Arthritis & Rheumatism (Arthritis Care & Research) Vol. 59, No. 10, October 15, 2008, pp 1495–1503 DOI 10.1002/art.
24116 © 2008, American College of Rheumatology
SPECIAL ARTICLE: DISABILITY AND REHABILITATION IN THE RHEUMATIC DISEASES
The Ergonomic Assessment Tool for Arthritis: Development and Pilot Testing
CATHERINE L. BACKMAN,1 JUDY VILLAGE,2
Objective. Ergonomic assessment and recommendations may help people with arthritis maintain employment; however, most ergonomic tools are designed to assess injury risk in the general population and are not speciﬁc to the needs of people with inﬂammatory arthritis (IA). Our objectives were to design and pilot test an ergonomic assessment tool for people with IA and to propose ergonomic modiﬁcations to prevent work loss and maintain at-work productivity. Methods. Relevant content was identiﬁed in a literature review by an interdisciplinary team. Respecting some clients’ reluctance to disclose arthritis to employers, no work site visit was required. An initial assessment tool was reviewed by a 4-person expert panel, revised and pretested with 13 adults with IA by 3 occupational therapists (OTs). The ﬁnal tool, comprised of a self-assessment, an interview guide, and a solutions summary, was used in a pilot test of a multifaceted program designed to prevent work loss and maintain at-work productivity. One OT conducted all ergonomic consultations and followed up with phone calls at 1 month. Implementation of recommendations was evaluated at 3, 6, and 12 months. Results. Nineteen women (mean age 51 years) with IA (mean disease duration 12 years) completed ergonomic assessments. A range of risks were identiﬁed and 87 recommendations were made (mean 4.5 per participant). At 1 year, 85% of recommendations had been implemented by 74% of the participants. Conclusion. The Ergonomic Assessment Tool for Arthritis is a feasible and comprehensive process for identifying ergonomic job accommodations.
Arthritis in the work place is relatively common. Population-based surveys of employed Americans indicate that more than 5% of the work force reports arthritis (1). Among employees ages 40 – 64 years, this increases from between 10% (1) to 15% (2,3). The economic costs are substantial: lost productivity due to arthritis has been val-
Supported by an operating grant from the Canadian Institutes for Health Research and from The Arthritis Society of Canada. Dr. Lacaille is the Nancy and Peter Paul Saunders Scholar and is supported by an Investigator Award from The Arthritis Society of Canada. 1 Catherine L. Backman, PhD, OT(C), Diane Lacaille, MD, MHSc: University of British Columbia and Arthritis Research Centre of Canada, Vancouver, British Columbia, Canada; 2Judy Village, MSc, CPE: University of British Columbia, Vancouver, British Columbia, Canada. Ms Village has received consultant fees (more than $10,000) for developing the Ergonomic Assessment Tool for Arthritis. Address correspondence to Catherine L. Backman, PhD, OT(C), Department of Occupational Science & Occupational Therapy, The University of British Columbia, T325-2211 Wesbrook Mall, Vancouver, British Columbia, Canada V6T 2B5. E-mail: firstname.lastname@example.org. Submitted for publication February 2, 2008; accepted in revised form July 8, 2008.
