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Occupational health physiotherapy The journal of the Association of Chartered Physiotherapists in Occupational Health and Ergonomics

in this issue‌ Back health in education Public health responsibility deal International FCE

2 editorial  


editorial IN NOVEMBER, WE remember; this year more than most. The last servicemen in the Great War have now died but a third of children born today can expect to see their 100th birthday. Life expectancy in the UK doubled in the 20th century and so has the ratio of working-age adults to pensioners. Today, there are nearly four (3.7) 20-64 year olds for every person over the age of 65, but by 2050 there will be only two. The economics don’t balance so the response has been to push pensionable age up to 68. Yet a longer life does not guarantee more years of reasonable health. People can only work if they remain in good health and, currently, the average “healthy life expectancy” is 63.5 years of age; well below pensionable age. In the last 20 years, life expectancy has risen by 4.6%, but healthy life by only 3%. Expanding healthy working life by one year would be the most effective way to boost GDP according to the International Longevity Centre (ILC).

It would be more effective than a 1% increase in the number of people working or a 1% increase in productivity. The ILC believes the answer lies not in more healthcare, but in investing in prevention and early intervention. This means addressing lifestyles and giving people the right support to stay healthy and productive at work. Occupational health teams are ideally placed and skilled to deliver this. We are pleased that we need not bid goodbye to physiotherapy colleagues in Scotland, but we are less pleased by the vote not to amalgamate the FOM and the SOM. When, in 1985, the NHS could not sustain training schools for two such similar professions as physiotherapy and remedial gymnastics, they merged. Phil Gray helped negotiate the merger saying that “the work of the two groups overlapped so significantly that both parties decided the only sensible way forward was to join forces”. I remember it well as I was working at Pinderfields Hospital Wakefield, where one of the two colleges of Remedial Gymnastics was based. The original core of the Society of Remedial Gymnastics was born out of war when redeployed military physical training

contents Chat from the chair Executive news ACPOHE news ACPOHE CPD groups News Back health in education Public Health Responsibility Deal NSOH progress FCE research Keyboard modifications Talking point WCPT news ACPOHE courses

02 04 05 09 10 14 20 23 24 26 27 27 28

instructors applied their skills to civilian rehabilitation. The remedial gymnasts had exercise, sports rehabilitation and class taking skills second to none. Their forte was to take attention away from the injury and apply a very back-towork approach. Sjukgymnast (gymnastics for sick people) was until recently the name of the physiotherapy (fysioterapeut) profession in Sweden. I often think that the title physical therapist explains what we do better; as for therapists in speech, music and art. But when I consider the very wide range of skills someone like Lorna Taylor brings to her work, then physical therapist just doesn’t cover it. Enjoy reading about her work in education on pages 14-19. Merrin Froggett Editor

Opinions expressed by contributors are not necessarily those of the Association of Chartered Physiotherapists in Occupational Health and Ergonomics (ACPOHE). Mention of any person, product, publication or organisation in the body of the newsletter or in any advertising does not imply that it/they have been endorsed, approved, accredited or investigated by ACPOHE. While every care is taken to provide accurate information, neither the editorial team, nor the association, accepts any liability for errors or omissions. © Copyright for all material published is held by the Association of Chartered Physiotherapists in Occupational Health and Ergonomics unless specifically stated otherwise. Designed and produced by Pages Creative www.pagescreative.co.uk Printed by Severn, Gloucester.

visit our website at

www.acpohe.org.uk OHP VOLUME 18.3

NOVEMBER 2014    executive committee


ACPOHE executive committee members and responsibilities Honorary chair Mark Armour Clinical Director RehabWorks Suffolk House Angel Hill Bury St Edmunds IP33 1UZ Tel 07834 710706 mark.armour@rehabworks.co.uk Honorary treasurer Heather O’Neill Physiotherapy Department Wansbeck Hospital Woodhorn Lane Ashington NE63 9JJ Tel 01670 564010 heather.o’neill@nhct.nhs.uk Honorary secretary Karin Gibberd Physio Department Royal Devon & Exeter (Wonford) NHS Foundation Trust Barrack Road Exeter EX2 5DW Tel 01392 405800 karin.gibberd@nhs.net OHP journal editor Merrin Froggett Occupational Health Department Doncaster Royal Infirmary Armthorpe Road Doncaster DN2 5LT Tel 01302 366666 ext 3750 mfroggett@nhs.net Public relations officer Josh Catlett First Point Health The Surgery Rutherford Way Bushey Herts WD23 1NJ Tel 020 8420 4600 josh@firstpointhealth.co.uk PRO support Charlie Cousin 17 Velsheda Court Hythe Marina Village Hythe Southampton Hants SO45 6DW Tel 07762 142505 c.cousin@uwclub.net

Membership support Tracey Atkinson Connect Physical Health 36 Apex Business Village Annitsford Cramlington NE23 7BF Tel 0191 250 4580 mobile 07921 782214 tracey.atkinson@connectphc.co.uk

Co-opted CPD Lead Katherine Roberts Working Health Consulting Ltd 7 Gatley Drive Guildford GU4 7JJ Tel 07718 541554 katherine@working-health.com

Education officer Katharine Metters Posturite The Mill Berwick East Sussex BN26 6SZ Tel 07838 171554 katharinemetters@posturite.co.uk

Website officer Miles Atkinson Physiotherapy Manager Duradiamond Healthcare D’Albiac House Cromer Road Heathrow Airport TW6 1SD Tel 020 8745 7047 miles.atkinson@duradiamondhealthcare.com

Conference director Simon Mesner Back in Action UK 1a Royal Mint Court London EC3N 4NQ Tel 020 7480 5976 simon.mesner@hcahealthcare.co.uk Research officer Heather Gray School of Health & Life Sciences Glasgow Caledonian University Cowcaddens Road Glasgow G4 0BA Tel 0141 331 8115 h.gray@gcu.ac.uk e-news Maggi Holmes Occupational Health and Wellbeing 151 Belfast Road Carrickfergus Co Antrim BT38 8PL Tel 028 9070 0718 magsjj@gmail.com Co-opted equality and diversity and education support, iCSP co-ordinator Virginia Jenkins Principal Lecturer School of Health Professions University of Brighton Rob Dodd Building 49 Darley Road Eastbourne BN20 7UR Tel 01273 643653 v.s.jenkins@brighton.ac.uk

Journal support Mark Kingston Rhondda Cynon Taf CBC Occupational Health Unit Municipal Buildings Gelliwastad Road Pontypridd CF37 1BF Tel 01443 494003 mark.kingston@rhondda-cynon-taff.gov.uk Horizon scanning Jonathan Hill Rhondda Cynon Taf CBC Occupational Health Unit Municipal Buildings Gelliwastad Road Pontypridd CF37 1BF Tel 07595 046641 jonathon.hill@rhondda-cynon-taff.gov.uk ACPOHE administration support Tracy Long ACPOHE c/o Bury Physio Maynewater Lane Bury St Edmunds Suffolk IP33 2AB Tel 01284 748202 acpohe@buryphysio.co.uk

MEMBER ENQUIRIES Many of our processes at ACPOHE are now online or easy to deal with by email, but occasionally you may need to speak to our administration support, Tracy Long. Tracy is in the office regularly on Monday and Friday mornings and Wednesday evenings on: 01284 748202 or email acpohe@buryphysio.co.uk OHP VOLUME 18.3

4 executive news  


chat from the chair IT WAS WITH DISAPPOINTMENT that we learned the outcome of the merger vote by the Faculty of Occupational Medicine (FOM) and Society of Occupational Medicine (SOM) – they didn’t achieve the objective of amalgamating their organisations. It throws into question the wider agenda of forming closer links with the allied and nursing professions in OH, as well as for governance and the future of training. There is, however, a strong desire by the FOM and SOM to continue to work towards this objective, demonstrated by the fact that the majority of FOM and SOM members did vote in favour of the change only to be scuppered by virtue of the SOM’s constitutional requirement to achieve a 60% majority. The FOM and SOM have released statements outlining their intentions to work closer – see the letter from their Presidents to ACPOHE members on page 7. Health Education England still has a remit of exploring a future central organisation for OH education. ACPOHE is continuing to support this vision through consultations and by contributing to evidence gathering. ACPOHE member Leonie Dawson is immersed in this developing work while on secondment from the CSP as a research fellow at the National School of Occupational Health. Leonie provides more detail on the consultation process in her article on page 23. We continue to anticipate the launch of the Health and Work Service which is to be delivered by Health Management Ltd. The service was very recently re-named as “The fit for work service” which will focus the minds of all players and create positive expectations. Physiotherapists working in OH should benefit from the outputs of the service as we expect to see increasing recommendations to employers to provide musculoskeletal specialist advice OHP VOLUME 18.3

and rehabilitation. Combined with the proposed £500 tax relief per case on OH related interventions, this should provide a strong business case for employers to use our expertise. Being able to evidence that you or your businesses are specialist providers of OH physiotherapy services is rapidly becoming a real advantage, and in the future perhaps a necessity? ACPOHE registered membership, based on the ACPOHE knowledge and skills framework, and the prospect of a tailored SEQOHS accreditation are going to be key levers. In this edition, we celebrate the success of those members who have already achieved registered status. See who they are on page 6. A large number of members are currently working through the application process which means a huge amount of work is going on behind the scenes by our small team of assessors. Our thanks are expressed to Tracey Atkinson, Nicola Hunter and Jude Jones who all used to have social lives. Thanks also to our busy administrator Tracy Long who keeps the wheels of this operation turning. We are reaching the conclusion of the SEQOHS in OH physiotherapy pilot and, while I am not in a position to communicate the results of this, I would like to thank the organisations that have taken part in the process; feedback from the FOM and SEQOHS has been extremely positive with regard to your participation. We await the results with baited breath! A very positive activity undertaken by ACPOHE has been the funding of a member of the recently formed interest group in functional capacity evaluation (FCE) and measurement to attend the world FCE conference in Toronto last month. I am delighted that Glyn Smyth attended, representing the ACPOHE clinical interest subgroup in order to understand the emerging research and to feed into our evidence base. Glyn

reports on his experiences in this journal. A number of our Executive Committee members have supported The Physiotherapy Works programme. The events are about equipping members with the tools and ability to make the case for change and shape the future of physiotherapy. As members, you are vital to the changes as you are in the best position to influence decision makers and promote the value of the professional. The CSP believes that members are key to helping shift and steer the profession’s thinking as to how we make a case for change as well as maintain and sustain the Physiotherapy Works messages. You can book onto these free events at www.csp.org.uk/physioworkslocally Further events will run in 2015 including Scotland, Wales and other regions in England. Mark Armour Chair

