"Navigating chaos": Urban, Rural, and Remote Patient Experiences in Accessing Healthcare with Indigenous and Non-Indigenous Perspectives of Living with Chronic Low Back Pain.

Background: Healthcare access for chronic low back pain is complex and should consider not only the health system, but patient care seeking experiences as well. People who live in rural and remote communities and/or identify as being Indigenous may often encounter additional barriers to accessing care for chronic low back pain; thus, these contexts must be considered to fully understand barriers and facilitators. Aims: The aim of this study was to understand care-seeking experiences of people living with chronic back pain in Saskatchewan and determine unique experiences facing urban, rural, remote, and/or Indigenous peoples. Methods: Thirty-three participants with chronic low back pain completed a preliminary survey followed by individual semistructured interviews. Participants were categorized as urban, rural, or remote including Indigenous status. A qualitative interpretive research approach with inductive thematic analysis was employed. Results: Three overarching themes were identified with the following subthemes: (1) healthcare access challenges: challenges to accessing care, challenges within the health system, and challenges leading to self-directed management/coping strategies; (2) healthcare access facilitators: funded care, participant education and knowledge, patient-provider communication, and care closer to home; and (3) participant recommendations for improved care provision: coordination of care, integrative and holistic care, and patient-centered care and support. Rural and remote participants highlighted travel as a main barrier. Indigenous participant experiences emphasized communication with healthcare providers and past experiences influencing desire to access care. Conclusion: Participants identified a range of challenges and facilitators as well as recommendations for improving access to care for chronic low back pain, with unique barriers for rural, remote, and Indigenous participants.

Contexte: L'accès aux soins de santé pour la lombalgie chronique est complexe et devrait tenir compte non seulement du système de santé, mais aussi des expériences de recherche de soins des patients. Les personnes vivant dans des communautés rurales et éloignées et/ou qui s'identifient comme autochtones font souvent face à des obstacles supplémentaires pour accéder aux soins pour la lombalgie chronique; il faut donc tenir compte de ces contextes pour bien comprendre les obstacles et les facilitateurs.Objectifs: L'objectif de cette étude était de comprendre les expériences de recherche de soins des personnes vivant avec une lombalgie chronique en Saskatchewan et de déterminer les expériences uniques d'accès aux soins auxquelles sont confrontées les personnes vivant en milieu urbain, rural, éloigné et/ou ayant un statut d'autochtone.Méthodes: Trente-trois participants souffrant de lombalgie chronique ont répondu à un questionnaire préliminaire suivi d'entretiens individuels semi-structurés. Les participants ont été catégorisés comme vivant en milieu urbain, rural, éloigné, incluant ceux ayant un statut d'autochtone. Une approche de recherche qualitative interprétative avec une analyse thématique inductive a été utilisée.Résultats: Trois thèmes principaux ont été répertoriés avec les sous-thèmes suivants : (1) difficultés d'accès aux soins de santé : difficultés pour accéder aux soins, difficultés au sein du système de santé et difficultés conduisant à des stratégies de gestion et d'adaptation autonomes; (2) facilitateurs de l'accès aux soins de santé : financement des soins, éducation et connaissances des participants, communication entre le patient et le prestataire de soins et proximité des soins par rapport au domicile et (3) recommandations des participants pour l'amélioration de la prestation des soins : la coordination des soins, les soins intégrés et holistiques, les soins et le soutien centrés sur le patient. Les participants des régions rurales et éloignées ont souligné que les déplacements constituaient un obstacle majeur. Les expériences des participants autochtones ont mis l'accent sur la communication avec les prestataires de soins de santé et les expériences passées qui influencent le désir d'accéder aux soins.Conclusion: Les participants ont répertorié un ensemble de difficultés, de facilitateurs et de recommandations pour améliorer l'accès aux soins pour les lombalgies chroniques, qui présente des obstacles uniques pour les participants vivant en milieu rural et éloigné et les participants autochtones.

The effect of selected rest break activities on reaction time, balance, and perceived discomfort after one hour of simulated occupational whole-body vibration exposure in healthy adults.

