Occupational health physical therapy

The field of Occupational Health Physical Therapy (OHPT) is a recognised subspecialty of the Physical Therapy profession in many countries. For many Physical Therapists, this may seem a ‘new’ field but Physical Therapists have been intimately involved in the prevention and management of work-related injuries for over 70 years. While this field of Physical Therapy is not yet recognised by the World Confederation of Physical Therapy, there are ongoing efforts by member countries advocating for inclusion of this speciality field. Physical Therapists have a role to play in the primary prevention of injury and the secondary prevention of disability through interventions to assist the individual to return to work safely and expeditiously. This special issue of Physical Therapy Reviews had two objectives. The first was to highlight the role of the Physical Therapist in industry and through a heightened awareness of the unique skills that Physical Therapists bring to the workplace, encourage others to move into this rewarding field of practice. Secondly, we wanted to provide a snapshot of the breadth of research being undertaken by Physical Therapists around the world in the field of OHPT. Evidence supporting the benefit of interventions where Physical Therapists play an integral role is essential to gain acceptance from within the profession and from external providers.

The role of the Physical Therapist in industry has several unique aspects. These include a working knowledge of local work health and safety legislation and workers’ compensation rehabilitation legislation, an understanding of workplace dynamics and the systems in place to manage employee health (e.g. human resources). Another unique feature is the range of stakeholders involved, and that each stakeholder may have different agendas. For example, the workers’ compensation insurer is focused on cost minimisation, the employer on maintaining productivity, the health provider on achieving recovery and the individual worker’s goal may be to limit personal financial impact and personal suffering.¹ Understanding the different perspectives of each stakeholder is necessary to ensure smooth implementation of interventions.

If there was any doubt that Physical Therapists had a role to play in industry, then the paper by Daley and Miller will help dispel such doubts. This paper explains that Physical Therapists working in industry need to focus on the ‘interface between the workers and the workplace’. The authors provide evidence that the OHPT requires skills beyond entry-level Physical Therapy by presenting many of the 142 critical tasks performed by these health professionals. Daley and Miller are to be applauded for the efforts of their members in creating a case for the speciality area of Occupational Health within the American Physical Therapy Association.

One way of recognizing the unique skill set of the occupational health Physical Therapist is through a specialization pathway. In the southern hemisphere, the Australian Physiotherapy Association has facilitated the specialization of Physical Therapists in specific areas of practice. Boucaut and McPhee provide a historical account of the birth of OHPT globally, then detail the journey the members of this special interest group take to become specialists within the profession in Australia. It is hoped that achieving specialist status will give the practitioner credibility within the profession and external to the profession equivalent to other occupational health providers.

An important area of practice for the occupational health Physical Therapist is primary prevention of work-related musculoskeletal injuries. Several strategies can be utilised to assist the employee and employer to manage the risk for injury associated with the performance of work. The next three papers provide examples of research conducted by Physical Therapists for primary prevention of musculoskeletal injuries: the use of risk assessments by home care staff for safe performance of work (Larsson et al); the value of health behaviour models to improve adoption of ergonomic interventions for injury prevention (Rothmore et al) and the benefits of screening potential employees to reduce the risk of injury (Legge et al).

The paper by Larsson et al examines the perceptions of health, working conditions and risk management in the home care sector in Sweden. While the risk management approach is regarded as the ideal approach to injury prevention internationally,² few of the home care workers in this study conducted a risk assessment when first visiting a new client. The home care workers also reported difficulties performing a risk assessment and following safety requirements. Interestingly, the results showed that workers who always participated in participatory risk management perceived themselves to receive higher levels of support from supervisors and co-workers, to have better decision-making authority, and to have a higher general level of safety at work. These findings support the use of a participatory risk management approach – something OHPTs can recommend to employers and implement as an injury prevention strategy.

The next paper by Rothmore et al discusses the barriers to implementation of research evidence into practice in the field of work injury prevention. The authors propose a researcher-practitioner divide suggesting practitioners consider health behaviour models to improve translation of research to ergonomic interventions in the workplace. This ‘divide’ may explain the lack of uptake of risk assessments by the home care workers in the previous paper.

