Work-related injury or work-related pain? A qualitative investigation of work-related pain and injury management among rehabilitation professionals1.

BACKGROUND: Patient mobility tasks place rehabilitation professionals (Physical and Occupational Therapists) working in hospitals at high risk for work-related musculoskeletal disorders (WMSDs). However, when investigating engagement with a Safe Patient Handling and Mobility program (SPHM), administrative records at a level one trauma hospital showed that rehabilitation professionals reported zero work-related injuries over an eight-year period. OBJECTIVE: As part of a qualitative study conducted to discover their unique work experiences, we explored some of the reasons that rehabilitation professionals might not report work-related injuries to their employers. METHODS: Using a collective case study design, six focus groups were conducted with 25 members of the rehabilitation team within a level-one trauma hospital. Focus groups were recorded; transcripts were analyzed for emergent themes using first and second cycle coding procedures. RESULTS: Participants in this study denied experiencing work-related injuries but frequently described working in pain, often attributed to patient mobility tasks. These experiences were not reported to employers. Self-management of their pain through co-worker treatment, over-the-counter medications, or informal alteration in job tasks were reported as common. CONCLUSION: Administrative injury records may underrepresent injuries among rehabilitation professionals. This may be due to their perception of work-related pain as something different than work-related injuries, or that many of these rehabilitation professionals treat their own work-related pain and symptoms rather than report them. To get a more accurate assessment of injury frequency among rehabilitation professionals, researchers should gather information directly from the participants, and should inquire about work-related pain in addition to injury.

Hand characteristics and functional abilities in predicting return to work in adult workers with traumatic hand injury.

BACKGROUND: Hand injuries affect a person's functioning, thus impeding their abilities to return to work. There is a limited understanding in return to work of the overall predictors when including hand characteristics and functional abilities. Therefore, it is essential to identify the most relevant predictors in return to work among individuals with a hand injury. OBJECTIVES: (1) To compare hand function characteristics and functional abilities of injured workers who have or have not returned to work. (2) To estimate hand function characteristics and functional abilities as predictors to return to work. METHODS: One hundred and fifteen adult workers with hand injuries aged 18- 59 years old from five general hospitals in Malaysia participated in a cross-sectional study. Predictors were estimated using logistic regression. RESULTS: There was a significant association between occupational sector (p = 0.012), injury duration (p = 0.024), occupational performance (p = 0.009) and satisfaction with performance (p < 0.001), grip strength of injured hand (p = 0.045- 0.002) and the Disability of Arm, Shoulder and Hand (DASH) disability/symptom (p = 0.001) with the person's return to work status. Significant predictors of return to work were identified using the Canadian Occupational Performance Measure (COPM) satisfaction's score, DASH disability/symptoms' score and duration of the injury. CONCLUSION: As two main predictors of return to work were COPM satisfaction and DASH disability/symptoms, occupational therapists working in rehabilitation should focus on achieving functional performance and satisfaction within the optimal time.

The Process of Rehabilitation, Return and Stay at Work of Aging Workers Who Suffered an Occupational Injury: A Portrait Based on the Experience of Canadian Stakeholders.

PURPOSE: This study aims to paint a picture of the factors that influence the process of rehabilitation, return, and stay at work, for aging workers who have suffered an occupational injury. METHODS: Based on a descriptive interpretative research design, the authors conducted interviews with 23 participants (i.e., aging workers, workers' representatives, employers, insurers, and rehabilitation professionals) to gather their perspectives. Qualitative data was analyzed through thematic analysis. RESULTS: Fifteen factors related to the worker, health system, workplace, or compensation system were identified. These factors prevail during rehabilitation, return to work, stay at work, or the entire process. CONCLUSIONS: This study contributes to the advancement of knowledge regarding three main ideas: (1) the importance of not placing the responsibility on the worker in this complex process, (2) the key role of the compensation system, and (3) the necessity of transforming work to reduce ageism.

JOSPT Infographic: Returning to Work After Injury.

