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Ergonomic and psychosocial factors affect function in workers with upper extremity disorders.

At a glance:
165 government employees who were off work and had a compensation claim accepted for a work-related hand/arm or shoulder condition were part of this study. After controlling for the effects of pain and gender, factors associated with greater functional limitation were:
  • Having upper limb
    upper limb
     symptoms other than pain (e.g. disturbed sleep, numbness, tingling)
  • Having symptoms in one or both hands
  • Feeling overwhelmed by pain
  • Low confidence in problem solving abilities
  • Higher exposure to ergonomic
    Designing activities and the workplace in a way to minimize discomfort. i.e. Adapting work tasks, hours, or workstation to accommodate people. An ergonomic computer workstation allows the person to work in the best position to relieve load on the muscles of the neck and arms.
    Injury to a muscle in which the muscle fibres tear or become irritated as a result of overstretching or wrenching
     at work
These results suggest that to improve function, interventions
A treatment or management program. Interventions often combine several approaches. In this field approaches include training in problem solving, adaptation of work duties, graded activity, an exercise and stretching program and pain relief.
 should teach pain coping and problem solving techniques and reduce exposure to ergonomic risks in the workplace.

Hand and arm soreness are common conditions. In some situations people have difficulty performing their normal activities. This study shows many factors influence peoples' ability to function. How bothersome the symptoms are makes a difference. However other factors such as a person's confidence in their ability to manage make a bigger difference.

Understanding the condition and learning how to manage the condition are important if you have arm pain. Improving workplace ergonomics can also help you function. Ask your doctor or treating health practitioner about what you can do to improve things. Approaches that have helped other people include arm exercises, learning how to deal with stressful situations such as deadlines, communicating about workplace concerns, and modifying the way things are done.

This study shows that an employee's return to work is influence by their pain. However more significant influences were their confidence in their ability to manage the problem, and the workplace ergonomics.

Employers can make a significant difference. The following can be done by the employer to help return to work.

1. Assess the workplace ergonomics or workstation layout and make relevant changes

2. Meet with the person and assess any workplace stresses that may be contributing. Issues such as job deadlines that create high volumes of work under pressure, workplace tension, and low job control can be modified

3. Does the person feel they understand the problem, are they worried and unsure about their future. If so encourage them to get advice so they understand the problem and what they can do to manage their problem.

4. Feeling overwhelmed by pain also reduces an employee's ability to function with a hand or arm condition. Support counselling for an injured employee to help them learn to cope with their pain and use problem-solving to overcome their limitation.
This study investigated which factors contribute to functional limitation in patients with hand and arm conditions. Factors other than pain explained twice as much variance in functional ability than was explained by pain alone. The factors that contribute to functional limitation were:
Non-pain related upper limb symptoms

Hand problems (greater than other upper limb)

Feeling overwhelmed by pain

Low confidence in problem solving abilities

Greater exposure to ergonomic risk at work
Therefore, treatments to improve function should include:

Pain coping techniques and active problem solving to overcome functional barriers

Reduction of workplace ergonomic risk factor

Consider ways of helping patients improve their coping skills. Contact the workplace to suggest ways to reduce ergonomic risk. If necessary conduct a work site visit and suggest specific changes.
This study suggests that interventions can help employees with hand and arm pain increase their ability to function even if their pain is not reduced. Treatment to improve ability to function in people with hand or arm conditions should include:

Pain coping techniques and active problem solving to overcome functional barriers

Reduction of workplace ergonomic risk factors
Encourage employers to review the overall situation. There is often an expectation medical treatments will sort out arm problems. For non specific arm pain medical treatments do not make a significant difference. The employer is in a strong position to help the employee by reviewing the:

Ergonomics of the job

Workplace relations

Job factors
Original Article, Authors & Publication Details:
W. S. P. Shaw1, M. P. Feuerstein2, A. E. S. Lincoln3, V. I. M. D. Miller4 and P. M. R. N. Wood4 (2002).

Ergonomic and psychosocial
Refers to psychological and social factors. Examples of psychosocial factors that affect return to work area include: a person's beliefs about how they will cope with their condition, the attitude of the inured worker's family to their condition and return to work, the employer's return to work policy and the influence of the WorkCover system on a person.
 factors affect daily function in workers' compensation claimants with persistent upper extremity
arm (upper extremity) or leg (lower extremity)
. Journal of Occupational & Environmental Medicine; 44(7):606-615.

1From the Liberty Mutual Center for Disability Research, 71 Frankland Road, Hopkinton, MA 01748
2Georgetown University Medical Center and The Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814
3The Johns Hopkins University Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205
4 US Department of Labor, Office of Workers Compensation Programs, 200 Constitution Avenue NW, Room S-3522, Washington, DC 20210
Background, Study Objectives, How It Was Done:
Work related upper limb conditions can cause significant distress
Severe suffering, pain, anxiety or sorrow
 and disability
A condition or function that leaves a person unable to do tasks that most other people can do.
 to workers. Pain and other symptoms such as disturbed sleep and muscle fatigue can affect a person's ability to perform work duties and other tasks. Identifying factors that contribute to a person's limitation of function can help us to design treatments to improve function.

