Ergonomics in the rehabilitation of low

back disability cases: towards development

of an evaluation framework that fosters team
collaboration

Kátia M. Costa Black

December 12th 2008
 Main
Disciplines

Occupational
Ergonomics
Rehabilitation

Rehabilitation
Ergonomics

Industrial Engineering
Occupational Psychology
Qualitative Research
Program Evaluation Research
 Presentation Plan
I. Introduction
– What is the problem?
– What is known about the problem?
– Why is there a problem?
– What is unknown about the problem?

II. Research Objectives

– Primary objective
– Key assumptions
Secondary objectives

III. Methodology & Results

– Study 1
– Study 2
– Study 3

IV. Final Results

– The framework

V. Discussion
– Remarks on each study
– General discussion
– Limitations of the framework
– Conclusion
– Recommendations for future research
I. Introduction
What is the problem?
What is known about the problem?
Why is there a problem?
What is unknown about the problem?
 What is the “problem”?

Facts about LBD:

— Affects 80% of population;
— 5-9% with persistent problem = $;
— More than 1% of lost GNP, mostly from
back disability;
— Main cause of worker compensation
claims;
— 100+ associated factors.

LBD is a complex phenomenon and must be considered

from a transdisciplinary perspective (Schultz et al 2007)
What is known about the problem?

Success factors:
— Early return-to-work;
— Proactive disability management;
— Close link to the workplace;
— Involve all stakeholders in the RTW process;
— Apply ergonomics to rehabilitation.
Halpern 1993
Baril et al 2003
Loisel & Durand 2003
Franche et al 2005

“Workplace centered rehabilitation programs are

recognized as effective in reducing the economic
and human costs of LBD”
 PREVICAP: an exemple

— Evidence-Based (EB) program

— Uses an interdisciplinary/inter-organizational approach
— Places the rehab process in the workplace

Loisel et al 1998;
Durand et al 2003
PREVICAP intervention
Control group
 Why is there a problem?
REVIEW OF CONCEPTS

1. Disability and RTW

2. Work as rehabilitation

3. Ergonomics
 1. Disability and RTW

Social ICF
model Economic
model
Biomedical Ecological
model model
Psychosocial
model

Forensic IOM model

model

Schultz et al 2008
 1. Disability and RTW (cont.)

Transdisciplinary model

Economic
Biomedical model
model Ecological
Social model
model
IOM model
Forensic
model Psychosocial ICF
model

PAST TODAY FUTURE

simplistic view comprehensive view

A comprehension continuum?
 2. Work as rehabilitation

— Change in focus based on best evidence

From…
rehabilitating people in order to return them to work
to…
returning people to work in order to rehabilitate them

— Inclusion of workplace actors in the RTW process;

— Stakeholders demands of proof of effective service
provision (beyond traditional health care).
 3. Ergonomics: Meaning

— What does it really mean?

Ergon “work” and nomos “principles of laws”
“This science of work, understood as work in the comprehensive and
integral sense, not merely its part that is physical labour or toil, but
physical, aesthetic, rational, and moral work….” Jastrebowski, 1857.

“Ergonomics is the design and engineering of human-machine

systems for the purpose of enhancing human performance.”
Dempsey 2000
3. Ergonomics: Scope

Physical
Cognitive
Psychic
Social
Emotional
HUMAN

Balance

TECHNOLOGY ORGANIZATION
Technological system Workplace system
Build environment Work organization
Workplace Jobs
Machine Tasks
Tool Work methods
Actions
What is unknown about the problem?

— Rehabilitation ergonomics for LBD:

The process, criteria and procedures used for

ergonomic evaluations are unknown
II.Research Objectives

Primary objective
Key assumptions
Secondary objectives
Primary objective

—To develop a framework for

assisting ergonomists in the
process of work evaluations for LBD
cases
 Premises (Lit. review)
— To consider a system-based model to describing work;
— To use a practice-to-research approach;
— To use Interdisciplinary teamwork model.

Assessment
Worker worksite
Continuous feedback

re-adjustment of goals
Re-assessment &
necessary

Goal planning

Plan execution

Williams 1987
 Secondary objectives

— Study I:
To explore/describe the work environment issues as
discussed by an interdisciplinary team engaged in the
rehabilitation/RTW process of individuals with for LBD;

— Study II:
To explore the content of ergonomic evaluation
for LBD cases within a work rehabilitation context; and

— Study III:
To evaluate the applicability of ergonomic
methods to the rehabilitation/RTW of LBD.
 In summary

Literature review
- What to evaluate?
- How to evaluate?

