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Australian Doctor - Legal fallout follows hike in bariatric surgery Mar 23rd, 2015
 This article, written by 

The rise in bariatric surgery has seen it become a 'medicolegal hotspot' with many patients harbouring unrealistic expectations and little understanding of the high complication rates for the procedure.

The majority of claims now being made focused on informed consent, negligent performance of the surgery and inadequate post-management and follow-up, Janine McIlwraith (pictured), principal lawyer at Slater and Gordon, told last week's Medico Legal Congress in Sydney.

Patients also needed to know the surgery was "not a panacea and just part of a solution to weight loss", she said.

"They need to be committed to lifestyle modifications after surgery, and they need to be aware of complications and their frequency."

Patients tended to be well-educated and financially well-off but expected unrealistic outcomes, so consent procedures needed to be robust, she said.

The number of procedures has increased dramatically - from just 500 in 1998/99 to over 17,000 in 2008/9. About four in 10 procedures resulted in complications, Ms McIlwraith said.

A Medical Services Advisory Committee report in 2012 said bariatric surgery should be performed as part of a multidisciplinary effort to improve long-term outcomes.

However, very few patients were receiving that kind of care, Ms McIlwraith said, with most patients visiting solo practitioners.

The spike in claim numbers for bariatric surgery could simply be the result of a rise in procedure rates, she said, "but there may be other causes worth investigating".

For successful RTW timing is everything! Mar 21st, 2015
Evidence suggests the longer the delay to rehabilitation and RTW planning following a workplace injury, the smaller the chances of a successful return to work outcome become. The following posts continue our focus on providing information to allow injury management co-ordinators to feel comfortable taking greater control of RTW processes.


AIA Australia is a life insurance specialist trusted to protect more than 2.5 million Australian lives. AIA Australia is committed to helping people improve their health and therefore is a strong believer in workplace rehabilitation and the power it has, where health conditions permit, in getting people back to work – and therefore a full life – faster.

In August 2013 AIA produced a paper titled “A critical equation: balancing Australian worker health and company wealth” that noted in terms of physical conditions, as the number of days off work increases, the chances of successful return to work significantly decreases:

These are fairly sobering figures and are cause for alarm given a number of employers continue to take a ‘return when you are fully fit attitude’ to work related illness and injury.


Work is a determinant of health, both physical and psychological.  The longer a person is away from work for an unplanned (or unmanaged) absence the more their health can potentially suffer.

Comcare engaged a consultant to conduct research into delays in providing rehabilitation or return to work assistance for their injured employees, after they identified a trend for employees injured at work to stay off work for long periods (6-12 weeks in majoity of cases)

The results were published in the paper “BODY STRESSING INJURIES: Key messages for rehabilitation providers”.  One of the things the Consultant found in their analysis was in most cases, RTW assistance was not provided until after the normal recovery period for the injury.  Consequently by the time assistance was offered it was often no longer appropriate.

The issue here is once a body stressing injury progresses beyond 12 weeks of incapacity it becomes a ‘chronic’ injury that is much harder to manage and rehabilitate due to numerous psychosocial issues.  Equally with psychological injury claims there is often deterioration in the person’s mental status the longer they are away from work.

Amongst other findings, this report promoted that early recovery and return to work involves effective management of an injured employee by their employer and needs to commence as soon as practicable after the injury occurs and preferably before any claim for compensation is made.

Next - Timing in RTW is everthing - What Next

Timing in RTW is everthing - What Next Mar 21st, 2015
Following on from the AIA paper, evidence from industry experts overwhelmingly supports early rehabilitation and RTW programs are a winning combination for all involved. 

Concord General Hospital, Sydney is a self insurer, who in 2003-4 found themselves with a huge number of open claims (~300), and a spate of very difficult cases who went on to have chronic pain syndromes. The organisation felt they were failing injured workers and that something needed to change.

After significant internal investigation, the consensus was that the first 4 weeks after an incident/injury was the answer, – after that you start to lose control! They instigated a rapid assessment and early intervention process, which included an assessment psychosocial risk (i.e. Yellow Flags). The idea was that high risk individuals needed to be identified in the first week/s. Nothing different needed to be done; only it needed to be done earlier. It was also important that a trusted GP was in control of the whole process through consultation and approval.