This JOSPT Infographic on return to work after injury is based on clinical practice guidelines by Daley et al titled "Clinical Guidance to Optimize Work Participation After Injury or Illness: The Role of Physical Therapists" (J Orthop Sports Phys Ther 2021;51(8):CPG1-CPG102. doi:10.2519/jospt.2021.0303), which reviewed the scientific literature between January 1999 and August 2020. J Orthop Sports Phys Ther 2021:51(10):529. doi:10.2519/jospt.2021.9002.

Who are less likely to return to work after getting injured on duty? A 12-month epidemiological evaluation in an orthopedic and traumatology center in Hong Kong.

OBJECTIVES: Cases of injury on duty (IOD) are common in Hong Kong, but literature on this group of patients is limited. This study aims to describe local IOD cases' epidemiological characteristics and identify factors affecting return to work (RTW) outcomes. METHODS: This is a retrospective epidemiological study of IOD patients in the orthopedic and traumatology center of Yan Chai Hospital in 2016, using the hospital's electronic clinical record analysis and reporting system; 323 out of the 10 730 patients (M:F = 206:117; mean age 46.9 ± 11.3) were included. Data on demographics, the injury episode, administrative procedures, treatment and rehabilitation were collected. Outcomes were measured by "RTW" and "time to RTW from injury." RESULTS: Around 80% of patients had a successful RTW and the mean time to RTW was 10.6 ± 9.0 months. Patients who were female, divorced or widowed and living alone in a public rental flat were less likely to RTW. Psychiatric consultations (OR 13.70, P < .001), legal disputes (OR 8.20, P < .001) and more than 5 months of waiting time for physiotherapy (OR 3.89, P = .002) were the strongest among the numerous risk factors for non-RTW. An increase in one visit to the general outpatient clinic and the presence of legal disputes had lengthened the time to RTW by 4.8 days (P < .001) and 18.0 months (P < .001), respectively. CONCLUSIONS: Several demographic, psychosocial and administrative factors were negatively associated with RTW in the local population. Recommendations were made for healthcare providers and policymakers accordingly.

Is Self-reported Return to Duty an Adequate Indicator of Return to Sport and/or Return to Function in Military Patients?

BACKGROUND: In the military, return-to-duty status has commonly been used as a functional outcome measure after orthopaedic surgery. This is sometimes regarded similarly to return to sports or as an indicator of return to full function. However, there is variability in how return-to-duty data are reported in clinical research studies, and it is unclear whether return-to-duty status alone can be used as a surrogate for return to sport or whether it is a useful marker for return to full function. QUESTIONS/PURPOSES: (1) What proportion of military patients who reported return to duty also returned to athletic participation as defined by self-reported level of physical activity? (2) What proportion of military patients who reported return to duty reported other indicators of decreased function (such as nondeployability, change in work type or level, or medical evaluation board)? METHODS: Preoperative and postoperative self-reported physical profile status (mandated physical limitation), physical activity status, work status, deployment status, military occupation specialty changes, and medical evaluation board status were retrospectively reviewed for all active-duty soldiers who underwent orthopaedic surgery at Madigan Army Medical Center, Joint Base Lewis-McChord from February 2017 to October 2018. Survey data were collected on patients preoperatively and 6, 12, and 24 months postoperatively in all subspecialty and general orthopaedic clinics. Patients were considered potentially eligible if they were on active-duty status at the time of their surgery and consented to the survey (1319 patients). A total of 89% (1175) were excluded since they did not have survey data at the 1 year mark. Of the remaining 144 patients, 9% (13) were excluded due to the same patient having undergone multiple procedures, and 2% (3) were excluded for incomplete data. This left 10% (128) of the original group available for analysis. Ninety-eight patients reported not having a physical profile at their latest postoperative visit; however, 14 of these patients also stated they were retired from the military, leaving 84 patients in the return-to-duty group. Self-reported "full-time duty with no restrictions" was originally used as the indicator for return to duty; however, the authors felt this to be too vague and instead used soldiers' self-reported profile status as a more specific indicator of return to duty. Mean length of follow-up was 13 ± 3 months. Eighty-three percent (70 of 84) of patients were men. Mean age at the preoperative visit was 35 ± 8 years. The most common surgery types were sports shoulder (n = 22) and sports knee (n = 14). The subgroups were too small to analyze by orthopaedic procedure. Based on active-duty status and requirements of the military profession, all patients were considered physically active before their injury or surgery. Return to sport was determined by asking patients how their level of physical activity compared with their level before their injury (higher, same, or lower). We identified the number of other indicators that may suggest decreased function by investigating change in work type/level, self-reported nondeployability, or medical evaluation board. This was performed with a simple survey. RESULTS: Of the 84 patients reporting return to duty at the final follow-up, 67% (56) reported an overall lower level of physical activity. Twenty-seven percent (23) reported not returning to the same work level, 32% (27) reported being nondeployable, 23% (19) reported undergoing a medical evaluation board (evaluation for medical separation from the military), and 11% (9) reported a change in military occupation specialty (change of job description). CONCLUSION: Return to duty is commonly reported in military orthopaedics to describe postoperative functional outcome. Although self-reported return to duty may have value for military study populations, based on the findings of this investigation, surgeons should not consider return to duty a marker of return to sport or return to full function. However, further investigation is required to see to what degree this general conclusion applies to the various orthopaedic subspecialties and to ascertain how self-reported return to duty compares with specific outcome measures used for particular procedures and subspecialties. LEVEL OF EVIDENCE: Level IV, therapeutic study.

