Current Musculoskeletal Trends
Positional stress spine
Musculoskeletal injuries are one of the leading causes of disability in Western societies  leading to unemployment or functional limitations at work and reduced ability to perform normal activities in general. The prevalence of musculoskeletal pain is about 30% per case year (range 14-47%) with an annual rate of 8.3%. It usually affects an individual at least once in a lifetime.
There is now a trend towards an increase in disability from musculoskeletal conditions. But as disability increases, broader rates normalize these conditions. Treatment options are also constantly increasing and performance decreases due to greater regulation.
It is thought that this increase in disability may be due to the following factors:
- Ageing populations
- Sedentary behaviour
Impact of musculoskeletal conditions on work
The impact of musculoskeletal disorders on workers is variable and influenced by many factors. Job type may play a role – a 2018 Norweigan study found an association between professional physical activity and the risk of receiving a disability pension for all causes and musculoskeletal conditions condition. 
- Patients with chronic musculoskeletal conditions are more likely to be inactive (i.e. 40% likely to work full-time) than people with other medical conditions such as diabetic heart and lung conditions (i.e. 50% likely to be employable). always).
- It is thought that these differences in employment rates among individuals with musculoskeletal conditions may be related to the fact that people are more likely to associate their health condition with work than individuals with other health conditions.
But each individual’s unique response to his or her pain will affect his or her prognosis. Depressive anxiety and psychosocial factors (including how well an individual copes with fear of pain moving (kinesiophobia), pain catastrophization low self-efficacy and passive pain coping pathways) are important areas to consider when assessing the suitability of these patients to return to work. If an individual fears that work will worsen his or her condition it can have an impact on his or her ability to return to work.
In general, patients with chronic nonspecific musculoskeletal pain who are still working report poor to moderate work capacity and performance, De Vries and colleagues report.  However, they found that a subset of workers were able to continue working and achieve high performance and competence. These individuals tend to have high levels of pain self-efficacy. Black and colleagues also noted a positive relationship between high self-efficacy and return-to-work outcomes in patients with upper-body musculoskeletal and psychological impairments.  From this point of view, the individual Work-related factors can affect work ability and performance, not just pain. 
Why is Work Important?
Work is considered an essential part of life, and being unable to work due to a disability or other health issue can take a significant toll on workers and the economy.  Staying active (including while working) is an important part of recovery, as inactivity delays recover. Therefore, returning to work should be the focus of these patients.  However, 5% of all sick absences will be long-term absences (ie lasting more than four weeks).  These chronic absences account for almost half of the total number of lost workdays per year.  more A person who is off hours is at greater risk that she/he will not return to work.  For example, if a person is absent from work for six months, there is an 80% chance that he or she will be unemployed for five years. 
Work is important for a number of reasons:
- it promotes physical and mental health
- It enhances a worker’s sense of purpose, self-confidence, self-worth, independence, and accomplishment
- Physical activity aids recovery – people more likely to be sedentary at home
- Increased social isolation during absence from work
- When people return to work, they are more likely to resume their hobbies and sports, which increases satisfaction
- Relationships at home can be complicated by role reversals due to long-term unemployment
The Role of the Occupational Health Physical Therapist
Occupational health physiotherapists help manage musculoskeletal injuries in the workplace. An impartial and objective investigation is conducted in order to ensure the best outcome for both the employee and the employer. An important part of their roles is to provide guidance on an individual moment ready to return to work after injury or other absences.
The primary goal of occupational health physiotherapists is to help an individual return to his or her existing job. If this is not possible, the focus is on returning to the same project but with some modifications. Alternatively, they can return to another job with the same employer. If neither is present these conditions are appropriate the goal would be to find employment with another employer.
Key information provided by occupational physiotherapists to the employer and employee includes:
- Advice on what workers can and cannot do for work
- Advice on what adjustments to job requirements may need to be made so that the worker can manage his or her role
A fit-for-job assessment will assess a worker’s ability. If a worker’s abilities match the job requirements, then she/he is likely to succeed in finding a job. However, when the ability of the laborers does not match the job requirements, occupational health Intervention will be necessary. These include:
- Ergonomic technology
- Changing job requirements (e.g. reduced lifting requirements)
Return to Work Assessment
The return to work assessment will include:
- Subjective assessment
- Objective assessment
- Patient reported disability
- Psychological assessment
- Functional testing
When conducting a subjective assessment, it is important to explore the medical history, including previous treatments and medical interventions. This will provide information about the stage of recovery and where the patient is in the recovery process. Although it provides key information Regarding a patient’s medical history, it doesn’t necessarily say anything about what might happen to the patient in the future. 
Objective assessment is important because it aids in diagnosis and guides physical therapy management. However, these tests are not always very specific and may not always correlate with loss of function. This means that they do not necessarily predict whether a patient will be able to Return to work. They also don’t show patients how they’re doing on the job.  For example, a patient with significant shoulder pain with limited motion and weakness can perform their job normally if it is computer-based.  Clinical examination also found that Tends to show greater limitations than functional testing (assessed by Isernhagen Work Systems Functional Capacity Evaluation).  Thus, while an objective assessment is useful, it alone cannot provide sufficient information to determine whether a patient is ready to return to work. 
