Documents Cole, Donald C. 8 results

"Objectives Workers' musculoskeletal disorders are often pain-based and elude specific diagnoses; yet diagnosis or classification is the cornerstone to researching and managing these disorders. Clinicians are skilled in pattern recognition and use it in their daily practice. The purpose of this study was to use the clinical reasoning of experienced clinicians to recognize patterns of signs and symptoms and thus create a classification system. Methods Two hundred and forty-two workers consented to a standardized physical assessment and to completing a questionnaire. Each physical assessment finding was dichotomized (normal versus abnormal), and the results were graphically displayed on body diagrams. At two different workshops, groups of experienced researchers or clinicians were led through an exercise of pattern recognition (clustering and naming of clusters) to arrive at a classification system. Interobserver reliability was assessed (8 observers, 40 workers), and the classification system was revised to improve reliability.Results The initial classification system had good face validity but low interobserver reliability (kappa. "

"Researchers of work-related musculoskeletal disorders are increasingly asked about the evidentiary base for mechanical exposure reductions. Mixed messages can arise from the different disciplinary cultures of evidence, and these mixed messages make different sets of findings incommensurate. Interventions also operate at different levels within workplaces and result in different intensities of mechanical exposure reduction. Heterogeneity in reporting intervention processes and in measuring relevant outcomes makes the synthesis of research reports difficult. As a means of synthesizing the current understanding of measures, this paper describes a set of intervention and observation nodes for which relevant workplace indicators prior to, during, and after mechanical exposure reduction can provide useful information. On the basis of this path of impacts from exposure reduction, an approach to the evaluation of multilevel ergonomic interventions is described that can assist fellow researchers in producing evidence relevant to the challenges faced by workplace parties and policy makers."

"Objectives. This study compared trends in the incidence of work-related morbidity and disability across 3 sources of surveillance data in a Canadian province. Methods. Time series estimates of workplace injuries and work-related disability based on 2 panel surveys in the province of Ontario, Canada, for the period 1993–1998 were compared with rates of work-related injury and illness compensation claims during the same period. Results. Lost-time compensation claims declined by 28.8% over this 6-year period. The incidence of self-reported work-related injury declined by 28.2%, and the selfreported incidence of work absence for work-related causes declined by 32.2%. Conclusions. Parallel reductions in work-related morbidity were seen in 3 independent data sources. These results support an interpretation that there has been an important reduction in injury risk in Ontario workplaces over the past decade. "

Existing tools for monitoring work related neck and upper limb disorders were reviewed. Analysis indicated that there were 12 domains which were major areas of life affected when a worker suffers a neck or upper limb disorder. These 12 domains included work, household and family activities and responsibilities, care of one's self, driving and transportation functions, sexual activity, securing adequate restful sleep, participating in social activities, enjoying recreational hobbies, one's attitude and mood swings, one's own feeling of self importance and independence, monetary aspects due to lower wages or added expenses, and iatrogenic effects of assessments and treatment. The study examined 52 instruments which were identified as being able to determine the functional status of the patient. Of the 52 identified, 21 met criteria of dealing with items of work, self care and domestic responsibilities which indicated they had the potential to be relevant. These 21 were rated on a three point scale for relevance and comprehensiveness for each of the 12 domains. Of the 21 instruments tested, ten adequately covered the areas of work, self care and domestic responsibilities. Six covered these three areas and also recreational activities. Very few of the instruments examined dealt with sleep, self esteem, sexual activities, iatrogenic effects, or financial impact. The authors urge the development of a new instrument designed for this population of workers.

The evidence concerning prognosis among workers with nonspecific work related musculoskeletal disorders (WMD) was reviewed and discussed. Data were taken from 13 published studies identified through a keyword search. Two of the studies were based on workplace surveillance; five clinical studies gathered their study groups from workplace screening. Seven studies provided an operational definition of cases and criteria for exclusion. One study used an inception cohort of employees without known previous similar disorders. Three studies reported blinded assessment of outcomes appropriate to the disorder and replicable. Nine studies measured and reported various potential prognostic factors along with the treatment provided. Most of the papers only offered crude proportions of response, recovery or recurrence. In contrast to the duration of weeks expected by many clinicians when first seeing the patients studied, the workers with nonspecific or multiple WMD had durations of their symptoms of months if not years. The authors state that the quality of the work reported here was hindered through deficiencies in patient selection, measurement of outcomes, and analysis for prognostic factors. The authors urge the adoption of clear operational definitions of cases. The authors recommend that the duration of symptoms and severity and other potential factors be measured. Follow up assessments at multiple time points should be included for as long as possible. Clinical, disability scales, psychological tests, work performance measures, and work status should all be measured and included in any analysis. Analysis by both stratified and multivariate methods incorporating time varying covariates should be employed.

"This article investigates management commitment to workplace health and safety through an analysis of the implementation of participatory ergonomic (PE) interventions in three worksites. The PE programs were established to address the burden of work-related musculoskeletal disorders. Drawing upon interview and observational data, the analysis examines the evolution of managerial support for PE programs over time and in the context of pressures internal and external to the worksites. Ergonomic Change Teams in all three sites experienced problems establishing authority to act as change agents and in accessing employee time to carry out their activities. Resolution of these problems was heavily contingent on the commitment of senior management, and the efforts of individual management personnel to intervene in support of the PE program. Our findings highlight that "management" is not a monolithic entity and managerial structures are often marked by divisions in priorities, including health and safety."