Multicomponent Intervention for Work-Related Upper Extremity Disorders

Abstract

Although several multidimensional models have emerged to explain the development, exacerbation and maintenance of work-related upper extremity disorders and disability, there is a paucity of data on the application of these models for the development of worksite-based prevention and management programs. Sign language interpreting is an occupation associated with increased risk for upper extremity symptoms. Ergonomic, work organization, work style, and work-related and individual psychosocial factors have been demonstrated to play a role in the exacerbation of symptoms and lost time in this group. Therefore, it was hypothesized that an intervention directed at reducing the impact of these factors would be associated with reductions in the number of upper extremity cases/year and associated lost time and health care costs in a group of full-time sign language interpreters. Subjects included 53 symptomatic and asymptomatic interpreters working at the National Technical Institute for the Deaf. The intervention (eleven 1.5-hr group sessions) was designed to 1) reduce musculoskeletal overexertion by reducing workload and biomechanical strain, while increasing flexibility and endurance through tailored exercise and preinterpreting “warm ups,” 2) improve the ability of workers to manage job stress and musculoskeletal pain, 3) reduce biomechanical exposure through work organization and work style changes, 4) alter organizational sources of stress by improving supervisor's managerial skills to address work related upper extremity problems and provide increased supervisor support, and 5) educate workers and supervisors regarding the optimal utilization of health care resources, given the present state of the art in terms of clinical evaluation and management. Results indicated a 69% reduction in the number of cases reporting upper extremity problems in the 3 years following the intervention. Indemnity costs were reduced by 64% and were maintained over the next 2 years. Health care costs followed a similar, although smaller magnitude, change. Despite this reduction, a partial rebound in all outcome measures was observed in Year 3 postintervention. This rebound followed a progressive increase in workload over the 3-year follow-up period.