The paper by Legge et al presents another method for preventing injury to workers – that of pre-employment screening. An overview of the evidence for pre-employment screening and relevant reliability and validity of some of the specific tests is presented. Legge et al point out that no one assessment tool would be suitable to predict a worker’s risk for injury, thus, they recommend consideration be given to the safety, reliability, validity, practicality, and utility of the tool. This paper will be useful for Physical Therapists considering moving into occupational health. The section on the role of the Physical Therapist and possible ethical challenges in pre-employment testing is pertinent to the professionals new to, and experienced in this speciality field.

While the importance of assessing an individual against the inherent demands of the job is essential, working life is becoming increasingly sedentary. Mackey et al have tackled two issues significantly impacting on our ability to remain healthy during our working years – ageing and sedentary work. These two issues have created urgency around the types of interventions required to stem the negative impact on health. This manuscript provides a comprehensive review of both issues and the interventions tested to date. It will be of relevance to both researchers and practitioners in the field of occupational health.

The next four papers move into the arena of secondary prevention. Taken together, these papers provide the rationale for Physical Therapists to adopt a holistic approach to rehabilitation with the International Classification of Function (ICF) serving as a sound theoretical framework. Escorpizo and Glässel discuss the use of the ICF by Physical Therapists in vocational rehabilitation. While the concept is not new, its application by Physical Therapists working in the field of occupational health may assist in the development of comprehensive client centred goals to achieve positive occupational outcomes for the worker. The framework of the ICF extends the traditional focus of Physical Therapists from impairment and activity disability to consider participation outcome measures pertinent to the individual receiving the intervention.

There is growing evidence that non-medical factors (e.g., pain beliefs, self-efficacy for work, workplace support) are influential variables in rehabilitation from injury and return-to-work, especially in the case of low back pain among working-age adults. The Physical Therapist is ideally situated due to their proximity to the injured worker to integrate any non-medical or psychosocial barriers with usual rapport building, exercise training, motivation, and goal setting.³ Thus the next paper by Johnston and Shaw provides practical tips for Physical Therapists to empower injured workers to help themselves remain at work or return to work safely. Empowerment can be promoted through education, collaborative problem solving, building self-efficacy for physical activity and reframing negative perceptions of recovery. These strategies however, must be based on a comprehensive understanding of the barriers preventing a worker from returning to work.

The paper by Gray and Howe describes a systematic review of studies that assessed the beliefs or skills of Physical Therapists related to their management of psychosocial and workplace factors (‘yellow’ and ‘blue’ flags, respectively) among clients with back pain. The authors found that while most Physical Therapists support the biopsychosocial approach to patient management, they failed to adopt specific practices related to psychosocial and workplace factors believing these issues were outside their professional role. The authors conclude that physical therapists need additional training, ideally commencing pre-registration, to tackle these factors for the prevention of disability.

The final paper in this special issue focusing on OHPT is that by Iles et al which describes an intervention to reduce the workers’ compensation costs associated with workplace injuries. The authors highlight several key features which they believed contributed to the successful outcomes – reporting of the injury within 30 minutes of occurring, high level medical care, proactive case management, open communication between the injured worker, medical provider and immediate supervisor and coordinated intervention at the workplace. As with the previous paper, Iles et al suggest Physical Therapists are well placed to identify the yellow, blue and black flags which may impede return to work. This paper is a clear example of the need for the Physical Therapist to contribute as a member of the team in the holistic management of the injured worker.

The Physical Therapist has an important role to play in industry, whether it is primary or secondary prevention. Examples of their role have been outlined in the papers in this special issue. Musculoskeletal injuries can be minimised and prevented through conducting risk assessments, running health promotion interventions or conducting assessments to determine the match between the individual and the work demands. Once a worker is injured, the Physical Therapist can facilitate the smooth transition from the clinic to the workplace by adopting the ICF model of care, using specific strategies to empower the worker to manage their return to work, and assessing barriers for work.

Acknowledgments

I would like to thank the editorial team at PTR for their foresight in agreeing to this special issue of PTR and their assistance in moving an idea to reality. In particular, my thanks to David Baxter, Suzanne McDonough, and Esme Loukota. In addition, my thanks to the reviewers for their time and thoughtful comments that contributed to the quality of the papers.