ued at $7,454 per person per year (3). In patients with rheumatoid arthritis (RA), work disability occurs early in the course of the disease and continues at a steady rate (4,5). A review of work disability studies reported that the prevalence is approximately 10% in the ﬁrst year after diagnosis of RA, progressing to 50% or greater after 10 –15 years, depending on the year and population studied (6). Prior to stopping work, individuals with arthritis report productivity losses such as working fewer hours, changing to less demanding jobs, or declining promotions (7). Efforts to reduce work and productivity losses have the potential to make important contributions to both individuals and society (8). Rehabilitation approaches aimed at preventing work loss or work disability may be preferred over return-towork strategies, based on the principle that it is easier to maintain employment than to reenter the employment market after a prolonged absence. Such approaches attempt to address the modiﬁable risk factors associated with work disability. A job accommodation is deﬁned as changes made to a job to better match the abilities of a worker. Ergonomic modiﬁcations, which include physical changes to the work place and alternative methods for work tasks, are one type of job accommodation applicable to people with arthritis (4). Ergonomic assessment draws on multiple disciplinary 1495
participants were given a disposable camera to take photographs in the work place to supplement the self-report (version 4). An iterative process was used to develop an ergonomic assessment tool involving client self-assessment at work and a semistructured interview by an OT. we found little evidence that ergonomic assessments were offered to people with IA. A systematic review of work place ergonomic interventions indicates positive effects on reducing musculoskeletal injuries. A review of published ergonomic assessment tools was conducted by an interdisciplinary team (rheumatology. The occupations in this pretest included administrative and management positions. indicating that important considerations for ergonomic assessment include attention to arthritis symptoms. identify risks. at 9% in one study (12). and one academic/researcher). ﬁndings from our prior focus-group study (18) provided the patient perspective. failing to adjust job demands or make changes to the work environment was associated with loss of employment (11). Some tools were limited to assessing injury risk to a speciﬁc body part such as the upper extremities (14. all of whom were employed at the time of diagnosis.5 times less likely to be work disabled (4). efﬁciently. and the photographs helped overcome the lack of direct observation. or work methods to prevent and reduce work-related risks for injury and optimize work performance. and rehabilitation (13). and absence from work among workers in general (10). physical therapists. ergonomic risk assessment. ergonomic principles may be applied to redesign the work place. and 5) use of diagrams and photographs to illustrate postures and risk factors when direct observation is not possible. Version 2 was pretested with 12 women and 1 man with IA by 3 different OTs (one practicing in an arthritis outpatient program. tools. and in ways that minimize arthritis symptoms and activity limitations. A professional ergonomist observed 2 assessments. Clients and OTs completed feedback forms designed to elicit information about ease of use. responding to 13 questions about whether or not the tool would lead to a good understanding of the client’s work tasks. In a study of predictors of work loss in patients with RA. school bus driver. designed for a speciﬁc industry such as automotive plants (16). They evaluated the assessment process and content. Although none of the tools were appropriate for our purpose. The ﬁrst draft (version 1) incorporated the desired content and program purpose outlined above. and work organization. 2) identiﬁcation of tasks currently causing problems or exacerbating symptoms. 3) proactive identiﬁcation of risk factors not yet causing problems but that may in the future. equipment. a work site visit was not planned. leisure. and green colorcoding system (20) to indicate levels of risk. minor improvements were made to clarify format and instructions (version 3). Ergonomic principles are also used by occupational therapists (OTs). Additionally. and dog groomer.18). and reluctance to disclose arthritis to employers. and ergonomists contribute to work place health and safety in a range of industries. and can be used outside of the work place. In another study of people with IA. Final revisions were made based on observa-
. ergonomics. work environment. Speciﬁcally. is applicable to different jobs.15). and alternative methods to accomplish work. the use of ergonomic modiﬁcations by people with IA is low. not an outcome measure. selected for their knowledge of ergonomics and work disability as judged by publications and professional experience. these principles should also improve work for people with arthritis. work disability. The tool was modiﬁed based on the panel’s expert opinion (version 2). an assessment by a person knowledgeable about arthritis. and indeed there is some evidence demonstrating that ergonomic modiﬁcations are associated with remaining employed. ﬂight attendant. one providing ergonomic consultations in a rehabilitation center.1496 perspectives to examine the ﬁt between individuals and their work. This article describes tool development. and we could not ﬁnd a tool suited to the unique needs of people with arthritis (13). and be applicable to a range of occupations. ergonomics is aimed at preventing work injury and work loss. When risks or problems are noted. Therefore. after the ﬁrst 3 pretests. but formal ergonomic evaluations do not appear to be commonly used in arthritis care. Logically. and results from a pilot test using the tool as part of the Employment and Arthritis: Making it Work program (19). Ergonomic modiﬁcations may help people with inﬂammatory arthritis (IA) to work more safely. applicability. which may be exacerbated at lower thresholds of work than for healthy populations. Most tools were designed to identify the risk for musculoskeletal injuries in the general population and did not account for symptoms associated with IA such as pain and fatigue. or required work site observations (14 –17). symptoms. occupational therapy) with experience in arthritis. assistive devices. As part of a program aimed at preventing work loss and maintaining work productivity among people with IA. In our review of ergonomic assessment tools. we designed an assessment tool to identify ergonomic risk factors in the work place and generate potential solutions. IA affects multiple joints among workers in different types of jobs.