Does gradually returning to work improve time to sustainable work after a work-acquired musculoskeletal disorder in British Columbia, Canada? A matched cohort effectiveness study.

OBJECTIVE: This study investigates if gradual return to work (GRTW) is associated with full sustainable return to work (RTW) for seriously injured workers with a musculoskeletal disorder (MSD), in British Columbia, Canada. METHODS: This is an effectiveness study using a retrospective cohort study design. Accepted workers' compensation lost-time claims were extracted for workers with an MSD who were on full work disability for at least 30 days, between 2010 and 2015 (n=37 356). Coarsened exact matching yielded a final matched cohort of 12 494 workers who experienced GRTW at any point 30 days post-injury and 12 494 workers without any GRTW. The association between GRTW and sustainable RTW through to end of 12 months was estimated with multivariable quantile regression. RESULTS: Workers who were provided with GRTW experienced more time-loss days until sustainable RTW between the 2nd and 5th months after the first time-loss day (<50th quantile of time loss), but less time-loss days until sustainable RTW between the 6th and 12th months of work disability (70th quantile of time loss), with the largest effect for women, workers with soft-tissue injuries and workers in the manufacturing or trades sector (all in the 60th and 70th percentile, after 6-7 months of time loss). CONCLUSIONS: For seriously injured workers with at least 30 days of disability due to a work-acquired MSD, the effect of GRTW becomes apparent at longer disability durations (more than 6 months), with larger beneficial effects for women, workers with soft-tissue injuries and for trade and manufacturing sectors.

An Evaluation of the Structural Validity of the Work Limitation Questionnaire Using the Rasch Model.

OBJECTIVE: To investigate the targeting, scaling, and structural validity of the Work Limitation Questionnaire (WLQ) using Rasch analysis. DESIGN: Secondary data analysis. SETTING: Tertiary care hospital. PARTICIPANTS: The data were sourced from an upper limb specialty clinic of injured workers using the convenience sampling method and from a national randomized controlled trial investigating 2 surgical options for rotator cuff repair by formal, randomized selection (N=315). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Work Limitation Questionnaire 25-item version (WLQ-25). The WLQ contains 25 items measuring a client's ability to perform specific job demands on a 5-point ordinal response scale ranging from 0 (difficulty none of the time) to 4 (difficulty all the time). The average of all 25 items is used as the total score, ranging from 0 to 4, where higher index scores indicate greater difficulty performing daily work. Subscales were used to assess time management, physical demands (PD), mental-interpersonal demands, and output demands. RESULTS: The Rasch analyses performed on the dataset included the test of fit of residuals, ordering of item thresholds, Person separation index, differential item functioning (DIF), dependency, and unidimensionality. The partial credit model was selected for the current Rasch analysis because the likelihood ratio test was significant at both the overall questionnaire and the subscale level (P<.001). The WLQ-25 did not fit with the Rasch model (χ2=1715.58; df=125; P<.001) and most of the thresholds were disordered. A series of steps were undertaken to improve the fit statistic, including item reduction (6 items) and response merging (9 items). DIF was absent in the revised scale based on sex, age, full- or part-time employment, and type of employment. Only 3 revised subscales, namely the PD, mental demands, and interpersonal demands subscales, demonstrated acceptable fit to the Rasch model. CONCLUSIONS: The WLQ-25 demonstrated substantial misfit from the Rasch model, which could not be fully mediated. The revised PD, mental demands, and interpersonal demands subscales could be used to assess these constructs.

