H O W T O AV O I D R E H A B A S R E H A B T H E R A P I S T S :

C U R R E N T U P D AT E O N W O R K - R E L AT E D I N J U R Y D ATA I N A C U T E I N PAT I E N T C A R E A N D P R A C T I C A L S U G G E S T I O N S F O R S O L U T I O N

C U RT I S H . C H O I , S P T A LTA B AT E S S U M M I T M E D I C A L C E N T E R & S A M U E L M E R R I T T U N I V E R S I T Y D O C T O R O F P H Y S I C A L T H E R A P Y P R O G R A M N O V E M B E R 3 , 2 0 1 5

C A L I F O R N I A O C C U PAT I O N A L S A F E T Y A N D H E A LT H A C T O F 1 9 7 3 1

19731973Regulates the operation of health facilities

- Employers to provide certain safety devices and safeguard methods that ensure employee safety.

- Willful or repeated violations are a crime

A B 1 1 3 6 : H O S P I TA L PAT I E N T A N D H E A LT H C A R E W O R K E R I N J U R Y P R O T E C T I O N A C T 1

AB 1136

1973Amends California Occupational Safety and Health Act of 1973

- Require an employer to maintain a safe patient handling policy

Concerning the lifting, repositioning, and transfer of patients in acute care hospitals and resulting injuries to hospital personnel.

Became effective on January 1, 2012

S A F E PAT I E N T H A N D L I N G P O L I C Y ( S P H P ) 1

AB 1136

1973SPHPSafe Patient Handling Policy includes:

- Provide trained lift teams

- Replacement of manual lifting and transferring of patients with powered patient transfer/lift devices or by lift teams

- Employers required to adopt a patient protection and health care worker back and musculoskeletal injury program

P R E VA L E N C E A C C O R D I N G T O A B 1 1 3 6 1

AB 1136

1973SPHP

Incidence

36,130 occupational musculoskeletal disorder (MSD) cases

- 11% of the 317,440 total cases of MSDs- At least 1 lost day from work in 2008

Almost all (99%) of MSD cases involving patient handlingwere the result of overexertion.- Sprain, Strain, or Tear (84% of the MSD cases)

W O R K - R E L AT E D M U S C U L O S K E L E TA L I N J U R I E S A N D D I S O R D E R S O F P T A N D O T 2

The American Journal of Occupational Therapy

- Amy R. Darragh, Wendy Huddleston, Phyllis King

“Work-Related Musculoskeletal Injuries and Disorders Among Occupational and Physical Therapists”

AB 1136

1973SPHP

Incidence

WMSDs

B A C K G R O U N DW O R K - R E L AT E D M U S C U L O S K E L E TA L I N J U R I E S A N D D I S O R D E R S O F P T A N D O T 2

Work-related musculoskeletal disorders (WMSDs) among nursing personnel is well documented

AB 1136

1973SPHP

Incidence

WMSDs

PTs & OTs move and handle patients differently from nursing

PTs & OTs have extensive training and education

B A C K G R O U N DW O R K - R E L AT E D M U S C U L O S K E L E TA L I N J U R I E S A N D D I S O R D E R S O F P T 3

AB 1136

1973SPHP

Incidence

WMSDs

A prospective cohort study by Campo et al., 2008

- PTs who transferred patients 6-10 times per day = 2.4 times higher odds for WMSDs

- PTs who reposition patients >10 times per day = Odds of low back WMSDs 2.61 times higher

- n = 882 PTs

- 1-year followup

B A C K G R O U N DW O R K - R E L AT E D M U S C U L O S K E L E TA L I N J U R I E S A N D D I S O R D E R S O F O T 4 - 6

Similar patterns of injury for OTs AB 1136

1973SPHP

Incidence

WMSDs

- Alnaser4

✤ 23% of OTs and COTAs reported work-related injuries

✤ OTs: Low back injuries most frequently injured body part

✤ COTAs: Wrists, hands and knees.

