A standardized protocol for the comprehensive assessment of dental hygiene work.

BACKGROUND: Work-related musculoskeletal disorders are prevalent in dental hygienists. Although engineering controls and ergonomic training is available, it is unclear why this intransigent problem continues. One possible barrier is that a comprehensive, standardized protocol for evaluating dental hygiene work does not exist. OBJECTIVE: This study aimed to generate a valid and reliable observational protocol for the assessment of dental hygiene work. METHODS: An iterative process was used to establish and refine an ecologically valid video acquisition and observation protocol to assess key activities, tasks, and performance components of dental hygiene work. RESULTS: Good inter-rater reliability was achieved across all variables when the final coding scheme was completed by three independent raters. CONCLUSIONS: This work provides an exemplar of the process required to generate a comprehensive protocol for evaluating the work components of a particular job, and provides standardized nomenclature for use by scientists and practitioners interested in understanding and addressing the pervasive issue of work-related disorders in dental hygienists.

Does Insurance Coverage Affect Use of Tests and Treatments for Working Age Individuals With Carpal Tunnel Syndrome in the United States? Analysis of the National Ambulatory Medical Care Survey (2005-2014).

OBJECTIVE: Carpal tunnel syndrome (CTS) is frequently seen as a work-related disorder. Few studies have examined the treatment of CTS by insurance coverage, and none have used a large, population-based dataset. This study examined the extent to which the use of CTS tests and treatments varied for those on workers' compensation insurance (WCI) vs private insurance and Medicaid, controlling for patient and provider characteristics. DESIGN: Analysis of 10 years of data (2005-2014) from the National Ambulatory Medical Care Survey. SETTING: United States office-based physician practices. PARTICIPANTS: Adults 18-64 years who had a physician visit for CTS (N=23,236,449). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: We examined use of 2 diagnostic tests, imaging and electromyography, and 7 treatments: casting, splinting, occupational therapy (OT), physical therapy (PT), carpal tunnel release surgery, steroid injections, and nonsteroidal anti-inflammatory drug (NSAID). RESULTS: Individuals who sought care for CTS were more likely to be covered by private insurance (56.9%) than WCI (9.8%) or Medicaid (6.5%). The most commonly prescribed treatment for all types of insurance coverage was splints, followed by NSAID prescription, and OT or PT therapies. Steroid injections (1.2%) and CTS surgery (4.5%) were used significantly less than other treatment types. Patients on WCI were less likely to receive diagnostic tests, and more likely to receive OT or PT than those on other types of insurance coverage. CONCLUSION: Patients with CTS who seek ambulatory care are most likely to be covered by private insurance. Insurance coverage appears to play a role in treatment and diagnostic choices for CTS.

What Types of Treatment Are Provided for Patients With Carpal Tunnel Syndrome? A Retrospective Analysis of Commercial Insurance.

BACKGROUND: Treatment of carpal tunnel syndrome (CTS) in commercially insured patients across the spectrum of provider types rarely has been described. OBJECTIVE: To describe patterns of types of treatment for patients with CTS using a large commercial insurance database. DESIGN: Retrospective cohort descriptive study. SETTING: Administrative health data from the Clinformatics Data Mart (OptumInsight, Eden Prairie, MN). PATIENTS: Adults with a primary diagnosis of CTS seen from between January 2010 to December 2012 who had a total of 48 months of continuous data (12 months before diagnosis and 36 months after diagnosis) (n = 24,931). OUTCOMES: Frequency of types of treatment (heat, manual therapy, positioning, steroids, stretching, surgery) by number of treatments, number of visits, provider type, and characteristics. RESULTS: Fifty-four percent of patients received no reported treatment, and 50.4% had no additional visits. Surgery (42.5%) and positioning (39.8%) were the most frequent single treatments. Patients who were seen by orthopedist for their first visit more frequently received some treatment (75.1%) and at least 1 additional visit (74.1%) compared with those seen by general practitioners (59.5%, 57.5%, respectively) or other providers (65.4%, 68.4, respectively). Orthopedists more frequently prescribed positioning devices (26.8%) and surgery (36.8%) than general practitioners (18.8%, 14.1%, respectively) or other providers (15.7%, 19.7%, respectively). Older adults more frequently had CTS surgery, as did people who lived in the Midwest. Overall, only 24% of patients with CTS had surgery. CONCLUSIONS: For more than one-half of patients with CTS no treatment was provided after an initial visit. Surgery rates were much lower than what has previously been reported in the literature. Generally, patients with CTS receive treatments that are supported by current treatment guidelines. LEVEL OF EVIDENCE: NA.

Computer use problems and accommodation strategies at work and home for people with systemic sclerosis: a needs assessment.

OBJECTIVE: We identified the extent of the need for interventions and assistive technology to prevent computer use problems in people with systemic sclerosis (SSc) and the accommodation strategies they use to alleviate such problems. METHOD: Respondents were recruited through the Scleroderma Foundation. Twenty-seven people with SSc who used a computer and reported difficulty in working completed the Computer Problems Survey. RESULTS: All but 1 of the respondents reported one problem with at least one equipment type. The highest number of respondents reported problems with keyboards (88%) and chairs (85%). More than half reported discomfort in the past month associated with the chair, keyboard, and mouse. Respondents used a variety of accommodation strategies. CONCLUSION: Many respondents experienced problems and discomfort related to computer use. The characteristic symptoms of SSc may contribute to these problems. Occupational therapy interventions for computer use problems in clients with SSc need to be tested.

The association between rheumatoid arthritis related structural changes in hands and computer keyboard operation.

INTRODUCTION: This cross-sectional study examined the effect of structural changes caused by rheumatoid arthritis (RA) on computer keyboarding style to provide insights on how changes may affect worker performance. METHOD: Computer keyboarding styles, as measured by the keyboard-personal computer style instrument, were compared between 45 keyboard operators with RA and 29 without. A severity of structural changes score (SSCS) was assigned after recruitment by observing subjects' hands while operating a keyboard. Significant differences between each item of keyboarding style by diagnosis were identified through Chi square analyses. Logistic regression models with age, diagnosis, SSCS, and touch typing training as the predicators further evaluated the effect of structural changes on each item of personal keyboarding style. RESULTS: Significantly more keyboard operators with RA used high force keystrokes, did not use a wrist rest, moved their hands to strike keys, maintained their wrists and fingers in a fixed position and used fewer than two fingers to activate keys. The amount of variance explained by each model varied from 8 to 56%. SSCS was the most common predictor of keyboarding style (54% of significant models), followed by age (35% of significant models), diagnosis (19% of significant models), and touch typing training (15% of significant models). CONCLUSION: Severity of structural changes and age are significant predictors of keyboarding style for computer operators with RA. The keyboarding styles used by computer operators with RA appear to reduce typing productivity and have the potential to put stress on joints already affected by RA. Computer operators with RA may benefit from worksite modifications that address keyboarding style such as alternate keyboards.