Along with aggressive acute injury/illness management, return to work planning for high risk individuals was commenced from the day of injury in the form of planning, discussion and communication between injury management co-ordinators, health professionals (GP and Physiotherapist) and employee supervisors.

Key Points of Concord Case Study:

  1. There is a significant difference between the 20% in the “high risk” category and the other 80% who manage pretty well with ‘usual care’.

  2. Psychosocial risk factors (i.e. ‘Yellow Flags’) predict the cost of a workers compensation claim within 48 hours regardless of what or where the injury occurs.

  3. The provision of an early and aggressive assessment and intervention, lead by a trusted GP can reduce costs in high risk claims.

 Next - Strategies to Help Employees Return to Work

Video - Diabetes Australia Healthy Eating Mar 20th, 2015

High Performance Jump Program Mar 10th, 2015

Day- Tuesday

Location – Central West Health and Rehab

Time – 4:00pm

Training focus – Jump Strength

Maximal strength determines jumping height. When trying to improve jump height athletes should focus on maximising strength development.


Day – Friday

Location – Central West Health and Rehab

Time – 4:00pm

Training focus – Jump Plyometrics

Plyometrics include performance of various types of body weight jumping-type exercise, like drop jumps (DJs), countermovement jumps (CMJs), alternate-leg bounding, hopping and other SSC jumping exercises. Plyometrics are a powerful tool for improving jumping performance.

Start Date: Tuesday; 21st of April 2015

Click for Registration Form

Payment required at initial physical assessment

Registration Form Mar 10th, 2015

Infographic - Calories Burned in 10 minutes! Mar 9th, 2015

Dietitian - 3 Day Food Diary Mar 9th, 2015

Test - Google Forms Mar 8th, 2015

This post is a test run of embedded Google Form data in News Post.

Medical Observer - Allied health keeps patients out of hospital Mar 7th, 2015

6th Mar 2015

Declan Bowring

STROKE, diabetes and osteoarthritis patients could avoid unnecessary hospital treatment with greater investment in allied health professionals, a new report says.

The report, produced for Services for Australian Rural and Remote Allied Health (SARRAH), found evidence that hip and knee replacements and diabetic limb amputations could be avoided and thousands of hospital beds freed up with targeted care by allied health teams.

“This report the first of its kind in Australia, has demonstrated the huge cost savings and patient benefits that Australia could achieve,” SARRAH CEO Rod Wellington said.

“It exposes the myth that allied health is an optional extra in healthcare.”

The report cited cases including:

  • A 64% drop in diabetic limb amputations and a 24% decrease in hospital stays after treatment by podiatrists under the Queensland Diabetic Foot Innovation project.

  • A 15-month reduction in the waiting list for joint replacement surgery at Melbourne’s Alfred hospital after triaging by physiotherapists.

  • Fifteen per cent of osteoarthritis patients removed from the joint-replacement waiting list at a Sydney hospital after treatment by a multidisciplinary team. 

  • A 37% prevention rate in the incidence of diabetes among 2241 high-risk participants in eight international trials after intervention by dietitians, physiotherapists and exercise physiologists.

  • Stroke care focusing on speech pathology in the NSW Illawarra region prevented 45 emergency presentations, 49 hospital admissions, 188 readmissions and saved 2808 bed days.

The report emphasised the value of physiotherapists, occupational therapists and speech pathologists in improving the function and independence of stroke patients.

Executive officer of Allied Health Professions Australia, Lin Oke, said affordability was a problem, noting Medicare Chronic Disease Management rebates for allied health services were “extremely limited”.

“The rebate of approximately $50 is based on a 20-minute service, regardless of the required length of the appointment with the allied health professional,” Ms Oke said.

“So many Australians just cannot afford the services which would keep them away from hospitals and surgical procedures.”

The report found a significant lack of access to allied health for rural patients, with only 14% of registered allied health professionals working in rural areas. 