Backman et al
MATERIALS AND METHODS
Development and pretesting of the ergonomic assessment tool. To enhance content validity. laboratory technician. yellow. version 1 was reviewed by an independent panel of 4 experts. It is a practical guide to assessment and intervention. content. and this formative feedback inﬂuenced ongoing revisions to the tool. However. some elements were applicable. Because some people were reluctant to disclose arthritis to employers or coworkers. This suggests a need for a tool that considers IA symptoms. and some people with arthritis are reluctant to disclose their diagnosis to their employer (7. lead to ergonomic recommendations. including 1) a systems approach to considering risk factors that includes work station. work site evaluation. equipment/tools. people who received ergonomic modiﬁcations were 2. and others working in arthritis rehabilitation when recommending joint protection techniques. and thoroughness of the content. asking questions based on known risks for musculoskeletal injuries and factors likely to exacerbate IA symptoms. and self-care tasks (9). and after 10 pretests. 4) use of a red. whereas we found only 20% reported access to an ergonomic assessment of their work (4).
4. 10 additional items address computer work (e. Occupational therapist interview guide/checklist A work task summary is documented. “Is the lift.g. full 2-drawer ﬁling cabinet). “During gripping tasks is the force required judged acceptable? Can 2 hands be used?”) If applicable.
* Components 1 and 2 are common to all workers. push. adjustable work surface. a shopping cart with 10 small items). and pulling is combined with questions about frequency and load. e.g. e. 10 items inquire about hand tools (e. e. tools. grasping..g.g.g. and repetition. moderate loads (e. Participant indicates if any of 6 statements describe their work.. feet supported? head upright and facing forward? 11 questions inquire about frequency of maintaining various postures. repetition. “Are there opportunities for rotation of tasks? Is training provided on how to adjust the work station? Are supervisors supportive?” 10 items probe for details about the chair (e. climbing stairs or ladders. motions.g. and if applicable. Standing work (includes walking and kneeling)
5. and using hand tools
6.. working with elbows raised? Is the ﬂoor ﬂat and free of obstacles?” 7 items describe hand movements (e.
2.. if any. Content of the self-assessment and interview components of the Ergonomic Assessment Tool for Arthritis* Self-assessment 1.. monitor height. and small loads (e. 5 questions about hand use. up to 16 items. components 3 to 7 are selected if relevant to the worker. workspace (e. Work diary and work layout diagram/photographs Participant keeps diary for 1 work day. noting equipment.. and any associated pain or discomfort.g. walking. e.g. or materials used and any difﬁculty or discomfort during the task. reaching forward. placement of tools).g.. keyboard type) 14 items probe for details about work space and tasks. a full shopping cart). e.g. “Are tools powered where necessary and feasible? Is the tool weight evenly balanced and distributed?”) Additional information on lifting. reaching above the shoulder or below the knee. including approximate weight of the load and associated discomfort..... depending on the job.g. pushing...
7. “Do you have to grip hard or squeeze with your hand? Do you manipulate small objects or do precise hand movements to use tools?” Frequency and discomfort are noted for each. e. identifying the duration of main tasks. “forearms horizontal? weight shared on both feet?” 13 questions inquire about frequency of maintaining various postures.g. A sketch of the work station or general layout of main work space is completed at the end of the diary. lumbar support). Lifting and carrying
2 questions address loads lifted close to the body and away from the body. The sketch or photographs of the work station illustrating the physical environment are reviewed prior to beginning the semistructured interview. and photographs are taken of the worker doing key tasks. Pushing and pulling
3 questions about frequency of moving heavy loads (e.g. gripping. based on the screening questions. A drawing is provided of a manikin standing with yes/no/sometimes questions about posture. “I control how fast or slow I do my work. identifying main task during each half hour. carrying. and tasks like operating foot pedals. lifting and carrying.
.g. Work organization
3.g. Upper extremity work. and ﬂoor surface. adjustable armrests. “Is the work surface height appropriate to the task? Is the work station designed to reduce or eliminate bending and twisting wrist. e.Development and Testing of an Ergonomic Assessment Tool
12 items probe for details. or pull task performed infrequently? For short/intermittent periods? Over short distances? Free from pressure of time or at a pace controlled by a machine? Is help available for heavy or awkward tasks?” See component 6.” A drawing is provided of a manikin seated with yes/no/sometimes questions about posture...
tions gathered throughout pretesting. One group session introduces partic-
. leading to the fourth component. The EATA is individualized to each client by selecting only the relevant job demand sections of the form. such as
prolonged static postures or repetitive motions.1498
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Question Neck Do you have to bend or twist your neck?
