Musculoskeletal Health in Informal Caregivers Amy Darragh, OTR, PhD Carolyn Sommerich, PhD Steve Lavender, PhD Marc Campo, PT, PhD, OCS

Assumptions Informal caregivers experience high exposure to physically demanding, high risk handling tasks Informal caregivers experience high rates of musculoskeletal symptoms associated with performance of these tasks Informal caregivers work status and retirement plans are affected by caregiving

Exposure to physically demanding, high risk handling tasks Tasks such as repositioning, transferring, moving and lifting have been identified as physically demanding and high risk among nurses, therapists, and personal care assistants (DOL-BLS, 2007; Campo et al., 2008; Darragh et al., 2009) Family caregivers perform many activities that require repositioning, transferring, moving and lifting, such as ADL, stair climbing, moving between rooms, and moving between bed-commode or bed-chair.

High rates of musculoskeletal symptoms High rates of musculoskeletal pain and injury have been well documented in nurses, therapists, and personal care assistants (DOL-BLS, 2007, Campo et al., 2007; Darragh et al., 2009) Musculoskeletal pain and injury are associated with bed repositioning, transfers, lifts, and functional activities (ADL, ambulation). (Hignett, 2003; Campo et al., 2008; Darragh et al., in press)

Not Just Minor Aches… PT Work – Related Pain – 58% annual prevalence – 33 % new onset incidence Major WMSD – 27% annual prevalence – 20% new onset incidence – 16.9 per 100 FTE incidence rate OT Work – Related Pain – 46% annual prevalence Major WMSD – 27% annual prevalence – 16.5 per 100 FTE incidence rate Campo et al. 2008; Darragh et al., 2009

Major Risk Factors for Therapists PTs Patient handling Manual therapy Facilitation/mat work Functional rehabilitation Awkward/Cramped Postures Work Stress OTs Patient transfers/lift Manual therapy Equipment use Documentation Functional Activities Awkward postures Overexertion

Impact of WRI and WMSDs in PT/OT 96% worked with WRI or WMSD 71% reported practice increased symptoms YET 19% missed work 12% limited patient contact time

Professional Ideals Professional identity – Superheroes – Expert in musculoskeletal disorders – Self-blame Responsibility to others – Patient responsibility – Responsibility to coworkers

Work status and retirement plans are affected by caregiving Time off work is required to meet needs such as transportation to MD, extra care when ill. Expenses associated with caregiving delay retirement; changes in work status (F/T to P/T) delay retirement

Work-related pain affected life outside of work in therapists Work-related pain had profound effects on the quality of life of the therapists Affected leisure, ADL/IADL, and social participation

So, do caregivers share similar experiences? Little information available about caregiving tasks and their relation to physical symptoms Little information available about musculoskeletal symptoms among informal caregivers, and whether they differ from those experienced in the general population.

A Pilot Study of Musculoskeletal Health and Disorders in Informal Caregivers who Care for Adults with Physical Disabilities Goals: – Identify and analyze the physically demanding tasks of informal caregivers associated with caring for an adult with chronic physical disability. – Describe the musculoskeletal health of caregivers performing these tasks. The project described was supported by award number UL1RR from the National Center for Research Resources, funded by the Office of the Director, National Institutes of Health (OD) and supported by the NIH Roadmap for Medical Research. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Center for Research Resources or the National Institutes of Health

Overview 3 Phases: – Focus group discussions regarding caregiving tasks and musculoskeletal health (underway) – Home observations and analysis of physically demanding tasks (underway) – Large scale survey to assess relation between demanding tasks and musculoskeletal health (02/10)

Focus groups – 6 groups conducted so far, 29 participants – Wide range of caregiver characteristics (age, ethnicity, diagnosis of care recipient) – Held at community libraries – 7 of the 29 have agreed to in-home evaluations

Focus groups Updates