Multicomponent intervention for work-related upper extremity disorders

Although several multidimensional models have emerged to explain the develo pment, exacerbation and maintenance of work-related upper extremity disorde rs and disability, there is a paucity of data on the application of these m odels for the development of worksite-based prevention and management progr ams. Sign language interpreting is an occupation associated with increased risk for upper extremity symptoms. Ergonomic, work organization, work style , and work-related and individual psychosocial factors have been demonstrat ed to play a role in the exacerbation of symptoms and lost time in this gro up. Therefore, it was hypothesized that an intervention directed at reducin g the impact of these factors would be associated with reductions in the nu mber of upper extremity cases/year and associated lost time and health care costs in a group of full-time sign language interpreters. Subjects include d 53 symptomatic and asymptomatic interpreters working at the National Tech nical Institute for the Deaf The intervention (eleven 1.5-hr group sessiona l was designed to Ij reduce musculoskeletal overexertion by reducing worklo ad and biomechanical strain, while increasing flexibility and endurance thr ough tailored exercise and preinterpreting "warm ups," 2) improve the abili ty of workers to manage job stress and musculoskeletal pain, 3) reduce biom echanical exposure through work organization and work style changes, 4) alt er organizational sources of stress by improving supervisor's managerial sk ills to address work related upper extremity problems and provide increased supervisor support, and 5) educate workers and supervisors regarding the o ptimal utilization of health care resources, given the present state of the art in terms of clinical evaluation and management. Results indicated a 69 % reduction in the number of cases reporting upper extremity problems in th e 3 years following the intervention. Indemnity costs were reduced by 64% a nd were maintained over the next 2 years. Health care costs followed a simi lar; although smaller magnitude, change. Despite this reduction, a partial rebound in all outcome measures was observed in Year 3 postintervention. Th is rebound followed a progressive increase in work-load over the 3-year fol low-up period.