MATERIALS & METHODS: Eleven healthy adults participated in four 1-hour sessions of ecologically valid WBV exposure followed by one of four 5-minute activities: sitting, walking, 2 min of gaze stabilization exercise (GSE) coupled with 3 min of trunk mobility exercise (GSE + MOBIL), or 2 min of GSE coupled with a 3-minute walk (GSE + WALK). Baseline and post-activity measurements (rating of perceived discomfort, balance and postural sway measurements, 5-minute psychomotor vigilance task test) were submitted to a paired t-test to determine the effect of WBV exposure and activities on physical, cognitive, and sensorimotor systems and to a repeated measures ANOVA to determine any differences across activities. RESULTS: We observed degradation of the slowest 10% reaction speed outcomes between baseline and post-activity after walking (7.3%, p < 0.05) and sitting (8.6%, p < 0.05) but not after GSE + MOBIL or GSE + WALK activities. Slowest 10% reaction speed after GSE + MOBIL activity was faster than all other activities. The rating of perceived discomfort was higher after SIT and WALK activities. There were no notable differences in balance outcomes. CONCLUSION: When compared to sitting for 5 min, an activity including GSE and an active component, such as walking or trunk mobility exercises, resulted in maintenance of reaction time after WBV exposure. If confirmed in occupational environments, GSE may provide a simple, rapid, effective, and inexpensive means to protect against decrements in reaction time after WBV exposure.

A 5-minute intervention activity after 1 hour of occupational whole-body vibration (WBV) exposure may provide protection against detriments in reaction time.Intervention activities that include a gaze stabilization exercise component maintained the slowest reaction speeds after 1 hour of WBV exposure, whereas sitting and walking activities resulted in a further slowing of the slowest reaction speeds.It may be possible for machinery operators to incorporate gaze stabilization activities in occupational environments, either in or out-of-cab, but further evaluation for feasibility and practicality of in-field adoption is required.

Healthcare Access Challenges and Facilitators for Back Pain Across the Rural-Urban Continuum in Saskatchewan, Canada: Cross-Sectional Results From a Provincial-Wide Telephone Survey.

Background: Chronic back pain is a common musculoskeletal disorder, disproportionately affecting rural and Indigenous people. Saskatchewan has a relatively high proportion of rural and Indigenous residents; therefore, understanding barriers and facilitators to accessing healthcare are needed to improve healthcare service delivery. Methods: A provincial-wide telephone survey explored experiences and perceived healthcare access barriers and facilitators among 384 Saskatchewan residents who experienced chronic low back pain. Chi-squared tests were performed to determine if people who lived in urban versus rural areas differed in the proportion who had accessed services from various healthcare practitioners. T-test and Mann-Whitney U analyses were conducted to determine differences between urban and rural, and Indigenous and non-Indigenous respondents. Results: Of 384 residents surveyed, 234 (60.9%) reported living in a rural location; 21 (5.5%) identified as Indigenous. Wait times (47%), cost (40%), travel (39%), and not knowing how to seek help (37%) were the most common barriers for Saskatchewan residents seeking care, with travel being the only barrier that was significantly different between rural and urban respondents (P ⩽ .001). Not knowing where to go to access care or what would help their low back pain (P = .03), lack of cultural sensitivity (P = .007), and comfort discussing problems with health care professionals (P = .26) were greater barriers for Indigenous than non-Indigenous participants. Top facilitators (>50% of respondents) included publicly funded healthcare, locally accessible healthcare services, and having supportive healthcare providers who facilitate referral to appropriate care, with urban respondents considering the latter 2 as greater facilitators than rural respondents. Telehealth or virtual care (P = .013) and having healthcare options nearby in their community (P = .045) were greater facilitators among Indigenous participants compared to non-Indigenous respondents. Conclusions: Rural, urban, Indigenous, and non-Indigenous people report overlapping and unique barriers and facilitators to accessing care for chronic low back pain. Understanding perceived access experiences will assist in developing more effective care models for specific communities or regions.

Addressing Exoskeleton Implementation Challenges: Case Studies of Non-Acceptance in Agriculture.

OBJECTIVES: The objective of this study was to detect success and failure factors for the implementation of passive exoskeletons in agriculture. Exoskeletons have been shown to reduce musculoskeletal loads during lab-based manual tasks, but long-term implementation experiences in agriculture are lacking. METHODS: We analyzed four intervention studies in agriculture focusing on methodological and contextual reasons why the trials were successful or unsuccessful. The study context, attempted intervention, and data collection of each field trial is compared. In the absence of long-term studies investigating the implementation and effectiveness of exoskeletons in agriculture, a set of multi-week pilot trials were initiated among German market vegetable farms and French vineyards from 2019 to 2022. Participant ratings, farm characteristics (e.g. employment duration and payment scheme) and intervention implementation characteristics (e.g. participation in implementation or language barriers) were analyzed using a mixed-methods approach to identify success and failure factors. RESULTS: The comparison of the studies showed that despite the organizational issues, there were several practical issues that limit the success of exoskeleton use in agriculture. We observed that participant rejection of the intervention is a major barrier to successfully conducting long-term field trials in agriculture. Factors like pain, discomfort, heat stress, or a lack of perceived benefits have been identified as failure factors but also the implementation process itself. CONCLUSION: In addition to careful targeting of trial sites and inclusion of participatory elements in the implementation plan, successful implementation of exoskeletons in agriculture requires fundamental human factors development of the exoskeletons themselves. This will require better matching the physical needs of the workers, the production needs of the tasks, and compatibility with the environment.

