical practice

Typical intervention person with severe

disabilities who is not working

Look to other rehabilitation professionals with

related backgrounds

Who and How?

Can Physical and Occupational

Therapists Administer the WES-

RC Successfully?

Explored the feasibility of WES-RC use by

physical therapists (PTs) and occupational

therapists (OTs)

Therapists’ perceptions regarding use of the

instrument for their patients.

Allaire S, Baker N, Keysor J. ARHP Annual Meeting, Philadelphia, PA 2009

Conducted focus groups with 10 PTs/OTs

from 2 large urban outpatient clinics

Therapists administered WES-RC to patients

Evaluated feasibility and use

Physical and Occupational

Therapists?

Allaire et al., ARHP 2009

Results: How did the WES-RC

go?

WES-RC viewed positively, comprehensive

Therapists viewed addressing work issues

as part of practice area

Anticipated administration length 60-90

minutes (took approximately 45 minutes)

Positive 16 of 20 (80%) administrations

Problem assessment easy to do (20/20)

Results: How did the WES-RC

go?

Negative experiences

Forming solutions

Addressing psychosocial aspects of work,

particularly advocacy aspects

WES-RC Solution Manual

Focus groups of physical and occupational

therapists with membership status in

ARHP conducted to identify possible

solutions

Asked for solutions to problems identified

previous study that were difficult to address

Developed “WES-RC Solution Manual”

Does the Solution Manual

Impact Quality of Responses

A randomized controlled trial of 124

physical/occupational therapists

“Paper cases” with patient history, work

history, and pre-identified problems

Therapists provided solutions to problems

Intervention group received Solution

Manual

Results: Barriers for Which the Handbook Added a Lot to Solution Development

Work Barrier

CTRLs giving helpful

solutions

EXPMs giving helpful

solutions

p Value for 0-4 scale

Cognitive activity:

Concentrating on work activities

45%

85%

<.0001

Vocational direction

Need to change job or career

35%

75%

<.0001

Commuting:

Walking etc. in using public transportation

44%

67%

.0006

Barriers for Which the Handbook Added Somewhat to Solution Development

Work Barrier

CTRLs giving helpful

solutions

EXPMs giving helpful

solutions

p Value for 0-4 scale

Work relationship:

Feeling need to hide condition due to self-

consciousness

32%

44%

0.06

Home life:

Attending children’s events due to fatigue

22%

41%

0.01

Summary

WES-RC Structured interview to guide the

discussion of arthritis related work

challenges

Identify and prioritize problems

Develop solutions

Pen & paper tool

PTs and OTs liked using the WES-RC

PTs and OTs difficulty with solution

generation

Summary

Solution generation manual for WES-RC

developed and currently being tested

Randomized controlled trial to determine if a

modified work accommodation intervention

delivered by PTs/OTs can impact work

disability (under way)

Acknowledgements

Funding provided by ACR REF

Health Professional Investigator Award

Thank You

WES-RC is Available for Use:

http://www.bumc.bu.edu/medicine/faculty/allaire/