Arm pain and RTW - work modifications that work
Take home messages:
Workplace accommodation are the changes an employer makes to the workplace to help an injured or disabled employee do their job e.g. providing a ramp, altering the desk height, or reducing the number of hours/activities at work.
The introduction of a structured approach to managing arm pain included problem solving training. This assisted the workplace to identify the common barriers to return to work.
What the research involved:
The Integrated Case Management study was a trial of a 4-month case management program designed to improve outcomes for work-related arm conditions.
Participants in the ICM study were U.S. Federal civilian workers who had not returned to their normal work. Their health conditions included carpal tunnel syndrome; tendon, soft tissue, cervical, muscular disorders, osteoarthrosis and vascular diseases.
The goal of the case management intervention was to provide a systematic approach to return to work after the diagnosis of a work related arm problem. An approach that would engage workers in collaborative problem solving to address ergonomic and psychosocial barriers and facilitate workplace accommodations.
The case management approach provided problem-solving skills training to claimants to address a range of problems experienced in returning to work. Workplaces were encouraged to follow a systematic procedure for recommending and implementing workplace accommodations.
Summary of research findings:
The study found a number of barriers to workplace accommodation efforts:
- Employers prefer to stress initial safety measures rather than redesigning the work of an individual with a specific functional limitation
- Work-related upper extremity disorders such as tendinitis and nerve entrapments are hard to accommodate because they are associated with prolonged and awkward positions and psychosocial factors such as perceived level of job stress
- Small employers may have less ability to reposition employees/rearrange job tasks
- Industries with high physical work demands (e.g., construction) cannot always reduce work hours/provide alternate positions
- Labor union agreements may limit job rotation
- Public safety concerns may make accommodation difficult (e.g., transportation)
On the basis of the questionnaire, greater functional limitation was associated with more upper extremity pain, sleep problems, pain, lack of confidence to overcome problems, and greater perceived physical exposures at work.
Results of the problem-solving skills training showed that concerns about the work environment were common:
- Need for workstation redesign (46% of participants)
- Repetitive tasks (40%)
- Lifting heavy objects (20%)
- Fast paced work (17%).
The most commonly found exposures in the study were:
- Repetitive tasks or movements (95% of participants)
- Holding arms outstretched (94%)
- Holding or carrying items (92%)
- Wrists are bent from neutral position (90%)
The case management intervention trialed a more systematic approach to return to work after work related arm problems. The focus was on engaging workers in collaborative problem solving to address ergonomic and psychosocial barriers and facilitate workplace accommodations.
Original research:
Generating workplace accommodations: lessons learned from the integrated case management study.
Shaw WS, Feuerstein M.
J Occup Rehabil. 2004 Sep;14(3):207-16.