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PubMed1999

Injuries in home health care workers: an analysis of occupational morbidity from a state compensation database.

BACKGROUND: Home health services represent one of the fastest-growing segments of the US economy. Home health care workers (HHCWs) might be expected to have a high incidence and increased severity of injury because of inherent difficulty in control over their work environment, and the limited amount of research on injuries in home health care appears to support this hypothesis. METHODS: Using data on workers' compensation claims for 1995-1996 from a large state database, we calculated the incidence, frequency, and types of injuries occurring in this working population. Comparison data were drawn from nursing home (NH) and hospital-based nursing personnel. RESULTS: An incidence of 52 injuries per 1,000 workers per year was calculated; this rate lies between nursing home workers (132/1,000) and hospital-based workers (46/1,000). The percentage of indemnified (> 3 days lost-time) injuries was increased over those occurring in nursing home personnel. Mean number of days lost from work by home health workers was 44, significantly increased from the average 18 and 14 days lost by NH and hospital nursing workers, respectively. Mean indemnity payment was $1,523 and mean medical costs were $1,276 per injury. Permanent partial disability awards were made to 19 (4.9%) of the injured HHCWs during the 2-year study period; back injuries accounted for 63% (12) of these awards. Overexertion injuries and falls accounted for 63% of total injuries in this group of workers, while 13.5% occurred as a result of motor vehicle accidents. The incidence of injury attributed to motor vehicles in HHCWs was 7 per 1,000 workers per year, an order of magnitude greater than in NH and hospital workers. CONCLUSIONS: These data indicate that injuries to HHCWs, though less frequent than in their nursing home counterparts, result in greater lost time from work and accompanying costs, which may indicate greater severity of injury. Characteristics of home health work, including increased intensity and speed of work, adverse working conditions, and the necessity of motor vehicle transportation as a condition of work may be contributors to injury in this setting. Further investigation of determinants of accidents and injuries in home health care, both in the actual setting where the work takes place and in the way it is structured, is warranted.

Accidents, Occupational↗
PubMed2001

Impact of chronic low back pain on military service.

The performance of 245 male conscripts with chronic low back pain (CLBP) during military service was compared with their pre-conscription performance and with that of 126 age-matched male controls without low back pain (LBP). The frequency of LBP in the conscripts with CLBP increased significantly during their service period compared to risk before service (odds ratio, 10.35; 95% confidence interval, 3.61-29.52). The same factors that induced LBP before entering service, mainly lifting and carrying, also caused LBP during military service. Of the conscripts with CLBP, 120 had experienced an accidental back injury and 125 had injured their backs during lifting or carrying before entering service. During service, back problems were caused by accidents in 88 cases and by lifting or carrying in 157 cases. The frequency of LBP injuries, measured as the need for medical consultation or treatment, increased 2.4-fold (95% confidence interval, 1.41-4.10) during the term of service. Conscripts with CLBP served significantly more frequently as ordinary soldiers than the controls. There was no difference in participation in leisure time or competitive sports activities between the two groups. The future expectations of the CLBP conscripts were pessimistic: only one-fifth believed in complete recovery, and two-fifths thought that they would need substantial outside help in the future.

Adolescent↗
PubMed1986

Prediction of overexertion injuries using biomechanical and psychophysical models.

This paper summarizes a three year epidemiological study conducted in five large industrial plants in order to evaluate the validity of two alternative modeling approaches to overexertion injury prediction. Detailed biomechanical and psychophysical job evaluations were performed for 55 industrial jobs comprised of 2934 potentially stressful manual materials handling tasks. The medical experiences of 6912 incumbent workers were monitored retrospectively for two years and prospectively for one year to establish a data base for comparison of the different models. The results show that each of the models can be used to predict both the incidence and severity of certain overexertion types of injuries such as contact, musculoskeletal and back injuries. The application of these models to identify or design administrative and engineering controls, however, may be limited as a result of the inherent correlation between the available indices and multifaceted jobs.

Accidents, Occupational↗
PubMed2006

Movement-based feedback may reduce spinal moments in male workers during lift and lowering tasks.

BACKGROUND AND PURPOSE: To assess if lifting performance can be modified and spine stresses reduced in workers who perform repetitive material-handling jobs in a warehouse environment via a novel real-time, movement-based feedback training protocol. METHOD: A pre-test/post-test group study design was used with a control group. Data were collected in a warehouse setting and analysed in a university setting. A convenience sample of 22 male warehouse employees was divided equally, based on height and weight, and assigned to either an experimental group or a control group. The experimental group received real-time, performance-based auditory feedback from their calculated moments during lifting or lowering using an electromagnetic tracking system. The electromagnetic tracking system was used to measure the side-bending, flexion and rotation moments during six lifts under four different conditions. A series of repeated-measures analyses of variance (ANOVA) (one between (Group); one within (Time)) was performed on the average maximum moments from six lifting or lowering cycles for all three directions: side-bending, flexion and rotation. RESULTS: There were significant group x time interactions for the side-bending moment (p < 0.05) and the flexion moment (p < 0.05) but not the rotation moment (p > 0.05). Lower moments were found in the experimental group, which received the training and feedback, compared to the control group. CONCLUSIONS: Real-time, auditory feedback combined with coaching during lifting or lowering tasks may be effective in the short term (six weeks) in reducing the average maximum side-bending and flexion moments in warehouse workers. Further research is needed to determine the long-term effects of this training protocol on low back injury rates.