Rarely or never
Up to 2 hours per day
2 hours or more per day
Any pain or problem? NO YES
Back Do you have to bend or twist your back?
Shoulder/arm (sitting) Do you work with your hands at or above your head? Shoulder/arm (standing) Do you work with your arms stretched out? Grip Do you have to grip hard or squeeze with your hand while lifting loads of 10 lbs. Pilot testing of the EATA. An interview guide/checklist was completed by the OT during the visit.. where to buy speciﬁc equipment. the Ergonomic Assessment Tool for Arthritis (EATA. based on responses to 5 screening questions: “Does your work involve (a) prolonged sitting? (b) prolonged standing. The Ergonomic Assessment Tool for Arthritis. with the interview guide going into greater depth (Table 1). The self-report and interview guide are parallel forms that begin with a description of work tasks and then assess up to 6 areas of job demands. probing for more detail to understand the potential risk and make appropriate recommendations.g. aimed at preventing work loss and maintaining at-work productivity. available online at www. from work organization to pushing and pulling. kneeling. identify and prioritize issues. has 4 components. or stair climbing? (c) gripping or grasping objects or hand tools? (d) frequent lifting or carrying? (e) pushing or pulling items (e. is a series of 5 group sessions and 2 individual consultations. The Making it Work program (19. Feedback from both clients and OTs indicated that the ergonomic assessment was acceptable regarding time and effort and relevant in terms of guiding a thorough review of work tasks. During the interview. The ﬁrst component is screening to match the assessment form to the person’s job. Sample items from the self-report component of the Ergonomic Assessment Tool for Arthritis. this is coded red to trigger further evaluation (Figure 1). carts or dollies)?” Self-assessment was completed by the client prior to the consultation visit (see Table 1 for content overview and Figure 1 for sample items and layout). the client and the OT collaboratively complete a job task summary. Items checked in yellow and red zones are the focus of the subsequent consultation with the occupational therapist. where increased duration is associated with increased risk.. identifying human resources or occupational safety personnel who can help) are documented on a solutions summary page given to the client. the solutions summary page. recommendations. The yellow and red levels of risk are based on risk factors for musculoskeletal injuries. Items checked in the yellow and red zones assist the OT to focus on the most pertinent issues during the interview. because people with IA may aggravate their symptoms even at low levels of risk. Responses to the job demand questions in the self-assessment are color coded. indicating incremental levels of risk. 1 with a vocational rehabilitation counselor and 1 with an OT for the ergonomic assessment described here. Clients check the appropriate column for each item in the self-assessment. walking. Regardless of level of exposure. or more?
Figure 1. and generate recommendations. if the worker experiences pain or problems. Issues.arthritisresearch. The ﬁnal version. and resources for implementation (e.ca).21).g.
When asked what was helpful about the ergonomic intervention. manager. HAQ ϭ Health Assessment Questionnaire.e.. such as obtaining an adjustable chair.6 9 (47) 4 (21) 2 (11) 4 (21)
* Values are the mean Ϯ SD unless otherwise indicated. The assessment process triggered 14 non-ergonomic recommendations for problems affecting performance of work tasks. ¶ Elementary school teacher. When changes had been made. or occupational health and safety. changing the height of the computer monitor and/or keyboard. implemented as they became more aware of ergonomics and how to problem solve on their own. provide clariﬁcation. nanny. Onethird of the changes involved making a request of the employer. and by 12 months. An additional 9% of recommendations were still in progress. Participants stated that they were experiencing less pain and stiffness.1 17 (89) 1 (5) 1 (5) 12 Ϯ 11. suggestions for job modiﬁcations. or eye examination. buyer. and if they were ineffective. 