Musculoskeletal disorders and work - ¢â‚¬¢Musculoskeletal disorders. Work and musculoskeletal health ¢â‚¬¢Many

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  • Musculoskeletal disorders and work

    Professor Karen Walker-Bone Director Arthritis Research UK/MRC Centre

    for Musculoskeletal Health and Work

  • Plan

    • Work and health

     Changes in modern workplaces

     Work and musculoskeletal health

    • A case presentation

    • The retrospectoscope

    • Results of a recent trial of treatment of ARM pain

    • What are the future questions for researchers in this area?

  • Plan

    • Work and health

     Changes in modern workplaces

     Work and musculoskeletal health

    • A case presentation

    • The retrospectoscope

    • Results of a recent trial of treatment of ARM pain

    • What are the future questions for researchers in this area?

  • Work and health

    • Work is central to human existence • It is the motive force for all economies

    and provides structure and meaning to individuals and societies

    • Good for health & well-being

    • Good for financial health & prosperity

    • Good for families

    • Socially inclusive & a right

  • The effects of unemployment on health

    • Higher mortality : 5-10 years earlier mortality

    • Poor general health

    • 2-3 fold higher risk of chronic disease

    • Poorer mental health

    • 3-fold risk of psychiatric morbidity

    • Higher medical consultation and hospital admission rates

  • Unemployment

    Mental illness

    Worklessness

    High personal debt

    Suicide x2 Self harm x10

  • Is ALL work good..?

  • Occupational research matters..

    • ‘Hazards’ in the workplace are expensive

    • The public tolerate hazards from work less well than those arising from personal lifestyle choices

    • Occupational hazards often more amenable to public health measures and controls

  • Prevention of serious hazards • Occupational medicine first

    emerged as scientific discipline in response to chemical, physical and biological hazards

    • Based on managing adverse effects by assessing risk related to each hazard

    • Measures to eliminate, substitute, reduce, protect against or manage risk

    • Monitoring to ensure control

    • Much occupational mortality and morbidity prevented, at least in the developed world

  • Health and work today

    • The workplace has changed!

    • Many major hazards identified

    • Health & Safety Executive

    • Legislation

    • Most of the ‘new’ causes of occupational ill-health are not diseases only found in the workplace…

    Asbestosis Phossy jaw Berylliosis

    Silicosis

    Neck pain Low back pain

    ‘Repetitive Strain Injury’ Osteoarthritis

    Asthma Lung cancer

    Stress

  • Plan

    • Work and health

     Changes in modern workplaces

     Work and musculoskeletal health

    • A case presentation

    • The retrospectoscope

    • Results of a recent trial of treatment of ARM pain

    • What are the future questions for researchers in this area?

  • Source: OECD (2014), Mental Health and Work: United Kingdom, Paris: OECD Publishing. Courtesy Shruti Singh

    New UK disability claims are among the highest in the OECD New claims per 1,000 of the working-age population (inflow rates),

    latest year available

    0

    2

    4

    6

    8

    10

    12

    OECD

    average

    UK: Disability burden and the benefit system

    Earlier intervention could

    improve this

  • In developed world, TWO main causes of work disability..

    • Mental health

    • Musculoskeletal disorders

  • Work and musculoskeletal health

    • Many of the 21st Century work and health issues affect the musculoskeletal system

    – Back and neck pain, shoulder and knee pain

    – Osteoarthritis

    • 5 of the top 6 problems that impact work productivity are musculoskeletal or musculoskeletal-related (fatigue /depression)

    • Responsible for 10 million days lost per year and £7billion societal costs

  • Musculoskeletal disorders become increasingly common with age

    ….and developed economies need people to work to

    older ages..

    Low back pain

    Knee osteoarthritis

  • Case history

    • A 45 year old female ambidextrous employee in a bank

    • Full-time employee for > 12 years

    • Recruited to do office administration including work with machines which sorted and organised envelopes

    • Work described as requiring precision but not physically taxing

  • Changes in the workplace

    • Over 5-6 years, two staff members retired and were not replaced

    • Job description altered to include more office work as well as machine work

    • Hand sorting letters became part of the workload

    • Initially 1300 letters/day

  • Changes in the workplace (2)

    • Gradual but steady increase in workload

    • 1500 letters/day increased up to 13,000 some days

    • All had to be sorted by 2.30pm by hand

    • Machine work still needed to be completed daily

    • Increased demands, deadlines tight and felt ‘pressured’

  • Onset upper limb symptoms

    • 2008, developed discomfort in her left thumb

    • Progressed quickly over two days such that within 2 days, she had acute locking of thumb joint

    • Pain radiated proximally to elbow and upper arm

  • Symptom progression

    • First day after the locking occurred, went to work as usual and reported pain and symptoms to Line Manager

    • Sent home to rest. Repeated the same pattern for 13 days then Occupational Health team called in

    • Advised that she must not work, must go off sick and report to her GP for assessment

  • Assessment in primary care

    • GP prescribed NSAIDs, wrist support and arranged physiotherapy

    • Despite these, steady progression of symptoms

    • Hand painful continuously, focussed around thumb, radial border of hand and forearm and gradually over 6 months, started to radiate proximally towards elbow

  • Assessment in secondary care

    • I personally assessed this lady 2 years after onset of symptoms

    • By this time, made redundant from Bank, taking statutory sick pay and attending job centre

    • Symptoms now involving hand, forearm, shoulder and neck

    • Chronic unrelenting pain, 7-8/10, marked disability despite co-codamol and regular NSAIDs

  • On examination

    • Anxious lady, distressed and in pain • Pain behaviour • Poor posture: Exaggerated cervical lordosis and

    thoracic kyphosis • Restricted cervical lateral rotation to the left • Restricted range of motion in left shoulder:

    active and passive, abduction and external rotation and internal rotation (capsular pattern)

    • Crepitus in IPJ of left thumb • Chronic thickening of common extensor origin

    but not acute de Quervain's and provocation tests unconvincing

  • Impression

    • 2 years of chronic non-specific arm pain

    • ?Work-related

    • Now secondary effects on shoulder and cervical spine (regional pain syndrome)

    • At risk for chronic widespread pain

    • Psychological impact of two years’ sickness absence

  • Proportion of people who will return to work in relation to duration of sickness absence

    83.3

    50

    30

    10

    0

    10

    20

    30

    40

    50

    60

    70

    80

    90

    1.5 6 12 24

    Duration sickness absence (weeks)

    %

  • Plan

    • Work and health

     Changes in modern workplaces

     Work and musculoskeletal health

    • A case presentation

    • The retrospectoscope

    • Results of a recent trial of treatment of ARM pain

    • What are the future questions for researchers in this area?

  • What would have made a difference?

    • Changes in work organisation factors:

    • Staffing

    • Job demands

    • Control over workload minimal

    • Support in work reduced

  • What else would have made a difference?

    • Occupational advice was to GO HOME and NOT return until better!!

    • Employee felt unvalued and created expectation that she could not work until 100% recovered

    • Task rotation?

    • Re-deployment elsewhere?

    • Amended duties

    • Maintenance of regular support and contact with work and co-workers

    • Fit note: what COULD she still do?

  • What else would have made a difference?

    • Excellent primary care management (by the book) but

    • Delays built into the system

    • Primary care does not have WORK as an outcome!

    • Developed shoulder-hand syndrome because of enforced rest and fear of movement

    • Medicalised symptoms and developed pain behaviour

    • Forced towards disability/benefi