More than 1000 deaths from diabetes in rural areas could have been prevented if the mortality rate matched that of urban areas. In very remote areas, diabetes was the second-highest cause of death.

Independent MP for Denison, Andrew Wilkie, used the report’s findings to blast the Tasmanian government for cutting allied health staff in the state.

“To sack these vital front-line workers who can get people home from hospital sooner and prevent elective surgery is complete madness,” Mr Wilkie said.

“These workers are worth their weight in gold because they save hospitals money.”


Click here to view the report.



Infographic - Coffee Vs Tea, What is healthier? Mar 4th, 2015

Medical Observer - We’re not all the same Feb 26th, 2015

‘One size fits all’ is doomed to failure, so weight loss strategies must be tailored.

IN THE classic 1979 Monty Python movie, The Life of Brian, the lead character, Brian, tells the swarming masses, “You’re all individuals”, to which the group responds as one, “Yes, we’re all individuals”.

The fact is, we are indeed all individuals and respond differently to different pharmaceutical and lifestyle prescriptions —  weight loss being a great example.

But does this mean we need a separate program for all three million overweight or obese adult Australians? And if not, how do we individualise without over-individualising?

The first law of thermodynamics states that energy is neither gained nor lost, it just changes form.

We’re told that this is immutable. And yet change the energy balance (food in/exercise out) of 1000 people in exactly the same way and you’ll get a variation in weight loss from nothing to more than the loss predicted through any calorific formula. The question is, why?

The simple answer is that the first law is based on a physics formula, which is linear (e.g. weight = energy in — energy out).

This only works approximately in a biological system.


Feedback in a living organism, such as through changes in metabolic rate, hunger levels and a range of other factors, makes generic lifestyle prescriptions such as diet and exercise, just that — generic, with huge variations around the mean.

The implications of this are profound: “A calorie is no longer a calorie.”

As the actual value of heat energy can be influenced differently by feedback in individuals, any attempt to prescribe or measure weight gain or loss by counting calories is bound to be flawed.

Using a systems theory model can complicate the issue but may be necessary.


In the UK, the Foresight Commission, a body set up to examine the future, published a complex diagram of known drivers of obesity1 which has come to be used by obesity lecturers around the world to draw a laugh. You can see it at http://www.foresight.gov.uk/Obesity/12.pdf.

Prescribing a set diet and exercise program alone to help a patient lose weight may work brilliantly for some, for whom these are the immediate divers, but it may not work at all for others.

What’s the alternative? Ultimately, a computer program including genetic analysis might reduce the variability in response. But this is some way off. So what to do in the meantime?


American obesity researcher and clinician Dr Robert Kushner has had a crack at this by looking at different personality types based on types of eaters, exercisers and stress managers.

In his book, Dr Kushner’s Personality Type Diet2 — which would normally be discarded as a ‘fad’ book on the basis of its title — Kushner developed a screening system to categorise people into six different types of eaters, exercisers and stress responders.

Kushner’s eating personality types are classified in such non-scientific categories as ‘unguided grazer’, ‘night-time nibbler’, ‘convenient consumer’, ‘fruitless feaster’, ‘mindless muncher’ and so on. Despite the appeal to a public audience, each does have some scientific basis, which is added to by Kushner’s respectability as a world-class obesity researcher.


Breaking the weight loss responder into different groups like this, according to Kushner, can help increase the prospects of success on a weight loss program.

This is not rocket science — yet! But individual targeting in prescription, just as in marketing of consumer products, points to the way of the future.

A good clinician might do this intuitively but the increasing complexities of the modern world make it more and more difficult to do so.

Kushner’s approach is a possible way of narrowing down the individual differences in weight loss response.

But, given that there are a number of other drivers that can influence lifestyle, including sleep, the environment and relationships, don’t expect any major breakthroughs in the clinical response to weight loss. 


Reference: http://www.medicalobserver.com.au/news/were-not-all-the-same#.VO6CvF1aUxA

Next Dietitian Talk Friday 6th March 2015 Feb 23rd, 2015

Catherine Dumont's next Dietitian Talk is on Friday 6th March, 12 noon at Central West Health & Rehabilitation in Geraldton. This talk is free for gym members and people who are completing Central West Health & Rehab's Diabetes Management and Chronic Disease Prevention programs.