Occupational specifics of elite female handball players in relation to injury recovery, social support and environmental factors.

OBJECTIVES: The aim of the study was to analyze the injury characteristics, satisfaction with social support and environmental factors in elite female handball players in the injury recovery process. MATERIAL AND METHODS: The retrospective study combined quantitative (questionnaire) and qualitative (interview) methods, and presented 3 distinct perspectives, i.e., those of active players, former players and coaching staff members (SMs). The research sample in the first part consisted of 51 active professional female handball players (aged 26.3±2.6 years) with an injury history. The answers from an online questionnaire were processed according to basic statistical parameters (SPSS). The second part of the study included 9 semi-structured interviews, 6 with former players and 3 with coaching SMs. RESULTS: All the 51 active players reported 140 injuries (on average 2.7 injuries/player) in the last 6 years. The recovery time ranged 1 day-10 months. No statistically significant differences were observed between the career length and anterior cruciate ligament tear (χ2-3.18, p = 0.53), and the career length and posterior cruciate ligament tear (χ2-1.87; p = 0.76). The former players' perceptions of social support and environmental factors are similar to the opinions expressed by the coaching SMs, while the active players held high expectations. The highest level of satisfaction with social support was reported for family members (M±SD 4.35±0.814) and the physiotherapist (M±SD 4.12±3.28), whereas the players were not very satisfied with the social support offered by the head coach (M±SD 2.73±0.75). Coaching SMs considered providing social support as something that exceeded their competences. CONCLUSIONS: The analysis of the injury recovery process indicated a need for a new function in handball clubs - an expert with interdisciplinary competencies, who would contribute to faster recovery and general wellbeing of professional handball players. Int J Occup Med Environ Health. 2021;34(1):101-10.

Results of a special interdisciplinary hand therapy program for work-related injuries.

The importance of postoperative care of hand injuries is undisputed, but sometimes more intensive therapy is needed. The objective of this study was to evaluate the benefits of a specialized hand rehabilitation program supervised by hand surgeons. The outcomes and short-term follow-up of 76 patients with upper extremity injuries were analyzed through patient self-reported parameters as well as objective functional scores. Improvement in all self-assessed parameters during rehabilitation was statistically significant for the DASH (p<0.001) as well as the EQ-5D (p<0.05). Further improvement in the short-term (14 weeks) was only seen for the DASH score (p<0.05). During rehabilitation, there was a statistically significant improvement in all objective measurements. Among patients with finger injuries, 71% were able to return to work. Our specialized hand rehabilitation program provides benefits for all patients. There are differences between types of upper extremity injuries in terms of the effects and necessary treatments.

Factors associated with unsuccessful return-to-work following work-related upper extremity injury.

BACKGROUND: Returning to work following occupational injury is a key outcome for both workers' compensation boards and injured workers. Predictive factors for returning remain unclear. AIMS: To describe factors associated with unsuccessful return-to-work (RTW) in a hand injury population to identify target areas through which occupational rehabilitation programmes can help injured workers achieve successful RTW outcomes. METHODS: Demographic data, functional, pain and psychosocial scores were recorded for injured workers discharged between April 2011 and September 2015 from a multidisciplinary upper extremity treatment programme. The primary outcome of RTW status was assessed at programme discharge. Bivariate analyses and multivariable logistic regression were used to identify factors associated with being unable to RTW. RESULTS: Of 872 participants who met the inclusion criteria, 65% were male and the mean age was 46 (standard deviation [SD] 11) years. In unadjusted bivariate analyses, the group with an unsuccessful RTW outcome had higher mean baseline pain, catastrophizing and QuickDASH scores; a higher baseline prevalence of depression, and reported a high level of pain more frequently than those who were working at discharge. In the adjusted logistic regression model, not working at baseline, higher QuickDASH score and presence of depression at baseline were independently associated with unsuccessful work status outcome. CONCLUSIONS: Negative baseline work status, greater self-reported functional disability and presence of depression were associated with greater odds of unsuccessful RTW following a workplace upper extremity injury. Integrating mental healthcare provision with occupational rehabilitation is a potential programmatic approach to improve RTW.

