You Can’t Have Good Work Conditioning Without Good Job Descriptions

Recently**, a physical therapist who I’ve known for years reached out to me for some advice. She had two patients that were being sent for “work conditioning” to her. The problem was that job descriptions weren’t provided for either of the two patients. She knew that the “I only have to do this…..I never have to do that” wasn’t the whole story. She also knew that I had been involved in writing job descriptions for those positions for some of our clients. Having performed Functional Capacity Evaluations with us in the past, she also knew that having a solid job description is key in matching up demonstrated performance to essential physical and postural demands.

Work conditioning is defined by the American Physical Therapy Association as “work related, intensive, goal-oriented treatment program specifically designed to restore an individual’s systemic, neuromusculoskeletal and cardiopulmonary functions. The objective is to restore the injured employee’s physical capacity and function for return to work.”

Without understanding what the functional demand is for a specific position, it is difficult to define the goals of a work conditioning program. One of the patients that she had inquired about was a school bus driver. He had told my friend that he “really didn’t have to do much beyond sit in the driver’s seat and drive. Maybe, open the door every so often to let the kids on in the morning or off in the afternoon.” He was returning to work from a lower extremity injury that resulted in a joint replacement. Having performed FCEs for school bus personnel before, she knew that the demands were more but was unsure of the other tasks.

School bus drivers are tasked with performing pre- and post- inspections of their vehicles. This involves checking in and around the vehicle, checking storage compartments (if the bus has one), ensuring that all emergency exits (including the roof exits) are operational, and being able to check under the seats for both children and their belongings. Also, in some districts, bus drivers may be switched to different routes based on employer needs. Switching routes may require drivers to pick up students who may be in wheelchairs. When the wheelchair lift malfunctions, drivers use a manual, hydraulic pump to elevate and lower the lift as needed. This task requires the driver to be able to squat or kneel to a level to operate the manual pump. Drivers, if an aide is not present, may have to secure wheelchairs to floor mounted devices, which requires the ability to kneel while reaching. With demands such as those listed, she needed to work with this patient on being able to step up/down to get into and out of the bus, to be able to kneel to perform tasks, and make sure that the driver demonstrated the ability to perform the overhead tasks of checking the emergency exits. The ability to perform these demands are even more important as a result of the NTSB school bus driver recommendations that I mentioned in a January blog post.

Based on the APTA definition, work conditioning covers a larger swath than when the patient was being treated solely for the injury that brought them to physical therapy. During that initial portion of the treatment, therapy focused on the needs of healing for the specific body part along with improving range of motion and strength as appropriate based on the healing process. Work conditioning helps to pick up to make sure that the other aspects of the injured worker such as their cardiovascular endurance, strength, power, and muscular endurance are not impaired when they are returned back to work. As a result, work conditioning includes activities to improve physical capacity in all of these areas. When an individual begins a work conditioning program, their initial status in these components should be documented – both as a baseline as well as for comparison to the essential postural and physical demands. This will help the therapist communicate to the patient, the case manager, the physician, and the employer as to where the patient is in regard to return to duty.

When quarantine/shelter in place orders begin to be lifted, work conditioning is going to play an important role in returning workers that had been out on workers comp prior to the pandemic to their previous roles. For many of these patients, they may have been shifted over to telerehab as clinics closed for safety issues. Telerehab and “virtual physical therapy” are great for keeping in contact with the worker and moving them along in their rehab journey as best as can be done in these circumstances. However, they may not have access to the resources or guidance to recondition themselves for work prior to returning to their job. Correcting this deconditioning is going to be vital to their success upon return to work as well as for reducing their risks for suffering another injury after return to work.

Yellow school bus. Vector illustration
Yellow school bus. Vector illustration

** – I had started writing this several weeks before all of the “shelter in place” orders started to come down from the different states and it sat in a draft folder for a while. As I revisited the draft after a little over 3 weeks in quarantine, it made me think about the fact that some injured workers currently in PT may be deconditioned if not by now, but definitely by the time the shelter in place orders are lifted. Getting these workers into a work conditioning program at the soonest appropriate time point may be the best chance for a successful return to work process.

Taking A Deeper Dive Into Your Injury Data

Recently, WorkersCompensation.com and Safety+Health Magazine ran two articles that provided interesting injury information that came from taking a deeper dive into reported injury data.

