Research Plus: December/January 2008/2009

Occupational shoulder pain

In a study population of 733 employees in manufacturing and healthcare jobs, 19% had dominant-side shoulder symptoms and 7.5% had rotator cuff syndrome (RCS). RCS cases were significantly more likely to report low job security and high job structural constraints. Significant physical risk factors were upper arm flexion above 45º for more than 15% of work time and forceful exertion, particularly pinch grip. Age and body mass index were not significant factors (though slight trends were observed).

Journal of Occupational and Environmental Medicine 2008; 50(9): 1062–1076.

Job placement RCT

The benefits of a job-placement programme as part of vocational rehabilitation is demonstrated in a randomised controlled trial. Sixty-six workers with musculoskeletal injuries, all of whom had been injured at work and had been off work at least six months, were randomly assigned either to a three-week job placement and support group or to a self-placement (control) group. All the participants had attended a ‘work-readiness’ programme designed to address psychosocial barriers after lengthy sick leave. The return-to-work rate was significantly higher (p < 0.05) in the job placement group (73%) than in the self-placement group (52%).

Journal of Occupational Rehabilitation 2008, online first: doi: 10.1007/s10926-008-9138-z.

Does impairment lead to greater injury risk?

A systematic review assessed links between common health conditions – and their treatments – and increased risk of workplace accidents. It identified 38 relevant papers, from 33 study populations, including 16 cross-sectional and 13 case–control studies. There is a moderately higher risk of occupational injury in workers with a hearing impairment, but little evidence of a risk associated with vision impairment. There is limited evidence of increased risk of injury in those with emotional problems, and with diabetes, epilepsy and use of sedating medicine. An improved evidence base is needed to underpin fitness-for-work decisions.

Occupational and Environmental Medicine 2008; 65; 757–764.

Behaviour therapy meta-analysis

Behaviour therapy seeks to modify behaviour without addressing internal mental states (thus differing from cognitive behavioural therapy, CBT, which additionally deals with the way the individual thinks). A meta-analysis of studies on the use of behavioural therapy to treat depression identified 17 randomised controlled trials, covering 1,109 subjects. Behavioural therapy is significantly better than controls, brief psychotherapy and supportive therapy, and as good as CBT in treating depression.

Psychological Medicine 2008; 38: 611–623.

Review of computerised CBT take up

A systematic review on the use of computerised cognitive behaviour therapy in the treatment of depression found 16 papers with information on patient recruitment, drop out and satisfaction. While drop-out rates were comparable with other therapies, take-up rates were much lower. More qualitative information on the reasons for low take up and dropping out is required.

Psychological Medicine 2008; 38: 1521–1530.

Adverse workstyle predicts pain

‘Workstyle’ is a relatively new concept to explain how an individual responds behaviourally, cognitively and physiologically to increased or stressful work demands, and may explain psychosocial and ergonomic factors of pain. In this study, 120 office workers with upper extremity musculoskeletal pain completed the 32-item Workstyle Short Form (WSF) questionnaire. All those with adverse workstyle still reported upper extremity pain at 12 months, compared with only one-third of those with good workstyle. The findings support the assessment of workstyle in workers experiencing pain and of interventions to change workstyle behaviour in ‘at risk’ individuals.

Journal of Occupational Rehabilitation 2008; 18(3): 262–266.

Flour dust exposure

Exposure to flour dust in bakeries, flourmills and ingredient-production plants is caused largely by short-term, sometimes very intensive peak exposures, according to research using real-time exposure monitoring. The findings inform the design of control strategies that take account of worker behaviour; most previous studies focus on eight-hour time-weighted average exposures, which may not be sufficiently sensitive to identify specific task-based exposures, or indeed the effectiveness of control measures.

Annals of Occupational Hygiene 2008 52(7): 587–596.

Back pain RCT

A randomised controlled trial of interventions for low back pain (LBP) in working adults found little additional benefit with manual therapy compared with an assessment and advice-only intervention at three-, six- and 12-months. In total, 134 employees with LBP were recruited from four OH centres in Finland and randomised to three groups: orthopaedic manual therapy (OMT); McKenzie method of mechanical diagnosis and therapy; and ‘advice only’ (45–60 minutes’ counselling by a physiotherapist on good prognosis for LBP, pain tolerance, medication and early return to work, and advice to remain active). The OMT and McKenzie groups showed no consistent treatment effects compared with advice only.

Journal of Rehabilitation Medicine 2008; 40(10): 858–863.

Surgeons don’t follow needlestick protocol

Surgeons responding to an anonymous in-house survey at a 687-bed UK district general hospital (77% response) admitted that they rarely follow agreed protocols in response to a needlestick injury. All consultant, non-career staff grade and registrar grade surgeons were surveyed and 44% admitted to having had a needlestick injury, but only 9% had followed the agreed protocol; 21% ‘simply ignored the incident and continued’. Few of the surgeons described the hospital needlestick policy as user friendly and there was a disparity between the policy and ‘real-life’ surgical practice.

Annals of The Royal College of Surgeons of England 2008; online first: doi: 10.1308/003588409X359213.

Early rehab systematic review

A systematic review found moderate evidence that multimodal vocational rehabilitation reduces the risk of disability pension and that return-to-work programmes decrease sickness absence spells lasting longer than six months. There is weak evidence that multimodal interventions based on medical treatment combined with early vocational rehabilitation increase job and physical wellbeing and decrease sick leave. There is insufficient evidence on the impact of early rehabilitation methods – such as education, counselling and exercise – when applied as the sole intervention.

Journal of Rehabilitation Medicine 2008; 40: 796–804

Cardiovascular risks in emergency responders

A literature review concludes that three-quarters of US firefighters, police officers, and emergency medical services personnel have pre-hypertension or hypertension. Elevated blood pressure is inadequately controlled among these professions, with profound implications for on-duty cardiovascular disease mortality and morbidity. Cardiovascular disease wellness programmes are advocated.

American Journal of Hypertension 2008; doi: 0.1038/ajh.2008.296.