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Letters and Responses |
I hope that this study can serve as a small step forward. Your personal story is not uncommon. Physical therapists appear to be reluctant to take time off or to seek formal evaluation and treatment after the onset of symptoms. They also appear to be too embarrassed to admit or report injuries.
With regard to wrist WMSDs, patient handling does exert high biomechanical loads on the wrists and hands. In this sample, however, the therapists who performed low levels of patient handling tended to perform high levels of manual therapy. Because manual therapy imparted a more substantial risk, the effects of patient handling on the wrists and hands were difficult to determine. Patient transfers and repositioning may indeed increase the risk for wrist and hand injuries but less so than manual therapy. Other studies are needed to quantify these risks.
The scope of exposure assessment was relatively narrow. There were many potentially risky activities, such as facilitation and mat work, that were not evaluated. In order to ensure a reasonable response rate, the questionnaire was limited to 4 pages and the response burden was low. The questionnaire also had to be relevant to therapists in a variety of settings. This precluded evaluation of some very specific activities. Moving forward, studies are needed that look more closely at the work tasks involved in different settings.
With regard to treatment and outcomes, it was difficult to quantify the remedies and fixes that therapists used after developing WMSDs because they were not assessed directly. In the questionnaire comments, therapists reported self-treating and seeking informal treatment from colleagues. This was consistent with prior research and Halloran's experiences, but it might not be the best way to address WMSDs.1
In terms of prevention, some therapists in the study cited fitness as an important preventive strategy. Others cited body mechanics. These measures are unlikely to substantially reduce the risks associated with physical therapy work. Only a cultural shift that involves both an honest appraisal of the risks involved with patient care and the use of equipment for high-risk tasks is likely to reduce injury rates. Marras et al2 demonstrated that regardless of lifting technique, the transfer of a lightweight (110 lbs) and cooperative patient resulted in forces that exceeded tissue tolerances in the lumbar spine. The force levels, in some cases, exceeded the threshold for vertebral endplate mircofractures. In the clinic, patients are likely to be substantially heavier and not as cooperative.
Although the focus of this study was work-related pain and injuries, making the job less physical and less strenuous is another goal. Therapists may leave clinical practice before they get injured because the job becomes too strenuous. Clinicians should be able to pursue full-time clinical work for as long as they wish. The presence of experienced clinicians in all settings will benefit patients as well as our less experienced colleagues.
MA Campo, PT, PhD, OCS, is Associate Professor, Mercy College, Dobbs Ferry, NY.
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