NOVEMBER 2014    acpohe news

SEQOHS pilot is nearly over The SEQOHS quality assurance pilot with ACPOHE is nearing completion. The six pilot occupational physiotherapy clinics have submitted evidence that has been assessed against the SEQOHS standard. Each has been given feedback on which standards are complete and which require further evidence in order to achieve accreditation. Early feedback from the pilot practices is that this has been a very worthwhile process for them. They have identified strengths in their practice and areas for improvement. They can see that the areas for improvement will help the practice deliver a more professional, consistent and quality assured service. As part of the pilot, two physiotherapists have been trained to be SEQOHS assessors and have worked alongside experienced assessors during the pilot. This is a skill and learning experience in itself. In the future, there will be the opportunity for more physiotherapists to train as SEQOHS assessors. The FOM Board met last month and have agreed to enable physiotherapy-led OH services to work towards accreditation when the revised standards go live in early 2015. This is fantastic news for both SEQOHS and ACPOHE and further work will be carried out in the next few months in readiness for this change. Nicky Hunter


Website makeover progress Miles Atkinson has made huge strides with improving our website since coming into post as website officer after the AGM in May. He has thoroughly familiarised himself with the functionality of the website and considered your responses to the membership survey. Thanks are due to Executive member Maggi Holmes who did an appraisal of the website last year and identified deficiencies. Miles has worked with the website’s current provider to understand and maximise the potential of what we already have. Here is what Miles has achieved: ●● Checked through pages within the site to ensure they are active and link to the correct pages/documents ●● Ensured links open in new window to keep traffic on to the site manageable

●● Loaded numerous documents such as: —— Assistive technology guidance —— Functional Capacity Evaluation


●● ●●

●● ●●

guidance —— Psychological screening guidance Loading the 2014 conference slides and removing password protection from previous years’ slides Uploading job descriptions of committee members on to the committee section Updated the news section of the site with recent events and removing old events/ news General editing of style, i.e. text size, font and length of content Currently renewing the Regional CPD groups page and adding capacity to share presentations/discussions.

Group to assess tool set Following the inaugural meeting at the ACPOHE conference this year in May, 11 members of the, as yet, unnamed FCE group held a phone conference on the 10 October 2014. Glyn Smyth was appointed chairman and Angela Sutherland agreed to be secretary. An initial discussion about aims and objectives for the group indicated that members want to identify and agree on a tool box of validated functional measurement tests to be used as appropriate in the process of assessing fitness for work. The hope is to develop a more standardised approach to functional measurement which can be used alongside our clinical examination skills. However, consideration will be given to selecting tools which are easy to use, accessible and not financially prohibitive. There was also considerable debate about the name of the group. Although the acronym FCE has been used to identify this fledgling group so far, several participants expressed concern about this term which is

normally used to describe specific commercial systems or products. Members of the new group will submit alternative name suggestions before deciding on the group title at the next meeting. It was agreed that the contents of a future tool box of measures will need to have an established evidence base. Four members volunteered to take on a research role and report back to the group with their findings. These tools could then be referenced and included in the ACPOHE Assessing Fitness for Work and Function course which is currently undergoing a review. In order to progress the aims and objectives of the group, a small committee was confirmed to take on specific tasks. The group plans to “meet” via phone conference in December and February and in person at the next ACPOHE conference. Anyone interested in contributing to this group should contact Glyn Smyth at glyn@work-fit.co.uk Katy Burke

JOB ADVERTS… We have listened to members who want to see more job opportunities and those who want to advertise them. ACPOHE members can now advertise OH physiotherapy jobs for free in the monthly e-news. The adverts must be 15 words or under including contact details for further information. OHP VOLUME 18.3

6 acpohe news  


Membership news ACPOHE saw a 20% increase in general membership from January to September. There are now 71 registered members. Their names will be published regularly in the journal and listed on the website. Fifty-five further applications are pending and are being progressed as quickly as the small team of assessors can manage. Registered members willing to act as mentors are needed. You may have a specialist area of knowledge or work in a particular field, or just be interested in helping to guide other ACPOHE members when needed, or be a link and support for someone who works in OH alone. Acting as a mentor is good for your CPD too.

Please let me know if you are interested: tracey.atkinson@connectphc.co.uk At the September Executive meeting it was decided to remove the difference in fees for ACPOHE membership and registered membership. In future, both types of membership will be the same: at present this is £50. Any registered members who have already paid £75 will be reimbursed £25, although this may take a little time. The website and registered member application guide will be updated to reflect this change. Tracey Atkinson

JOURNAL TO GO DIGITAL ONLY ACPOHE journal has already moved into the digital age by being produced in print and electronic versions. From July 2015, this journal will be produced in digital format only. The link to the e-journal will be emailed to members and will continue to appear in our monthly e-news. Please make sure that your ACPOHE account contains your preferred and correct email address. A pdf version of the journal is also available in the members zone of the ACPOHE website.


CONFERENCE UPDATE 2015 will see an ACPOHE conference with a difference. By invitation of the CSP we are joining Physiotherapy UK in Liverpool on 16-17 October. There has never been a better time to influence the profession and share the occupational health and ergonomics agenda with a wider audience. With a core conference theme of public health, prevention and wellbeing, the Executive decided that ACPOHE had to be a key player. It will be business as usual for ACPOHE members with our AGM and a social function for networking. Put the date in your diary. Call for abstracts The CSP is inviting abstract submissions for poster and platform presentations. Platform presentations are ten minutes with five minutes for questions. If you have research, service evaluation or audits relating to the programme themes, see detailed guidance at www.physiotherapyuk.org.uk or discuss your ideas with ACPOHE research officer Heather Gray h.gray@gcu.ac.uk before the deadline of 19 January 2015.

If you signed up to the registered membership application during the period of reduced fees, remember that you have until the end of December to send in your completed evidence.

GUIDANCE UPDATE The final version of the ACPOHE “Guidance on the use of Assistive Technology in the Workplace” written by Gill Gilworth is now on the website. If you downloaded or printed the draft version, please replace it with this final version in the members’ zone.

REGISTERED MEMBERS UPDATE Congratulations to the 71 ACPOHE members who are the first to have achieved registered status… Successfully completed ROUTE 1 Lesley Platford, Jan Vickery, Pauline Cole, Salim Mughal, Katie Freeman, Judith Jones, Susan Mitchell, Donna Bush, Nicola Hunter, Graham Forman, Elaine Skilling, Susan Delve, Amanda Jones, Katharine Metters, Karin Gibberd, Theresa Robinson, Bronwyn Clifford, Anne-Liese Badyan, Julie Kelly, Kathy Roberts, Jason Chillingworth, Heather Watson, Juliet Sanders, Glyn Smyth, Catherine Albert, Heather O’Neill, Alison Nesbitt, Catherine Burke, Merran OHP VOLUME 18.3

Barber, Jenny Willis, Marian Dowd, Cindy Gaimster, Claude van Kouteren, Katie Birch, Alison Wheeler, Anita McDonald, Tracey Atkinson (Millington), Carol Croshaw, James Phelan, Andrew Barrowcliffe, Anne Pointer, Jillie Blincow, Sudhir Daya, Huw Adams, Fran Polak, Val Noble, Nicola Harris, Austin Wiehahn, Angela Sutherland, Susan Wilshaw, Miriam Sutherland, Gillian Gilworth, James Thackray, Jason Papworth, Latika Sethi, Helen Callahan, (Alison) Kirsty Parry.

Association of Chart ered Physiotherapists in Occupational Health and Ergonomics

Successfully Registered Member completed ROUTE 2 Jennifer Collis, Karen Ogle, Maggi Holmes, Stuart Paterson, Caroline Davidson, Deborrah Thornhill, Caroline Bennett, Judith Pitt-Brooke, Sara Ralph, Anthony Blackwell, Jayne Crook, Jim O’Donoghue Successfully completed ROUTE 3 Clare Rayner, Gemma Plowright (Barlow)

NOVEMBER 2014    acpohe news


Members vote not to merge their organisations The members of the Society and Faculty of Occupational Medicine have voted to remain as two separate entities. The two organisations have, however, agreed that they will work more closely together to represent the interests of health and the workplace and the occupational health community. The Society will be liaising with occupational health physiotherapists through ACPOHE to find out how it can support them better in the future. It envisages a shift of focus where it actively considers encouraging more physiotherapists to join and developing

new services specifically for them. The Faculty, with the support of the Society, will liaise with physiotherapists involved in workplace health so that it can work with the new National School of Occupational Health to improve the quality of education for physiotherapists. We hope that we can continue to work together and develop our relationship for the benefit of the working age population. Richard Heron, President, FOM Alasdair Emslie, President, SOM

The announcement in full…

Academy of It will also continue to work with the of Medical Royal Colleges, Royal College ncil to Cou ical Med eral Gen Physicians and the tice. prac of s dard stan maintain and improve lty of Facu the of t iden Dr Richard Heron, Pres an been has re “The Occupational Medicine, said: We . vote the excellent debate in the run up to to our must build on this decision to listen We will members and refocus our attention. for the redouble our efforts and work together munity benefit of the occupational health com ” ion. ulat pop and the working age ety of Dr Alasdair Emslie, President of the Soci a not ile “Wh ed: Occupational Medicine, agre new a ks mar formal merger, I believe that this between era of co-operation and collaboration the Society the Society and Faculty. I hope that es and can also create a natural home for nurs th.” heal l ona pati occu others working in Christina Butterworth, chair of the Nurse Association of Occupational Health can and we that Practitioners, said: “I believe ety and Soci should continue to work with the tice in prac Faculty to share and develop good on setting occupational health and work together . bers continual mem professional standards of practice and of lty Facu the for s focu c tegi stra A key ent. king with the professional developm Occupational Medicine remains wor l School of iona “Through the Nat lth and with training for National School of Occupational Hea Occupational Health, we can develop Education iate other key stakeholders, such as Health ropr app the the profession, liaising with the number England, with the aim of increasing regulators.” l medicine. of new trainees entering occupationa

al The Society and Faculty of Occupation are to Medicine have announced that they s. remain as two separate organisation by the two s vote ws follo ent The announcem ther to toge join to ns lutio memberships on reso l ona pati occu for create a single organisation the of ur favo health. The Faculty voted in of the resolution and while more than 60% lution reso Society’s membership agreed, their tion stitu was not carried due to the Society con requiring a two-thirds majority. , agreed The two organisations have, however together that they will continue to work closely the and th heal of s to represent the interest th heal l ona workplace and the occupati community. hasis on The Society will place a greater emp more ng extending its membership and attracti . It will nurses and AHPs to become members it undertake a review of the services that its quality g ndin exte ng ideri provides, including cons ts the mee it that so assured appraisal scheme provide to e tinu con needs of these groups. It will its of all excellent education and CPD for