Development of the evaluation framework

Process Content Tools

Study 1 Study 2 Study 3

Interdisciplinary Ergonomists’ Ergonomists’
perspective perspective perspective
III.Methodology & Results

Study 1
Study 2
Study 3
 Study 1: Methods
—Design: Multiple case-study;
— Study setting: PREVICAP program;
— Sample: rigorous case selection to assure heterogeneity
(Stake 1994).

The team:
- team coordinator;
- psychologist;
- kinesiologist;
- General practitioner;
- Occupational therapist;
- ergonomist.
 Study 1: Methods (cont.)
—Design: Multiple case-study;
— Study setting: PREVICAP program;
— Sample: rigorous case selection to assure heterogeneity
(Stake 1994);
—Analysis: verbatim of relevant cases was analyzed
using a qualitative content analysis.

Quality assurance process for validating the content

of issues discussed in the team:

STEP 1. Expert STEP 2. Individual-

panel/TRIAGE method expert consultation.
(Gervis 1996)
 Study 1: Methods (cont.)

—Cases selected for content analysis:

- Total: 10 workers (all employed);
- Job tittles: bricklayer; railroad maintenance
worker, lumber lift operator, crane driver,
office clerk, clerk-manager, saleswoman, welder,
bus driver and day labor-mason;
- Ages: 31 to 58 yrs old;
- Gender: 8 males and 2 females;
 Results: Study 1

— A classification scheme of the interdisciplinary

factors in the person-environment interface
based on real-life situations. Interdisciplinary
perspective

Work factors
CONTENT
 Study 2: Methods
— Qualitative method: exploratory and descriptive;
— 12 ergonomists working in rehab facilities in Montreal
which include a team approach were recruited;
— 5 agreed to participate;

∗ DESS = post-graduate professional degree

 Study 2: Methods (cont.)

— Data gathering & analysis

Analysis approach was a two-step content analysis

1. Expert consensus 2. Deductive thematic

NGT method analysis
(Gill & Delbecq 1982) (Landry 2003)

consensus on work factors converged into

the elements
of the Work Compatibility Model (WCM)
 Study 2: Methods (cont.)

Work Compatibility (WC) as an integrator of work energizers

(WE) and work demands (WD).
(Abdallah et al 2004)
 Results: Study 2

- Business type
- Company’s size
- Corporate culture
- Job content
- Level of job rotation
- Production demands
- Etc.

- Workplace receptivity
- Relationship with peers
- Employer acceptance
of ergo intervention
- Etc.

Work Compatibility Model

(Genaidy et al 2002, 2005, 2007, 2008)
 Results: Study 2 (cont.)

- Level of physical fatigue

- Perceived effort
- Perceived mental
demands
- Physical capacity

No factors

No factors

- Level of task difficulty

- Pace of task performance
- Work related stress

Hypothesis generated: this data might be obtained by

another professional in the team
 Results: Study 2 (cont.)

—Ergonomic evaluation PROCESS Ergonomists’

- Challenges encountered in practice: consensus
1. Source of data on work system =
multi-professional integration
2. Source of the request (e.g. legal
implications); PROCESS
3. Status: when away from work it is CONTENT
necessary a flexible methodology
and use of various sources of data.
 Study 3: Methods

— Literature review and expert consultation;

— Experts: ergonomists from Quebec working as a
collaborative member of a rehabilitation in a team.
— Use of a structured questionnaire survey: open and
close-ended questions;
— Questionnaire content: questions on tools’ features,
familiarity and usage of tools in the field;

— Data analysis:
- open-ended questions: thematic content analysis;
- closed-ended questions: defined scores for
each feature and content analyzed.
 Study 3: Methods (cont.)
Analysis of utility and content
Utility features analyzed (top
priority):
1. Recommended for rehab/RTW
2. Adapted to various workplace
3. Easy data collection & analysis
4. Meaningful data
5. Reliable
Content analyzed (Shoaf et al 1998):
6. Valid
1. Environment elements
2. Physical workload
3. Mental workload
4. Social elements
5. Organizational elements
6. Individual capacities
7. Human-task interactions
 Results : Study 3
Literature review

67 methods
(65 identified via review process and 2 from pilot interviews)

Step 1

Recommended Not recommended

for rehab/RTW (18) for rehab/RTW (49)

Step 2

Used by at least 3 Not used by at least Used by at least 3 Not used by at least
participants (8) 3 participants (10) participants (5) 3 participants (34)

Step 3: analysis of utility and content

 Results: Study 3 (cont.)