85% of recommendations had been implemented by 14 (73%) participants. (%) Rheumatoid arthritis Systemic lupus erythematosus Psoriatic arthritis Disease duration.Development and Testing of an Ergonomic Assessment Tool ipants to general ergonomic principles. All participants completed the ergonomic assessment and 1-month telephone call to discuss ergonomic modiﬁcations. and appropriate referrals were made to address the problems. Participant characteristics* Characteristic Age. where 3 ϭ worse. and 12 months. The full program is described elsewhere (21). no. no. ﬂuent in English. Participants reported that the ergonomics content of the Making it Work program prepared them for their consultation with the OT (35% stated very well prepared. psoriatic arthritis.37 2 (11) 15 (79) 2 (11) 4 (21) 5 (26) 3 (16) 4 (21) 3 (16) 28 Ϯ 8 12 Ϯ 11 34 Ϯ 8. and communicating with employers to implement modiﬁcations. building caretaker. Time required to complete the self-assessment and consultation visit varied depending on the complexity of the job and problems reported. had more energy. trouble shooting was offered. Five participants did not complete any changes. fabric artist. supervisors. The most frequent recommendations related to supporting a well-aligned posture when seated. A research assistant asked the screening questions and provided applicable sections of the EATA self-assessment form and camera when booking the participant’s OT appointment. Participants reported an additional 10 self-initiated changes. discuss ways to overcome barriers to implementation or suggest alternative recommendations. human resources. ‡ Receptionist. Data on usefulness of the ergonomic assessment and implementation of recommendations were collected by a study coordinator conducting telephone interviews at 3. Five recommendations were for future planning (designing a new work station to
be integrated into upcoming renovations or requesting easier-to-use equipment in the course of routine replacement of capital equipment). The OT phoned participants 1 month later to review progress toward implementing recommendations. such as obtaining hand splints. supportive shoes. † Range 0 –3. and ages 18 – 60 years. no. Participant characteristics are shown in Table 2. All ergonomic consultations were conducted by the same OT. Implementation of ergonomic recommendations took time (Table 3). (%) Administrative/clerical‡ Health sector occupations§ Education and child care¶ Other# Value 51 Ϯ 7. years Diagnosis. no. foot orthoses. comments pertained to easing of symptoms or difﬁculty with tasks. none of the participants had jobs that required completion of all 5 sections. Ethical approval for the project was obtained from the Research Ethics Board of the University of British Columbia. (%) High school diploma Technical/trade/vocational college Some university University degree Graduate or postgraduate training Years employed Years in present job Hours of work per week Type of work. 6. developed by a certiﬁed ergonomist (JV). participants were asked about their effect. The OT made 87 recommendations relating to either work techniques or modiﬁcations to the physical environment and equipment purchase (Table 4). # Library assistant. and the present article is limited to the ergonomic assessment/intervention. (%) Single Married or living with a partner Divorced Education. but all sections were applicable to at least 7 participants (Table 3). home health case manager. and if necessary. “How useful were the changes?” (measured on a 5-point response scale. where 1 ϭ very useful and 5 ϭ not at all useful). equipment had been ordered or accommodations requested from the employer.
Table 2.7 0. 41% well prepared. or using a footstool. experienced in arthritis and trained in ergonomic principles by means of a 2-hour self-study module on CD. Eligible participants consisted of employed adults with IA (RA. Questions included “How useful for you was the ergonomic assessment by the OT?” and if ergonomic changes had been made. The assessment forms were individualized based on job demands.41 Ϯ 0.
Nineteen women met eligibility criteria and participated in the proof-of-concept study of the Making it Work program. years HAQ disability index† Marital status. lupus). Table 4 shows results from implementation of the EATA. that is. and 24% somewhat prepared). events coordinator. or felt better at work. less stress. and when recommendations were
. but had not yet been implemented. § Laboratory technician. administrative assistant. and all participants gave informed consent. i.
and armrests Nonadjustable work surface: build or install adjustable height table Difﬁculty using regular scissors: purchase spring-loaded scissors Books.
