Hands and arms at risk

21 Oct 2016
UCC report calls for Occupational health and safety guidance required for hand-intensive occupations in health care.

Research from University College Cork has shown that practicing employed and self-employed therapists in Ireland- including chartered physiotherapists, physical therapists and athletics therapists- are more likely to suffer from work-related upper limb disorders.

The Study, funded by the Institution of Occupational Safety and Health and conducted by researchers from the University College Cork’s Department of Epidemiology & Public Health under the leadership of Dr. Birgit Greiner, reviewed existing international health and safety guidance for these occupations.  The research has shown that work-related upper limb disorders (WRULDs) are persistent in 83% of therapists, with reported symptoms in at least one upper limb region in the past year, with 55% reporting symptoms that lasted for over 3 days. Shoulders (53 %), neck (50 %) and thumbs (46 %) were the most affected sites.  Over a third (37 %) had at least one clinical diagnosis of the upper limbs, e.g. shoulder tendonitis (13 %) or overuse syndrome (12%). For one in four therapists, symptoms were incapacitating so that they could not carry out normal activities at work, home or during leisure time. First onset of symptoms was mainly within the first five years of practice or even as early as during training.   

Kate Field, Head of Information and Intelligence at the Institution of Occupational Safety and Health (IOSH), said: “We commissioned this study in the hope that it will help to improve the risk assessment and management of work-related musculoskeletal disorders (MSDs) in hand-intensive healthcare occupations. The study represents a comprehensive approach to this wide-ranging professional issue and provides awareness through practical guidance, training and checklists for professionals and students to improve the way they understand their health, safety and wellbeing.”

The research not only listed the physical work factors associated with WRULDs, but also psychosocial and work organisation factors that exist across work environments and, as a result, the risk faced by practitioners.  The research lists the probability that incapacitating symptoms decreases with increasing level of influence at work (e.g. on workload and specific tasks to be completed) and the level of predictability of work assignments. In addition, therapists who schedule their appointments themselves were half as likely to experience WRULDs compared to those who use assistant or electronic booking systems. Therapists who do not take any or very short rest periods after each client were 2.3 times more likely to have incapacitating upper limb symptoms than those taking five or more minute breaks.

The very high prevalence of upper limb problem in therapists working with hand-intensive tasks warrants further attention from the health and safety community, therapists themselves, employers, the relevant professional bodies and policy makers. A systematic approach can help to reduce musculoskeletal hazards and so prevent the early onset of WRULDs in these occupations. It is recommended that prevention starts early during training, as already practised by several training and educational institutions to be followed by offers in continuing professional education and training.   Dervla Hogan, a Doctoral student with the team: ‘These rates are much higher than for the Irish working population as a whole, with 8 per cent of workers reporting pains in shoulders and neck, and less than 5% reporting muscular pain in arms and fingers.’

There is a need for capacity-building in assessing the occupational risk factors in hand-intensive occupations before symptoms start or worsen and in making the necessary changes in work organisation, ergonomics or psychosocial environment.  Sheilah Nolan, a Chartered IOSH Health & Safety professional, member of the research team and initiator of the study states that “We found that legislation and guidance exists for other hand-intensive occupations, such as manufacturing computer work, there are no current international guidelines on risk assessment and management in hand-intensive healthcare occupations to prevent WRULDs.”



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