Analysis of Variance↗
PubMed1998

Whole-body vibration and health effects in the agricultural machinery drivers.

Recently farm mechanization has been widespread and developing rapidly, in particular riding farm machines are increasingly used in paddy fields in Japan. We have no information available on the actual situation regarding whole-body vibration on the seats of these farm machines from the standpoint of labour protection. Measurement and evaluation of whole-body vibration was performed on the seats of popular riding agricultural machineries. Whole-body vibration on the seats of combine harvesters and wheel tractors exceeded exposure limits and the fatigue-decreased proficiency boundary limit of 8 hr and also shortened the reduced comfort boundary limits of ISO 2631 (1985). Some combines, tractors and carieers had only less than one hour exposure duration as compared with the ISO 2631-1 standard (1997). On the other hand a questionnaire was also performed on the subject of agricultural machine operators. Any specific injury or other effects, i.e. low back injuries were not found among the group of operators as compared with those in non-operator farmers. It seems to be difficult to find out the health effects of whole-body vibration itself, because there may be a lot of causes, i.e. working posture, operating heavy materials, in farm working conditions.

Adult↗
PubMed1997

Injuries to elite rowers over a 10-yr period.

The purpose of this study was to analyze retrospectively all injuries occurring in a population of elite rowers over a 10-yr period to determine their pattern of injury. The medical records of all rowers at the Australian Institute of Sport from 1985 to 1994 inclusive were reviewed and all injuries included. Injuries were categorized according to time, location, cause, and whether acute or chronic. The study found a significant incidence of chest injuries, rib stress fractures, and low back injuries, and a high number of injuries occurring outside specific training. Elite rowers have little risk of major injury, but mild and moderate injuries are common.

Athletic Injuries↗
PubMed2005

Golf injuries of the upper extremity.

Golf has demonstrated increasing popularity and with this heightened enthusiasm has come an increased awareness of the significant number of injuries associated with playing golf. While back injuries represent the most commonly injured specific body part, upper extremity injuries are most frequent overall and the most likely to result in loss of play. Patterns of injury differ based on level of play and time spent playing or practicing golf. Among golf professionals, the hand/wrist is the most commonly injured upper extremity structure. Among amateurs, the elbow is most commonly injured. The vast majority of upper extremity injuries are due to overuse. Age, ability, equipment, and swing mechanics also play contributing roles. Most upper extremity golf injuries can be successfully treated with appropriate cessation or modification of play, anti-inflammatory modalities, and rehabilitation. Surgical treatment is rarely required, but if needed can prove successful in a high percentage of patients.

Carpal Bones↗
PubMed1995

Injury surveillance at the USTA Boys' Tennis Championships: a 6-yr study.

Injuries that required physical or medical assistance were recorded for participants at the United States Tennis Association National Boys' Tennis Championships from 1986-1988, 1990-1992 (N = 1440, 240 athletes per year). Over the 6-yr period, a total of 304 athletes (or 21.1%) sustained new or recurrent injuries that required evaluation by the medical team. New injuries alone numbered 145 (incidence rate of 9.9 per 100 athletes). The analysis of injuries showed a higher rate of lower than upper extremity injuries. When evaluated by anatomic regions, back injuries were most common followed by thigh, shoulder, and ankle injuries, respectively. When evaluated by injury type, strains and sprains were most common (71% of all injuries) with fractures and dislocations being rare (1.3% of all injuries). The lower extremity provided the majority of sprain type injuries with 87.5% of ligament sprains coming from the knee and ankle. Injuries with tennis eponyms (i.e., tennis toe, tennis leg, tennis elbow, and tennis shoulder) were rare (0%-5% of all injuries). It would appear that these young elite athletes are at significant risk of injury.

Adolescent↗
PubMedDate not supplied

Evaluation of a hidden occupational healthcare risk: the portable X-ray.