B A C K G R O U N DW O R K - R E L AT E D M U S C U L O S K E L E TA L I N J U R I E S A N D D I S O R D E R S O F O T 4 - 6

Similar patterns of injury for OTs AB 1136

1973SPHP

Incidence

WMSDs

- Highnett5

✤ Patient handling identified as risk factors for injury.

- Bureau of Labor Statistics (BLS)6

✤ Patient care activities/ patient lifting = responsible for 100% of all OT injuries

✤ Patient lifting: 71% of injuries to OTs

✤ 75% injuries involved Trunk/back and shoulder regions

W O R K - R E L AT E D M U S C U L O S K E L E TA L I N J U R I E S A N D D I S O R D E R S O F P T A N D O T 2

- Amy R. Darragh, Wendy Huddleston, Phyllis King

“Work-Related Musculoskeletal Injuries and Disorders Among Occupational and Physical Therapists”

AB 1136

1973SPHP

Incidence

WMSDs

P U R P O S E

W O R K - R E L AT E D M U S C U L O S K E L E TA L I N J U R I E S A N D D I S O R D E R S O F P T A N D O T 2

- Amy R. Darragh, Wendy Huddleston, Phyllis King

“Work-Related Musculoskeletal Injuries and Disorders Among Occupational and Physical Therapists”

AB 1136

1973SPHP

Incidence

WMSDs

P U R P O S E P R E VA L E N C E , I N C I D E N C E ,

C H A R A C T E R I S T I C SC O M PA R E

W O R K - R E L AT E D M U S C U L O S K E L E TA L I N J U R I E S A N D D I S O R D E R S O F P T A N D O T 2

- Amy R. Darragh, Wendy Huddleston, Phyllis King

“Work-Related Musculoskeletal Injuries and Disorders Among Occupational and Physical Therapists”

AB 1136

1973SPHP

Incidence

WMSDsP U R P O S E

P R E VA L E N C E , I N C I D E N C E ,

C H A R A C T E R I S T I C SC O M PA R E I D E N T I F Y E F F E C T

O F I N J U R Y

W O R K - R E L AT E D M U S C U L O S K E L E TA L I N J U R I E S A N D D I S O R D E R S O F P T A N D O T 2

- Amy R. Darragh, Wendy Huddleston, Phyllis King

“Work-Related Musculoskeletal Injuries and Disorders Among Occupational and Physical Therapists”

AB 1136

1973SPHP

Incidence

WMSDs

- Methods

✤ 3,297 surveys mailed out ✤ PTs = 1,861 ✤ OTs = 1,436

W O R K - R E L AT E D M U S C U L O S K E L E TA L I N J U R I E S A N D D I S O R D E R S O F P T A N D O T 2

- Amy R. Darragh, Wendy Huddleston, Phyllis King

“Work-Related Musculoskeletal Injuries and Disorders Among Occupational and Physical Therapists”

AB 1136

1973SPHP

Incidence

WMSDs

- Results✤ 1,189 responses received

✤ OT (477): 104 reported 190 injuries over 3 years.13.5% reported multiple injuries.

✤ PT (681): 144 reported 279 injuries over 3 years.16.7% reported multiple injuries.

W O R K - R E L AT E D M U S C U L O S K E L E TA L I N J U R I E S A N D D I S O R D E R S O F P T A N D O T 2

- Amy R. Darragh, Wendy Huddleston, Phyllis King

“Work-Related Musculoskeletal Injuries and Disorders Among Occupational and Physical Therapists”

AB 1136

1973SPHP

Incidence

WMSDs

- Results

Body Region OT PT

Low Back 30% 33%

Hand 21% 20%

Shoulder 17% 15%

Neck 14% 15%

Wrist 14% 14%

S U G G E S T I O N S F O R S O L U T I O N

AB 1136

1973SPHP

Incidence

WMSDs

ABSMC

Use the Lift TeamSolution

Communicate with other therapists ✤ 2-person assist?

✤ Max or Dependent?