We developed an ergonomic assessment tool for the purpose of recommending necessary ergonomic modiﬁcations as job accommodations for people with IA. it was applicable to administrative. mean (range) Ergonomic solutions related to technique/work methods (n ϭ 87 total recommendations) Ergonomic solutions related to physical environment or equipment (n ϭ 87 total recommendations) Ergonomic recommendations implemented (cumulative totals) 3 months 6 months 12 months Participants who implemented Ն1 recommendation by 12 months (n ϭ 19 participants) Participants who reported the ergonomic assessment was useful (n ϭ 18 participants answering this question at 12 months) Very useful Useful Somewhat useful Result 29 (10–45) 60 (45–95) 4. mean (range) minutes† Time to complete interview. infrequent. The EATA was sufﬁciently ﬂexible to assess different occupations. Our pilot study demonstrated that the use of the EATA by an OT with arthritis experience is feasible. including interview to identify issues and risks requiring attention and explanation of recommendations. and elicits solutions to reduce er-
gonomic risk factors. Asked if they would be willing to have the OT make a work site visit as part of the assessment. † Work diary. and relevant job demand sections. and 4 other occupations (library assistant. back. work station drawings and/or photographs. guides a comprehensive ergonomic assessment. Summary of ergonomic factors identiﬁed in job demands sections of the self-report and interview components of the Ergonomic Assessment Tool for Arthritis (EATA) EATA job demands section Work organization Seated work Participants completing section 19 18 Participants with issues/risks 9 15 Solutions proposed 10 34 Sample issue and proposed solution Meetings impinging on lunch breaks: set priorities. 33% said no.1500
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Table 3. it was generally due to a lengthy process for planning substantive changes or because the job demands had changed (Table 5).5 (1–9) 48 (55) 39 (45)
60 (69) 66 (76) 74 (85) 14 (74)
7 (39) 6 (33) 5 (28)
* Values are the number (percentage) unless otherwise indicated. building caretaker. with job demands ranging from seated ofﬁce work to more physically demanding lifting and carrying. education. In this pilot test of 19 women with IA. negotiate rescheduling Nonadjustable. ﬁles too heavy to carry: obtain a trolley No risks identiﬁed because loads were small. Used in the context of a multifaceted program to prevent work loss in IA. The individualized approach based on 5 screening questions to select only the relevant sections of the form helped minimize response burden to both the person with IA and the OT. mean (range) minutes‡ Ergonomic solutions recommended per participant.
Standing work Gripping and grasping Lifting and carrying Pushing and pulling
13 12 7 7
8 10 5 0
19 19 5 0
not implemented. and buyer). the EATA led to recommendations for
Table 4. health care. ill-ﬁtting ofﬁce chair: purchase chair with adjustable seat. fabric artist. The cautionary yellow and red response codes in the self-assessment identiﬁed areas for further evaluation by the OT. Results from implementation of ergonomic assessment using the Ergonomic Assessment Tool for Arthritis* Implementation factor Time to complete self-assessment. ‡ Consultation time with the occupational therapist. and appropriate equipment was already in place.
positions. Some participants reported considerable support from their employers and coworkers. After accomplishing some of the occupational therapy suggestions. Sample participant comments on usefulness of ergonomic modiﬁcations and reasons for not implementing recommendations Usefulness of ergonomic modiﬁcations Removing my armrests allowed my chair to be closer to my desk—posture is important and self-awareness of posture is difﬁcult. emphasizing the importance of sufﬁcient support and followup to evaluate the effectiveness of ergonomic interventions at work. However.Development and Testing of an Ergonomic Assessment Tool
Table 5. the rest can wait because a new library is being built. or tasks that are already associated with pain or fatigue. laminators with hoods.25) to make work place modiﬁcations. rather than engineering solutions to modify the work place. Headphones have eased my fatigue.23). To be completed in a single visit. and noted that suggestions they brought to the work place resolved a general ergonomic
concern for all employees. and a single-use camera must be provided for those who do not have one available. and would decline an on-site visit. however. The approach described here relies on self-report rather than observation at the work site. This solution preference may reﬂect the training and experience of OTs compared with ergonomists. computer placed so I can sit or stand.