Self-reported measures of disability highlight patients’ perceived ability to participate in various activities.  There are a number of different self-report disability questionnaires for different body parts, including the Roland Morris DASH for back pain or quickDASH for upper extremities and Knee KOOS. There are also evaluations specific to injuries, including carpal tunnel evaluations. 
Each questionnaire indicates the impact of the injury or condition on the person’s quality of life. However, the main problem with this scale is that it is influenced by the individual patient’s perception of pain. It has been observed that a patient often reports high limits relative to the limits determined by objective analysis or functional testing.
How a person responds to pain can affect their prognosis. As noted above, mental health and psychosocial factors are important areas to consider when assessing suitability to return to work. 
A range of psychological tools can be used when assessing a patient’s return to work status. However, Sleijser-Koehorst and colleagues found that the following areas should be explored when assessing musculoskeletal pain:
- Fear of Exercise Using the Fearful Avoidance Beliefs Questionnaire and the Kinesitophobia Tampa Scale
- Ability to cope using the Coping Strategies Questionnaire or the Chronic Pain Coping Index
- Self-efficacy and catastrophizing using the Pain Catastrophizing Scale
Functional testing is often referred to as performance measurement. It is usually task-based and assesses individuals performing a range of tasks, including strength-based activities, postural tolerance balance, weightlifting mobility, and hand dexterity.  It has been suggested that these functions Measures are best suited to track age-related differences in functional capacity.  Return-to-work assessments should include tests that explore a range of different physical activities. 
Recent research has explored which of the above tools best assess ability to return to work. However, evidence suggests that no single test or measure predicts return-to-work health.  For example, self-reported clinical examinations and functional tests have shown Significant differences exist in trying to predict limitations, and it is important that health professionals be aware of these limitations when using these measures. 
However, when taken together, performance (i.e. functional tests) and non-performance (i.e. self-reported social assessments of disability) measures can provide information about an individual’s ability to return to work. 
Gouttebarge and colleagues discuss a three-step process that vocational rehabilitation workers should go through:
- First step – establishing the medical condition and its related functional limitations
- Step two – assignment of a functional context
- Step 3 – selecting a functional test from the full Functional Capacity Assessment to measure functional limitations
This multidimensional approach is known as the biopsychosocial model. Includes:
- Biological assessment (psychological and clinical assessment of the condition) .
- Psychoanalysis (a patient’s fearful beliefs and opinions about his condition and abilities
- Social assessment ( self-reported disability) .
The information obtained from the biopsychosocial assessment should then be considered alongside functional testing so that the occupational physical therapist has a reliable means of determining the appropriateness of return to work in the 19th century.
Using Functional Tests
A major benefit of functional testing is the therapist’s ability to follow a standardized protocol with standardized scoring. This means results are consistently valid and easily reproducible.  Furthermore, they provide data on patients that can be compared with the general population (via specification data) or job requirements. Therefore, it is beneficial to use these tools when assessing the health of returning to work. 
When selecting a functional test, it is important to select the following tests:
- Scientifically robust (i.e. reliable and valid)
- Clinically useful (i.e. in terms of time required, cost and equipment required)
- Relevant to the employee
- Reflective of job demands
It’s also important to remember to choose tests that focus on a series of body movements. In order to select the correct test, you must:
- Understand the medical condition, including its impact on the individual – information will become clear based on a biopsychosocial assessment
- Identify restricted activities – job analysis should be performed to identify the tasks required for the job and the results of functional testing compared to the job tasks 
Examples of Functional Tests
Sit to stand test
Ask a person to stand up from sitting 10 times (this has some variations such as 5 times sitting up (shown below) or ask the patient to stand up from sitting as many times as possible within 30 seconds). This test is a quick, simple and reproducible way to measure the lower extremities Strength   Evidence suggests that lower muscle strength is a good predictor of later disability.  There is a significant relationship between time and age for different sexes.  Results can thus be compared to normative data, but it is important to consider whether the data represent The population being tested (e.g. race gender)  Francis et al stated that reference ranges for lean tissue mass or skeletal muscle are best generated from the thigh region as the thigh appears to be most sensitive to age-related changes or interventions , So it’s a useful metric. biggest Thigh power generation is best represented by the knee extensors because they:
- the fullest part of the thigh
- Are a more stable measure
- Play an important role in many activities of daily life
- Greater decline compared to knee flexors
Maximum grip strength
This is a measure of general fitness and strength based on the average of the three maximum grip tests. The results should again be compared with standard data. Individuals should not practice ahead of time as this may cause fatigue.  Grip strength is not just a measure of hand strength – it is Also associated with various aging outcomes and associated with sarcopenia and frailty phenotypes  as well as all-cause cardiovascular death and cardiovascular disease.  Grip strength is known to peak in early adulthood. Next comes a maintenance period, then intensity The decline with age begins as early as age 40 in both men and women. [twenty three]
Maximum lifting test
Performance-based lifting tests (such as the floor-to-hip test in patients with chronic low back pain) appear to predict work engagement . This is possible because the lifting requires many physical actions including gripping holding bending lifting and lowering – . there is conflicting evidence regarding the association of acute pain fear with fear of movement or (re)injury depression with sex and age. It is an important predictor of functional outcome in patients with musculoskeletal complaints.