Experiences of Health Care Access Challenges for Back Pain Care Across the Rural-Urban Continuum in Canada: Protocol for Cross-sectional Research.

BACKGROUND: Back pain is common and costly, with negative impacts on both individuals and the health care system. Rural, remote, and Indigenous populations are at greater risk of experiencing back pain compared to urban and non-Indigenous populations. Potential barriers to health care access among Canadians with chronic back pain (CBP) have been identified; however, no study has used lived experiences of people with CBP to drive the selection, analysis, and interpretation of variables most meaningful to patients. OBJECTIVE: The aims of this study are to (1) engage with rural, remote, and urban Indigenous and non-Indigenous patients, health care providers, and health system decision makers to explore lived experiences among people with CBP in Saskatchewan, Canada; (2) cocreate meaningful indicators of CBP care access and effectiveness; and (3) identify program and policy recommendations to overcome access barriers to CBP care. METHODS: In phase 1, one-on-one interviews with 30 people with current or past CBP and 10 health care providers residing or practicing in rural, remote, or urban Saskatchewan communities will be conducted. We will recruit Indigenous (n=10) and non-Indigenous (n=20) rural, remote, and urban people. In phase 2, findings from the interviews will inform development of a population-based telephone survey focused on access to health care barriers and facilitators among rural, remote, and urban people; this survey will be administered to 383 residents with CBP across Saskatchewan. In phase 3, phase 1 and 2 findings will be presented to provincial and national policy makers; health system decision makers; health care providers; rural, remote, and urban people with CBP and their communities; and other knowledge users at an interactive end-of-project knowledge translation event. A World Café method will facilitate interactive dialogue designed to catalyze future patient-oriented research and pathways to improve access to CBP care. Patient engagement will be conducted, wherein people with lived experience of CBP, including Indigenous and non-Indigenous people from rural, remote, and urban communities (ie, patient partners), are equal members of the research team. Patient partners are engaged throughout the research process, providing unique knowledge to ensure more comprehensive collection of data while shaping culturally appropriate messages and methods of sharing findings to knowledge users. RESULTS: Participant recruitment began in January 2021. Phase 1 interviews occurred between January 2021 and September 2022. Phase 2 phone survey was administered in May 2022. Final results are anticipated in late 2022. CONCLUSIONS: This study will privilege patient experiences to better understand current health care use and potential access challenges and facilitators among rural, remote, and urban people with CBP in Saskatchewan. We aim to inform the development of comprehensive measures that will be sensitive to geographical location and relevant to culturally diverse people with CBP, ultimately leading to enhanced access to more patient-centered care for CBP. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/42484.

Towards safety and autonomy in the home bathroom: Identifying challenges, needs and gaps.

This qualitative study aims to identify challenges, needs and gaps for home care bathroom tasks and gather information that will allow for user-centered, sustainable solutions for home care in the bathroom. Twenty-one interviews were carried out with participants with the perspective of client, health care worker or care organization. The data were analyzed using qualitative content analysis and interpretive description. The findings identify important factors for enabling both independent living for clients and a sustainable work environment for the health care workers. They include adequate space, access to assistive devices and regular risk assessments to recognize changing needs. Enabling independent living is one strategy that can be used to manage the ongoing demographic change as well as the expected future labor shortage in the care sector. Changes can be made in the physical environment (the residential bathroom) in order to facilitate safer task performance for both the clients and the health care workers.

Evidence of rotator cuff disease after breast cancer treatment: scapular kinematics of post-mastectomy and post-reconstruction breast cancer survivors.