ergonomic changes for all participants. Two-thirds of the present sample was willing to consider an on-site ergonomic assessment. I have a wheeled stool I can sit on and a slanted desktop to use. participants also had a group session on ergonomics as part of the overall Making it Work program. not all recommendations were implemented. Higher surface makes it easier on back and shoulders to work. Done all I can with the current work setup. I didn’t want to do that because it means losing my ofﬁce. a perspective that is sometimes lost when clients and health professionals focus on managing illness symptoms. and future research might more fully explore why suggestions were not viewed as helpful or necessary. technique-based solutions that centered on the person making changes to the way they did things. In our pilot test. to complete ergonomic changes. It was observed that it takes time. some OT practices may not ﬁnd work site visits feasible for all clients. Just over half of the recommended solutions for ergonomic risk factors were simple. the EATA can be augmented with a work site visit. If I do things a little differently I experience less pain. A strength of the EATA is that it aims to identify potential risks associated with work tasks or the environment before they cause pain or aggravate IA. Therefore. and this may enhance the evaluation by encouraging the client to observe their work and engage in a collaborative problem-solving process leading to practical solutions. I now have a new job where the suggestions no longer apply. it requires additional steps prior to the OT encounter: 5 screening questions determine which sections of the self-assessment form the client should complete. I moved. a 1-month followup phone call to discuss recommendations and encourage changes supplemented the in-person consultation. It has been reported elsewhere that workers may be poor judges of the magnitude of their exposure to risks (26). instructions need to be provided for the work diary and for taking photographs of the work station. as well as identifying the motions. a plan for followup visits or phone calls is advisable. I was asked speciﬁcally what I needed: counters on 2 different levels. Engineering-based ergonomic modiﬁcations may improve the work site for all workers. Cutoffs in the Swedish guide are based on scientiﬁc evidence of increased risk of musculoskeletal injuries in otherwise healthy workers. and in some cases persistence. but because only 1 OT was involved in the present evaluation. However. and 73% of participants had implemented at least 1 change at 1 year of followup. The tool helps the client and the OT focus on basic ergonomic risk factors and elicits options for resolving problems encountered at work. It may also be related to the type of jobs assessed. Keeping in mind the relatively lengthy time required to implement job accommodations. like ergonomics programs in general (22. but one-third did not want to disclose their arthritis to employers or coworkers. On-site work visits would also enable the OT to communicate directly with employers and encourage support for changes. Reasons for delays or not implementing ergonomic recommendations My boss said that instead of ordering a new desk that I should move to another area to work where there are ergonomic desks available. In this study. One year later. When indicated and agreeable to both parties. this is speculation. there is a place for a tool like the EATA to facilitate an ergonomic consultation for all people with IA. Given the time (and therefore cost) to conduct.23) and noted a need for supervisory support (24. To overcome the lack of available cutoffs for people with IA. The use of the color-coded levels of risk in the selfassessment is based on the guide for preventing musculoskeletal injuries by the Swedish National Board of Occupational Safety and Health (20). which found that a similar proportion of recommendations were implemented (22. Instead of stooping or squatting to work with children. The EATA was designed to be a practical assessment in a typical clinical setting with access to an OT. One advantage is that the client is actively involved in preparing for the consultation by completing the self-assessment component. I pace myself and think about my actions more. the self-assessment must be sent. Lack of direct observation by a skilled evaluator and relying on a report of current difﬁculties at work may miss detecting risk factors in the job that are not obvious to the client but may present difﬁculties in the future (13). This is consistent with evaluations of participatory ergonomics programs in the general work force. I didn’t know I was poking my head forward.
1502 we included a column in the EATA to indicate pain or aggravation of symptoms. The EATA is speciﬁcally designed for people with IA. The tool is best used by OTs who have prior experience or training in both arthritis care and ergonomics. Verkleij H.60:1025–32. A limited number of occupations were assessed. Backman. Burke T. recommendations had been implemented and new issues were identiﬁed. Backman CL. reach. Rivilis I. 5 subjects participated in both the pretesting of the EATA and the proof-of-concept study. J Occup Environ Med 2003. Arthritis Rheum 2004. Statistical analysis. Identiﬁcation of modiﬁable work-related factors that inﬂuence the risk of work disability in rheumatoid arthritis. Arthritis Rheum 2004. Overview of work disability in rheumatoid arthritis patients as observed in cross-sectional and longitudinal surveys [review]. The most physically demanding occupation among this sample was that of building caretaker. However. Arthritis Rheum 2005. 