This talk covers:

  • Healthy Eating Habits

  • Glycemic Index

  • Fat Types and Cholesterol

  • Recipe Modification Label Reading

A 'Real and Substantial' Connection to Employment Feb 21st, 2015

Kathleen Kay v Woolworths Limited [2014] NSWWCC 365 (1 October 2014)

In the following case, a Woolworths Customer Services Manager, who worked predominately daytime and afternoon shifts, bought proceedings to the NSW Arbitrator. She suggested that the insurer’s decision to reject her claim was inappropriate as while her injuries did not happen at work, they were ‘substantially connected’ to her employment.

On the week of the workers accident, the shop’s floors were being stripped and resealed by cleaners. The works took place overnight, and required a manger to be present. In the afternoon of Wednesday 17 October 2012, the worker was told by her employer that she was required to work the following Thursday night to supervise the cleaners. The worker was unable to sleep before the shift due to a dentist appointment.

Upon completion of her shift at 8am on Friday, the worker had been awake for over 24 hours. On her journey home, she fell asleep at the wheel, causing her to veer onto the wrong side of the road and collide with an oncoming vehicle.

The medical evidence confirmed sleep deprivation was as a significant causal factor in the accident. The worker subsequently made a claim for workers compensation, which was declined by the insurer on the basis that there was no ‘real and substantial’ connection between her employment and the accident.

Considering a case where it was held that a ‘real and substantial’ connection does not necessarily require a worker’s employment to have caused the accident, the Arbitrator rejected the insurer’s submissions, and held that the worker satisfied the requirement set out in section 10(3A).

The Arbitrator highlighted that this section merely requires that there be a ‘real and substantial’ connection between the employment and the accident; meaning that there can be several factors involved.

The worker was required by her employer, at short notice, to complete the night shift. Her inability to properly prepare herself physically and mentally beforehand meant she was sleep deprived, which the Arbitrator accepted to be a significant factor in her accident.

Importantly, the Arbitrator held that in the circumstances, the worker’s risk of injury “was not outside the control of the employer.” The employer did not conduct any risk assessment as to whether it was safe for the worker to work the night shift, at short notice, without any substantial prior experience working the shift, and without having slept beforehand.

It was held that the employer, despite observing the worker’s tiredness at the completion of her shift, failed to determine how much sleep the worker had gotten in the preceding 24 hours. Arbitrator suggested that the employer, in order to avoid the risk, could have simply asked how the worker was feeling and offered the worker a taxi voucher.

Mal Chronique - Chronic Pain and Exercise; Evidence and Benefits Feb 19th, 2015
click to enlarge

Chronic pain involves symptoms of prolonged pain and fatigue, leading to an inactive lifestyle. However being inactive can increase your levels of pain and fatigue, leading to deconditioning of the body. Deconditioning can make you more prone to injury and put you at risk of more severe health problems.

Breaking the pain cycle can be difficult, especially if your body has been in pain for quite some time. Sometimes people feel their attempts at exercise cause more pain and lead to flare ups, avoiding exercise and turning to rest. Even if there is discomfort in the beginning, retraining your body and remaining active will be beneficial for your health and wellbeing in the long term. 

Best Evidence for Chronic Pain and Exercise

Exercise works best when delivered as part of a multi-factorial approach. This includes sound knowledge and education about your condition, physical activity and the pain experience. The body and mind love movement, where gradually becoming more active is essential for treating and managing chronic pain.  Recent evidence shows people with chronic pain reported moderate exercise decreases pain, fatigue, stress and symptoms. It also improved perceptions of health, physical function and aerobic fitness. Other studies have shown low intensity exercises such as walking and pool exercises improved joint and muscle pain, improving the ability to carry out daily activities.

Exercise-induced Hypoalgesia

Recent studies have shown exercise inhibits descending pathways. Descending pathways can inhibit or facilitate transmission of noxious (painful) information, and are therefore of major importance in pain modulation. Studies demonstrate a reduction in pain sensitivity during and following exercise, in both the healthy and chronic pain population.