Transcultural validation of the return-to-work self-efficacy scale in Korean patients with work-related injuries.

BACKGROUND: This study aimed to develop a Korean version of the Return-to-Work Self-Efficacy (RTWSE)-19 Scale using forward- and backward-translation and investigate the validity of the RTWSE Scale specifically for Korean workers with work-related injuries. METHODS: Participants were 202 injured workers who had filed a claim accepted by the workers' compensation system and had received medical rehabilitation at workers' compensation hospitals following a work-related musculoskeletal injury. Among these participants, 88.1% were male, 54.5% were over 45 years, 45.5% were manufacturing employees, and 54.5% were craft or machine operator and assemblers. The 19 item RTWSE-19 scale was developed by Shaw et al. and have three underlying subscales: (i) meeting job demands, (ii) modifying job tasks, and (iii) communicating needs to others. Statistical analysis included exploratory factor analysis (maximum likelihood estimation with oblique quartimin rotation), internal consistency reliability using Cronbach's alpha, and correlations with related measures: pain intensity; fear-avoidance beliefs; general health; depression; and general self-efficacy. RESULTS: Using exploratory factor analysis, three factors with 17 items were identified: meeting job demands, modifying job tasks, and communicating needs to others. The removal of two items in the modifying job tasks domain resulted in an increased reliability. The Korean version of the RTWSE-17 showed reasonable model fit (CFI = .963; TLI = .943; RMSEA = .068; SRMR = 0.029), satisfactory reliability (r = 0.925), no floor and ceiling effect, and construct validity. CONCLUSIONS: The Korean RTWSE-17 scale was found to possess good psychometric properties and could address different injury types ranging from fractures to amputations involved in sub-acute and rehabilitation phases in the Korean context. This study's findings provide insights for practitioners and researchers to return to work after rehabilitation in a Korean clinical and workplace setting.

Development and Pilot Assessment of the PACE Tool: Helping Case Managers Identify and Respond to Risk Factors in Workers' Compensation Case Management.

Purpose The aim was to develop a tool to be applied by workers' compensation case managers to guide intervention and avoid delayed return to work. Methods The Plan of Action for a CasE (PACE) tool was developed based on a review of existing literature, focus groups with case managers and analysis of existing claims data. Combined with analysis of existing case manager practice, these sources were used to determine key constructs for inclusion in the tool to be aligned with the demands of case manager workload. Mapping of existing interventions was used to match risk identified by the tool with appropriate intervention. Results The final PACE tool consisted of 41 questions divided into Ready (worker), Set (employer) and Go (treating practitioner) categories. Questions in the tool were linked to appropriate case manager actions. Data collection was completed by case managers for 524 claims within the first 2 weeks of the claim being accepted. The most commonly identified risks for delayed RTW included both worker and employer expectations of RTW, as well as certification of capacity. Factor analysis identified two factors operating across the tool categories. Case managers reported benefits in using the tool, but reported it also increased their workload. Conclusions The PACE tool is a unique example of the implementation of risk identification in case management practice. It demonstrates that case managers are ideally placed to collect information to identify risk of delayed RTW. Future work will establish the impact of case-manager led intervention based on identified risks on outcomes for injured workers.

Return to Work and Ripple Effects on Family of Precariously Employed Injured Workers.