4. Tyson J. Arthritis Rheum 2004. 7. Appl Ergon 2008. Village J. Miedema HS. Lacaille. Irvin E. Lynch WD. Prevalence of arthritis and associated joint disorders in an employed population and the associated healthcare. force. Gignac MA. 13. is completed in a single consultation (with advance planning for self-assessment).39: 342–58. Lacaille. Spinelli JJ. 9. Hootman JM. Stewart WF. Managing arthritis and employment: making arthritisrelated work changes as a means of adaptation. RA: rheumatoid arthritis. disability. Chee E. and fosters collaboration between clients and OTs in identifying ergonomic risks and solutions aimed at enhancing work performance. Employment and work disability in rheumatoid arthritis. editors. Allaire SH. Muchmore L. because current occupational health and safety guidelines are based on the repetition. p. Arthritis Rheum 2007. and therefore had the tool administered twice. Hochberg MC. OT and Gillian Palejko. because no problems were identiﬁed in this area during the pilot test. In 2 cases. 57:355– 63. What work changes do people with arthritis make to preserve employment. Theis KA. Chalmers A. Manuscript preparation. Village. This pilot test had its limitations. Badley EM. so the acceptability and applicability of the tool to men with IA is unknown. Lacaille. Van Eerd D. Village. and loads that precipitate injury in the general population. no changes were implemented in the interim period and the assessment led to the identiﬁcation of the same issues and recommendations. Backman. Backman. 11. Esdaile JM.53: 673– 81. Charlson ME. Backman. Evaluation of selected
. Backman had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.51:909 –16.51: 488 –97. Reliability should be evaluated in further studies. The EATA needs to be tested with other occupations. The ergonomic tool introduced here adds to the repertoire of rehabilitation tools and services for people living and working with arthritis. Ann Rheum Dis 2001. Future research is needed to examine the thresholds for risk factors for vulnerable populations. and systemic fatigue suggest that people with arthritis are prone to exacerbations of injury at much lower levels. 8. Leotta C. 10. Prevalence and correlates of arthritis-attributable work limitation in the US population among persons ages 18 – 64: 2002 National Health Interview Survey data. Verstappen SM. In: St Clair EW. and Pam Rogers for coordinating the pilot test. and more than one-quarter will leave work prematurely within 10 years of diagnosis (4). Our pilot testing of the tool did not include an assessment of intrarater or interrater reliability. Lacaille D. 2. Yelin E. Cullen K. Pisetsky D.16:148 –52. Murphy L. Lacaille. and may make an important contribution to reducing work disability. which means that some users may need to participate in continuing education to update their skills in one or both areas before using this kind of assessment. Cory Anderson for taking photographs and assisting in the design of the ﬁrst draft of the EATA. Chorus AM. et al. Pain exacerbation as a major source of lost productive time in US workers with arthritis. Pathologic changes such as joint instability. Backman CL. for testing the ergonomic assessment tool. Village. Bijlsma JW.51:871–3. Study design. 5. especially those with more physical demands such as pushing and pulling. Anis AH. Ergonomic assessments and interventions are one approach that can be used by rehabilitation practitioners to facilitate job accommodations aimed at preventing work loss and maintaining at-work productivity. Wevers CW. Lacaille D. Sheps S. Lacaille D. A background in arthritis care helps the assessor to probe during the interview to elicit information about the ﬂuctuating nature of symptoms or problems experienced at work and to frame recommendations in the context of managing this chronic illness. muscle weakness. Philadelphia: Lippincott Williams & Wilkins. Foley K. Gardner HH.51:843–52. Ricci JA. Buskens E. et al.
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The authors thank Cheryl Shefﬁeld. 6. Backman CL. Paget SA. Cott CC. Arthritis Rheum 2004. Williamson T. In 3 clients. Effectiveness of participatory ergonomic interventions on health outcomes: a systematic review. Village. the time spent assessing and implementing ergonomic recommendations is relatively minimal. on behalf of the Utrecht Rheumatoid Arthritis Cohort Study Group. Acquisition of data. 431–9. 3. Mancuso CA. and are such changes effective? [editorial]. Kuchta G. Given the cost of work loss or reduced productivity at work. Previous research shows that more than one-third of people with RA report limitations in their work as a result of their arthritis (27). can be used without a work site visit. AUTHOR CONTRIBUTIONS
Dr. Adam P. van der Linden S. Only women participated. and workers’ compensation beneﬁts cost and productivity loss for employers. ter Borg EJ. Work factors and behavioural coping in relation to withdrawal from the labour force in patients with rheumatoid arthritis. Fairleigh A. Backman. Helmick CG. Analysis and interpretation of data. Cole DC. including IA. Adaptations made by rheumatoid arthritis patients to continue working: a pilot study of workplace challenges and successful adaptations. 12. Blaauw AA. OT. 45:269 –78. Curr Opin Rheumatol 2004. Hayes BF. sick leave. 2004. although there was a reasonable sampling of different types of work.
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