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Occupational health physical therapy

Article in Physical Therapy Reviews · October 2013

DOI: 10.1179/1083319613Z.000000000132

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Guest Editorial
Occupational health physical therapy
Venerina Johnston
Division of Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland,
St Lucia, Australia
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 Con-
federation 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 interven-
tions 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 exam-
ple, the workers’ compensation insurer is focused on
cost minimisation, the employer on maintaining
productivity, the health provider on achieving recov-
ery 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 implemen-
tation of interventions.
ß W. S. Maney & Son Ltd 2013
DOI 10.1179/1083319613Z.000000000132
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 facili-
tated 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 strate-
gies 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 adop-
tion 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
Physical Therapy Reviews 2013 VOL . 18 NO . 5 313
Guest Editorial
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 ergo-
nomic 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
314 Physical Therapy Reviews 2013 VOL . 18 NO . 5
International Classification of Function (ICF) ser-
ving 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 pro-
blem solving, building self-efficacy for physical
activity and reframing negative perceptions of recov-
ery. These strategies however, must be based on a
comprehensive understanding of the barriers prevent-
ing 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 occur-
ring, high level medical care, proactive case manage-
ment, 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
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Guest Editorial
to manage their return to work, and assessing barriers
for work.
Acknowledgements
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.
References
1 Franche R, Baril R, Shaw W, Nicholas M, Loisel P.
Workplace-based return-to-work interventions: optimizing the
role of stakeholders in implementation and research. J Occup
Rehabil. 2005;15:525–42.
2 International Standards Organisation. Risk Management -
Principles and Guidelines Geneva, Switzerland: International
Electrotechnical Commission; 2009.
3 Shaw WS, Main CJ, Johnston V. Addressing occupational
factors in the management of low back pain: Implications for
Physical Therapist practice. Physical Therapy. 2011;91:1–13.
Physical Therapy Reviews 2013 VOL . 18 NO . 5 315