Purpose Work injury and return to work processes can have adverse effects on injured workers and their families. Family members may experience increased workloads, role reversals, dissolution of marriages or changes in relationships with children, as well as financial strain from loss of income. How these associations interact when the injured worker is precariously employed, however, is unknown. The aim of this study was to explore the impacts of work-related injury or illness as well as subsequent compensation and return to work processes on families and relationships of precariously employed workers. Methods Interviews were conducted with fifteen precariously employed injured workers recruited through on-line advertising, injured worker groups, and social media platforms in Ontario. Situational analysis was used to identify how family members were affected and their role throughout the injury process. Results Precariously employed injured workers felt caught between self-interested employers and disinterested workers' compensation. In some cases, this led to deteriorated mental health and well-being. The worker's difficulties with RTW challenged financial security of families and affected their day-to-day normal routines. While some workers received emotional and instrumental support from their family members, others had their families fall apart when chronic disability and unemployment proved to be too much. Conclusions This study addressed the complex ways that work injury and illness among precariously employed workers interact with family life and relationships. Findings illustrate how the income and employment insecurity associated with precarious employment has ripple effects on workers and their families when they become injured.

Impact of Work-Related Burn Injury on Social Reintegration Outcomes: A Life Impact Burn Recovery Evaluation (LIBRE) Study.

OBJECTIVE: To examine differences in long-term social reintegration outcomes for burn survivors with and without work-related injuries. DESIGN: Cross-sectional survey. SETTING: Community-dwelling burn survivors. PARTICIPANTS: Burn survivors (N=601) aged ≥18 years with injuries to ≥5% total body surface area or burns to critical areas (hands, feet, face, or genitals). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The Life Impact Burn Recovery Evaluation Profile was used to examine the following previously validated 6 scale scores of social participation: Family and Friends, Social Interactions, Social Activities, Work and Employment, Romantic Relationships, and Sexual Relationships. RESULTS: Older participants, those who were married, and men were more likely to be burned at work (P<.01). Burn survivors who were injured at work scored significantly lower on the Work and Employment scale score after adjusting for demographic and clinical characteristics (P=.01). All other domain scale scores demonstrated no significant differences between groups. Individuals with work-related injuries scored significantly worse on 6 of the 19 items within the Work and Employment scale (P<.05). These individuals were more likely to report that they were afraid to go to work and felt limited in their ability to perform at work. CONCLUSIONS: Burn survivors with work-related injuries report worse work reintegration outcomes than those without work-related injuries. Identification of those at higher risk for work reintegration challenges after burn injury may enable survivors, providers, employers, and insurers to better use appropriate resources to promote and target optimal employment outcomes.

Improvements in Match-Related Physical Performance of Professional Soccer Players After the Application of an on-Field Training Program for Hamstring Injury Rehabilitation.

CONTEXT: Although there are multiple, validated return-to-play programs following hamstring strain injuries, no studies have evaluated their changes in match performance parameters. OBJECTIVES: The aim of this study was twofold as follows: (1) to determine the changes in match-based physical performance parameters in professional soccer players before and after sustaining a hamstring strain injury and undergoing a soccer-specific rehabilitation program and (2) to observe the progress of these performance parameters 6 to 10 weeks after the player returned from injury. DESIGN: Prospective, quasi-experimental longitudinal study. SETTING: Soccer playing and training grounds. PARTICIPANTS: Nineteen players suffering a hamstring strain injury from 2 male professional teams playing in the Spanish professional football league (La Liga) were followed during the 2015-2016, 2016-2017, and 2017-2018 seasons. INTERVENTION: Participation in on-field training program following a hamstring injury. MAIN OUTCOME MEASURES: Match global positioning system data were collected in the following stages: prior to injury (PRE), after return to play (RTP), program, and 6 to 10 weeks following RTP (C2). Peak velocities and distances ran at sprint velocities showed most likely improvements in C2 versus PRE, and very likely improvements in RTP versus PRE. RESULTS: The distances ran at high and very high intensities, the average velocity, and work-to-rest ratio showed very likely improvements in C2 versus RTP and likely improvements in RTP versus PRE. Likely improvements were observed for all variables in C2 versus RTP. The authors' results showed an improvement of physical performance during competitive match after RTP, compared with PRE. There was a steady progression in the progress, and in 8 months following RTP, there was no injury reported in the players. CONCLUSIONS: The current findings may indicate that the hamstring muscle complex not only recovered completely from the injury but could also withstand a greater training and match load reducing the risk of reinjury.