8 acpohe news  


PROFILE Mark Armour ACPOHE Chair I JOINED THE ACPOHE committee in 2012 as website officer. In 2013, I was appointed deputy chair to Jan Vickery, working closely to ensure a smooth handover and continuity of relationships with other organisations. I graduated in 1992 from Queen’s College, Glasgow, and hold a master’s degree in Health Sciences. I worked in occupational health physiotherapy and employment related activities for 14 years. Between 2004 and 2006, I was on secondment to the DWP with the task of engaging the NHS and DWP in joint programmes for health and employment. After joining RehabWorks in January 2006, I became Operations Director and more recently moved in to the Clinical Director’s post. CURRENT WORK ROLE Put simply, I hold responsibility for the safety, effectiveness and quality of every clinical interaction which RehabWorks carries out. I chair the clinical advisory board whose role is to evaluate our current practice as well as identifying new areas of evidence and research to be considered. TYPICAL DAY My day starts at 5.40am when I take the dog (Archie) for a quick whizz round the block (run or walk

depending on time) before a lengthy drive to the office. A typical day involves reviewing reports, contributing to proposals, conducting presentations to potential clients and “directing” our employees. As a member of the RehabWorks board, I also work with fellow directors on business strategy and responsibility to our investors. My working day ends around 7pm when I arrive home to eat, do some reading, watch some TV and crash. INITIATION INTO OH WORK I was four years into my NHS career and I spotted an ad by COPE asking for candidates to help deliver OH physio to Scottish Power; it was too good an opportunity to pass up and I am glad to say I got the job! INFLUENCES ON YOUR WORK When I started with COPE, Lynn McAtamney and Jim Bowden were clinical leads and inspirational characters. Nicky Hunter has been a great mentor and friend. Some more unlikely influences came from my couple of years working in condition management, a fantastic team of OTs and

mental health nurses opened my eyes to what was a true biopsychosocial approach. SECTORS MOST IN NEED OF OCCUPATIONAL REHABILITATION That’s a really tricky one. However, if you look at the on-flow to benefits from people falling out of work due to MSDs, it will be the lower paid, unskilled groups such as catering, services etc. Employers don’t feel the need to invest in rehab because they can easily replace the labour. So, technically, it’s these groups who need the support. IN YOUR OWN TIME We have four teenage children and I enjoy being as active as possible, running 10ks and half-marathons and taking long weekend country walks (often to a pub) with our Labradoodle. We try to see four or five live bands or comedians a year; last year it was Muse, The Proclaimers, The Killers, Jimmy Carr and Marcus Brigstock. DO YOU ACHIEVE GOVERNMENT GUIDELINES FOR PHYSICAL ACTIVITY? Generally I do, with a few press-ups and pull-ups each morning as well as my running. However, there is the odd working week that flies past without so much as a stretch to the fridge! FAVOURITE FILM I’m a bit of a boy here, I’m afraid – the Jason Bourne trilogy wins every time, closely followed by The Great Escape. SURPRISING PERSONAL FACT A few years back I had some instances of being “Physio to the stars”– among them members of Boyzone and Steps! Altogether now, 5-6-7-8.


NOVEMBER 2014    acpohe news


ACPOHE REGIONAL CPD GROUPS Here’s what is and has been happening around our regions… NORTH WEST Rachel Nicholls is on maternity leave, so if anyone is willing to take over organising the North West meetings in her absence for the next year please let Katherine Roberts know. katherine@working-health.com WALES The Welsh Regional CPD Group met in the Royal Glamorgan Hospital on the 21 October to discuss how fitness to work is evaluated, with a specific focus on the ACPOHE documents Guidance on Functional Capacity Evaluation and Psychosocial Screening in FCE. Gillian Pratt talked about attending the ACPOHE Assessing Fitness for Work and Function course. Gill described how useful the course was and agreed with other members who had also attended that it definitely changed their practice. Over cake and coffee the group discussed the challenge of implementing best practice within time and resource constraints. Although there were various opinions regarding the best means of achieving this, it was good to see that most were already working in line with ACPOHE guidance. Next meeting: TUESDAY 21 APRIL at 10am in the Rhondda Cynon Taff OHU, Pontypridd. This will be a practical session on functional measurement with case studies welcomed. Gillian Pratt is the new CPD lead, Maggie Burcher is enjoying retirement greatly. The group meet twice yearly. Gillian.Pratt@wales.nhs.uk SCOTLAND Scottish Regional Group had a highly successful and enjoyable event on 10 September. Twenty-three ACPOHE members from across Scotland attended and after an entertaining speed dating/ice breaker game and very nice buffet lunch we settled into the education session.

Guy Osmond from Osmond Group and his training manager Stuart Entwistle came to Edinburgh and ran an afternoon session on using the “Back Track” inclinometer and movement monitoring device in rehabilitation and Hug Bos came over from the Netherlands and covered latest computer equipment and factors related to home working. No other events planned at the moment but always looking for ideas and offers of hosts. Amanda.Jones@nhslothian.scot.nhs.uk SOUTH CENTRAL Benita Coates is CPD lead for this region which is more geographically challenged than some. The last meeting was cancelled because only one other person was attending. However, Benita and Charlie Cousin are going to issue an invitation to join them, so look out for this. If you think it would work better to form sub-regional splinter groups of ACPOHE members where travel is more reasonable, please get in touch with Benita to discuss this. benitacoates@tiscali.co.uk YORKSHIRE AND HUMBERSIDE Six members met in Tadcaster in September to discuss topics presented at this year’s HWB@work conference and how they could influence practice. The next meeting will be in January, date and venue TBA. lorna.cushnie@nhs.net

h group in Edinburgh

On track… the Scottis

EAST OF ENGLAND A small group had a great talk at the last meeting from Dr Tim Hunter about tools to encourage activity in the workplace. It is time to hand the baton of regional leader to a new pair of hands. If everyone takes a turn, it won’t be a burden. Please contact sarah@physio4business.co.uk or phone 07722 145 311

Diary dates 2015 Health and Wellbeing at Work Conference n 3 –4 March n NEC Birmingham Physio First n 28 – 29 March n Nottingham IEHF n 13 –16 April n Daventry WCPT Congress n 1 – 4 May n Singapore ACPOHE Conference at Physio UK n 16 –17 October n Liverpool OHP VOLUME 18.3

10 news  


ME sufferers likely to be covered by Equality Act

Home in on exercise… Not everyone can get to the gym, but a recent study suggests that you don’t have to in order to meet exercise guidelines. Public Health England recommends at least 150 minutes of moderate intensity activity a week. Researchers found that MET (Metabolic Equivalent of Task – energy consumption/hour) scores for a range of indoor and outdoor tasks could account for a significant proportion of this exercise target. Household tasks such as vacuuming or mopping and outdoor tasks like washing the car or mowing the lawn were all found to be moderate intensity – which is anything with a MET score of 3 or more. Top these up with some brisk walking or even dancing and you can achieve your 150 minutes without donning lycra!

Seating company ceases trading ACPOHE has learnt that Advance Seating Designs (ASD) ceased trading on 31 July 2014, writes Charlie Cousin. This a huge loss to all who work within the industry and are involved with workplace seating and ergonomics. The company was founded 25 years ago by Alan and Lesley Glaser, both graduate physiologists. Alan Glaser and his team have always been very supportive of ACPOHE and its members. ASD has attended our conferences and meetings, organised training sessions with its products and most generously provided numerous chairs as prizes at our events. Many will know not only Alan but also know Kevin Webb and Sarah Duncan OHP VOLUME 18.3

who have each been with ASD for many years. ACPOHE is pleased to hear that Kevin has now joined the Osmond Group as Customer Development Manager (kevin.webb@ergonomics.co.uk) and Sarah has joined RBLI as an assessor. Alan would like to inform the membership that as from 8 September his new company SITABILITY www. sitability.co.uk will be continuing to specialise in the manufacture and sale of the eMove and eLift range of powered office chairs together with service and repair for existing owners. Alan has relocated to Reading and can be contacted on 07788 423559 or at alan.glaser@sitability.co.uk

There is often confusion around ME (myalgic encephalomyelitis). Some people use the term chronic fatigue syndrome (CFS) because the main symptom for many is fatigue and the condition is chronic. However, many sufferers prefer the name ME because fatigue is not always the main symptom and others include muscle pain (myalgia), problems with short-term memory and concentration, sleep disturbances and emotional imbalances. The term CFS is often used medically because the main symptom is fatigue and there is no evidence of inflammation in the brain or spinal cord. The symptoms vary and can fluctuate. Someone with mild symptoms may need the odd day off to rest when the fatigue is bad. Those with severe symptoms may have significantly affected mobility and activities of daily living. Despite ME being recognised as a neurological condition by the World Health Organization, it is believed by many to be a “made up” condition because of the fluctuation and variety of symptoms, the cause is unknown and there are no tests to definitively diagnose it. Because ME is a long-term and fluctuating condition, sufferers are likely to be protected from discrimination under the Equality Act 2010 if the ME has a substantial and long-term adverse effect on their ability to carry out normal day-to-day activities. If they meet the requirements of the Act, employers need to ensure they do not treat them any less favourably than any other employee.