BACKGROUND: Breast cancer survivors may be at risk of experiencing rotator cuff disease after treatment. Biomechanical alterations following surgery potentially predispose survivors to develop this disorder. OBJECTIVE: To examine scapular kinematics in breast cancer survivors with and without impingement pain during an overhead reach task. DESIGN: A cross-sectional study. METHODS: Three surgery groups were included: non-cancer controls, mastectomy-only survivors and post-reconstruction survivors. Breast cancer survivor groups were also categorized by the presence of impingement pain. Scapular motion was tracked during an overhead reach task, performed separately by both arms. Maximum scapular internal rotation, upward rotation and tilt were calculated. Two-way analyses of variance with interactions (p < .05) were used to test the effects of group (control, mastectomy-only, reconstruction) and impingement pain (pain, no pain) on each variable within a (left/right) side. RESULTS: Scapular kinematics varied with the group by pain interaction. On the right side, the mastectomy-pain group had reduced upward rotation, while the reconstruction-pain group had higher upward rotation (mastectomy-only: 22.9° vs. reconstruction: 31.2°). On the left side, the mastectomy-pain group had higher internal rotation, while the reconstruction-pain group had reduced internal rotation (mastectomy-only: 45.1° vs. reconstruction: 39.3°). However, time since surgery was longer in the mastectomy-pain group than reconstruction-pain group, suggesting there may be a temporal component to kinematic compensations. CONCLUSIONS: There are kinematic alterations in breast cancer survivors that may promote future development of rotator cuff disease. Compensations may begin as protective and progress to more harmful alterations with time.KEY MESSAGESScapular kinematics varied with surgery and pain interaction: upward rotation was lower and internal rotation higher in mastectomy-pain group, while upward rotation was higher and internal rotation lower in reconstruction-pain group.Kinematics alterations may also be associated with time since surgery, as the mastectomy-pain group had longer time since surgery than the reconstruction-pain group.Kinematic alterations may transition from protective to harmful over time.In-depth analyses by reconstruction type are needed to determine surgery-specific effects on kinematics and their potential impact on the development of rotator cuff disease.

Higher unemployment and higher work-related traumatic fatality: trends and associations from the Canadian province of Saskatchewan, 2007-2018.

OBJECTIVE: Although Saskatchewan appears to have the greatest burden of work-related fatality (WRF) in Canada, it is unclear how WRF rates have varied over time. We investigated the WRF rate in Saskatchewan over the past decade and modeled potential risk factors for WRF, including economic indicators. METHODS: In this cross-sectional, population-based study, Saskatchewan workplace traumatic fatalities grouped by year, season, and worker characteristics (eg, age, industry) were used in addition to Statistics Canada labor force survey total employment, total labor force, and the number of unemployed workers by year and season. WRF rates were calculated as fatalities per total number of employed workers. A Poisson generalized additive model was employed to examine the association between WRF rates and personal characteristics, and economic indicators. RESULTS: The rate remained fairly stable between 2013-2014 and 2015-2017 but sharply increased from 2017 to 2018. On average, the highest rate was observed among workers aged ≥60 years (0.70 ± 0.21 per 100 000). Men had a more than 13-fold greater risk of WRF than women [relative risk (RR)13.7, 95% confidence interval (CI) 10.48-17.9), with the highest RR of WRF observed in the construction industry (RR 9.2, 95% CI 6.1-13.8). The risk of mortality increased non-linearly with increasing unemployment rate, with instability as the unemployment rate reaches the highest modeled values. CONCLUSION: Workplace fatality in the province has fluctuated over the past decade, with differential impact observed among industry groups. Furthermore, an increase in the unemployment rate was followed by an increase in mortality risk. Prioritizing and encouraging prevention strategies during periods of economic recessions could help address the incidence of fatalities at work.

Ergonomic assessment of veterinarians during performance of bovine reproductive examinations.

OBJECTIVE: To identify and quantify potential ergonomic hazards associated with routine reproductive examinations of cattle. SAMPLE: 7 bovine veterinarians. PROCEDURES: Each veterinarian was observed and videotaped during 2 bovine reproductive examination appointments. During each appointment, a force-matching protocol was used to estimate the entry force used by the veterinarian to insert an arm into a cow's rectum. Veterinarian posture and repetitive movements and the work environment were assessed and quantified during review of the video recordings. Descriptive data were generated. RESULTS: Of the 14 appointments observed, 9 and 5 involved examination of beef and dairy cows, respectively. For all veterinarians, an arm inclination ≥ 60° was observed during most reproductive examinations. The number of examinations performed per hour ranged from 19.1 to 116.8. The estimated entry force ranged from 121 to 349 N. During all 9 appointments involving beef cows, the veterinarian participated in other tasks (eg, operating overhead levers, opening gates, or assisting with cattle handling) that represented ergonomic hazards. CONCLUSIONS AND CLINICAL RELEVANCE: Results confirmed that reproductive examination of cattle exposes veterinarians to various ergonomic hazards involving awkward positions and repetitive and forceful exertions that can contribute to musculoskeletal discomfort and injury, particularly of the upper extremities (neck, shoulders, upper back, arms, elbows, wrists, and hands). Veterinarians frequently participated in other tasks during reproductive examination appointments that exposed them to additional ergonomic hazards. Risk mitigation strategies should prioritize minimizing exposure of veterinarians to tasks not directly associated with the reproductive examination procedure to decrease their overall ergonomic hazard burden.