Aerobic exercises (running, cycling etc) produce exercise-induced hypoalgesia, particularly when performed at moderate to high intensities for longer periods. This is also true for isometric exercises (static muscle contraction), when performed at either low or high intensities.

Benefits of Exercise

  • Joints become better lubricated and glide easier

  • Nerves and discs of the spine get their required nutrients

  • Muscles become stronger and fatigue less quickly

  • The nervous system winds down promoting relaxation

  • Increased levels of energy, improving mood and helping with anxiety and depression

  • Your body produces Endorphins - your own pain relieving medication!

  • Improves efficiency of the heart, controls blood sugar levels, and improves your ability to burn fat


Rhianne Turner (Physiotherapist)

Next - 7 exercise tips for people with chronic pain

5 Steps to a Better Back Feb 19th, 2015

Mal Chronique - 7 exercise tips for people with chronic pain Feb 19th, 2015

  1. Incorporate exercises in everyday life – take the stairs whenever you can, get up more often and do tasks around the home

  2. Choose exercises that you enjoy, whether its swimming, yoga, walking, or weights

  3. Add a component of aerobic exercise to your programs (swimming, walking, stationary bike)

  4. Stretching and breathing exercises are great additions to your program as they improve blood supply and nutrients to the joints, reduce your risk of injury, improve your balance, and reduce stress in muscles

  5. Avoid exercises which cause pain, though some discomfort is okay

  6. Avoid the boom-bust approach, start slowly and gradually increase your program (increasing volume before intensity)

  7. Be consistent from day to day, avoid good day and bad day behaviour

A Foundational Model for Good Work Design Jan 20th, 2015
Principles of good work design are a key element of the Safe Work Australia members collaborative project Good Work through Effective Design. This project contributes to the Australian Work Health and Safety Strategy 2012-2022 and the national action area Healthy and Safe by Design. Particular focus has been placed on achieving the strategic outcome of 'eliminating or minimizing risks and hazards by ensuring all work, work processes and systems are well designed'.

Comcare and Workplace Health and Safety Queensland have been tasked with phase one of the Good Work through Effective Design project, to produce a set of principles for good work design. Phase two of the project is to promote good work and effective design, through case studies, education and other guidance materials.


‘Good work’ is healthy and safe work where the hazards and risks from the work have been eliminated or minimised, as far as reasonably practicable, through the process of design. Good work is designed to manage the structure of tasks, demands, supports, and work processes to optimise human performance, organisational productivity and job satisfaction.


When making decision about work tasks, activities, and responsibilities, there are typically four interrelated elements that are important. These are:

  • physical elements—aspects of the work environment or context that creates physical or physiological demands on the human body, for example physical hazards, chemical hazards and biological hazards.

  • biomechanical elements—aspects of the work that include hazardous manual tasks and the biomechanical risk factors that leads to musculoskeletal disorders, for example force, vibration and movement.

  • cognitive elements—aspects of the work that create demands on the human mental capacity, for example attention, mental workload and complexity.

  • psychosocial elements—social, psychological, and organisational aspects of work that place demands on human capacities, for example work demands, job control, supervisor/peer support, role variables, managing relationships, rewards and recognition, management of change an organisational justice.

Risk factors are interrelated and interdependent so focusing on one or two factors in isolation will likely be ineffective as a strategy. The interaction amongst elements, and their co-occurrence, means that a holistic approach should be adopted when evaluating work, and when designing solutions.

There are many models that are applied in the context of designing good work. The report reviewed the following key approaches and perspectives from the research evidence:

  • Work Design-Specific

  • Risk Management

  • Continual Improvement Process

  • Health Promotion

  • Change Management

  • Human Factors Engineering

Mal Chronique - Chronic Pain Explained Jan 13th, 2015

Chronic pain refers to pain that is experienced beyond expected healing timeframes, for example low back pain, neuropathic pain, neck pain, post operative pain, shoulder pain.

You’re not alone - 1 in 5 Australians are affected by chronic pain.

