“When Medical Management and Ergonomics is not enough”

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April 2015: Psychosocial Risk Factors


By all accounts, Rachel is a healthy and beautiful 26 year old administrative assistant. Her work injury diagnosis is relatively benign with no significant or objective medical findings to explain the severe neck, upper back and arm pain she’s had for the last year. She has no apparent loss of function either. However, when asked about her pain, she rates her discomfort level as an 8 to 9 on a 10 point scale (0= none and 10=excruciating). Despite physical therapy, intermittent leave, task restrictions and providing her with good ergonomic equipment including a sit to stand workstation, why isn’t Rachel getting better?

In this story, conservative medical management and good ergonomics are not enough to get Rachel well. So what’s causing the pain and the ongoing workers’ compensation claim? Once physical ergonomics, including demonstrable safe work practices is ruled out, employers should explore the psychosocial risk factors at work.

If your employees are unhappy, in pain and/or dissatisfied with their life or job, it will affect their health and wellbeing at work. Job stress, job demands, job support and job control at work may be to blame if workers’ compensation claims continue unresolved. The psychosocial work environment variables of high, demand, low control and low social support are consistently associated with workers’ experiencing high strain and low wellbeing.

According to Karasek’s model (1979) (Figure 1.), job demands are the psychological stressors:

1. Involved in accomplishing the work load.
2. Related to unexpected task assignments.
3. Associated with job-related personal conflicts.
4. Of job control and decision latitude in day to day work tasks.

The combination of high job demand and low job control produce job strain, which can be associated with high pain levels, often disproportionate to a diagnosed medical condition, such as an ongoing musculoskeletal disorder like Rachel’s case. In such instances, the doctor is not likely to recognize this as contributing to the claim or document it either in the medical record. Psychosomatic pain is real, but often not acknowledged, especially in workers’ compensation claims. So employers should be willing to explore solutions focusing on the interactions between employee and supervisor as they may be hampering healing and wellness.

Based on the literature and in my experiences dealing with similar cases, management should:

1. Engage and interact with injured workers sincerely regarding the performance of essential functions.
2. Understand the importance of social support by providing employees with advice, assistance and feedback on balancing work demands within their abilities and limitations.
3. Provide helpful social interaction with co-workers including them in committee or team work.
4. Provide emotional support, empathy, and active listening to employee’s problems.
5. Allow co-workers to assist with task completion when needed to reduce stress and work demands.

The impact of psychological job demands, job control and social support are consistently found to be predictors of employee strain and wellbeing. Providing support, empathy and being more engaged in discussing work demands, work flow and productivity with injured workers is critical if progress is not evident with typical ergonomic changes and medical management. Such actions will shift the balance of demands and control allowing for reduced stress, pain and ultimately, return to normalcy, work/life balance and wellbeing.

So what’s next for Rachel? More time off or restructuring her work demands giving her more control over her essential functions? Which option is likely to reduce her pain level and help resolve her workers’ compensation claim? For support in dealing with complex workers’ compensation claims with psychosocial overtones,
See in the site under: Our Services/workersComp


Ref: Review of the Job Demand-Control and Job Demand-Control-Support models: Elusive moderating predictor effects and cultural implications, Southeast Asia Psychological Journal, Vol 1 (2012)10-21.

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Comments on: When Medical Management and Ergonomics is not enough

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Marcy

Hi Alison, Such a tough one- we know the longer she is out, the more she is likely to assume the “sick role” and the related sequelae. Hopefully, there is a case worker or at least a proactive HR person who will be contacting her weekly. All the best, Marcy

Alison Heller-Ono

- In reply to Marcy -
Thank you for your reply Marcy. You are “right on” in suggesting management give Rachel more control over certain aspects of her job. In fact, this was suggested to include more special projects/committee work in teams with her peers or working with other managers she responded well with and related to her job as these were tasks she indicated she liked and excelled in. Unfortunately, management decided to give Rachel “more time off” to see if that helps with her pain levels. Rachel may perceive this action as punitive or as further alienation because of her work injury. We definitely do not feel it is the best solution in the long run.

Marcy

According to the literature, job control (the ability to make decisions and decide how the job is done, skill discretion) is a key issue, along with social support. Thus, beyond positive social interaction with colleagues, perhaps management can give Rachel increased control over aspects of her job including breaks, content, deadlines, and special projects. Cardiovascular disease and increased prevalence of MSDs are highly associated with lack of job control in many of the Karasek studies.

Alison Heller-Ono

In reply to Tom.
Thank you for you comment. The term “beautiful” is descriptive for the article and was not intended to be anything other than an observational term given the picture selected. The purpose is to draw attention to a young person with chronic benign pain unexplained and unresolved by medical management and ergonomics interventions indicating the need to explore psychosocial risk factors often ignored in the workplace.
In reply to Caroline Lobban.
Hi Caroline, Thank you for your response. Rachel was well trained in safe work practices and good posture. She did not demonstrate poor or unhealthy postures. In addition, she had a good home office chair and workstation. For the most part, this case was based on psychosocial stressors and environmental stressors including cubicle location adjacent to rest room and in a high traffic area. Your questions are very good and should be asked given the conditions presented.

Tom

What does being beautiful have to do with this article? This type of subtle sexism promotes the pervasive notion that women are judged based on appearance. And yes, I realize the author was woman.

Caroline Lobban

Having provided good ergonomic equipment what measure are in place to support her good neutral posture for both sitting and standing throughout her working day? My experience is you often find poor posture while working and every assistance to support should be considered. Observation,using a buddy system,fit breaks for all offices workers. Had job specific conditioning been considered. What is her out if office computer use exposure?



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