Does functional performance and upper body strength predict upper extremity reaction and movement time in older women?

BACKGROUND: Reaction time to initiate upper limb movement and movement time to place hands on the landing surface may be important factors in forward fall landing and impact, contributing to injury reduction. The aim was to investigate the relationship of physical function and upper body strength to upper limb reaction and movement time in older female participants. METHODS: 75 female participants (72 ± 8 yrs) performed 5 arm response trials. Reaction time (signal to initiation of movement), and movement time (initial movement to contact), were collected using 3D motion capture. Additional variables were: handgrip; sit-to-stand; shoulder flexion and elbow extension strength measured by hand-held dynamometry; one-legged balance; fall risk; and physical activity scores. Prediction variables for reaction and movement time were determined in separate backward selection multiple regression analyses. Significance was set at P < 0.05. FINDINGS: Significant regression equations for RT (r2 = 0.08, P = 0.013) found a relationship between stronger handgrip (Beta = -0.002) and faster reaction time, accounting for 8% variance. For movement time (r2 = 0.06, P = 0.036) greater shoulder flexion strength (Beta = -0.04) was related to faster movement time, explaining 6% variance. Stronger SF strength was related to a decrease in MT by 4%. DISCUSSION: A relationship between arm strength measures and faster upper body reaction and movement time was shown, with 10-20% higher strength associated with a 5% faster response time. Even though this was a relatively weak relationship, given that strength is a modifiable component this provides a potential avenue for future intervention efforts. This in turn could have an impact on forward fall landing and potential reduction of injury risk.

A randomized controlled trial investigating effects of an individualized pedometer driven walking program on chronic low back pain.

BACKGROUND: Walking is an easily prescribed physical activity for people with low back pain (LBP). However, the evidence for its effectiveness to improve pain and disability levels for people with chronic low back pain (CLBP) within a community setting has not been evaluated. This study evaluates the effectiveness of a clinician guided, pedometer-driven, walking intervention for increasing physical activity and improving clinical outcomes compared to education and advice. METHODS: Randomized controlled trial recruiting N = 174 adults with CLBP. Participants were randomly allocated into either a standardized care group (SG) or pedometer based walking group (WG) using minimization allocation with a 2:1 ratio to the WG. Prior to randomization all participants were given a standard package of education and advice regarding self-management and the benefits of staying active. Following randomization the WG undertook a physiotherapist guided pedometer-driven walking program for 12 weeks. This was individually tailored by weekly negotiation of daily step targets. Main outcome was the Oswestry Disability Index (ODI) recorded at baseline, 12 weeks, 6 and 12 months. Other outcomes included, numeric pain rating, International Physical Activity Questionnaire (IPAQ), Fear-Avoidance Beliefs Questionnaire (FABQ), Back Beliefs questionnaire (BBQ), Physical Activity Self-efficacy Scale, and EQ-5D-5L quality of life estimate. RESULTS: N = 138 (79%) participants completed all outcome measures at 12 weeks reducing to N = 96 (55%) at 12 months. Both observed and intention to treat analysis did not show any statistically significant difference in ODI change score between the WG and the SG at all post-intervention time points. There were also no significant between group differences for change scores in all secondary outcome measures. Post hoc sensitivity analyses revealed moderately disabled participants (baseline ODI ≥ 21.0) demonstrated a greater reduction in mean ODI scores at 12 months in the WG compared to SG, while WG participants with a daily baseline step count < 7500 steps demonstrated a greater reduction in mean ODI scores at 12 weeks. CONCLUSIONS: Overall, we found no significant difference in change of levels of (ODI) disability between the SG and WG following the walking intervention. However, ODI responses to a walking program for those with moderate levels of baseline disability and those with low baseline step count offer a potential future focus for continued research into the benefit of walking as a management strategy for chronic LBP. TRIAL REGISTRATION: United States National Institutes of Health Clinical Trails registry (http://ClinicalTrials.gov/) No. NCT02284958 (27/10/2014).