NOVEMBER 2014    news

Fit note – employers ‘losing faith’ The manufacturers’ organisation EEF reported great improvements in companies’ management of sickness absence last year, but found that progress in reducing sickness absence has stalled. EEF’s10th annual Health Survey (June 2013) conducted in association with Westfield Health, showed sickness absence rates falling from 3% in 2007 to 2.2% in 2011, but flattening at 2.3% in 2012. Days lost to absence showed a minor increase from 5.1 in 2011 to 5.3 in 2012 despite employers implementing measures such as RTW interviews and manager training. Although management of short-term sickness absence improved, the average duration of sickness absence increased. EEF supports the fit note but feels that employers are losing faith in it and that it isn’t fully delivering potential benefits. Only 26% of employers felt that fit notes resulted in employees returning to work earlier and one third said they could not

make the work adjustments advised. Employers are dissatisfied with the quality of fit notes and 49% did not feel that advice given by GPs about fitness to work had improved. EEF reports that fewer than 10% of GPs have completed available training on health and work and call for this to be linked to appraisal. They request that the Government, Royal College of GPs, the BMA and employer organisations meet to identify, clarify and resolve the obstacles that are preventing the fit note from working effectively. EEF is concerned that, on the introduction of the health and work service, medical professionals will avoid making decisions on fitness to return to work at around four weeks, which is the time when an employee can be referred into the service. The report is available to view at www.westfieldhealth.com/pdfs/EEF/ survey/EEF-Sickness-AbsenceSurvey-2013.pdf

Survey reveals painful arthritis facts Arthritis Care recently announced the results of Arthritis Nation 2014, a survey of 2,008 people, assessing the experience and real-life implications due to arthritis. The pain of arthritis affects every aspect of life. The burden increases in relation to how long each person has had arthritis; few treatments, with the exception of self-management, help the pain. The results highlight the importance of support and advice for self-management, with 78% of those receiving it saying it was helpful. However, only one third of people with arthritis are currently being offered this help. Results show that 70% of people living with arthritis experience constant pain despite taking relevant medication. Among those of working age, 43% report an impact on their or their partner’s working life, 18% give up work entirely and 13% take early retirement.


MORBID OBESITY ‘A DISABILITY’ The case of Mr Kaltoft, a Danish childminder who alleged that he was dismissed because of his weight, was referred to The Court of Justice of the European Union (CJEU). The Advocate General has given an opinion that where obesity has reached such a degree that it hinders full participation in professional life, it can be considered to be a disability. It is most probably the case that only morbid obesity (BMI of 40 or more) would create the types of limitations (e.g. problems in mobility, endurance, mood and prejudice based on physical appearance) that could satisfy the definition of disability. Someone in other categories of obesity (such as those with a BMI of 30 to 40) would not be regarded as disabled just because of their obesity. Currently in the UK, obesity is not, in itself, a recognised disability for the purposes of the Equality Act 2010, but this opinion makes it more likely that someone who is morbidly obese would be found disabled by an Employment Appeal Tribunal. An Advocate General’s opinion is not binding on the CJEU, but it is usually followed. In the UK, this means that morbidly obese employees are likely to fall within the definition of disability if their obesity prevents them from fully participating in working life. It would also trigger the duty to make reasonable adjustments. This could include providing parking spaces close to the worksite, special chairs or furniture or even amending an employee’s duties to include less walking or travel. The Advocate General also commented that the reasons for an employee’s obesity are irrelevant to the question of whether that person is disabled or not, and does not depend on whether the impairment could be said to be “self-inflicted”. OHP VOLUME 18.3

12 news  


BACK PAIN ADVICE BEING IGNORED Two-thirds of back pain sufferers who visit their GP apparently do not follow the advice given or do not do the exercises recommended. So millions of people are risking poor outcomes because they are not doing what they are told, according to a survey carried out for the back care device makers bac<. The survey of 2,056 people revealed that 19% felt their pain prevented them from enjoying their hobbies, 14% were unable to drive and 8% couldn’t look after their children. Some 24% suffered poor mental health and 35% said it made them short-tempered and snappy. Sufferers admitted that pain affected relationships with family, friends and work colleagues. The Work Foundation commented that family doctors are not taking back pain and similar conditions seriously enough because they are not life threatening, and making sure patients are fit to work is not regarded as important as other “clinical” priorities.

DID YOU KNOW… In Britain, 82% of employees use a visual display unit (VDU) as part of their job? A survey of 7,000 UK workers by Westfield Health found that more than half (53%) of UK employees say their current working environment has had a negative impact on their eye health. Eye-related problems included headaches, blurred vision, eye strain and dry eyes. Nearly a third (32%) were not aware of the statutory health and safety requirements for their employer to pay the full cost of an eye test and basic spectacles if required for VDU use. The survey also found that 7% of people had taken time off work because of an eye-related illness or accident, such as conjunctivitis, burst blood vessels, cataracts, and headaches and migraines due to eyestrain. OHP VOLUME 18.3

Boost for mental health services NHS ENGLAND HAS announced a £120 million boost to mental health services. This is a crucial step towards mental health problems being treated as seriously as physical ones. Currently, if you need a hip operation, you can expect treatment within a clear timeframe, but people with mental health conditions have no clarity about when they will receive help. From April, NHS England has committed £80 million to help underpin new access and waiting times’ standards, as well as help for those in crisis to get effective support in acute hospitals. The new standards call for 75% of people referred for talking therapies to start their treatment within six weeks and 95% within 18 weeks, and for at least 50% of those going through their first episode of psychosis to get NICE-approved help within two weeks of referral. The moves are part of a five-year ambition to put mental health on an equal footing with physical health services. Mental health conditions cost £100 billion a year in lost productivity and hospital admissions and at least one-in-four people experience a mental health problem during their lives. Improving early treatment for psychosis is expected to make huge savings in reduced hospital admissions.

Ladders are OK, if used for short time The Health and Safety Executive’s guidance on working at height was overhauled and updated in January 2014 as part of the Government’s Red Tape challenge to abolish or simplify outdated or over-complicated regulations. The updated guidance presents in clear, simple terms what to do and what not to do, as well as debunking some common myths, such as the rumour that ladders/stepladders cannot be used for working at height. For straightforward short duration work, stepladders and ladders can be a good option, but you wouldn’t want to be wobbling about on them doing complex tasks for long periods. See the guide at www.hse.gov.uk/pubns/ indg401.pdf

How to assess workplace sickness rate How do you calculate sickness rates in your organisation? This is often essential data for monitoring the effect of services or benchmarking against others. Here is a guide: Average number of days = absent per employee Absence rate


Total number of working days lost to absence Average number of employees across the year

Total number of working days lost to absence 228 days x average number of employees across the year

NOVEMBER 2014    news



CIPD More than one million over-50s pushed out of employment. According to The Prince’s Initiative for Mature Enterprise (PRIME), up to 1.5 million mature workers involuntarily left the workforce in the last eight years, citing reasons such as redundancy, ill-health or “forced” early retirement, despite around 1.1 million of them still being willing to work. Its report, The Missing Million: illuminating the employment challenges of the over-50s, highlights the fact that there are currently 3.3 million economically inactive people between the ages of 50 and 64. www.prime.org.uk/wp-content/ uploads/2014/10/PRIME-report-themissing-million.pdf

FIT FOR WORK EUROPE New study reveals that healthcare intervention could significantly reduce the impact of one million EU workers needlessly off sick each day. An extra one million employees could be at work each day if early interventions were more widely accessible for people with musculoskeletal disorders (MSDs) such as back pain. This is according to a new report from the Fit for Work Europe Coalition, written by The Work Foundation and published on 16 October. www.fitforworkeurope.eu/pressreleases.htm

FIT FOR WORK UK If the benefits of work for people with

chronic MSDs are to be truly realised, then the way in which self-management at work is supported needs to be significantly improved. The report Self-management of chronic musculoskeletal disorders and employment, published in September, aims to capture the barriers which people with chronic MSDs are facing in the workplace, and makes a series of practical recommendations for the Government, employers and clinicians to tackle the issue. Commissioned by Public Health England, it addresses the role of employment opportunities and good quality work in improving health and makes recommendations including investment in specialist nurse roles to help people with MSDs remain active at work. www.fitforworkeurope.eu/default. aspx.locid-0afnew01j.Lang-EN.htm

GMC The GMC’s recent annual State of Medical Education and Practice report highlights concern at diminishing recruitment in occupational medicine. A greater proportion of specialists in occupational medicine are aged over 50 than in most other specialities. It is important that influential funding bodies recognise the future workforce crisis facing the specialty and ensure that funding for speciality training is increased and protected. The GMC are working closely with Health Education England and others so that access to occupational health provision is available to more UK workers in future.

Constructing Better Health and SEQOHS announce new collaboration. Constructing Better Health (CBH) and Safe Effective Quality Occupational Health Service (SEQOHS) have announced a new collaboration to improve the accreditation of occupational health services in the construction industry. www.fom.ac.uk/qualityimprovement/constructing-betterhealth-and-seqohs-announce-newcollaboration

HMRC HM Revenue and Customs (HMRC) published its proposals for tax relief to be applied to employer funded return to work interventions. The relief will be capped at £500 per employee per year and applies to National Insurance Contributions (NICs). The absence (or expected absence) must be at least 28 days to qualify for the tax relief and the treatment must be recommended by the Health and Work Service (HWS) or a healthcare professional. Physiotherapists are among the qualifying professions. www.rehabwindow.net/Display. aspx?id=2152

HEALTH AND WORK SERVICE The introduction of the Health and Work Service (HWS) has been delayed until December. It is believed that this delay was to ensure provisions could be put in place to encourage GP referrals to the service.


14 risk in schools  


Back health in education Author: LORNA TAYLOR Lorna Taylor is a Chartered Paediatric Physiotherapist and ACPOHE member working in primary and early years education. She is an active campaigner for improved back health in the education sector. Here, she shares recent research relating to the back health of adults working in schools, identifies risk factors and suggests practical interventions to improve back health and wellbeing for teachers and teaching assistants.