The relationship between pain and injury: Pain injury

Pain is very useful when we have an acute injury. For example, with a sprained ankle our brain sends signals of pain to cause us to limp and offload the ankle, ultimately allowing the inflammation to settle and promote healing. This is great! However in chronic pain, these signals are not so helpful.

The relationship between pain and injury becomes uncoupled in the chronic pain experience, where pain is not a reliable predictor of the severity of the injury. A multitude of other factors play a role in the chronic pain experience. The longer pain persists, the more important these ‘non-tissue related’ factors become in driving the pain experience. Pain can even occur with no identifiable cause. Take for example phantom limb pain post-amputation– pain can persist in the absence of tissue injury and even in the absence of any tissue at all.

Multiple Failed Treatments

This is not uncommon in the chronic pain population, due to the complexity of a multitude of contributing factors. The most up to date evidence for treatment is to take a multi-factorial treatment approach. Treatments that have failed to deliver adequate pain relief often do so because of failure to account the multiple factors that contribute to someone’s pain.  Treatment works best when delivered as part of a multi-factorial approach, including education and knowledge about your condition, physical activity and pain.

“It’s all in your head”

Those who have experienced chronic pain may have experienced a clinician who tells them “it’s all in your head”. This in fact has truth to it, because the brain is in the head and the brain tells us how much something hurts. Pain is a survival mechanism – when the body is injured nerve endings in the injured part send messages to the brain. When the brain suspects the body is under threat the brain acts to protect it by producing pain. Pain is created by the brain, but that does not make it any less real. The more times the brain uses a certain neural pathway, the easier it becomes to activate the pathway. Neurons that fire together, wire together – for example: if every time you lift a box there is pain in your back, the brain has created a pain experience with lifting boxes. We need to reshape this pain experience and lower the perceived threat.


Rhianne Turner (Physiotherapist)


Minimum requirements to reduce work-related musculoskeletal disorders Dec 30th, 2014
WMSDs are typically viewed as related to manual handling and as such risk management is targeted at addressing the physical aspects of jobs and tasks. However, effective risk management for MSD needs to accurately identify, assess and control the most relevant worksite risk factors for a particular job, not particular tasks. To determine what these risk factors are a participative systems approach is needed using hazard surveillance evidence collected from employees within a particular job.

Risk factors for WMSDs include psychosocial and physical hazards; therefore, to ensure effective WMSD risk management practice all relevant hazards must be identified and systematically controlled.

Research evaluating the effectiveness of various workplace interventions intended to reduce WMSD risk has identified the following key factors:

  1. A multifactorial approach–addressing psychosocial hazards concurrently with manual handling hazards;

  2. Participation by workers and their representatives, along with other stakeholders including supervisors and key managers, and management commitment which includes ensuring that workers have the time needed to participate in risk management processes and that risk controls are implemented as fully as practicable

Better understanding of MSD aetiology, based on current research evidence is required. One approach that would address these key requirements is a risk management toolkit. 

The advantage of the toolkit approach is that it can be customised by organisations to fit into their existing policies and procedures, while still offering a more holistic approach to WMSD risk management.

Next- Designing Worksite Toolkit for MSD Risk


Designing Worksite Toolkit for MSD Risk Dec 30th, 2014
A toolkit should provide practical tools and strategies for workplace use in identifying hazards and assessing risk. Training materials and guidance documents to support effective implementation of the risk management process should also be included. Another key requirement in using a toolkit approach is that of worker participation.

The advantage of the toolkit approach is that it can be customised by organisations to fit into their existing policies and procedures but it offers a more holistic approach to WMSD risk management—than is currently undertaken—which is needed if adequate coverage of all hazards and risks associated with WMSDs is to be undertaken.

Figure 1 above depicts three groups of workplace hazards: external (biomechanical) loads, organizational factors, and social context; those within the latter two groups are commonly known as psychosocial hazards.

Hazards within all three categories interact with each other (shown by linking arrows) and all of these hazards can affect processes internal to individual workers (internal biomechanical loading, physiological responses) and personal outcomes (discomfort, pain, impairment, disability). As shown on the right of the diagram, individual factors influence all personal processes and outcomes. ‘Stress’ is not highlighted here, although it is implicit within ‘Physiological Responses’.