— 23 ergonomic tools were analyzed in terms of Applicability

the utility features and content.
of tools
— On utility features: the AET, Borg RPE, F-
JAS, JCQ, JDQ, OWAS, Snook’s tables and
WRFQ showed potential applicability for
rehabilitation;
— On domains covered: the AET, F-JAS, JDQ TOOLS
and WRFQ are the most comprehensive CONTENT
tools.
— Responses from ergonomists:
- need flexible tools;
- sometimes use their own method instead of
a formal tool;
- etc.
IV.Final results

Framework
Ergonomic evaluation framework for LBD
Criteria Adapted to Easy data Meaningful Reliable Valid Total
various collect. & data score
Methods workplace analysis

IDENTIFICATION OF
Dictionary of Occupational Titles (DOT) 2 n/a 0 1 1 4

PROBLEM PHASE
Job Content Questionnaire (JCQ) 2 1 1 2 2 8
Job Demands Analysis (JDA) 2 ? ? 0 0 2
Job Description Questionnaire (JDQ)λ 1 2 1 2 1 7

Decision-matrix
Position Analysis Questionnaire (PAQ) 2 0 1 2 2 7
Work Role Functioning Questionnaire 2 1 2 2 2 9
(WRFQ)
AET job analysis method 2 1 1 2 2 8
Borg Rated Perceived Exertion (RPE) 2 2 1 2 2 9

Use of formal methods

Fleishman Job Analysis Survey (F-JAS) 2 1 1 2 2 8

BOTH
OVAKO Working posture Analyzing System 2 1 1 2 1 7
(OWAS)
Biomechanical model of lifting tasks 0 1 0 0 1 2

IN-DEPTH ANALYSIS
Lifting Guidelines for people with LB 0 1 2 0 1 4
Disorders
Lumbar Motion Monitor (LMM) 1 0 1 1 1 4
NIOSH lifting equation 0 2 0 2 2 6
Organizational Policies and Practices (OPP) 2 1 2 2 2 8
Rodgers Muscle Fatigue Assessment (MFA)◊ 1 1 1 0 1 4

PHASE
Snook’s tablesρ 1 1 1 2 2 7
3D (2D) Static Strength Prediction Program 1 1 1 0 1 4

Decision-tree
Plan of action
Worksheet
Multi-professional
Integration of data
Steps 1 to 4: Investigation phase

Decision matrix
on tools

Emphasis on data
exchange
Formalizing the
interdisciplinary
data exchange
process
Steps 5 to 7: Interpretation phase

Emphasis on data
exchange

Engaging key
stakeholders in
the process
Steps 8 & 9: Intervention phase

Engaging key
stakeholders in
the process
V. Discussion

Remarks of each study

General discussion
Limitations of the framework
Conclusion
Recommendations for future research
 General discussion
—Regarding the proposed framework:
- Provides a basis for formulating a more work-oriented
rehabilitation plan, according to an interdisciplinary
approach;
- Decision-tree format is easy to use, case-sensitive and
flexible in selecting formal methods applicable to rehab; and
- It integrates an ergonomics perspective in the rehabilitation
process.

— Regarding this research:

- It clarified terms and definitions regarding work factors from
practice-to-research;
- It built blocks of information which can contribute towards the
development of a transdisciplinary vision of the disability
problem.
 Main limitations of the framework

— It’s important that users

become familiar with tools
and have the tools in the
decision-matrix;
— Up until now the format is not
user friendly and too time
consuming;
— More research is needed on
ergonomic factors.
 and remember that….

The information obtained by the ergonomist is but

one piece of the disability assessment puzzle!
 Conclusion

— The framework allows for an improved capacity to

assign priorities for ergonomic intervention for
LBD;
— It also facilitates information-sharing regarding
worker-work environment interactions within a
rehabilitation ergonomics context.
Recommendations for future
research

— It is necessary to validate the

framework in practice.
Thank you