PART 1: STAFF BACKGROUND Physiotherapists are familiar with anecdotal evidence of work related musculoskeletal disorders (MSDs) in education professionals, particularly because of the associated low working heights and the accompanying risks. Many are familiar with the challenge of low environments as parents or through our working practices. The hazards of child friendly environments are often little considered in mainstream schools. Factors such as budget restrictions, pupil academic targets, limited understanding and/or belief in heathier working practices, together with cultural resistance to change in some schools, may be barriers to improving occupational health and ergonomics. However, as professionals, this allows us to be creative in our thoughts and approach and gives us a great opportunity for positive improvements in the health of staff and pupils. Change is needed and it is important to look beyond the classroom. The concept of back health in education is an emerging one. Given the increasing number of children now experiencing back pain as technology and sedentary lifestyles take their toll on young, growing spines, this is something schools should be concerned about. OHP VOLUME 18.3

Above is a genuine school resource room, used daily. It is neither safe nor an effective use of teachers’ time.

The implications for ignoring back health are costly and far-reaching for employees, employers and society. For children, striving to reach their full potential and as our future workforce, the implications have a potentially greater impact. If their teachers and teaching assistants are absent due to ill health, this may have additional impact on the children’s education. As a parent, the implications of an unsettled child, disrupted at school, is a concern, but fundamentally, I believe every member of staff, volunteer and pupil should be respected, valued and cared for. A recent review carried out by the Work Foundation and the Teacher Support Network entitled “Healthy Teachers, Higher Marks?” reports that healthy teachers who are mentally and physically fit produce better exam results in their students. Dame Carol Black, who was instrumental in positively influencing the wellbeing of NHS staff, commented: “We know from research that whatever you are producing, whether that is machinery or healthcare, your product depends on the people who work for you. The product in education is the performance and education of children, therefore having your teachers healthy and well, both mentally and physically, is crucial”.

MSD risk factors

repetitive and heavy lifting bending and twisting, repeating an action too frequently uncomfortable working position exerting too much force working too long without breaks adverse working environment (e.g. hot, cold) psychosocial factors (e.g. high job demands, time pressures and lack of control) ●● not receiving and acting upon reports of symptoms quickly enough ●● ●● ●● ●● ●● ●● ●●

The HSE identified MSDs as a priority because, although they have the potential to ruin people’s lives and they impose heavy costs on employers and society, “you can do things to prevent or minimise MSDs and prevention measures are cost effective”.

NOVEMBER 2014    risk in schools


Figure 1: Reported career prevalence and type of work related MSD in relation to service years

Never experienced discomfort at work


With more than one million primary teachers, teaching assistants, nursery nurses and playgroup leaders and more than 20,000 primary schools and 29,000 nurseries/pre-schools, this is an area where occupational health professionals have great potential to influence change positively. RECENT RESEARCH ●● 55% of all teachers in locally

maintained schools and academies in England took sick leave for a total average of 8.1 school days (Department of Education 2013). This equates to 4½ school days per teacher. ●● In 2011-2012, 2.2 million teaching days were lost due to sickness absence. ●● There is a risk of short-term problems turning into long-term absence. In the UK, once a person has been on incapacity related welfare benefits for one year, they are statistically more likely to die than return to work (Bevan 2012). ●● MSDs in education professionals decrease productivity at work due to sick leave, absenteeism and early retirement (Erick & Smith 2011). As the retirement age increases, this may have implications for staff and schools.


Neck and shoulders

●● The number of five GCSE A*-C

grades attained in a given school decreases when more supply teachers are needed (Department of Education and Skills 2006). Supply cover is costly and not afforded by all schools, but if it is not provided and cover is sourced internally, pupils lose additional teacher and/or assistant time. ●● A systematic review has found that the prevalence of self-reported MSD among schoolteachers ranges between 39%-95% (Erick & Smith 2011). In 2011, I carried out a self-administered anonymous questionnaire with Voice – the union for education professionals – and the National Union of Teachers to gain an overview of the situation and challenges experienced in UK schools and nurseries, entitled “Work-relevant musculoskeletal disorders in early years and primary teaching professionals”. In total, 705 questionnaires were received (436 paper, 269 online). The age groups of children worked with were infants 48% (333), pre-school 31% (215) and juniors 21% (147). KEY FINDINGS ●● Reported career prevalence of

work-related MSDs – 98%.


●● 88% reported experiencing back

pain (Figure 1). ●● 82% experienced MSDs once a week

or more (Figure 2). ●● 38% had been off work with MSDs. ●● 70% had received treatment for

their symptoms. ●● Only 8% had officially recorded it. ●● 99.5% thought work-related MSDs in the education profession were under-reported (Figure 3). ●● Work activities causing discomfort were: 91% bending over low tables, 85% sitting on children’s chairs, 71% kneeling at low tables/on the floor (Figure 4). In all, 98% of respondents reported discomfort which they felt was work-relevant (caused or exacerbated) at some point in their career. The most prevalent was back pain (88%), followed by neck and shoulder pain (73%). These findings echo that of the Erick & Smith 2011 systematic review which reported the most prevalent body sites for pain are the back, neck and upper limbs. In addition to the above, open responses included discomfort in the arms, wrists, feet and ankles. Several respondents had received hip, knee and back surgery to reduce their pain – two reception staff members in their 30s had undergone back surgery. OHP VOLUME 18.3

16 risk in schools  

NOVEMBER 2014 ●● that they are often considered age

Figure 2: On average how often do you experience discomfort at work?

or stress related ●● it is not taken seriously by many

people ●● hidden problems are not seen as

important ●● reminded that there is no money ●● made to feel that all money should be spent on the children and not staff discomfort.

Every day

More than once a week

About once a week

Figure 1 also highlights that the type of MSD reported is not dependent on service years. A similar level of back pain was reported by staff who had worked with young children for less than five years as it was in those who had worked more than 20 years, so it is not necessarily age related. The majority of respondents (82%, Figure 2, columns 1-3) reported discomfort once a week or more. More than a third (36%) reported daily pain; 7% rarely experienced discomfort which they felt was work related. Just over one-third, 38%, had been off work and 70% had received treatment to ease their pain – either self-financed/private, NHS or, in a quarter of cases, both. Private treatment included: physiotherapy, chiropractic, osteopathy, acupuncture, massage, podiatry and orthopaedic surgery.




Only 8% of respondents had officially recorded their work-related discomfort, despite nearly half (48%) visiting their GP and 83% discussing it with friends and family. 11% did not mention their discomfort to anyone and only 1% contacted their union. Figure 3 shows that 99.5% of respondents feel that work relevant musculoskeletal discomfort in the education profession is under-reported: 77% feel that it is accepted as part of the job, more than half (55%) are unaware of reporting systems in place and over a third (37%) because of fear of jeopardising a career. The majority of open text responses suggested that people don’t realise these pains are related to the work conditions as they come on slowly and they are unsure of cause. Other responses included:

Figure 4 shows the top three work activities which respondents felt caused or contributed to their discomfort were bending over low tables (91%), sitting on children’s chairs (85%) and kneeling (71%). In addition to the above, other job tasks associated with symptoms included: ●● manual handling activities (lifting/carrying children, lifting off climbing equipment, for nappy changes, if children have fallen) ●● putting up/preparing displays ●● working at child height computers or bent over laptops in class ●● standing all day ●● constantly picking things up from the floor ●● removing heavy boxes from above head height ●● working at low fixed height whiteboards ●● physically assisting children with special needs and/or unpredictable behaviour ●● being outside for long periods in the cold and wet.

Figure 3: Reported reasons for under reporting of MSDs It’s accepted as part of the job


Staff don’t wish to complain


Unaware of reporting systems in place

55.7% 37.2%

Fear of jeopardising career No – it is fully reported



NOVEMBER 2014    risk in schools


Figure 4: What activities at work cause you/your colleagues discomfort? Bending over low tables

90.7% 84.9%

Sitting on children’s chairs Kneeling at low tables/on the floor


Moving equipment


Admin and preparation activities at children’s desks


Sitting on the floor


Washing up at low sinks Carrying bags

The Erick & Smith 2011 systematic review concluded that the work tasks of schoolteachers often involve the significant use of head down posture, such as frequent reading, marking of assignments and writing on a backboard/ whiteboard. Nursery teachers also perform a variety of tasks combining basic child care, health needs and teaching duties which require sustained mechanical load and constant trunk flexion. During the ErgoKiTa Project, Burford & Ellegast (2014) found that teachers in nursery schools experienced upper body postures with trunk flexion greater than 20º for at least 16% of an eight-hour shift. The load bearing activities were noticeably higher in nurseries, especially with children aged under three where loads of 10-20kg were frequently encountered by staff.

58.4% 35%

ergonomics, causes of MSDs and safer handling of equipment. Many said: “It is too late for me” or “You don’t realise that smaller aches and pains you are regularly experiencing early in your career are contributing to serious long term damage”.

Other coping strategies included staff discovering ways to manage symptoms, such as: “I bend my knees to pick things up”, “I use a chair to wash up”. Many agreed that simply avoiding certain activities was not the answer because “fewer staff are left to do

Classroom working practices

COPING STRATEGIES Many staff said that they could no longer sit on the floor, worked part-time supply rather than full-time, moved to work with older children and some were forced to take ill-health retirement. Several self-financed regular treatment: “I visit my physiotherapist every two months (since 2000).” Staff working in special needs really valued the manual handling training they received and felt that all other educational workers should receive it. Many respondents, in particular trainee teachers, felt that they should have access to improved information and training on manual handling, posture, OHP VOLUME 18.3

18 risk in schools  


Classroom working practices

hazardous tasks, so are at more risk themselves”. PSYCHOSOCIAL FACTORS Increasingly, research has found that psychological factors such as high workloads/demands, high perceived stress level, low social support, low job satisfaction and monotonous work have been positively associated with MSD among schoolteachers (Samad et al 2010; Erick & Smith 2011; CIPD 2013). Presenteeism (working when genuinely ill when you should be at home recovering) may account for up to 50% more working time lost than absence as staff are less productive, have an increased risk of making mistakes and recovery time can be lengthened. Presenteeism is more likely in organisations that have seen major changes in structure and workload. It is significantly more common in women with the most common reason being “not wanting to let your team down” (CIPD 2013). Education professionals often work in demanding situations with large classes, a lack of education resources, curriculum changes and with limited reward for their work. These are important issues when considering an OHP VOLUME 18.3

effective approach. There are emotional demands of working with children and parents in addition to the pressures widely recognised by Ofsted assessment. PERSONAL AND ENVIRONMENTAL FACTORS A previous episode of back pain is a known risk for further episodes, so prevention of the first episode is important. Physical factors such as frequent bending, twisting, repetitive work, static postures, awkward or

uncomfortable postures, lifting, pushing, pulling are all observed in educational settings. On average, 600 hours is spent sitting on children’s furniture every year. If you think of this as a workstation, then the HSE risk factors which include “sitting at a workstation for a long period of time if the workstation is not correctly arranged or adjusted to fit the person, combined with time in stooping, bending over or crouching (poor posture), stretching, twisting, reaching”

