Canadian Association of Occupational Therapists

1. Canadian Association of Occupational Therapists Professional Issue Forum Workplace safety and injury prevention in occupational therapy practice in Canada Thursday June 7, 2012 8:30-11:30

2. Background • What are PIFs? • Today’s PIF on Workplace Health and Safety • Issues • Objectives

3. Who we are: Welcome: Karyne Lapensee, OT Student, Janet Craik, OT Reg. (Ont.), CAOT Facilitator: Andrea Dyrkacz, OT Reg. (Ont.) Lonita Mak, OT Reg. (Ont.) Mike Brennan, CAOT Althea Stewart-Pyne, RNAO

4. Objectives • explore and document current trends/issues around workplace safety and injury prevention with in occupational therapy practice in Canada. • raise awareness, and offer possible solutions to enable a healthy, sustainable workforce.

5. Agenda 8:30 WELCOME & INTRODUCTION 8:35-9:45 PANELIST PRESENTATIONS 9:45 COFFEE 10- 10:45 ROUNDTABLE DISCUSSIONS 10:45-11:30 SUMMARY AND NEXT STEPS

6. Work-related injuries in occupational therapy – causes, prevalence and impact on practice Lonita Y.M. Mak,BSc(OT) Andrea P. Dyrkacz,BMR(OT), BA, MDiv Carol S. Heck,BScPT, MSc, PhD

7. Definition In 2007, Human Resources and Skills Development Canada, defined an occupational injury as, “Any injury, disease or illness incurred by an employee in the performance of (or in connection with) his or her work.”

8. Definition (continued) Additionally, “Healthcare workers are more likely to miss time due to illness or injury than any other worker in Canada.”(Canadian Institute for Health Information, 2005)

9. Rationale Although occupational therapists are considered to be expert in the prevention and treatment of work-related injuries – little has been done to study the injuries experienced by occupational therapists themselves.

10. Rationale(continued) Indeed, the bulk of the extant literature extrapolates and infers this information, and is generally taken from physiotherapy and nursing practice.

11. Rationale(continued) • Until recently, the only studies that examined work-related injuries sustained by occupational therapists focused on clinical speciality-specific injuries, such as those experienced by hand therapists. (Stevens, 1994; Caragianis, 2002) • However, because of the narrow focus of these studies and small sample sizes, their findings can not be generalized across clinical practice settings.

12. Rationale(continued) • Only one published article systematically reviewed the impacts of occupational injuries on occupational therapy practitioners. • However, it also used the literature of other healthcare disciplines to posit the prevalence, incidence and causes of work-related injuries in occupational therapy practice.

13. Rationale(continued) • It strongly recommended that occupational therapy-specific research be undertaken, recognizing that occupational therapy is a unique and distinct profession, and that it occupational risks are similarly specific. (Alnasar, 2007) • A focus on work-related injuries experienced by occupational therapists was long overdue.

14. Research question What are the types and prevalence of work-related injuries experienced by Canadian occupational therapists across practice contexts?

15. Research objectives • To identify the types and location of work-related injuries experienced by occupational therapists; • To determine how practice context affects type and location of work-related injuries; • To determine how occupational therapists respond to work-related injuries, and the cultural and structural factors that modify and shape that response; and • To identify strategies employed by occupational therapists in managing their return to work after experiencing an injury.

16. * Methodology • All English-speaking occupational therapistswith accessible email addresses registered with the Canadian Association of Occupational Therapists (CAOT) received an electronic survey (n=2623) in June 2009. • Non-responders received subsequent follow-up reminders.

17. * Methodology (continued) • 260 survey participants were excluded for various reasons, leaving 2363 eligible survey respondents. • Demographically, the occupational therapists who submitted the 610 completed questionnaires were generally representative of Canadian occupational therapists, when compared to CAOT membership statistics. (February 2009)

18. * Demographics:province/territory

19. * Demographics:practice setting(s)(Note: multiple responses were permitted for this question)

20. * Demographics:area(s) of clinical practice(Note: multiple responses were permitted for this question)

21. * Demographics:gender

22. * Demographics:age

23. * Experience of work-related injury • Have you ever been injured in your work as an occupational therapist? * 13.9% of survey participants indicated they had experienced two or more episodes of work-related injury.