Figure 2 above highlights the interacting effects on MSD risk of ‘physical’ hazards (mainly biomechanical) and psychosocial hazards. A person’s internal ‘stress response’, as shown here, occurs when situations are experienced as stressful; it is multidimensional, with physiological and behavioural, as well as cognitive and affective dimensions, with potentially profound effects on health, including MSD risk.

The model in Figure 3 below is in accord with the above 2, however but more directly applicable to workplace risk management because it provides more specific detail concerning the wide range of work-related hazards that can combine to affect risk.

MSD risk is increased if Job and Task Demands are hazardous or excessive in relation to available Coping Resources, and that risk is also affected by Other Psychosocial Hazards. The physical hazards of manual task performance are included within Job and Task Demands, along with the cognitive and emotional demands of task performance, and the broader demands of the overall job. Coping Resources are determined both by workplace factors (support systems and resources; psychosocial and physical environment influences) and by the individual’s own capabilities. Importantly, it is the combination of these diverse variables that determines risk.

Figure 3 is a great resource for planning worksite toolkit to assist to reduce worksite MSD’s. Click for downloadable template.

MSD hazards and risk factors - US National Research Council Dec 30th, 2014

Cumulative tissue damage and stress Dec 30th, 2014

Where should we target strategies to reduce work-related musculoskeletal disorders? Dec 29th, 2014
Accurate identification of all relevant hazards is the first step in effective workplace risk management of work-related musculoskeletal disorders (WMSDs). Given the huge variation in operational demands both between and within different industry sectors and their respective organisations, appropriate targeting of strategies requires careful consideration. Generic risk management strategies may not be appropriate given these large differences.

No single or multi-dimensional strategy is generally effective across occupational settings. Therefore a degree of customisation is required for maximum effectiveness.

Both physical and nonphysical work environments should be assessed so that interventions specific to individual workplaces can be developed which in turn can lead to more definitive conclusions about changes being reached.

The relative contribution of physical and psychosocial hazards to worksite MSD development may vary between different jobs, gender and age. Even in work considered as predominately physical in nature, psychosocial factors have been associated with MSD risk.

The relative importance of particular hazards will be defined by the nature of the work, as well as the physical and cognitive demands placed on individuals. Importance will also vary greatly across different organisations and sectors. In addition, the organisational and sociotechnical context in which the organisation is operating will influence a range of workplace demands including job security, deadlines and working hours, all of which have been linked to WMSD development.

Next- Where should risk management strategies be targeted?

Where should risk management strategies be targeted? Dec 29th, 2014
The conventional approach to OHS risk management has been to focus on hazard management – identifying hazards, assessing risk from each identified hazard, and taking any necessary steps to control risk from each hazard separately.

However effective risk management for MSD needs to accurately identify, assess and control the most relevant worksite risk factors for a particular job. To determine what these risk factors are a participative systems approach is needed using hazard surveillance evidence collected from employees within a particular job.


Target Job Levels

The following study showed risk management strategies need to be targeted at the ‘job level’ if they are to be maximally effective (i.e. target specific job task and roles, rather than specific organisations or employment sectors).

Risk mitigation should be aimed at individual jobs to ensure maximum effectiveness in reducing MSD risk. This does not suggest that organisational influences are not critically important. In a systems approach, the influences from an organisational level play a vital role in determining a range of factors directly related to job design including safety, efficiency and effectiveness.

Be Job specific, not Task Specific

Another important distinction is the need for a job rather than a task focus, which is currently employed by many ergonomists and safety personnel. Whilst tasks were not directly examined in the current study, the problem with a focus on examining specific tasks is it fails to take account of the range of activities and demands placed on an individual. By evaluating tasks it is likely that important interactions will be not be accounted for.

The potential for interactions between hazards means that risk assessment on a hazard-by-hazard basis can be unreliable, because the effect on WMSD risk of a particular observed hazard level is likely to depend on the type and severity of other hazards experienced, that is, the combination of tasks may increase the risk of developing a WMSD.

Next- What are the Minimum Requirements