NOVEMBER 2014    risk in schools are present for long periods of the day. Ergonomically poor DSE workstation set-up and inappropriate seating may be factors for pupils and staff. Environmental issues such as lack of space for movement and equipment storage are often present, as well as frequent needs to move furniture around. Workplace culture and relationships might add to stress and anxiety. Rest breaks may be insufficient during the working day. SCHOOLS HEALTH AND WELLBEING INITIATIVE Drawing on research and identified risk factors, an injury prevention and wellbeing intervention pilot has been carried out in three primary schools. Head teachers were contacted through the Derby City Healthy Schools Team so that the pilot began where a supportive health and wellbeing culture was already embedded. The HWB charter: 1 A Back/MSD Health Wellbeing Representative was assigned. 2 Staff training was given to explain the concept of MSDs and ergonomics, the importance of prevention and rehabilitation, with a Q&A and discussion on MSD challenges faced in school and at home. 3 A HSE Health and Safety (H&S) checklist for classrooms and workplace assessment was completed with the school representative (catering and office staff were included too). Playground and storage room assessments were also carried out. 4 A staff MSD helpline was available. 5 Jolly Back’s BackChat training resource (An Essential Guide to Manual Handling, Back and Voice Care for Education Professionals) was viewed and self-assessment was completed by all staff. An annual

refresher was recommended. 6 Presenteeism was discouraged and rest breaks were encouraged. 7 Cumulative strain injury was recorded in the accident book and appropriate H&S and OH professionals were involved early on. 8 Jolly Back’s staff self-assessment could be completed by those with discomfort to track personal changes. 9 Information on external professional organisation support was supplied – Teacher Support Network (offering emotional wellbeing and counselling), union advice and support. Both the NUT and Voice now provide good practice guidance on classroom ergonomics and back health for members. It can be seen on their respective websites. 10 Practical “posture improving” equipment was suggested and provided as necessary and as budgets allowed (for the classroom, staff room, office areas and playground). 11 MSD health was put on the staff meeting agenda each term to identify and discuss new issues – identify, reduce, control and review process. Each school’s Back/MSD rep can be contacted any time and is familiar with onward referral. 12 Schools formulised their own MSD management policy. A staff competition created discussion and helped consolidate learning and potential changes in behaviour and practice. Six-month and 12-month review meetings were held with the pilot schools. Outcomes from the pilot are being assessed. Feedback so far is positive and includes: “Staff morale has greatly improved”, “We now run staff Pilates classes”, “It’s changed my practice, I also now think about pupils’ posture too”, “It’s been a light bulb moment, I understand why my neck aches”, “We


have been a Jolly Back school for over 18 months and have never had anyone off work with back pain”. CONTACT I would welcome the opportunity to be in touch with any readers who are interested in this topic and who wish to know more and share good practice. For further advice and information, please see www.jollyback.com or email lorna@jollyback.com REFERENCES Bevan S (2012). The Impact of Back Pain on Sickness Absence in Europe. Burford EV, Ellegast R (2014). Analysis of musculoskeletal workload of nursery teachers. The Ergonomist May 2014. Chartered Institute of Personnel and Development /CIPD (2013). Employee Outlook: Focus on employee well-being. Erick PN, Smith DR (2011). A Systematic Review of Musculoskeletal Disorders Among School Teachers. BMC Musculoskeletal Disorders 2011;12 (260). HSE (Health and Safety Executive) (2014). Back pain in the workplace – Causes of pain.www.hse.gov.uk/msd/ backpain Samad NIA, Hashim Z, Abdullah H, Moin S, Tamrin SBM (2010). Prevalence of low back pain and its risk factors among school teachers. American Journal of Applied Sciences 7(5): 634-639. USEFUL RESOURCE Teacher Support Network – a helpline dedicated to schoolteachers and staff in FE and HE www.teachersupport.info ●● In the next issue, Lorna will write

about improving back health for children.


20 a good deal  


Public Health Responsibility Deal – what does it mean to OH physiotherapists? from the various sectors in improving the health of the general population.

Author: MILES ATKINSON Miles Atkinson is Business Unit Manager for Fit For Work and until recently was Physiotherapy Manager for Duradiamond Healthcare, a nationwide OH provider based at Heathrow Airport. He has wide experience in many sectors of industry and in sports physiotherapy.

WHAT IS THE RESPONSIBILITY DEAL? The responsibility deal comes from the Government’s belief that public health is everyone’s responsibility and its ambition for a collaborative approach to tackling challenges caused by unhealthy lifestyle choices. Too many people eat too much, drink too much and are not doing enough physical activity. The Public Health Responsibility Deal aims to tap into the potential of businesses and influential organisations to improve public health. There are already nearly 700 responsibility deal partner organisations. Organisations signing up to the responsibility deal commit to taking action voluntarily to improve public health through their responsibilities as employers. Through their commercial and community activities, employers can also send out positive messages to clients and the wider community. Creating the right environment can empower and support people to make informed, balanced choices that will help them lead healthier lives and more productive and sustainable working OHP VOLUME 18.3

lives. They can pledge to help people lead healthier lives through one or more of the following areas: ●● ●● ●● ●●

alcohol food health at work physical activity.

HOW DOES IT WORK? Dame Carol Black has recognised that people are more likely to make lifestyle changes if they are encouraged and supported by their employer rather than left to their own devices. If you create the opportunities, give capability and motivate individuals, you can make positive and lasting behavioural changes. It seems that if your employer encourages you to make healthier lifestyle choices, you are more likely to listen than if left to your own devices. The Black Report emphasised the importance of improved collaboration between medical and non-medical sectors to tackle the public health crisis. Through the responsibility deal, the Department of Health is aiming to get improved accountability and action

HOW DID I GET INVOLVED? Dame Carol Black invited me to participate in the Public Health Responsibility Deal Partnership Forum in April in London. The forum was targeted at the construction and civil engineering industry, attempting to bring a variety of organisations together in order to pledge to manage occupational disease and improve the health and wellbeing of people working in the industry’s offices and sites, large and small. WHY TARGET THE CONSTRUCTION INDUSTRY? Construction employs around 5% of the total UK workforce, but accounts for 27% of fatal injuries and 10% of reported major injuries. For every fatality, approximately 100 die from an occupational disease of which 31,000 new cases are reported each year. In all, 54% of men working in the construction industry do not reach a working age of 60. WHAT HAPPENED? I presented the role that the occupational health provider, Duradiamond Healthcare, played in improving and promoting better health during the build of the London Olympic Park. In particular, I demonstrated the proactive activities undertaken during my time on site during the construction of the Olympic Park. (For more on this see our July 2012 journal, vol 16.2.) I was one among a number of speakers presenting to key stakeholders in the industry. Together, we were

NOVEMBER 2014    a good deal


Miles Atkinson, far left, on the Olympic Park site in London with construction workers in 2012 aiming to give examples of activities and tools that can be used to prevent occupational disease, and promote and improve the health and wellbeing of individuals working in construction and civil engineering. The business case for signing up to these pledges was highlighted. There was also an open forum chaired by Dame Carol Black, Lawrence Waterman OBE (Head of Health and Safety on the London Olympic Park build), and Steve Hails (Head of Health and Safety on the London Crossrail project). Questions to the panel were about how to engage the workforce in health and wellbeing and safety initiatives. Huge strides have been made in recent years and the excellent record of improving the safety of those working in the industry was discussed. The fact that there were no fatalities during London Olympic Park construction, the first time in Olympic Games history, is a testament to this. It

was clear that it is the “health” in Health and Safety that still needs work. WHAT ARE PLEDGES? There are core commitments for all signatories such as to use consistent messages and to monitor, evaluate and report progress. Then supporting pledges can be selected from: alcohol (A), food (F), health at work (H), physical activity (P). Toolkits with a framework, practical guidelines and resources are being developed for specific sectors like construction. Other toolkits are coming for carers, higher education, police, fire and rail sectors. The emphasis for the construction sector is on health at work. The aim is to engage enough partners in the sector so that supporting employee health and wellbeing becomes the norm. Pledges taken by the construction and civil engineering industry can be seen in the toolkit www.h10constructionpledge.co.uk

EXAMPLES ARE: H1 Chronic health conditions: Embed the principles of the chronic conditions guides (developed through the responsibility deal’s health at work network) within HR procedures to ensure that those with chronic conditions at work are managed in the best way possible with reasonable flexibilities and workplace adjustments. H2 Occupational health standards: Provision of clinical occupational health services that work in accordance with the relevant standards, e.g. SEQOHS. H6 Health checks for employees: Encouraging staff to make use of freely available health checks and online tools to help their health and wellbeing. H7 Mental health: Create an environment where anyone with experience of mental health issues is valued, respected and is able to OHP VOLUME 18.3

22 a good deal  


The Public Health Responsibility Deal aims to tap into the potential of businesses and influential organisations to improve public health

flourish. Provide all staff with the environment, knowledge and tools to develop and maintain emotional resilience and mental wellbeing, while raising awareness of, and providing support for, mental health in the workplace. Manage the workplace so that it doesn’t place pressure on workers that exceeds their ability to cope. P4 Physical activity: Increase physical activity in the workplace, e.g. through modifying the environment, promoting workplace champions and removing barriers to participation during the working day. WHAT DOES IT MEAN FOR US? Occupational health physiotherapists are ideally placed to facilitate and drive these initiatives. It is our challenge and responsibility to step outside the treatment room to ensure we are a catalyst. From a personal perspective, while initially daunting, donning a hard hat and boots and getting face-to-face with workers is extremely rewarding. You can OHP VOLUME 18.3

capture an audience unlikely to make contact with the health profession. You won’t have a hard time convincing them, most people are thirsty for these types of activities, we just need to take it to them and remove any barriers to accessing this information. I am sure that those who do go on site will agree that there are multiple benefits. From a clinical perspective, you get to see the individual in the working environment, better understanding the demands placed on them and tailor your treatment plans and advice to their employers. From a business perspective, it improves the visibility and awareness of occupational health and it lets employees feel that their employer cares about their health and wellbeing. It is key to getting buy-in and support from relevant stakeholders. WHAT DOES THE FUTURE HOLD FOR US? At this year’s Physiotherapy UK event, CSP Chair Karen Middleton made a stirring call to stand up and be counted for promoting the profession. She said

that her “greatest fear is that this profession will sleep walk into obscurity”. The healthcare industry is an ever changing fiscally tightened environment with multiple players and pressures. Occupational health physiotherapists are in a perfect position to make a meaningful difference to the health and wellbeing of the working population. We do it already clinically on a one-toone basis but need to expand these skills and deliver them to a larger audience, because, as we all know, prevention is better than cure. USEFUL RESOURCES https://responsibilitydeal.dh.gov.uk/ wp-content/uploads/2013/02/HatWFlyer-Final.pdf https://responsibilitydeal.dh.gov.uk/ dame-carol-black-challenge-of-healthimprovement-among-workers-acrossthe-construction-and-civil-engineeringindustry/ www.csp.org.uk/frontline/article/fielddreams