In 2002, the services industry, of which healthcare is a part, led the US in nonfatal injuries by industry division with 27.3%. Health services--Standard Industrial Classification (SIC) code 80--was the primary contributor, with more than 623,000 recordable cases. Hospitals (SIC code 806) led the total number of cases and incidence rates of nonfatal occupational injuries and illnesses for industries with more than 100,000 reported cases, with more than 321,000 cases and an incidence rate of 9.7. In particular, back injuries associated with patient care were identified as a leading injury associated with healthcare incidents. This study focuses on the portable radiograph (x-ray). The tasks required to place and position the cassette beneath the patient offer similar risk factors as a typical patient transfer. The study includes a literature review, process mapping, staff involvement, and a technical evaluation of options to consider that may reduce the exposure. The 3 techniques that registered the highest in the force to place the cassette were the pillowcase around the cassette, the plastic slider sheet around the cassette, and the "typical" placement, respectively. The techniques that used additional staff to roll or lift the patient registered the lowest amount of force for the cassette placement. Initial analysis of this data reveals that there is the potential for risk to staff members'shoulders and upper torsos when performing portable chest x-ray procedures. The study revealed that further research into safer techniques and devices is warranted, as incidents have been reported, yet no associated published research was identified to offer advice on the topic of portable x-ray ergonomics.

Back Injuries↗
PubMed2003

Decreasing back stress in home care.

Although back injuries are a significant problem in home care, limited information exists regarding which tasks are stressful and how stress can be reduced. This study describes home health aides' perceived stressfulness to the back and provides ideas all home care workers can use to decrease back stress.

Adult↗
PubMedDate not supplied

Workplace risk factors and occupational musculoskeletal disorders, Part 1: A review of biomechanical and psychophysical research on risk factors associated with low-back pain.

Injuries and disorders caused by overexertion and repetitive motion are the leading causes of compensable lost-time cases in the United States. Epidemiological and laboratory-based research methods have been used to evaluate the significance of various risk factors associated with overuse injuries and disorders. The National Institute for Occupational Safety and Health performed a comprehensive review of over 600 epidemiological studies in 1997 and concluded that there was evidence of a causal relationship between low-back injuries and disorders and workplace exposures to forceful exertions, awkward posture, and vibration. Although epidemiological studies provide important insights to understanding the causes of work-related overuse disorders, they are sometimes criticized for their inability to measure precisely how people respond to specific risk factors found in the workplace. This article presents a review of recent laboratory studies and biomechanical models of work factors believed to be associated with increased risk of low-back injuries and disorders. Biomechanical models and laboratory studies do not replace epidemiological studies. However, these approaches provide important complementary information that is needed to understand the complex process of how exposures to physical risk factors result in strain that may ultimately lead to injury or disease. These studies also provide important insights as to how people react and respond to specific physical risk factors found in the workplace. Combined with epidemiological research, laboratory studies are an essential element in understanding the causes and prevention of work-related overexertion injuries.

Back Injuries↗
PubMed1989

Bone scintigraphy in the evaluation of ejection injuries.

The Royal Air Force (RAF) experience on local back injury with all ejection seats is that 50% have vertebral fractures on radiographic examination, with or without symptoms. These aviators are placed under the care of an orthopedic specialist and restricted from flying duties for 3 months or more. About half of the remainder demonstrate positive bone scans. Until recently, RAF policy was to treat these individuals the same as those with radiographically defined fractures. The author recommends this group of pilots be examined by orthopedic surgeons, and reviewed annually to assess long-term sequelae. Meanwhile, if asymptomatic, they are allowed to return to flying duties. The RAF recently incorporated most of these recommendations into a policy change.

Aerospace Medicine↗
PubMed1999

Delayed diffuse upper motor neuron syndrome after compressive thoracic myelopathy.

A 54-year-old man developed progressive spastic paraparesis beginning 2 weeks after a back injury caused by a subacute compressive thoracic myelopathy attributable to a post-traumatic arachnoid cyst. Three to 18 months after surgical decompression of the thoracic arachnoid cyst, the patient developed a diffuse predominantly upper motor neuron syndrome characterized by spastic quadriparesis, pseudobulbar paresis, and pseudobulbar affect. Retrograde corticospinal tract degeneration and upper motor neuron death after spinal cord injury is recognized. This case suggests that focal upper motor neuron injury can occasionally precipitate diffuse upper motor neuron dysfunction.

Arachnoid Cysts↗
PubMed1994

Liver abscess following blunt trauma: a case report and review of the literature.

We report a case of Haemophilus paraphrophilus causing primary liver abscesses after blunt nonpenetrating trauma. A 32-year-old previously healthy white man sustained a back injury 2 months prior to admission with fever, chills, and night sweats. A computed tomography (CT) scan-directed needle aspirate of several hypoechoic hepatic lesions grew H paraphrophilus. Recent blunt trauma to the lower back may have contributed to the localization of this infection to an area of contusion or hematoma within the liver, followed by an episode of bacteremia that seeded the injury.

Adult↗
PubMed1994

Relationship of performance on the ERGOS work simulator to illness behavior in a workers' compensation population with low back versus limb injury.