High Risk? Indoor Cannabis Producers' Perceptions of Occupational Health and Safety.

Introduction: Recent legal changes mean Canadian cannabis production has moved from an illegally grown crop to a potentially common one. However, little is known about the needs of long-time producers accustomed to operating outside a legal framework. In order to develop effective safety communication strategies, there is a need to better understand cannabis producers' perceptions of OHS regulations, OHS controls, and sources of OHS information.Methods: The specific objectives of this study are to (1) Describe production tasks and identify potential hazards related to these tasks and (2) describe workers' current sources of OHS information.This study gathered two types of information: facility and production information gathered from key informants during three facility walkthroughs, and health and safety perceptions gathered during face to face interviews with nine cannabis production workers. Interviews were thematically analyzed using interpretive description.Results: Cannabis production and related occupational health and safety issues occur within a larger context, and descriptions of contextual factors were interwoven with workers' responses which, on the whole, expressed positive views of occupational health and safety. Perceived barriers to OHS included cost, lack of specialized skills, and lack of worker consultation, while named sources of OHS information included courses, requests to OHS agencies, and the internet.Conclusion: It is hoped that an enhanced understanding of Canadian cannabis producers can inform the development of effective occupational health and safety interventions to promote the health and productivity in this workforce.

Potential exoskeleton uses for reducing low back muscular activity during farm tasks.

BACKGROUND: As the sustainability of the agricultural workforce has been threatened by the high prevalence of back pain, developing effective interventions to reduce its burden within farming will contribute to the long-term health and productivity of workers. Passive back-support exoskeletons are being explored as an intervention to reduce the physical demands on the back muscles, and consequently mitigate the risk of back pain, in many industrial sectors. METHODS: This study investigated whether exoskeleton use could reduce farmers' low back muscle load. Electromyography was used to evaluate exoskeleton use in field and laboratory settings. A total of 14 farmers (13 males and 1 female) with a mean age of 49 (SD = 12) years and 6 female nonfarmers (mean age 28, SD = 5 years) performed a standardized set of tasks that included symmetric and asymmetric lifting and sustained trunk flexion. Following the standardized tasks, 14 farmers also performed regular, real-world, farm tasks with and without use of the exoskeleton at their farms. RESULTS: Exoskeleton use decreased back muscular load during farming activities up to 65%, 56%, and 48% in static, median, and peak muscle activity, respectively. This indicates potential benefits of exoskeleton use to help farmers work under less muscular load. Paradoxically, exoskeleton use during standardized tasks increased muscle activity for some participants. CONCLUSIONS: This study demonstrates the potential effects of using passive exoskeletons in agriculture through observational and experimental research, and is among the first that explores the potential for using exoskeletons during actual work tasks in farm settings.

Risk factors associated with work-preventing musculoskeletal discomfort in the upper extremities of bovine practitioners.

OBJECTIVE: To identify risk factors associated with work-preventing musculoskeletal discomfort (MSKD) in the upper extremities (defined as neck, shoulders, upper back, arms, elbows, wrists, and hands) of bovine practitioners. SAMPLE: 116 members of the Western Canadian Association of Bovine Practitioners. PROCEDURES: Data from a previously described cross-sectional survey of western Canadian bovine practitioners underwent further analysis. The survey, developed to glean information about MSKD in bovine practitioners, was a modified standardized Nordic questionnaire that included questions regarding personal and work characteristics and incidence and location of MSKD during the preceding 12 months along with perceptions about most physically demanding tasks. Logistic regression was used to identify factors associated with work-preventing upper extremity MSKD. RESULTS: 18 of 116 (15.5%) respondents indicated they had experienced work-preventing upper extremity MSKD during the preceding 12 months. The final multivariable regression model indicated that practice type (mixed animal vs primarily [> 50%] bovine; OR, 3.20; 95% CI, 0.96 to 10.67), practitioner height (OR, 0.93; 95% CI, 0.87 to 0.99), and number of veterinarians in the practice (OR, 1.32; 95% CI, 1.05 to 1.66) were significantly associated with the odds of work-preventing upper extremity MSKD. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggested that reproductive examination of cattle was not a significant risk factor for upper extremity MSKD in bovine practitioners. Further research into the effects of biomechanical, organizational, and psychosocial workplace factors on the development of MSKD in bovine practitioners is necessary to help inform prevention strategies to foster career longevity in this increasingly diverse practitioner group.

Economic analysis of new workplace technology including productivity and injury: The case of needle-less injection in swine.