WorkersCompensation.com reported that injury rates in construction workers in Tennessee were higher for those on the job under two years. In both Tennessee and Ohio, injury rates for workers with less than 1 year of experience accounted for 47.5% and 45.6% of the total injuries, respectively. Workers with less than 6 months of experiences accounted for 37.1% and 33.6%, respectively.   The article notes two important thoughts:

  • Fingers and hand injuries were among the top 10 injured body parts – an issue that can be reduced with appropriate PPE
  • Teaming up new, inexperienced workers with mentors to learn to recognize work hazards

Safety+Health took an interesting look at the effects of shift length and inexperience on the risk of injury to those working in the mining industry. They reported on data from a study by researchers at University of Illinois at Chicago that found that miners working shifts longer than 9 hours “were 32% more likely to suffer work-related fatalities and 73% more likely to be part of an incident that caused injuries to multiple miners.” Risk factors for injury for those working more than 9 hours included workers that had less than 2 years experience in the job as well as irregular work schedules. Among the suggestions to reduce the risks were fixed schedules and a recommendation into looking deeper into the effects of longer shifts on “fatigue and nutrition”.

One of the key things that we ask on our FCE intake paperwork is the amount of time that a claimant has been working in their current position. More often than not, many of those who have been sent to us for the functional capacity evaluation have less than 1 year in the position in which they were injured. Length of employment at time of injury is a data point that all employers should be monitoring. When trends appear such as in the two studies noted, employers need to take a look at hiring practices and new hire training practices. They may find that their hiring process should include a post-offer pre-employment test of physical abilities to ensure that new hire candidates meet the essential physical and postural demands of the position.

Looking at injury data (OSHA logs, loss run data, etc.) should be a part of the process of setting up a post-offer pre-employment process in conjunction with performing on-site measurements to create a customized job description of the essential postural and physical demands. The injury data may help to pinpoint job tasks that require a deeper look to determine why employees are getting injured. Is it an ergonomic issue? Is it an issue of strength? Is it an issue of better standard operating procedures?

One of our clients asked for our assistance in reviewing the injury data after initiating a post-offer pre-employment testing process for an ambulance transport service to determine the effectiveness of the program. We looked at data from 3 years prior to initiation of the process as well as 3 years after (we encourage employers to look at this more frequently).   The initial review of the data indicated a minor drop in injuries after initiating the program (an overall drop of 6 injuries after initiating testing).

With only a small reduction in injuries, a deeper dive into the data was required. Several interesting variables were found during this deeper dive:

  • The number of neck, shoulder, and lower back injuries decreased but injuries involving the hands and exposure injuries increased
  • The number of employees decreased by 20% between the two periods
  • The number of transports increased after testing when there were less employees increasing the amount of exposure opportunities to be injured

Taking into account the reduction in the number of employees and the increase in patients transported, there is a 26.8% reduction in injuries.

Taking the deeper dive into the data allows for a greater understanding of the mechanisms that may be driving the injuries that your employees are experiencing. Make the time to look at your OSHA logs to see if there are injury trends, look at the amount of time employed at time of injury to see if there are trends with your new employees, or take a look at your loss runs to see if certain departments have either a greater number of injuries or a greater amount of lost time compared to other departments. All of these become a starting point in reducing future injuries.minied

 

 

 

Friday Five – 4/13/18

The Friday Five is a set of five links that I have come across this week that pertain to ergonomics, occupational health, safety, human performance, or human factors.  For whatever reason, I found them interesting, but they are provided with minimal or no commentary and are not meant to be endorsement for a given product or research paper.

The topic this week is going to be a little bit different – ergonomics and space.  I noticed that Mike Massimino had posted on Twitter yesterday (@AstroMike) that it was #InternationalDayOfHumanSpaceFlight.  When I read his biography, one of the things that struck me from an ergonomics standpoint was the section about the attempts to automate the final Hubble repairs but in the end, it needed to be performed by human astronauts – and they needed to modify/create tools to get it done.  So, in honor of @AstroMike and all of the other astronauts who have done work in space, here is the Friday Five.

Due to the fact that we perform Post-Offer Physical Abilities testing at Biokinetics, this first study is interesting to me.  Taylor et al. looked at 8 NASA astronauts to look at performance on a series of tasks to determine whether task performance can be predicted when in a weighted suit.

Hackney et al.  look at the astronaut as an athlete (it’s an apt comparison, similar to the industrial athlete that we talk about within the occupational/industrial health realm) and what can be done to counter the decline of musculoskeletal strength and endurance during space flight to ensure that crew safety and mission success are not negatively impacted by astronaut performance.

