MSK: integrating occupational factors (FS-15)

Focused symposium

Hutting N1Johnston V2Gross D3Watson H4Stigmar K5 
1HAN University of Applied Sciences, Research Group Occupation and Health, Nijmegen, Netherlands, 2The University of Queensland, RECOVER Injury Research Centre, Herston, Australia, 3University of Alberta, Department of Physical Therapy, Edmonton, Canada, 4Designed2Move Ltd, Derbyshire, United Kingdom, 5Lund University, Department of Health Sciences, Lund, Sweden

Learning objective 1: Participants will gain knowledge of how to integrate occupational factors within (generalist) physiotherapy for musculoskeletal disorders.
Learning objective 2: Participants will gain knowledge, practical skills and tools with regard to addressing occupational factors within their practice.
Learning objective 3: Participants will enhance their current practice with regard to the integration of occupational factors and will be better equipped to support patients with regard to their work and return-to-work.
Description: The main complaints for visiting a physiotherapist (PT) in primary healthcare worldwide are musculoskeletal disorders (MSDs).1 MSDs have a negative effect on an individual´s quality of life and are the leading cause of disability globally.2 Work-related MSDs are disorders whereby work activities and conditions significantly contribute to the onset or progression of the disorder, but are not necessarily the sole cause of the disorder. But health conditions can also be work-relevant, which refers to how work can impact health and health can impact work. Although work exposure can cause health problems, work can also have a beneficial influence on the individual´s wellbeing and quality of life. Return to work can be an important component of rehabilitation if appropriate clinical and workplace interventions are provided. These interventions can contribute to the prevention of long-lasting absenteeism.3
Although participating in work is an important factor of wellbeing, most caregivers in primary healthcare -including physical therapists (PTs)- pay insufficient attention to the relationship between MSDs and occupational factors among their working patients. Often patients receive insufficient guidance and support with regard to their work problems.3 Therefore, it is recommended that healthcare providers improve their knowledge of occupational factors to allow them to focus on prevention of absenteeism and on return to work.
With their expertise in MSDs, PTs can play an important role in remaining at work with a health condition, facilitating rehabilitation, return to work (RTW), and prevention of absenteeism after an injury.4,5 Several countries have specific educational programs or professional training programs that lead to becoming an occupational physical therapist (OPT). However, for example in the Netherlands, less than 1% of PTs are registered as an OPT. Therefore, it is incumbent on generalist physiotherapists (GPTs) to gain sufficient knowledge and skills to address occupational factors, and to refer patients (if needed) to other professionals.6 GPTs may be reluctant to include work-related factors in their treatment plan if they lack occupational health training. The lack of knowledge of GPTs is also seen as a barrier for addressing work within the physical therapy consultation.6 Recent qualitative research revealed that GPTs place insufficient priority on work participation.6 GPTs reported a lack of knowledge and a need for additional information about several important work-related factors (e.g. work content, the workplace, physical and psychosocial working conditions) and how to address these work-related factors.6 
Another recent survey3 revealed that occupational factors should be addressed to a greater extent within physiotherapy. Survey respondents identified the following needs: 1) Questionnaires about patients´ work participation; 2) screening lists to assess to what extent the patient´s complaint is work-related; 3) knowledge about work tasks/work activities, work methods/techniques, working hours, workload; 4) practical tools to integrate work within GPT practice; and 5) more practical skills to carry out basic workplace assessments.3 Moreover, a lack of cooperation between GPTs and OPTs was identified.3,6
Based on the expertise of the presenters and the available evidence, this focused symposium will discuss how GPTs can better integrate occupational factors within their practice to contribute to reducing absenteeism and facilitating RTW. During this session, topics such as the use of a biopsychosocial approach to return to work, work assessment techniques, the use of questionnaires7, a work place dialogue tool8, and (workplace) interventions9,10 will be addressed. Also, the role of patient education, (identifying) obstacles to recovery, authorization of work capacity certificates and collaboration with other professions will be discussed. Moreover, a recent developed intervention, which integrates work participation in shared decision making in physiotherapy practice, will be presented. During this focused symposium, practical advice and examples will be provided, which can be easily implemented by the audience.
Implications / Conclusions: As primary care practitioners, GPTs are ideally positioned to integrate occupational factors into their practice to facilitate stay at work, recovery and return-to-work.5Currently, GPTs take insufficient account of work participation in the treatment of patients with MSDs.6 Systematically addressing occupational factors could increase the effectiveness of physiotherapy management of patients with work-related and work-relevant MSDs.6 Therefore, it is important to support GPTs in addressing these factors. This focused symposium will provide valuable training of physiotherapists to enhance their current practice and to better support patients with work-related and work-relevant MSDs. 
Key-words: 1. Occupational health 2. Musculoskeletal disorders 3. Work participation
Funding acknowledgements: 
Relevance to physical therapy globally: GPTs are ideally positioned to integrate occupational factors into their practice to facilitate recovery and return-to-work. However, physiotherapists take insufficient account of work participation as a determining factor in the treatment of patients with MSDs. This focused symposium will contribute to the training of physiotherapist to enhance their current practice. If generalist physiotherapists successfully integrate occupational factors within their practice, this will potentially advance the scope of physiotherapy practice in the healthcare system.
Target audience: This topic will appeal to practitioners, researchers, educators, students and policy makers.