Ergonomic Abatement/Modification
Description of Intervention
Engineers and health professionals define "ergonomics" as "fitting the work to the worker." Ergonomics (Human Factors) is the scientific discipline concerned with the understanding of interactions between humans and other elements of a system, and the application of theory principles. data and methods of design in order to optimize human well-being and overall systems performance. 1,2
When the physician or therapist identifies a patient’s work/task environment as a possible contributing factor to a patient’s upper quarter symptoms and pathology, ergonomic intervention becomes an essential component in assisting patients back to a state of comfort, well-being, and ability to engage in occupation. Occupation includes ADL, home responsibilities, recreation, and work activities. The intervention may consist of any or all of the following:
- Modifying the physical work environment
- Adapting the manner in which the patient performs the task
- Suggesting workflow or administrative modifications
The therapist may only be able to discuss the work environment and suggestions from the clinic or an on-site evaluation may be an option. A patient seen in the clinic or on-site may need a therapist’s guidance for the management of movement dysfunction and postural faults. This intervention may or may not be a part of a requested consultation if the initial request is a workstation evaluation and clarification of the referral may be needed. Education may be required to facilitate healthy work habits to minimize stress associated with personal or work responsibilities and maintaining work-life balance. The overall goal is to provide suggestions that improve the safety and comfort as the patient engages in tasks that have value and importance to the individual.
Indications for Intervention
When patients present with complaints of pain in the upper quarter that are not sequelae of obvious injury, therapists may identify workstation or other types of activity-based problems that may be contributing to or causing the client’s neuro-musculoskeletal pain and symptoms.
Evaluation to Determine Need for Intervention
Clinical evaluation typically begins with a neuro-muscular-skeletal upper quarter evaluation. (Link to upper quarter screening?) The therapist interviews the patient for history and information that may help indicate the offending activities or situation. If the therapist determines that ergonomic factors at home or at work may contribute to or cause the dysfunction, a series of environmentally based measurements, photographs, videos or site visits may help to further identify these contributing factors. While the initial discussion and/or evaluation may implicate the workplace, the clinician should always consider the global activities in which the patient engages.
An understanding of specific definitions of personal and industrial risk factors may assist discussion about contributing issues at work or at home. The following is a list of physical risk factors that may occur with work and personal task performance.
Physical Risk Factors:
- Abnormal and/or sustained postures
- Contact stress
- Duration of exposure
- Repetition
- Long work hours
- Force
- Suboptimal equipment
- Poor fit of equipment
- Environment: lighting, temperature
Personal risk factors to consider include:
- Personal
- Age
- Avocational activities
- Fitness level
- General health status
- Physical attributes
- Mental health Status
Other issues to consider include:
- Psychosocial
- Workplace culture
- Employee morale
- Change in work ethics
- Work satisfaction
- Work stress
Work Organization
- Workflow
- Lines of command
- Decision-making
- Lines of communication
- Training
Work from Home Issues
- Home distractions
- Individuals and/or pets
- Environment
- Less frequent breaks
- Transition time between work and/or home (commute)
- Work and/or home balance
- Social interaction
The therapist will use a consistent and systematic virtual and/or on-site method of evaluation to enhance documentation and recommendations. Therapists may access a wide range of evaluation guidelines. The patient’s job description may be a helpful tool to develop an initial understanding of work tasks performed and possible contributing factors to symptoms. Emerson describes an approach to evaluation of both the commercial on-site and home-office computer workstation that has application for in-person and virtual evaluation. The following list of basic evaluation tools for upper extremity risk evaluation may be applicable and of assistance.3,4
- OSHA Basic Screening and Ergonomic Assessment Checklist
- Washington State Checklists
- Paid Upper Limb Assessment (RULA)
- OSHA VDT
Identification of primary or secondary ergonomic design factors (biomechanical mismatches between the individual and their task environment or performance) may assist the therapist to modify the situation and improve treatment outcomes.
Intervention Options
As described above, the therapist may provide the intervention in the clinic, at the activity/work site or at the patient’s home.
- Physical modification of the work environment
- Adapting the manner in which the patient performs the task
- Suggesting workflow or administrative modifications
Therapists with special training and awareness of state labor laws and worker compensation systems may be able to work at a more sophisticated level to identify ergonomic issues related to reintegrating the worker to the workplace.
Precautions for this intervention include:
- Attributing the neuro-muscular-skeletal dysfunction to work related tasks exclusively when other life tasks may either be the cause or contribute to the dysfunction.
- Changing one or more features of a workstation or work process only to create ergonomic problems that did not previously exist.
- Fiscal or operational limitations in the work environment
Associated diagnoses where this intervention may be relevant
- Any upper quarter neuro-muscular-skeletal diagnosis that does not original from a traumatic event.
