Rehabilitation Ergonomics - Fundamentals and Assessment Tools for Occupational Ergonomics - page 482

22.5 Rehabilitation Ergonomics as Part of a Medical
Continuum

In the 1990s, the focus on return to work outcomes became an important area of research. Pransky's
comprehensive review of the literature categorized the variables that affect return to work. 35 He identified
that work absences were related to a higher preinjury ergonomic risk, a dissatisfaction of the worker with
return to work accommodations and a negative relationship with the worker's compensation insurer. He
also identified an important, but lightly studied variable, that of reduction of reinjury. He concluded, that
the reinjury rates are increased in women with jobs that have both high preinjury ergonomic risk and
high postinjury ergonomic risk, dissatisfaction with work accommodation, negative employer reactions,
dissatisfaction with the medical services and dissatisfaction with low back statistics. Two of these items
relate to the ergonomic risk being either high or a negative perception of work capacity in returning
workers. If workers had high postinjury ergonomic risk, it tended to decrease their perception of capacity.
Feuerstein evaluated clinical and workplace factors associated with the return to modified duty in
upper extremity disorders. 36 The model could predict or classify those not working and those on modi-
fied duty. Increased ergonomic stressors was one of the four primary predictors for those not working.
Return to work should not just be limited to medical and clinical signs only.
Staal performed a descriptive review of return to work interventions for low back pain. 37 Out of the
seventeen studies that he evaluated, only three had ergonomic interventions and none of those had ran-
domized controlled studies. He noted that multi-model treatment consisting of exercise, education,
behavioral training and ergonomics would be the most promising.
Matheson looked at the predictability of functional capacity to identify whether return to work would
take place and at what level. 21 Data on return to work and, specifically, return to work at the original
job original employer, were collected. Functional capacities' items were evaluated for their relationship

to those outcomes. FCE lifts were linked with both return to work and the level of return to work.
In the mid 1990s, Loisel et al. developed the Sherbrooke Model, 38 which postulated that ergonomic
interventions should be used with clinical interventions in return to work. For subjects that had been
off work 6 weeks, this model went into effect. Early and active treatment was part of the regime but,
additionally, ergonomic evaluations and interventions were utilized. In 1997, his randomized clinical
trial indicated that the occupational intervention, which included ergonomics on the job, was an
important component of full case management. 39 The best results were in returning to work and were
accomplished by combining clinical interventions with occupational interventions.
A 6-yr follow-up study in 2002 40 demonstrated that the occupational interventions, combined with
clinical interventions, saved days on benefits and saved costs. In 2003, the group defined a PREVICAP
model, which had three dimensions. 41 It revolved around the worker, the work environment and the
interaction between the work and work environment.
Anema et al. looked at participatory ergonomics as a return to work intervention. 42 Those with low
back pain were studied. Anema acknowledged the use of ergonomics for prevention and added a
study for disability management. When ergonomic suggestions and interventions were developed for
low back pain patients the results were positive. Over half of the ergonomic interventions were
implemented and workers were satisfied with the solutions and reported that they had a stimulating
effect.
Lemstra's (2003) study evaluated one industry in Canada and demonstrated the effectiveness of occu-
pational management. 43 This included a physical therapist onsite using ergonomic reassurance and
encouragement to assist injured workers to be on the job safely. The work was based on the physical
and functional information from the physical therapist and the medical information from the family
physician. This blending of prevention and return to work ergonomics allowed the intervention to
take place sooner, onsite and with professionals known to the workers. Upper extremity and back
injury claims with the new model demonstrated decrease in days lost upto 91%. This was superior to
the traditional medical model of standard care or a regime of clinical physical therapy service.

/