A prospective blinded cohort study was performed to test for a difference in the pattern of physical activity factors measured with the ERGOS work simulator in subjects with low back injuries versus those with limb injuries. Also tested was the relationship between physical activity factors measured with the ERGOS and several psychological tests and measures of nonorganic pain behavior in subjects with low back pain. Subjects were 70 men, 22 to 64 years old, who attended a 2-week physical capacity assessment after undergoing rehabilitation for a work-related injury. In subjects with a complaint of low back pain, nonorganic pain behavior was measured with the Waddell score. In addition, two brief psychological tests, the Coopersmith Self-Esteem Inventory and analog self-rating of wellness, were administered. It was found that subjects with low back complaints underperformed globally in comparison with subjects with limb complaints. This underperformance was statistically significant (P < .05) for 7 of 13 strength variables and 2 of 7 dexterity variables. In the subjects with low back complaints, those who exhibited excessive illness behavior (Waddell score, 3 to 5) performed significantly worse on all 13 strength variables and on 3 of 7 dexterity variables. In the subjects with low back complaints, those with low self-assessment ratings were found to have a high Waddell score (P < .01) and to perform significantly worse (P < .05) on 12 of 13 strength variables and 6 of 7 dexterity variables. There were no significant relationships (P > .05) between Coopersmith Self-Esteem score and Waddell score or performance on ERGOS testing.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2005

Transfer of the horizontal patient: the effect of a friction reducing assistive device on low back mechanics.

Recognizing that the transfer of bedridden patients is associated with a high rate of low back injuries, various devices have been developed to assist with sparing the patient handlers. The purpose of this study was to quantify the friction-reducing ability of three different 'sliding' patient transfer devices together with the subsequent consequences on the low back loads of people performing the transfers. Coefficients of friction of the devices were determined by 'transferring' a standard object and a 'patient' over several surfaces common to a hospital setting. Then three participants performed controlled transfers with the various devices. Electromyography to measure muscle activation levels together with external forces and kinematic positional data were collected during push, pull and twist transfers. Spine loads were estimated with a three-dimensional biomechanical static link-segment model of the human body. Simply sliding a patient on a cotton sheet (control condition) produced a coefficient of friction of 0.45. The assistive devices substantially reduced friction by well over one-half (coefficients of 0.18 - 0.21). However, when using the devices the subjects adopted a variety of postures and techniques, such that there were no consistent influences on trunk inclination, low back compression or muscle activation profiles. Direct measurement of reduced friction between the bed and the patient with a friction-reducing device together with measurement of the back loads when actually transferring a patient formed a proof of principle. Specifically, while the device lowers friction, the transfer technique adopted by the lifter must be proper to reduce low back loading and any subsequent risks of back troubles associated with patient transfers. The direction of hand forces and torso position remains important.

Adult↗
PubMed2004

Workplace design guidelines for asymptomatic vs. low-back-injured workers.

While numerous efforts have attempted to provide quantitative guidelines for the prevention of initial low back disorders during material handling tasks, none have appeared in the literature that address the issue of recurrent low back disorders due to materials handling when returning to the workplace. A study comparing the spine loads of low back pain patients and asymptomatic controls was conducted. Subjects lifted weights varying from 4.5-11.4 kg at four vertical heights, two horizontal distances and five task asymmetries collectively representing common industrial lifting situations. Spine loading was calculated using a validated EMG-assisted biomechanical model. Spine loads observed during lifting tasks were compared to spine tolerance values believed to initiate low back injuries. In addition, the percentage of patients successfully performing the lift was noted and used as an indication of the willingness of the subject to perform the task. These evaluations are summarized in a series of three lifting guidelines indicating safe, medium risk and high risk lifting tasks for low back patients as well as asymptomatic workers. It is believed that adherence to these guidelines can minimize the risk of recurrent low back disorders due to occupational lifting.

Back Injuries↗
PubMed1984

Assessment of workers' compensation claims for back strains/sprains.

Workers' compensation claim data for 1979 obtained from the Bureau of Labor Statistics' Supplementary Data System (SDS) were utilized to examine the demographic and occupational incidence of back strains/sprains among U.S. industrial employees covered by state compensation systems. These data were combined with estimated employment figures to provide incidence ratios, which allowed better approximations of industry- and occupation-specific risk. Industries found to have the largest incidence ratios were construction (1.6 claims/100 workers) and mining (1.5 claims/100 workers). Occupations with the largest ratios were miscellaneous laborers (12.3 claims/100 workers) and garbage collectors (11.1 claims/100 workers). The 285,468 compensation claims due to back strains/sprains filed in the 26 SDS states in 1979 suggest that back injuries continue to be a large and costly problem for U.S. workers and their employers.

Adolescent↗