Work-related upper limb disorder:- An investigative study

The primary aim of occupational health staff within a manufacturing company is to ensure the health and well being of the employees are safeguarded. The aim may be difficult to achieve as it goes directly against the ethos of business, i.e. making money. It is the researcher's experience that company owners, especially Far Eastern owners, are disinclined to introduce health and safety measures that cost money. The study is conducted in an electronic company (Company X) in the northeast of England, owned by foreign nationals. Retrospective examination of accident, sickness and absenteeism records reveal that work-related upper limb disorder (WRULD) is apparent and upper limb discomfort is a significant problem in Соmpany X. Research shows that the principle of job rotation tends to reduce fatigue and the incidence of WRULD, consequently sickness and absenteeism and labour turnover will also be reduced. In Company X physiological stress to the limb is highly relevant to the production line workers, based on case studies of employees with work-related upper limb disorder. This led to conducting a study of two sites building different electrical equipment. 80 employees participated in the study which involved monitoring the employees on six paced production lines in the Personal Computer Monitor factory PCM which included seven teams and employees in five teams on four production lines in the Microwave Oven Factory. A semi paced line, the Bent Tool Machine BTM in MWO were also involved in the job rotation experiment. Discomfort scale measurements were administered to all that took part and an extra objective measurement of grip strength was provided by the employees in the BTM to provide information on fatigue. A comparison between grip strength and discomfort was analysed for any con-elation. The main data collection took place between September and December 2000.There is some evidence that the differences in discomfort is caused by job rotation as where job rotation was taking place the employees in the study had lower levels of discomfort than those on non- rotational duties. In the CDT prep job PCM where job rotation was taking place a comparison between job rotation and the non-rotation group with regard to discomfort in body parts differed (Fisher's exact test, p=0.05).The job action analysis that was designed specifically for the production line environment allowed comparisons of upper limb score for different jobs. It would appear that regular job analysis should be introduced as a matter of practice in Company X in the future. The study demonstrated the importance of prevention and innovation ergonomics and there was evidence to suggest that the occupational health department should adopt an active role in the future for the benefit of the employees and the financial survival of the Company

Evidence Synthesis of Shoulder Pain Among Canadian Firefighters

Injury or degeneration of rotator cuff tendon leads to rotator cuff disease (subacromial impingement syndrome and rotator cuff tears). Shoulder pain – pain in the upper arm close to the deltoid muscle insertion has been reported as the most common symptom for subacromial impingement syndrome and rotator cuff tears. However, the current state of evidence on treatment effectiveness of rotator cuff disease is indeterminate. The shoulder function is essential for many of the physically demanding tasks that firefighters perform on the fire ground. For fire services and firefighters, the preservation of active duty is critical for their continued service to their communities. However, the prevalence of shoulder pain among Canadian firefighters has not been synthesized. Further, high quality randomized clinical trials (RCTs) provide the highest level of evidence and assist in clinical decision making. The International Committee of Medical Journal Editors (ICMJE) recommendation of RCT trial registration in public trials registry has been made to improve the reporting, transparency, rigor and reproducibility in RCTs. However, there is a paucity of evidence on the proportion of RCTs with proper trial registrations in the field of rehabilitation therapy. Therefore, the purposes of this thesis were 1) to assess the effects of arthroscopic versus mini-open rotator cuff repair surgery on function, pain and range of motion at in patients with rotator cuff tears; 2) to quantify the effects of surgical vs conservative interventions on clinical outcomes of pain and function in patients with subacromial impingement syndrome; 3) to assess the prevalence of musculoskeletal disorders (MSDs) among Canadian firefighters, 4) to examine the proportion of RCTs that were reported to have been prospectively, retrospectively registered or not registered in the field of rehabilitation therapy, and 5) to use the synthesized evidence to inform the design of a single center (fire-station), investigator-blinded, randomized, 12-month, parallel-group, superiority trial for the evaluation of the efficacy of a shoulder exercises on clinical outcomes in firefighters with shoulder pain. From the existing literature, we found evidence that both arthroscopic and mini-open techniques to rotator cuff repairs with post-operative rehabilitation exercises were effective in improving clinical outcomes of function, pain and shoulder range of motion in patients with rotator cuff tears. However, the between-group differences in outcomes were too small to be clinically important. The effects of surgery plus physiotherapy (exercises) vs physiotherapy (exercises) alone on pain and function were too small to be clinically important at 3-, 6-months, 1-, 2-, 5- and ≥ 10-years follow up. This further highlighted that rehabilitation exercises be considered as the first treatment approach in patients with shoulder pain. We also identified high point-prevalence estimates (1 in 4 firefighters) of shoulder-, back-, and knee-related MSDs among Canadian firefighters (shoulder pain was 23%). Our review study indicated that fifteen years after the introduction of standards for RCT registration by ICMJE, only one-third of the RCTs in the field of rehabilitation therapy were prospectively registered. Subsequently, the emergence of further evidence (observational studies in firefighters and RCTs in active-duty military personnel) indicating the clinical effectiveness of occupation-specific rehabilitation exercises along with our evidence syntheses provided the rationale for the design and conduct of an RCT to assess the effectiveness of firefighter-specific rehabilitation exercises among Canadian firefighter with shoulder pain