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Author Response
Getting WMSD's in PTs Out of the Closet!
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Marc A Campo, PT, PhD, OCS, Associate Professor Mercy College
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mcampo{at}mercy.edu Marc A Campo, PT, PhD, OCS
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I thank Dr Halloran for the commentary and thoughtful feedback on my article. I agree that work-related musculoskeletal disorders (WMSDs) require much greater attention within our profession. The results of this study may have understated the problem to some extent. There were many therapists who had WMSDs that were just short of the severity cutoff used in the case definition. I hope that this study can serve as a small step forward. Your personal story is not uncommon. Physical therapists appear to be reluctant to take time off or to seek formal evaluation and treatment after the onset of symptoms. They also appear to be too embarrassed to admit or report injuries. With regard to wrist WMSDs, patient handling does exert high biomechanical loads on the wrists and hands. In this sample, however, the therapists who performed low levels of patient handling tended to perform high levels of manual therapy. Because manual therapy imparted a more substantial risk, the effects of patient handling on the wrists and hands were difficult to determine. Patient transfers and repositioning may indeed increase the risk for wrist and hand injuries but less so than manual therapy. Other studies are needed to quantify these risks. The scope of exposure assessment was relatively narrow. There were many potentially risky activities such as facilitation and mat work that were not evaluated. In order to ensure a reasonable response rate, the questionnaire was limited to 4 pages and the response burden was low. It also had to be relevant to therapists in a variety of settings. This precluded evaluation of some very specific activities. Moving forward, studies are needed that look more closely at the work tasks involved in different settings. With regard to treatment and outcomes, it was difficult to quantify the remedies and fixes that therapists used after developing WMSDs because they were not assessed directly. In the questionnaire comments, therapists reported self-treating and seeking informal treatment from colleagues. This was consistent with prior research and your own experiences, but it may not be the best way to address WMSDs.1 In terms of prevention, some therapists in the study cited fitness as an important preventive strategy. Others cited body mechanics. These measures are unlikely to substantially reduce the risks associated with physical therapy work. Only a cultural shift that involves both an honest appraisal of the risks involved with patient care and the use of equipment for high-risk tasks is likely to reduce injury rates. Marras et al2 demonstrated that regardless of lifting technique, the transfer of a lightweight (110 lbs) and cooperative patient resulted in forces that exceeded tissue tolerances in the lumbar spine. The force levels, in some cases exceeded the threshold for vertebral endplate mircofractures. In the clinic, patients are likely to be substantially heavier and not as cooperative. Although the focus of this study was work-related pain and injuries, making the job less physical and less strenuous is another goal. Therapists may leave clinical practice before they get injured because the job becomes too strenuous. Clinicians should be able to pursue full-time clinical work for as long as they wish to. The presence of experienced clinicians in all settings will benefit patients as well as our less-experienced colleagues. References 1 Glover W, McGregor A, Sullivan C, Hague J. Work-related musculoskeletal disorders affecting members of the Chartered Society of Physiotherapy. Physiotherapy. 2005;91:138–147. 2 Marras WS, Davis KG, Kirking BC, Bertsche PK. A comprehensive analysis of low-back disorder risk and spinal loading during the transferring and repositioning of patients using different techniques. Ergonomics. 1999;42:904–926. |
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Susan W. Halloran, PT, DPT
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susyhalloran{at}msn.com Susan W. Halloran
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Thank you for your exceptional study to bring work-related musculoskeletal disorders (WMSDs) in physical therapists out of the closet. It is particularly relevant to my own situation because, after 20 years of providing physical therapy for people with spinal cord and brain injuries, I suffered career-ending ligamentous wrist injuries. I fit the profile of the therapist who was embarrassed to admit an injury, who continued to work after warning signs appeared, who worried about making situations difficult for my patients and colleagues, and who then felt guilt for using the workers’ compensation system. I was passionate about my work, and it was a devastating loss. And, it was a surprise! Somehow I had no idea I was so at risk (back, yes; wrists, no). I thought: this must happen all the time; “someone” needs to know. Regarding the results of your study, I am interested in specifics about the lack of wrist and hand injuries related to transfers and patient handling. Those activities—along with management of abnormal tone, balance, motor paresis, and so forth—are what led to my own wrist injuries. What were the employment settings for the cohort of physical therapists who had wrist injuries related to transfers and handling? Was there a correlation between number of years doing the same job? (And were they obsessively making micromillimeter adjustments in the seating position of their patients with C4 quadriplegia?) Understandably, a study can only be specific about a limited number of variables. The outcome and relevance of your study is important and, I agree, more research is needed, not only to document prevalence of WMSDs, but also to (1) document the benefits of prevention, education, and sensitivity to the physical therapy culture that contributes to WMSDs, and (2) provide specific ways to address how we do what we do. What type of “fixes” are physical therapists with WMSDs getting, and what are the outcomes? (For my wrists: 6 surgeries on the right, 3 surgeries on the left, and a total fusion still on the way, all after conservative measures failed.) In my opinion, screening physical therapists for vulnerability to injury would be helpful; however, what are the implications for physical therapists who are found to be vulnerable? I recently completed my tDPT at Boston University and used this topic for my first paper. I am impressed with your study. Thank you for your excellent publication. Susan W Halloran, PT, DPT |
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