An outcome evaluation of a work hardening program for a group of wrist injured workers

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An outcome evaluation of a work hardening program for a group of wrist injured workers

 

Author: Lai, Ho-yin Frank
Title: An outcome evaluation of a work hardening program for a group of wrist injured workers
Degree: M.Sc.
Year: 2001
Subject: Wrist -- Wounds and injuries -- Patients -- Rehabilitation
Hong Kong Polytechnic University -- Dissertations
Department: Multi-disciplinary Studies
Dept. of Rehabilitation Sciences
Pages: vi, 88, [34] leaves : ill. ; 30 cm
Language: English
InnoPac Record: http://library.polyu.edu.hk/record=b1578463
URI: http://theses.lib.polyu.edu.hk/handle/200/2522
Abstract: The main purpose of this study is to explore the outcome of work hardening program for wrist injured patients. Traditional treatment for wrist injuries includes splintage, mobilization and strengthening. However, high relapse rates have been reported. Occupational therapists utilize purposeful activities and work hardening program to facilitate patients back to their own work. Therefore, a comprehensive work hardening program was used in this study. To study the treatment effectiveness and efficacy, a quasi-experimental design was performed. Repeated measure design was used to study if there is any changes in body function level, activity level, their participation level and to determine if there is any other social consequence upon patients' return to work. Double baseline assessments were set at 3 weeks before work hardening program (Baseline 1) and initial assessment - immediately before the implementation of work hardening program (Baseline 2). Assessment periods were placed at 3th week, 6th week and 9th week after the implementation of work hardening training. Moreover, there would be three months post discharge telephone follow-up. The study subjects were confined to Chinese men aged eighteen to fifty, should be full time workers in either construction site or mechanical fields of work. Moreover, should with job demand from heavy to very heavy level of work [referenced from job description in the Dictionary of Occupational Title (DOT). (DOT - US Department of Labor, Employment and Training Administration 1972) 1977 & 1981)]. Subject selection criteria are those male workers within six months after injuries. Meanwhile, subjects should have no history of neurological disorder, no previous major traumatic injury on either side of upper extremities, no diagnosed arthritis, and no other condition limiting strength in their upper extremities, will be invited to the study. Fifty injured subjects were recruited into 18 sessions of work hardening program. Demographic data like age, sex, mode of injury, occupation, duration of post injury, hand dominance and affected hand were documented. Outcome indicators are based on the theoretical framework of ICIDH-2 International Classification of Functioning and Disability (WHO 1999). Outcome indicators including pain, strength and range of motion of wrist (body functions, structures and impairment), clients specific job demand, structured work simulation activities and work capacity evaluation (activity level). Sessions of work rehabilitation program participated, feasibility in return-to-work (participation level) and other social consequence upon return to work (environmental factors) would also be considered. For statistical procedure, descriptive statistics was generated for the basic characteristics of the population. Paired T-test was used to test to verify there is significant difference between the baseline and pre-discharge assessment. Each category of the dependent variable was related to the independent variable using binary logistic regression model controlling the presence of the confounding factors. General linear model - repeated measures was used, and showed there is significant difference between different stage of evaluation i.e. baseline, 3rd week 6th week and 9th week. The result showed that the work rehabilitation program in occupational performance improved body level and activity level of wrist injured patients. Result also supported the hypothesis that there were significant improvement in work capacity enhancement with use the work hardening program. It can concluded that the work hardening program made positive changes in enhancing body function and activity level, but due to the high influence of contextual factors, therefore, make it difficult to conclude the effectiveness of enhancing patients' participation level. This study also provided insights for improving treatment accountability by comparing different treatment protocols in the future. Further studies might be useful to clarify factors that may impact on efficacy of work hardening program. Hopefully, the future will bring the knowledge, the insights, and the diagnostic and management methods that we need.

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