Increasing intensification in swine production has led to new and specialized technologies, but the occupational health and safety impacts are rarely quantified in the business plans for adoption. Needle-less injection has potential to increase productivity and eliminate needle stick injury in workers, but it is not clear whether these benefits offset high capital investment and potential increases in musculoskeletal loads. This economic evaluation employed probabilistic scenario analysis using injury, cost, and production data gathered from interviews with swine producers in Manitoba and Saskatchewan. After adoption of needle-less injection, rates of needle-stick injury went down with no measureable effect on upper limb musculoskeletal disorders, resulting in lower health and safety costs for needle-less injectors. Needle-less injection duration was 40% faster once workers acclimatized, but large start-up costs mean economic benefits are realized only after the first year. The incremental benefit cost ratio promoted adoption of needle-less injectors over conventional needles for the base case of a 1200 sow barn; the conventional method is beneficial for barns with 600 sows or less. Findings indicate that well-designed technologies have the potential to achieve the dual ergonomics goals of enhancing human wellbeing and system performance. We anticipate that the economic and decision models developed in this study can be applied to other new technologies in agriculture and animal production.

Trunk Posture Exposure Patterns among Prairie Ranch and Grain Farmers.

Objectives: Low back disorders (LBD) are the most common musculoskeletal disorder among farmers, and awkward trunk postures such as repetitive bending are often cited as a contributor. However, it is not clear whether trends of increasing mechanization in agriculture may be impacting the requirement for trunk-intensive tasks. This study compared the patterns of working trunk posture among prairie farmers during both machine-intensive and non-intensive work days.Methods: Forty-nine adult farm workers from 22 farms participated in this study. Individual and farm characteristics were documented via questionnaire. Trunk angles and velocities were measured with an I2M inertial sensor placed on the chest. Participants completed electronic posture assessments during up to three regular work days throughout the growing season for a total of 91 electronic posture measurements. Forward and lateral trunk bending patterns were expressed in three domains: magnitude, duration, and frequency.Results: Working tasks were categorized into driving, manual, and mixed. Driving was the most commonly measured task (52% of work days), and mixed tasks the least (12%). Both 90th percentile trunk flexion-extension angles and velocities were significantly higher for manual as compared to driving tasks. Participants spent 38% of their working time in trunk forward flexion ≥ 20°, which, according to previous epidemiological studies, may increase their risk for LBD.Conclusion: The directly-measured trunk posture exposure patterns in this study suggest that machinery-intensive workdays result in less awkward trunk posture and lower velocities. Increasing mechanization invites more research on the exposures associated with machinery operation and increasing automation.

Mapping Physiotherapy Use in Canada in Relation to Physiotherapist Distribution.

Purpose: In this cross-sectional study, we examined the distribution of physiotherapists at the health region level across Canada in relation to self-reported physiotherapy use across the provinces and territories. Method: We drew on two data sources: the physiotherapy use question from the 2014 Canadian Community Health Survey and physiotherapists' primary employment information, obtained from the Canadian Institute of Health Information's 2015 Physiotherapist Database. We then applied geospatial mapping and Pearson's correlation analysis to the resulting variables. Results: Physiotherapy use is moderately associated with the distribution of physiotherapists (Pearson's r 92 = 0.581, p < 0.001). The use and distribution variables were converted into three categories using SDs of 0.5 from national means as cut-off values. Cross-classification between the variables revealed that 15.2% of health regions have a high use-high distribution ratio; 18.5% have a low use-low distribution ratio; 4.3% have a high use-low distribution ratio; 2.2% have a low use-high distribution ratio; and 60.0% have medium use-medium distribution ratio. Conclusions: The distribution of physiotherapists and self-reported physiotherapy use varies across health regions, indicating a potential inequality in geographical access. Given that most provinces have a regionalized approach to health human resources and health service delivery, these findings may be helpful to managers and policy-makers and may allow them to make a more granular comparison of intra- and inter-provincial differences and potential gaps.