NOVEMBER 2014    NSOH progress


Food for thought on OH collaboration Leonie Dawson reports on a collaborative conference and progress at NSOH In September, the National School of Occupational Health (NSOH) ran its first multiprofessional conference, focused on promoting the role of the many professions in various areas of occupational health. Traditionally, this conference has been a medical event but this year, in line with the school launching as a multiprofessional organisation, it was opened out to include other occupational health practitioners. Attendance was divided fairly equally among OH medical trainees, OH nurses and other professions engaged in occupational health. Reflecting the concept of multiprofessional working, each session was presented by a different profession, all with the goal of improving the health and wellbeing of the workforce. The presentations extended from guidance provided by the HSE, through the roles of dieticians, ergonomists, health and safety officers, psychologists and occupational hygienists within occupational health, to presentations on practical applications such as physiotherapy and occupational therapy in logistics and the whisky production industry, and wholeorganisation approaches to the health and wellbeing of the workforce. The theme of the conference was “food for thought” and covered a broad area from which examples of health promotion, injury and ill health prevention and effective intervention could be transferred to other sectors. While the theory that access to occupational health is vital to reduce unnecessary sickness absence and maintain productivity levels, the NSOH conference aimed to make the multiprofessional approach and the breadth of engagement more tangible. CONSULTATIONS In addition to the conference, the NSOH have been progressing the

second report on the future occupational health workforce project, looking forward at what will be needed in the next five to 20 years. The work to date has included appreciative inquiry interviews with OH professional groups and individuals to understand issues better and has identified needs and a literature review on multi-professional working in occupational health in developed countries. Currently, three consultations are seeking further insight into UK specific opinions on what is required to support people back into work and to overcome recognised barriers. The consultations have progressed along a modified Delphi process, whereby the product of brainstorming was accessed by people online and their responses analysed. This process has allowed a multi-professional working group to develop qualitative and quantitative data from a wide range of stakeholders. The first consultation focused on strategy and what needs to be done to support people back into work. Responses came mainly from the originators of the brainstorming data and from other healthcare professionals. The second consultation asked what barriers prevent people returning to work, with a view to identifying potential improvements to the holistic approach to occupational health. This consultation was open to the original brainstorming group, plus patient groups. Condition specific charitable groups were also targeted for their views. The third and final consultation in this work has been to identify generic competencies of the different professions working within the field of occupational health and safety. The current provision of OH training is wide in sourcing, funding and content. Only occupational physicians have a comprehensive and funded training programme; many of the other professional groups depend on peer training to achieve specialist competence. Jan Vickery and Nicky

Hunter have been most generous with their time and expertise in supporting the development of statements used in this consultation; the criterion for the brainstorming data was that the competencies included in the consultation had to be sourced from established professional, OH-relevant competency frameworks. This consultation was open to professions working in the field of OH with patient representation for inclusiveness. WORKFORCE The future occupational health workforce working group is addressing current and future occupational health requirements. There is little information available to indicate the evidence or form guidance on what an occupational health team should look like, how many practitioners now work within occupational health or what the ideal numbers should be, so predicting a vision for the future is a challenge. A call has gone out to the Council for Work and Health and other relevant groups, such as the professional bodies of practitioners working within occupational health, to ask how many practitioners work in the field, what these professions perceive is the shortfall in their current numbers of OH practitioners, and what is deemed an appropriate number of workers per OH whole time equivalent practitioner. The first report in this work “Planning the future: Delivering a vision of good work and health in the UK for the next five to 20 years and the professional resources to deliver it”, was published in 2014 by the Council for Work and Health: www.councilforworkandhealth.org. uk/images/uploads/library/Planning the Future - OH and its Workforce April 2014.pdf The second report, with recommendations, is due out in March 2015. OHP VOLUME 18.3

24 FCE research  


Psychosocial factors in the return to work Glyn Smith attended the 2nd International Functional Capacity Evaluation (FCE) research meeting in Toronto, Canada… THANK YOU, ACPOHE, for funding me to attend the 2nd International FCE research meeting, held on 2 October 2014 in Toronto. This also gave me the opportunity to attend the Work Disability Prevention and Integration (WDPI) Conference that preceded the FCE research meeting. Let’s just say that spending a few days in the Toronto sunshine wasn’t the burden I expected and I am glad that Nicky Hunter twisted my arm to go as chair of the newly formed, but yet unnamed, ACPOHE FCE interest group, and to present the ACPOHE FCE guidelines. The FCE research meeting was attended by 50 delegates from around the world. Approximately one third were from the USA and Canada, one third from Holland and the rest of us from as far afield as Australia, Hong Kong and the UK. The delegates were a fascinating mix of researchers, commercial company representatives and interested individuals. As a relative newcomer to the world of FCE, one of the things that struck me was the number of different FCE systems and approaches represented in the room. In a spirit of co-operation, all enmities were left at the conference door. Well, nearly all. I won’t go through all the delegates or the research papers that were presented on the day, but I will highlight the more “interesting” ones. The day started with the keynote presentation from Rueben Escorpizo from the University of Vermont in USA; he talked about using FCE within the International Classification of Functioning, Disability and Health Framework (ICF). Rueben reminded the delegates that the ICF is based on a biopsychosocial model of disability, and wondered if “given the current diversity in FCE instruments and administration, whether the ICF could be used as a basis in developing a ‘core’ set in FCE”. OHP VOLUME 18.3

Following on from Reuben’s talk, all the delegates agreed that FCE should sit within a biopsychosocial framework. However, it was interesting to note that although all the delegates agreed to this principle, a significant proportion of the FCE systems (mainly from the USA) did not incorporate psychosocial screening. Dee Daley from WorkWell in the USA even commented (tongue in cheek, I think) that this was because people in the USA didn’t have any psychological problems. Well, obviously, they haven’t watched Breaking Bad (the American crime drama television series.) At the WDPI conference two days earlier, psychosocial factors, including expectation of recovery and return to work, had been presented as one of the strongest predictors of return to work. In addition, an interesting tool presented at the WDPI conference was the Somatic Pre-Occupation and Coping (SPOC) questionnaire to predict functional recovery in tibial fracture patients. This questionnaire has been found to be a valid measurement of illness beliefs in patients with tibial fracture and is highly predictive of their long-term functional recovery. Current research is now exploring SPOC in other trauma and musculoskeletal populations and whether modification of unhelpful illness beliefs is feasible and would result in improved functional outcomes www.ncbi.nlm.nih.gov/ pubmed/22011635. For me, one of the strongest themes that came out of the FCE research meeting was the difference between assessing individual capability purely in physical terms, or using FCE to assess an individual’s fitness for work within a biopsychosocial approach. This was illustrated by the next talk of the day. “Should FCE tests be complemented with non-organic somatic signs (NOSS)?”, presented by Maurizio

Trippolini and Beatrice Jansen from Switzerland. This practical session introduced new Waddell signs for the neck, so called modified cervical NOSS (mcNOSS), a simple screening tool for identifying patients with neck pain who exhibit abnormal illness behaviour1 . These 13 modified mcNOSS were presented as five categories: 1 Tenderness (over the cervical and thoracic spine) 2 Simulation (axial loading) 3 Distraction (range of movement in prone lying) 4 Regional disturbances (altered sensation not corresponding to dermatomes) 5 Overreaction (examiner interpretation of grimacing [due to pain], disproportional verbalisation/ sighing, etc). Trippolini and Jansen concluded that inclusion of NOSS led to “substantially higher amounts of explained variation in FCE lifting performance than previously found”, implying that Waddell signs could be used to explain submaximal effort. However, no rationale was offered as to the possible underlying reasons for the new Waddell signs, for example, central pain sensitisation or fear avoidance behaviour. The researchers did say that these new Waddell signs should not be used to determine sincerity of effort but only to highlight the need for further investigation. However, my own conclusion is that, as a significant number of FCE systems make no attempt to explore psychosocial factors, the use of mcNOSS could be used inappropriately to imply poor sincerity of effort. Later, Dee Daly from WorkWell presented an interesting paper looking at the rationale of using high blood pressure in pre-employment screening



mko Soer and H

Glyn, left, with Re

xon University ik Bieleman of Sa

to exclude those individuals “at risk” during FCE testing. Dee has concluded that there is a danger in excluding a significant number of workers with high blood pressure from work, who would not be at risk, either during testing or at work. Further research is needed on this – watch this space. Carole James from Australia presented an informative paper on whether FCE clinical assessors could accurately determine an individual’s safe maximal lift. She did this by correlating the assessors’ opinion on safe maximal lift with observed biomechanical changes in the laboratory. The results suggest that physiotherapists are good at detecting changes in biomechanics associated with safe maximal lifting, for both low and high lifts, and therefore it would seem reasonable to use clinicians’ judgement to determine safe maximal lifts. There were lots of other interesting papers but too many for this article. If you want to find out more about any of them, please drop me an email. Here is a list of them: 1 ICF meets FCE 2 Should FCE tests be complemented with non-organic somatic signs?