24. * Injury rates • While there was no significant difference between rates of injury and age, females (55%) were significantly more likely more likely to experience a work-related injury than males(31%). (p=0.006) • This is perhaps explained by the finding that female (20.4 + 9.4) survey participants reported working as occupational therapists significantly longer than male(15.2 + 8.2) respondents. (p=0.003)

25. * Number of reported occurrences

26. * Practice settings Survey participants were significantly more likely to be injured if they worked in General or Rehabilitation Hospital settings. (p=0.05)

27. * Areas of clinical practice

28. Client age ranges

29. * Injury location: occupational therapists(Note: multiple responses were permitted for this question) Head/Face 6.71% Spine 30.97% n=536 Torso 10.82% Upper Extremity 33.39% Lower Extremity 18.09%

30. * Injury location by profession

31. * Limitations of the study • Surveys were sent only to members of CAOT who expressed a willingness to participate in studies – a subset of all Canadian occupational therapists • It is possible that occupational therapists that have had a work-related injury might be more likely to complete a survey dealing with injuries in clinical practice – influencing the data obtained.

32. * Limitations of the study (continued) • This study asked occupational therapists to self-report their experience(s) of injury. Because of this, there is no way to absolutely verify that any injury is directly attributable to a work-related incident. • This is particularly true of reported Repetitive Strain Injuries (RSI), soft tissue injuries and degenerative conditions, such as osteoarthritis.

33. * Injury type n=486

34. * Patient handling education • Physiotherapy and nursing literature indicate that work-related musculoskeletal injuries are often attributed to patient-handling activities. • Survey participants were asked to recall if they had participated in formal pre- and post-professional patient handling education.

35. Patient handling education (continued) Pre-professional n=577 Post-professional n=586 Have you had formal patient handling education as part of your pre- or post-professional education?

36. * Patient handling injuries • It is not surprising that occupational therapists also reported that patient handling incidents caused the majority of work-related injuries. • 20.82%(n=127) of survey respondents reported being injured in a patient handling incident.

37. * Causative factors (Note: multiple responses were permitted for this question) What do you think contributed to your patient handling injury?

38. How are occupational therapists different? • Occupational therapists are similar to their physiotherapy and nursing colleagues in the predominance of patient handling injuries. • The locations of physical injuries experienced in the workplace are also similar to those of their comparator professions.

39. How are occupational therapists different? (continued) • However, there are also differences in the causative factors described by survey respondents. • These differences maybe specific to the practice of occupational therapy, and where Canadian occupational therapists find themselves interacting with their patients/clients.

40. Equipment-related injuries • The first difference is in the equipment used by occupational therapists in their workplaces.

41. Equipment-related injuries (continued) Five general areas of equipment-related injuries were noted by survey respondents: • Lifting/carrying and setting up equipment for clinical interventions (33.1%) • Computer use (23.5%) • Splinting activities (17.1%) • Cuts and lacerations not specific to splinting (13.5%) • Wheelchair-related(11.9%)

42. Equipment-related injuries: lifting/carrying and setting up equipment for clinical interventions • 33.1 % attributed their equipment-related injuries to setting up equipment for treatment sessions, and lifting and carrying equipment and reports. • These injuries were attributed to both single-episodes of lifting, and repetitively carrying/lifting equipment and reports while travellingto provide services.

43. Equipment-related injuries: lifting/carrying and setting up equipment for clinical interventions What were the most significant factors that contributed to your lifting/carrying and setting up-related injury?

44. Equipment-related injuries: computer use • 23.5% attributed the injury to computer use: • Hours spent writing reports(in an office or in client homes/workplaces) • Computer stations set-up for multiple users • Old/poorly functioning computer peripherals and desks/chairs

45. Equipment-related injuries: splinting • 17.1% attributed their equipment-related injuries to splinting activities. • Lacerationsdue to cutting splinting materials • Repetitive strain injuries due to dull scissors or cutting blades • Burnsdue to heat gun and heating pan use

46. Equipment-related injuries: cuts and lacerations not specific to splinting • 13.5% reported cuts or lacerations while using sharps or cutting tools not related to splinting.

47. Equipment-related injuries: wheelchair-related • 11.9% reported a wheelchair-related equipment injury, most often due to • Unanticipated patient action • Being hit or run over by a wheelchair • Through body parts being caught in wheelchair components

48. Transportation or mobility-related injuries • Occupational therapists also reported a significant number of transportation or mobility related injuries (15.1%) • This may be related to the significant number of occupational therapists who are community, rather than institutionally based. • As well, the vast expanse of our country, and our challenging Canadian climate contribute to the injuries reported in this grouping.

49. Transportation or mobility-related injuries (continued) • It is interesting to note that many of the walking/climbing (falls) injuries, and the majority of the motor vehicle accidents were attributed to inclement weather conditions, particularly ice and snow.

50. Threats and acts of violence • Studies show that workplace violence in the health sector is often considered part of the job, and has therefore been frequently overlooked. • It is simply considered part of healthcare culture.