Taking Preventative Steps to Avoid Work Related Injuries of the Upper Extremity Chelsea Lee, OTS January 23, 2015 ASOT 2015 Vision and Action Conference

Level II Fieldwork Kentucky Hand and Physical Therapy (KHPT) Lexington, KY Lee Memorial Hospital Acute Rehab Ft. Myers, FL

Work Related Injuries (WRI) Work Related Upper Extremity Disorders (WRUED) Upper Extremity Work Related Musculoskeletal Disorders (UE-WRMSD) Cumulative Trauma Disorders (CTD) Repetitive Strain Injuries (RSI) Repetitive Trauma Disorders (RTD) Repeated Motion Disorders (RMD) Overuse Syndrome

Research Question For individuals in the workplace, will practicing joint protection techniques using ergonomics, as compared to no intervention, significantly decrease work related upper extremity disorders?

Why should we care? WRIs are costing employers an estimated $1 billion per week in the United States Occupational therapists can drastically reduce these costs by: Education on: Ergonomics Behavioral Changes Joint Protection Techniques We ALL overuse and abuse our joints…yes even YOU!

Everyday Activities Thumb extension and abduction=stress on CMC joint Prolonged neck flexion=stress on Atlanto-Occipital Joint Uneven weight distribution=stress on Gleno-Humeral joint

Current Research Research Article 1 Darragn, A. R., Harrison, H., & Kenny S. (2008) Interventions: Group 1: Control Group Group 2-Education only Group 3: Education and OT intervention Outcomes: Improved body positioning, body mechanics, and workstation design Research Article 2 McCormack, S. (2010) Interventions: Ergonomics and Behavioral Outcomes: Client demonstrated improved posture and improved behavior habits, reported decreased elbow pain with keying and mousing, and increased activity tolerance.

Current Research Research Article 3 Buchi, S., Bie, R.A., Ciurea, A., Kubli, R., Niedermann, K., Steurer- Stey, C., & Villiger, P. M. (2010) Interventions: Control Group: Conventional JP education Intervention Group: PRISM-based JP education- consisted of standardized JP education but much more individualized and based on the PRISM tasks, the social learning, and self management. Outcomes: Individualized, resource-oriented psycho-educational JP education (PRISM-JP) supported the acquisition and maintenance of JP behavior more successfully than C-JP.

Clinical Relevance Look at the person as a WHOLE, rather than just an extremity Saves clients time and money Saves employers time and money Educate, educate, EDUCATE Ergonomics Behavioral Changes Joint Protection Techniques

Ergonomics Keyboards Various keyboards available to help reduce pain from CTDs Correct Mouse Posture Relaxed Grasp Movement distributed throughout arm Locations Place items used frequently within arms reach Stand up to retrieve items placed overhead

Behavioral Changes Breaks Every minutes stretch! Change positions Every minutes-change positions Set a timer if needed to remember!

6 Principles of Joint Protection 1. Respect Pain 2. Balance Rest and Activity 3. Exercise in a Pain Free Range 4. Avoid Positions of Deformity 5. Reduce the Effort and Force 6. Use Larger/Stronger joints

Joint Protection Principles Beasley, 2013, p. 459

References Beasley, J. (2013). Arthritis.In C. Cooper (Ed.), Fundamentals of Hand Therapy: Clinical Reasoning and Treatment Guidelines for Common Diagnoses of the Upper Extremity. (pp ). St. Louis, MO: Elsevier Buchi, S., Bie, R.A., Ciurea, A., Kubli, R., Niedermann, K., Steurer-Stey, C., & Villiger, P. M. (2010) Effectiveness of individual resource-oriented joint protection education in people with rheumatoid arthritis. A randomized controlled trial. Patient Education and Counseling, 82, (42-48) doi: /j.pec Darragn, A. R., Harrison, H., & Kenny S. (2008) Effect of an ergonomics intervention on workstations of microscope workers. American Journal of Occupational Therapy, 69, doi: /ajot Hammond, A., & Freeman, K. (2004). The long-term outcomes from a randomized controlled trial of an educational–behavioural joint protection programme for people with rheumatoid arthritis. Clinical Rehabilitation, 18(5), doi: / cr766oa McCormack, S. (2010). Ergonomic and behavioral interventions as the primary treatment for work-related lateral epicondylitis. Work, 37(1), doi: /WOR Ripat, J., Giesbrecht, E., Quanbury, A., & Kelso, S. (2010). Effectiveness of an ergonomic keyboard for typists with work related upper extremity disorders: A follow-up study. Work, 37(3), doi: /WOR Ripat, J., Scatlif, T., Giesbrecht, E., Quanbury, A., Friesen, M., & Kelso, S. (2006). The effect of alternate style keyboards on severity of symptoms and functional status of individuals with work related upper extremity disorders. Journal of Occupational Rehabilitation, 16, doi: /s z. Soares, M. M., Jacobs, K., Levanon, Y., Gefen, A., Lerman, Y., Givon, U., & Ratzon, N. Z. (2012). Multi dimensional system for evaluating preventive program for upper extremity disorders among computer operators. Work, doi: /WOR

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