e, Netherlands

of Applied Scienc

3 Vital Signs Prior to Pre-employment Testing 4 The Effect of Load on Biomechanics during WorKHab FCE 5 Can FCE tests predict future work capacity in patients with whiplash associated disorders (WAD)? 6 Comparison of Minnesota Manual Dexterity Test and the new Workability Rate of Manipulation Test 7 Performance of patients with chronic non-specific low back pain without Waddell signs 8 A systematic review of the reliability of the WorkWell Systems 9 Heart Rate Changes in FCE in a Workers’ Compensation Population 10 Does physical work capacity of 25 subjects with early OA of the hip and knee decline in five years? 11 Do analgesics improve FCE in patients with chronic back pain? 12 Use of normative data for FCE in occupational/rehabilitation medicine and disability claims 13 Reliability testing of the FCE-OH-Q Flying home from the conference, I reflected on my overall assessment of the day and concluded as follows:

●● The ACPOHE FCE guidelines are very

good, they were well received by the conference. ●● For me, FCE is most effective when used within a biopsychosocial framework of assessing someone’s fitness for work. ●● There is a continuing need to develop “open access” FCE protocols. ●● As clinicians, we have to be very careful about how we express “inconsistency or sincerity of effort” in our reports. ●● There is a great opportunity to educate employers and employees on the validity of using functional capacity measures when assessing an individual’s fitness for work. ●● Toronto is a great city and a good place to hang out with like-minded therapists. Glyn Smyth glyn@work-fit.co.uk Cervical nonorganic signs: a new clinical tool to assess abnormal illness behavior in neck pain patients: a pilot study. Sobel JB, Sollenberger P, Robinson R, Polatin PB, Gatchel RJ. Arch Phys Med Rehabil 2000;81:170-5 www.archives-pmr.org/article/S00039993(00)90136-9/abstract



26 keyboard modifications  


Weighing up the typing angles… Keyboard modifications for overweight office workers Our regular contributor Dr Timothy Peter Hunter, a chartered physiotherapist and clinical scientist, reports on a six-week typing research project involving 22 overweight and obese workers WHAT IS THE BACKGROUND TO THIS WORK? Over the last decade, there has been an alarming increase in obesity rates in the UK and more than half of the current workforce is composed of office workers who are overweight or obese. Increased body weight and obesity leads to changes in body anthropometrics which has potential implications on workstation fit. In line with this idea, there has been some initial evidence to suggest that obese workers are more than twice as likely to develop carpal tunnel syndrome compared to their colleagues who are classified as a healthy weight. This new paper is based on the idea that ulnar deviation is exacerbated in overweight/obese individuals when they try to use a standard keyboard, while the wrist is more neutrally positioned when they use an open angle keyboard. The aim of this study was to investigate the effects of using an open keyboard on levels of body discomfort, keyboard acceptability and typing productivity in overweight/obese office workers. WHAT DID THEY DO? A small convenience sample of 22 overweight (10) and obese (12) workers took part in a six-week study. Typical work activities of the workers included using keyboards for general correspondence and typing as well as numerical and graphical data input. During weeks 1-3 the subjects used their standard straight QWERTY keyboard and during weeks 3-6 they used an open keyboard (Goldtouch Adjustable Open Angle Keyboard). To assess the impact of each keyboard, they measured a combination of self-reported body discomfort in the neck, shoulders, upper arms, elbows, lower arms, wrists and hands (once every week); keyboard OHP VOLUME 18.3

Normal weight Standard keyboard

Overweight/obese Standard keyboard

usability/acceptability (beginning of week 1 and end of week 6) and typing performance (once every week). WHAT WERE THE KEY FINDINGS? All the participants reported a significant reduction in low back pain discomfort and an increased ability to type for long periods with the open angle keyboard compared to the standard keyboard. Interestingly, there was no significant change in other measures of body discomfort and no significant change in typing performance. It is also notable that it took participants approximately 11 days to adjust to the alternative keyboard style. WHAT WERE THE KEY LIMITATIONS? Given the nature of this article, it is possible only to highlight some of the more salient study limitations. Firstly, because the work was a pilot study the authors used only a small number of subjects for a limited period of time, which reduces the statistical power to detect significant differences in the outcome measures. The small numbers also make it difficult to do meaningful analysis on the subgroups within the study, i.e. overweight versus obese. In addition, because no postural measurements were recorded it is impossible to say if the subjective measurements recorded (which are subject to response bias) were actually associated with real measurable changes

Overweight/obese Alternate keyboard

in posture. Finally, since the keyboards were designed to improve user positioning it would have been helpful to have more information about how the researchers attempted to standardise the subjects’ sitting position. WHAT WAS THE TAKE HOME MESSAGE? While it is not yet time to be prescribing open keyboards routinely for overweight/obese employees, this study does highlight the importance of developing a better understanding of how increasing body mass impacts upon upper limb keyboard positioning. It will be particularly interesting to use motion analysis systems to investigate further how self-reported discomfort relates to changes in sitting posture and how this can be influenced by keyboard shape. References: 1. Smith ML (2015). Typing performance and body discomfort among overweight and obese office workers: A pilot study of keyboard modification. Applied Ergonomics 46, 30-37. 2. Lam N (1998). Association of obesity, gender, age and occupation with carpal tunnel syndrome. Aust. N. Z. J. Surg. 68, 190-193. 3. Witters D (2011). Unhealthy US Workers’ Absenteeism Costs $153 Billion. Gallup. www. gallup.com/poll/150026/unhealthyworkersabsenteeism-costs-153-billion.aspx.

n If you have any questions about this article, please contact timothy.peter@ fluto.co.uk


wcpt news / talking point


WCPT NEWS by Nicky Hunter

Singapore countdown is on… NETWORK PLANS THREE EVENTS n We are now into countdown to the WCPT congress in Singapore, 1-4 May 2015. The WCPT network for Health Promotion in Life and Work is running a discussion panel, a networking meeting and a post congress education session. If you are coming to Singapore, I hope you will join one of the events. We have also started producing a bi-monthly newsletter. Members from around the globe are contributing articles about health promotion in their countries. If you are interested in finding out more, sign up to the network at www.wcpt.org/hplw JOIN UP… AND SEE WHAT'S HAPPENING n There is also a WCPT network in Occupational Health and Ergonomics you can join to find out what colleagues around the world are doing in our field www.wcpt.org/IFPTOHE

Here are two interesting articles from WCPT news you may have missed that I thought were worth highlighting: PEDRO PINPOINTS TOP TRIALS n The Physiotherapy Evidence Database (PEDro) has identified the most important trials to have influenced the practice of physical therapy. They include studies in back pain, sports injuries, ageing, stress incontinence and pulmonary and stroke rehabilitation. Read the full article at www.wcpt.org/ node/112744 A PHYSICAL DAY TO REMEMBER n World Physical Therapy Day 2014 was marked by physical therapists around the world with a cascade of attention grabbing activities – everything from potato races to meetings with politicians; from gait analysis in shopping arcades to inter-school quiz competitions. Read the full article “PTs get things moving around the globe” at www.wcpt.org/node/112741


STORYTELLING by Dr Julie Denning

IN PRIMARY SCHOOL we were taught how to write stories. Teachers told us to think about “who did it, why they did it, when did it happen, where did it happen, what happened and how did it turn out?” It has certainly been drilled into my mind… but then maybe I wasn’t a good storyteller and I had it drummed into me lest I forget! This early influence has paid dividends for me. I may not be a good storyteller, but I can help my patients to be. Like the Elephant’s Child in Rudyard Kipling’s Just So stories who had “‘satiable curtiosity”, I keep my six

honest serving men in mind, and start the questions I ask them with who, what, why, when, how and where. I am then transported into my patient’s world through good solid open questions. I’ll show you what I mean Consider the question “Did you go to your GP about that?” A reasonable question and one likely asked a number of times a day, but it gives you a very different answer to “Who have you told about your symptoms?”. One gives you yes/no, the other tells you the many people your patient has come into contact with, allowing you to understand just why your contact today needs to be different.

asked. An alternative question would be “How do you manage your pain?”. This question explores more than medication. It enables you to know the breadth of someone’s coping mechanisms. So the next time you find yourself talking to a patient, ask yourself first what is their story, why do they do what they do, how do they see their future, what is their experience of their pain, who is the storyteller behind the story? Then ask them the same. Who, what, why, when, how, where? Don’t forget your six honest serving men.

Consider another question “Do you take painkillers?” is a very normal question which most patients in pain are OHP VOLUME 18.3



physios for work and health

Full details of courses, including the course aims and objectives, pre-course requirements and profiles of the presenters, can be found at www.acpohe.org.uk in the events section. Courses are booked through the website and can be paid by PayPal, BACS or cheque. Attendance at ACPOHE courses is open to all ACPOHE members. Full membership of ACPOHE is available to all members of the CSP and those working in related professions may also join as Associate members. We welcome requests for course places from non-members on appropriate courses.

OCCUPATIONAL REHABILITATION AND WORK HARDENING 10-11 January 2015 Venue Birmingham Tutor Krishna Naidu and David Bonham Cost £280 members, £340 non-members Lunch NOT included

OFFICE WORKSTATION ERGONOMICS (DSE) LEVEL 1 13-14 June 2015 Venue Guildford Tutor Katherine Roberts Cost £280 members, £340 non-members Lunch NOT included

OTHER COURSES Details for the following courses will be on the ACPOHE website as soon as they are available:

OFFICE WORKSTATION ERGONOMICS (DSE) LEVEL 1 7-8 March 2015 Venue Guildford Tutor Katherine Roberts Cost £280 members, £340 non-members Lunch NOT included

AN INTRODUCTION TO OCCUPATIONAL HEALTH (This course is accredited by the CSP.) 23/24/25 September 2015 Venue Birmingham Tutors Nicola Hunter and Amanda Jones Cost £455 members, £515 non-members Lunch included


AN INTRODUCTION TO OCCUPATIONAL HEALTH (This course is accredited by the CSP.) 25/26/27 March 2015 Venue Salisbury Tutors Nicola Hunter and Amanda Jones Cost £455 members, £515 non-members Lunch included n  For course information and to book online www.acpohe.org.uk/events



Profile for ACPOHE

ACPOHE OHP 18.3 November 2014  

The journal of the Association of Chartered Physiotherapists in Occupational Health and Ergonomics

ACPOHE OHP 18.3 November 2014  

The journal of the Association of Chartered Physiotherapists in Occupational Health and Ergonomics

Profile for acpohe