ARTICLE #15: A WORKPLACE EDUCATION PROGRAM THAT PREVENTS NECK AND BACK PROBLEMS, AND LIMITS RE-INJURY
The source of this article is RTWKnowledge.org
At a glance:
This study evaluated the effectiveness of Vocational Oriented Medical Rehabilitation
(VOMR). Aircraft maintenance workers are a high-risk group for back and neck
problems, their job involves constant bending and twisting. VOMR showed good
results in reducing severity of pain, days on sick leave, and in decreasing
limitation of function over five years.
PERSPECTIVES:
Employee
If you work in awkward or fixed posture positions for long periods you are more
likely to experience soreness in the neck or back.
This study shows that learning how to alter posture and using stretching exercises improve outcomes and prevents reinjury.
A lot of research has shown that the best way to prevent back problems or reinjury is to improve general and back fitness. This study supports these conclusions and indicates that changing posture regularly while keeping the muscles active and strong improves outcomes.
Talk to your employer about what can be done to enable changes in posture and mobility if your job requires long periods in a fixed or awkward posture.
Employer
Some employees work in awkward positions for long periods of the day. This study
shows that people can be taught how to improve the situation, i.e. by learning
about the difficulties of awkward postures, improving fitness, and being given
the opportunity to change posture regularly.
Productivity is improved when such an education program is implemented.
Does your workplace have people doing difficult jobs for long periods? If so, involving a professional in setting up an appropriate education program and reviewing tasks can pay long-term dividends.
Treater
The best way to prevent recurrent spinal problems is to have a fit and active
spine.
This study demonstrates that people can be taught to self manage, and reduce musculoskeletal problems. The employees in this study undertook long periods of tasks requiring an awkward posture. When they were encouraged to improve their general level of fitness and flexibility and to change posture regularly, outcomes improved and pain was reduced.
Encouraging fitness and activity is an important part of managing musculoskeletal and spinal problems.
Insurer
People who have had a problem with their back often experience a recurrence.
Teaching people how to self manage carries the best chance of preventing further
injuries. This study shows that even people who undertake tasks requiring an
awkward posture can be shown how to manage the situation and reduce longer term
problems, by changing postures and position regularly and improving fitness.
Original Article,
Authors & Publication Details:
K. Holopainen1, N. Nevala2, P. Kuronen3, J. P. A. Arokoski4 (2004)
Effects of vocationally oriented medical rehabilitation for aircraft maintenance personnel – A preliminary study of long-term effects with 5-Year follow-up. Journal of Occupational Rehabilitation; 14(4):233-242
1Finnish Institute
of Occupational Health, Helsinki, Finland.
2Finnish Institute of Occupational Health, Kuopio, Finland.
3Headquarters of the Finnish Air Force, Tikkakoski, Finland.
4Department of Physical and Rehabilitation Medicine, Kuopio University Hospital
Kuopio, Finland.
Background, Study Objectives, How It Was Done:
Developed in Finland for workers in various industries, Vocational Oriented
Medical Rehabilitation (VOMR) is a program to help people actively recover from
workplace injury.
The aim of this study was to characterize poor work techniques in Finnish Air Force machinists and determine the effect of the VOMR program on their physical capacity, symptoms and perceived work ability at six months and five years after the course.
Participants:
The Finnish Air Force was chosen for this study as machinists work in uncomfortable postures for long periods and are typically not taught correct techniques for minimizing strain. Twenty male air force workers were included in the study. They had worked for an average of 15 years in their profession, and had been at least 3 years in their current position. All participants had been on sick leave (less than 60 days) due to musculoskeletal symptoms (back or neck pain) in the last two years, but had no other medical condition and wanted to continue working. All of the subjects participated over the entire five year study period.
VOMR course:
The rehabilitation course consisted of physical exercises and training in how to minimize discomfort and strain at work (ergonomic techniques). It aimed at teaching participants about their physical functioning, to encourage them to exercise regularly and increase their strength and flexibility whilst improving their mental and physical health.
Participants were trained in groups of 10, in two rehabilitation periods. The first for 12 days, and then for 5 days six months later. The course was taught by a team of health professionals, including a physiotherapist; psychologist; physician; physical trainer; an ergonomics instructor; a social worker and a nurse.
Postures:
Each machinist's work postures analyzed by a computer program after being videoed working the three daily tasks of working under the plane, checking the flight deck and working with the engine. By dividing the work postures into different classes and estimating the weight of the load or the amount of force used, the degree of harmfulness to the musculoskeletal system (back, neck, arms and legs) can be estimated. The degree of potential problems from the job was ranked in four categories:
1. Normal posture – no need for corrective measures
2. May cause problems dash; corrective measures needed in the near future
3. Likely to cause problems dash; corrective measures needed as soon as possible
4. Very likely to cause problems – corrective measures needed immediately
Questionnaires:
The patients completed a questionnaire one month before each rehabilitation period and five years after the completion of the rehabilitation course. They rated how severe they felt their pain was, and the level of physical and mental strain they felt at work. They were asked how many times they had visited a doctor or physiotherapist, and how many sick days they had taken due to their injury in the last six months. They were also asked how often they did vigorous exercise (e.g. jogging, cycling) in their own time and how often they took exercise breaks at work.
Measurement of physical capacity:
During each rehabilitation period the subjects' physical fitness (oxygen uptake/heart rate vs workload), strength (lifting weight/bodyweight) and flexibility (range of motion) were measured. The tests were carried out by the same health professional in both periods.
Study Findings:
Postures:
• The machinists
worked most of the time in a bent posture.
• They worked with a twisted back:
- 66% of the time when working under the plane.
- 56% of the time when working on the engine.
• Their arms were over shoulder level when working with the engine 85%
of the time.
• They were kneeling when checking the flight deck or working with the
engine 45% of the time.
Most of these common work postures were problematic and needed correction (i.e. fell into categories 2-4, above), especially those used when working under the plane or with the engine.
Questionnaires:
Over the five year study period:
Measurement of physical capacity:
Six months after the rehabilitation period:
• The range
of motion of the participants' spines increased.
• The strength of the participants' abdominal, back, and upper arm muscles
increased.
• The participants' physical fitness did not change.
Conclusions:
This particular rehabilitation program tried to prevent disability by acknowledging
that the worker's physical environment and postures can contribute to the condition.
This study shows that workers can be taught the correct techniques to minimize the strain of physical work. Work techniques that have been learnt over years may be difficult to change. The postures that are possible may be limited by the workplace, as is the case for aircraft maintenance machinists. Workers in this situation were able to be taught self care and techniques specific to their workplace.
The participants reported that their pain decreased six months after rehabilitation. After five years, the severity of back pain was still less than it was prior to rehabilitation, but neck pain had increased back to a similar a level of severity.
The program encouraged the participants to exercise regularly in order to strengthen their ability to perform work tasks. While the amount of physical exercise the participants did in their own time didn't change, they were taking more exercise breaks at work five years after the program.
The number of sick days the participants took had decreased five years after the rehabilitation program, which may have been due to the participants leading a generally healthier lifestyle after the training.