Ergonomic Principles as an Adjunct to the Profession of Biokinetics.

Work-related injuries date back to antiquity. Attempts to resolve these work-related challenges have, inter alia, led to the establishment of the professions of Ergonomics, Occupational Therapy, Physiotherapy, Occupational Hygiene, and Biokinetics. The objective of this article is to illustrate the value of Ergonomic principles as an adjunct to the profession of Biokinetics. Insofar as Ergonomics addresses the physical and environmental risks which predispose and precipitate injuries, the profession of Ergonomics is primarily concerned with the practice of eradicating work-related challenges that impede human-machine interfacing, and which adversely influence work productivity and employee health. While Occupational Therapy and Biokinetics, by rehabilitating work-related injuries, assist in improving working conditions, little is known about the exact interface between the professions of Ergonomics and Biokinetics. The Google Scholar database was consulted in order to determine the relationship between Ergonomics and Biokinetics. The key words used were ergonomics and biokinetics and lead to the identification of 545 records, none of which pertained to the aforementioned subject. A subsequent search was conducted using the key words work-related musculoskeletal injuries and biokinetics. This search identified 925 records, the number of which were reduced to 42 (4.76%) after the exclusion of patents (n = 24), citations (n = 3), and nonbiokinetic work-related injury research (n = 856). Given that many work-related injuries are managed through the use of biokinetic rehabilitation, knowledge of the physical ergonomic risk factors at play will afford biokineticists an enhanced understanding of the etiology of work-related injuries, thereby helping to improve the vigor of the rehabilitation.

Outcomes of an interdisciplinary work rehabilitation program.

BACKGROUND: Work rehabilitation programs were developed to help workers with an injury return to work (RTW). While studies have examined intervention characteristics, prognostic factors, and disability level, there is little or no research examining interdisciplinary interventions, lifting capacity/strength and the level of a patient's RTW status (e.g., not working, new job, or ongoing restrictions) at the time of discharge. OBJECTIVE: To evaluate outcomes (RTW status and lifting capacity/strength changes) of an interdisciplinary work rehabilitation program and examine whether time off work prior to the program and type of injury were related to RTW status and strength changes. METHODS: A retrospective database analysis was conducted with a sample of 495 participants (Mage = 44.44 years, SD = 10.13) of which 375 (76%) were male. Participants were workers with injuries who participated in an interdisciplinary work rehabilitation program from 2006 to 2010. RESULTS: A significantly higher number of participants were working at the end of the program than at the beginning (83.9% vs. 31.6%, p < 0.0001). Mean strength was higher at the time of discharge compared to at admission (p < 0.0001). The participants that did not RTW had had significantly more days off work prior to the program (U = 11757, z = -3.152, p = 0.002). The type of injury was not related to strength at the time of discharge. CONCLUSIONS: Findings suggest the interdisciplinary program is associated with positive outcomes and early intervention may be an important factor when treating patients with work-related injuries.

A Robot with an Augmented-Reality Display for Functional Capacity Evaluation and Rehabilitation of Injured Workers.

Occupational rehabilitation is an integral part of the recovery process for workers who have sustained injuries at the workplace. It often requires the injured worker to engage in functional tasks that simulate the workplace environment to help regain their functional capabilities and allow for a return to employment. We present a system comprised of a robotic arm for recreating the physical dynamics of functional tasks and a 3D Augmented Reality (AR) display for immersive visualization of the tasks. While this system can be used to simulate a multitude of occupational tasks, we focus on one specific functional task. Participants perform a virtual version of the task using the robot-AR system, and a physical version of the same task without the system. This study shows the results for two able-bodied users to determine if the robot-AR system produces upper-limb movements similar to the real-life equivalent task. The similarity between relative joint positions, i.e., hand-to-elbow (H2E) and elbow-to-shoulder (E2S) displacements, is evaluated within clusters based on the spatial position of the user's hand. The H2E displacements for approximately 50% of hand position clusters were consistent between the robot-AR and real-world conditions and approximately 30% for E2S displacements. The similar clusters are distributed across the entire task space however, indicating the robot-AR system has the potential to properly simulate real-world equivalent tasks.