Proper body mechanics & Ergonomic settings

✤ Refer to Health Stream: Personal safety

S U G G E S T I O N S F O R S O L U T I O N

AB 1136

1973SPHP

Incidence

WMSDs

ABSMC

Sutter SAFESafetyAlwaysFirst.Everytime.

Solution

Patient handling

✤ Bed height

✤ Rails down

✤ Therapist position

1. Get close! Reducing the moment arm = Less torque!

2. Set up environment for success

http://pch-health.com/wp-content/uploads/2014/07/physical-therapy.jpg

S O M E A R T I C L E S U G G E S T I O N S

AB 1136

1973SPHP

Incidence

WMSDs

ABSMC

Solution

S O M E A R T I C L E S U G G E S T I O N S

AB 1136

1973SPHP

Incidence

WMSDs

ABSMC

Solution

S U P E R F E E T F O R S U P E R T H E R A P I S T S

AB 1136

1973SPHP

Incidence

WMSDs

ABSMC

Solution

Superfeet insoles

Influence of a Commercially Available Orthotic Device on Rearfoot Eversion and Vertical Ground Reaction Force When Running in Military Footwear

• Year Completed: 2003 (Published in 2007 in Military Medicine)

• Author(s): Dixon and Warren (School of Sport and Health Science, University of Exeter)

• Peak eversion was not significantly influenced by the Superfeet

• The timing of that peak eversion, however was significantly affected by the addition of Superfeet

• Peak impact force, average loading rate and peak rate of loading were all decreased when Superfeet was used

S U P E R F E E T F O R S U P E R T H E R A P I S T S

AB 1136

1973SPHP

Incidence

WMSDs

ABSMC

Solution

Superfeet insolesStanding Balance on the Ground – The Influence of Flatfeet and Insoles

• Year Completed: 2013 (Published in Journal of Physical Therapy Science, (25): 1519-1521)

• Author(s): Takta, Matsuoka, Okumura, Iwamoto, Tatahashi and Uchiyama

• On level ground Superfeet insoles were effective in stabilizing standing balance in both flat-footed and normal footed subjects

Insole Effects on Impact Loading During Walking • Year Completed: 2011 (Published in Ergonomics Volume 54, Issue 7)

• Author(s): Creaby, May and Bennell  

• Peak impact force at the knee was reduced for flat material insoles and heel cup insoles (Superfeet)  

Static and Dynamic Biomechanics of Foot Orthoses in People with Medial Compartment Knee Osteoarthritis

• Year Completed: 2002 (Published in Clinical Biomechanics, (17): 603-610)

• Author(s): Maly, Culham and Costigan  

• The peak displacement of center of pressure was reduced relative to the x-axis of the laboratory when wearing Superfeet insoles  

R E F E R E N C E S

1. Sate of California department of Industrial relations. Available at: http://www.dir.ca.gov/dosh/Safe_Patient_Handling.htm. Accessed November 1, 2015.

2. Darragh AR, Campo M, King P. Work-related activities associated with injury in occupational and physical therapists. Work. 2012;42(3):373-84.

3. Campo, M., Weiser, S, Koenig, K. L., & Nordin, M. (2008). Work-related musculoskeletal disorders in physical therapists: A prospective cohort study with 1-year follow-up. Physical Therapy, 88, 608–619.

4. Bureau of Labor Statistics. (2006). Table SNR01. Highest inci- dence rates of total nonfatal occupational injury and illness cases, private industry, 2006. Retrieved December 10, 2007, from www.bls.gov/iif/oshwc/osh/os/ostb1753.pdf

5. Alnaser, M. Z. (2007, April). Perspectives on occupational musculo- skeletal injuries incurred by occupational therapy practitioners. Paper presented at the American Occupational Therapy Asso- ciation 87th Annual Conference & Expo, St. Louis, MO.

6. Hignett, S. (2001). Manual handling risk assessments in occupational therapy. British Journal of Occupational Therapy, 64, 81–86.