Walters and Webb used a NASA Task Load Index to look at factors such as physical demands and effort for personnel involved in robotic surgery.  The goals were to determine appropriate staffing levels based on workload to maintain efficiency, team satisfaction, and patient satisfaction.

Strauss et al. reviewed data from extravehicular mobility training to look at the injuries and complaints that occurred during training at the Neutral Buoyancy Laboratory when astronauts were training in space suits to perform tasks and use the data to determine the best multidisciplinary approach to resolve these issues.

Petersen et al.  investigated a new testing battery to look at fitness of astronaut candidates for the European Space Agency.

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This is a shot of the Space Shuttle Discovery at the Steven F. Udvar-Hazy Center of the National Air and Space Museum that I took on March 30, 2018.  Back in 2001, I was lucky enough to get to spend a short period of time in one of the mock-up shuttles at Johnson Space Center that was used for training the astronauts.  It still amazes me that the astronauts could spend the time in orbit and perform science missions in the crew space which wasn’t very large.  We were also able to watch some of the training that was going on in the NBL from one of the control rooms.  I’d like to think that the training we witnessed was part of the data set for the paper by Strauss.

 

 

Friday Five – 4/6/18

It’s been a while, but I am going to get this started back up with a new edition of the Friday Five.

The Friday Five is a set of five links that I have come across this week that pertain to ergonomics, occupational health, safety, human performance, or human factors.  For whatever reason, I found them interesting, but they are provided with minimal or no commentary and are not meant to be endorsement for a given product or research paper.

Kesler et al.  looked at the impact of the size of SCBA units (the self-contained air packs that firefighters wear) as well as fatigue (based on different bouts of work-recovery) on the gait of firefighters.  As can be imagined, there are changes based on both parameters. A second study with similar parameters by Kesler looked at the impact on balance.  A third study by Kesler’s team looked at physiological stress and work output – as can be imagined, the baseline fitness of the individual firefighters has an impact on these values.

Putting ergonomics programs into place within companies has always been a tricky intervention.  Visser et al. compare participatory ergonomics programs of a face-to-face nature and e-guidance programs to see how well they work.  There are some interesting findings.

Michel et al. looked at the collaboration in the return to work process in French occupational centers in dealing with patients who had chronic low back pain.  There are some interesting aspects to the communication between the different participants in the rehab process.

Hegewald et al. take a look at the data on technical devices to reduce musculoskeletal injuries during patient handling.  The overall finding is very interesting.

As we have had the discussion with some surgeons who are located in our building, the review by Stucky et al. on complaints of surgeons of work related pain and musculoskeletal complaints and surgical ergonomics is very interesting.  Of note, operating exacerbated complaints in 61% of the surgeons but only 29% sought medical treatment.

 

 

Friday Five – 3/10/17

The Friday Five is a set of five links that I have come across this week that pertain to ergonomics, occupational health, safety, human performance, or human factors.  For whatever reason, I found them interesting, but they are provided with minimal or no commentary and are not meant to be endorsement for a given product.

The news media this morning had several stories noting that beginning in July medical residents may work consecutively from 16 hours to 24 hours.  Interestingly, there were many medical residents that were in favor of this change.   Taking this change to resident’s shifts and the upcoming changing of the clocks for Daylight Saving Time, this Friday Five is focused on shift work.

Some residents looked forward to the increased hours as a way of reducing mid-case handoff of ER cases due to hitting the 16 hour mark.  A research letter by Charlie Wray, DO et al. in JAMA looked at handoff policies for residents at hospitals as implemenation of these practices, despite guidelines, is left to each hospital to implement.

A study published last year investigated the effect of hours per week worked by an admitting resident on patient outcomes.  It found that individuals admitted by residents working 80+ hours per week had longer hospital stays and more ICU transfers than those admitted by residents working less than 80 hours per week.  However, there did not appear to be a relationship between hours worked and 30 day readmission rates or in-hospital mortality rates.

Fernando and Roswell looked at the work performed during nursing shifts and noted that the types of work and volume of work performed varied through a 24 hour work cycle.  They note that the scheduling of shifts needs to take type of work and work volume into account.

Two older studies looked at the incidence of work related injuries following onset of Daylight Saving Time.  A study of American mine workers found an increase in injuries on the Monday following the start of DST and a decrease in total sleep for that night by 40 minutes.  A Canadian study found no statistical relationship between injuries and the onset of DST.

Interestingly,  researchers found that the rate of ischemic strokes increases during the first two days after the onset of daylight saving time.