Pain is not the only factor that limits ability to function in people with upper limb conditions. Individuals with a similar severity of pain report varying difficulty performing daily activities at work and home. This varying ability to function may be due to factors such as having symptoms other than pain, general health, pain coping skills, problem solving, distress and workplace factors.

This study aimed to determine which factors contribute to limiting a person with an upper limb conditions functional ability.

165 US government employees who were unable to work due to a work-related hand or arm condition, and who had recently had a workers' compensation claim accepted, were included in the study. Eligible workers were identified from the US Department of Labor Office of Workers Compensation database
Store of information (e.g. published research articles). Information can be retrieved by searching (e.g. for key words, authors, or titles).
 over a two year period and sent a letter inviting them to participate in the study.

After agreeing to participate, the workers completed a questionnaire that included questions about symptoms, ability to function, work conditions, work style, problem solving, medical history and distress. To determine each workers ability to function the Upper Extremity Functional Scale was used, which asks them to rate the level of difficulty they have in performing 12 activities (on a scale of 1 to 10). To determine how much ergonomic risk the worker was exposed to at work they were asked about how often and for how long each day they performed certain work tasks.
Study Findings:
Participants varied in age (26 to 69 years) job type and years worked at their job (<1 to 33). The most common diagnosis
The process of identifying a medical condition or disease by its symptoms, the findings from a medical examination, and from the results of various diagnostic procedures.
 was carpal tunnel syndrome.
Carpal Tunnel Syndrome
A condition characterized by pain and numbness in the hand and sometimes the forearm. It is caused by pressure on the nerve which connects the arm to the hand (through the carpal tunnel) and gives sensation to the hand, thumb and three fingers
 and most participants reported symptoms in the hand or wrist. 70% of participants had undergone surgery by the time the survey was completed.

Pain explained only 16% of the variation in functional limitation. Participants had most difficulty opening jars, carrying a milk jug from the refrigerator and least difficulty sleeping and washing dishes. Females reported more severe limitation than males, but there were no differences between different job types, whether the worker had had surgery, or the type of diagnosis. Participants who reported hand/wrist or elbow involvement were most limited in function.

Functional limitation correlated better with the full range of symptoms associated with upper limb disorders (including difficulty sleeping, numbness and tingling etc.) than to pain alone. Greater functional limitation was also associated with:

Feeling overwhelmed by pain
Feeling less able to apply problem solving strategies
More physical exertion at work
More ergonomic risk at work
Finding treatment less helpful

There was a high correlation between greater physical exertion at work and greater ergonomic risk. More confidence in problem solving was associated with better mental health
mental health
Emotional wellbeing. Ability to cope with difficulty and enjoy life. THe absence of a mental health problem.
 and less physical exertion at work.

After controlling for gender and pain severity, an additional 27% of variance in limitation of function can be explained by the following factors:

Having symptoms associated with upper limb disorders (20% of variance), especially
  • Reduced grip strength
  • Length of individual pain episodes
  • Disturbed sleep
Feeling overwhelmed by pain and confidence in problem solving ability (5% of variance)

Exposure to ergonomic risk in the workplace (1% of variance)
This study investigated work-related upper limb pain and functional ability in workers from various occupations, but within the same workers compensation system. The level of discomfort and limitation to functional varied widely between participants. Factors other than pain explained twice as much variation (31%) in upper limb function than were explained by pain alone (17%).

The factors that contribute to functional limitation were:

Non-pain related upper limb symptoms
Hand problems (greater than other upper limb)
Feeling overwhelmed by pain
Low confidence in problem solving abilities
Greater exposure to ergonomic risk at work

Trying to integrate these factors with medical treatment for upper limb conditions may improve outcomes for the patient.

As feeling overwhelmed by pain and low confidence in coping skills are associated with poor ability to function, coping with pain through active problem solving is important for rehabilitation.
The process of helping a person back to their former abilities and quality of life (or as close as possible) after injury or a medical condition.
 For those with confidence in their ability to overcome adversity in life through problem solving, a work-related upper limb condition may be seen as a surmountable problem rather than an affliction that will change their lives forever. General health status, including mental health, is not associated with ability to function, suggesting that upper limb functional limitation is not merely a reflection of general psychological
Refers to a person's perceptions, thought processes, emotions, personality and behaviour. Psychologists can treat mental health problems.
 health but rather pain-specific distress and coping.

Integrating workplace and individual factors with medical treatment can be challenging, but may be an effective way to improve function in people with work-related upper limb problems. Treatments to improve function should include:

Pain coping techniques and active problem solving to overcome functional barriers
Reduction of workplace ergonomic risk factor
PubMed Abstract

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