Objectif : la présente étude transversale a porté sur la répartition des physiothérapeutes dans les régions sanitaires du Canada par rapport à l'utilisation déclarée des services de physiothérapie dans les provinces et territoires. Méthodologie : les chercheurs ont puisé dans deux sources de données : la question sur l'utilisation des services de physiothérapie de l'Enquête sur la santé dans les collectivités canadiennes de 2014 et les renseignements sur l'emploi primaire des physiothérapeutes tirés de la Base de données sur les physiothérapeutes de l'Institut canadien d'information sur la santé de 2015. Ils ont ensuite appliqué la cartographie géospatiale et l'analyse de corrélation de Pearson aux variables obtenues. Résultats : l'utilisation des services de physiothérapie s'associe modérément à la répartition des physiothérapeutes (r 92 de Pearson = 0,581, p < 0,001). Les chercheurs ont converti les variables d'utilisation et de répartition en trois catégories, dont les seuils correspondaient aux écarts-types de ± 0,5 des moyennes nationales. La classification transversale entre les variables a révélé que 15,2 % des régions sanitaires présentaient un ratio forte utilisation/forte répartition, 18,5 %, un ratio faible utilisation/faible répartition; 4,3 %, un ratio forte utilisation/faible répartition, 2,2 % un ratio faible utilisation/forte répartition et 60,0 %, une combinaison de ratios utilisation modérée/répartition modérée. Conclusions : la répartition des physiothérapeutes et l'utilisation déclarée de services de physiothérapie varient selon les régions sanitaires, ce qui est indicateur d'inégalités potentielles à l'égard de l'accessibilité géographique. Puisque la plupart des provinces ont une approche régionale des effectifs en santé et de la prestation des services de santé, ces observations peuvent être utiles pour les gestionnaires et les décideurs, qui peuvent s'en servir pour faire une comparaison plus stricte des différences intraprovinciales et interprovinciales et des lacunes potentielles.

Stable prevalence of chronic back disorders across gender, age, residence, and physical activity in Canadian adults from 2007 to 2014.

BACKGROUND: Chronic back disorders (CBD) are a global health problem and the leading cause of years lived with disability. The present study aims to examine overall and specific trends in CBD in the Canadian population aged 18 to 65 years. METHODS: Data from the Canadian Community Health Survey (CCHS), a cross-sectional study, from 2007 to 2014 (8 cycles) were used to calculate CBD prevalence across gender, age, geographical area (urban/rural and ten provinces and northern territories), and physical activity levels. CBD was defined in the CCHS as having back problems, excluding fibromyalgia and arthritis, which have lasted or are expected to last six months or more and that have been diagnosed by a health professional. Prevalence of CBD using survey weights and associated 95% confidence intervals (95% CI) were calculated yearly using balanced repeated replications technique. Trend tests were calculated using joinpoint regressions; ArcGIS software was used for mapping. RESULTS: Age-standardized CBD prevalence in 2007 and 2014 were 18.9% (95% CI = 18.4;19.5) and 17.8% (95% CI = 17.2,18.4), respectively. CBD prevalence was consistently higher in women, older age groups, rural dwellers, and people classified as inactive. Crude and age-standardized CBD prevalence decreased faster in people classified as physically active compared to those who were inactive (p < 0.006). Although CBD slightly decreased over time, no statistically significant trends were found overall or by gender, area of residence, province or level of physical activity. The prevalence of CBD remained consistently high in the province of Nova Scotia, and consistently low in the province of Quebec over the eight CCHS cycles. CONCLUSION: Despite prevention efforts, such as the Canadian back pain mass media campaign, CBD prevalence has remained stable between 2007 and 2014. Tailored prevention and management of CBD should consider gender, age, and geographical differences. Further longitudinal studies could elucidate the temporal relationship between potentially modifiable risk factors such as physical activity and CBD.

Prevalence and risk factors of low back disorders among waste collection workers: A systematic review.

BACKGROUND: Waste management is a growing industry worldwide. Working conditions may entail risk factors for musculoskeletal disorders, and especially low back disorders (LBD). OBJECTIVE: The purpose of this study was to perform a systematic review on: (i) the prevalence of LBD; and (ii) risk factors for LBD among waste collection workers. METHOD: A search was conducted in three electronic databases: Ovid Medline, EMBASE, and Global Health ePublications. Data were extracted on study design, sampling strategy, geographical region, LBD prevalence, and risk factors. Data were reported narratively. RESULTS: Thirteen full-text articles met the study criteria. Using a range of definitions for LBD, the included articles reported a 12-month prevalence of 'LBD' between 16 to 74%, although none of the included studies quantified relationships between risk factors and LBD. None of the studies met all 9 risk of bias criteria. No articles investigated the association of risk factors and LBD, but even in absence this evidence authors of included studies suggested physical risk factors for LBD among waste workers: awkward posture, repetitive motion, and work duration. CONCLUSION: In light of these risks and future growth in this industry, the lack of high quality studies and investigation of risk factors highlight the need for more research in this sector which will support future LBD prevention efforts.