One lifting test is the Progressive Isoinertial Lifting Evaluation (PILE) (shown below) – which involves an individual standing in front of a box and then lifting 4 times in 20 seconds to a 75cm table.
Special Notes Before Starting Functional Testing
Before carrying out any test it is important to obtain consent to ensure the patient understands the test and ensure its safety through appropriate screening and assessment including:
- The BORG scale can be used to assess natural – pain and exertion levels
- Physiological – measure BP at baseline and HR and RR throughout
- Biomechanical – look at muscle fatigue or weakness poor movement patterns
- Brendbekken R, Eriksen H, Grasdal A, Harris A Hagen E, Tangen T. Return to Work in Patients with Chronic Musculoskeletal Pain: Multidisciplinary Intervention Versus Brief Intervention: A Randomized Clinical Trial. Journal of Occupational Rehabilitation. 2016; 27(1).
- Hutting, N., Oswald, W., Nijhuis-van der Sanden, M.W., Filart, M., Raaijmakers, T., Bieleman, H.J., Staal, J.B. and Heerkens, Y.F., 2020. The effects of integrating work-related factors and improving cooperation in musculoskeletal physical therapy practice: protocol for the ‘WORK TO BE DONE’cluster randomised controlled trial. BMC Musculoskeletal Disorders, 21(1), pp.1-10.
- Sleijser-Koehorst MLS, Bijker L, Cuijpers P, Scholten-Peeters GGM, Coppieters MW. Preferred self-administered questionnaires to assess fear of movement, coping, self-efficacy, and catastrophizing in patients with musculoskeletal pain-A modified Delphi study. Pain. 2019;160(3):600-606.
- Gouttebarge V, Wind H, Kuijer PP, Sluiter JK, Frings-Dresen MH. How to assess physical work-ability with Functional Capacity Evaluation methods in a more specific and efficient way?. Work. 2010;37(1):111-115.
- Albert C. Assessment of Fitness to Return to Work Course. Plus. 2020.
- Fimland MS, Vie G, Holtermann A, Krokstad S, Nilsen TIL. Occupational and leisure-time physical activity and risk of disability pension: prospective data from the HUNT Study, Norway. Occup Environ Med. 2018;75(1):23-8.
- de Vries HJ, Reneman MF, Groothoff JW, Geertzen JH, Brouwer S. Self-reported work ability and work performance in workers with chronic nonspecific musculoskeletal pain. J Occup Rehabil. 2013;23(1):1-10.
- Black O, Keegel T, Sim MR. Collie A, Smith P. The Effect of Self-Efficacy on Return-to-Work Outcomes for Workers with Psychological or Upper-Body Musculoskeletal Injuries: A Review of the Literature. J Occup Rehabil. 2018; 28: 16–27.
- Wind H, Gouttebarge V, Kuijer PP, Sluiter JK, Frings-Dresen MH. Complementary value of functional capacity evaluation for physicians in assessing the physical work ability of workers with musculoskeletal disorders. Int Arch Occup Environ Health. 2009;82(4):435-443.
- Black C, Frost D. Health at work – an independent review of sickness absence. London: Department of Work and Pensions; 2011. Available from: http://www.dwp.gov.uk/policy/welfare-reform/sickness-absence-review [Accessed 13 April 2020]
- Department of Work and Pensions. Department of Health and Social Care. Health in the Workplace- Patterns of Sickness Absence, Employer Support and Employment Retention. 2019. Available from https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/817124/health-in-the-workplace-statistics.pdf. [Accessed 13 April 2020].
- Chartered Society of Physiotherapy. Physiotherapy Works: Occupational Health. United Kingdom; 2010. Available from https://www.csp.org.uk/publications/physiotherapy-works-occupational-health (accessed 13 April 2020).
- Roberts, K. An Introduction to Occupational Health. Plus. 2020.
- Ishimaru T, Chimed-Ochir O, Arphorn S, Fujino Y. Effectiveness of fitness for work interventions for workers with low back pain: A systematic review. Journal of Occupational Health. 2021;63(1):e12261.
- Brouwer S, Dijkstra PU, Stewart RE, Göeken LN, Groothoff JW, Geertzen JH. Comparing self-report, clinical examination and functional testing in the assessment of work-related limitations in patients with chronic low back pain. Disabil Rehabil. 2005;27(17):999-1005.
- Noll L, Mallows A, Moran J. Consensus on tasks to be included in a return to work assessment for a UK firefighter following an injury: an online Delphi study. International archives of occupational and environmental health. 2021 Jul;94(5):1085-95.
- Francis P, Lyons M, Piasecki M, Mc Phee J, Hind K, Jakeman P. Measurement of muscle health in aging. Biogerontology. 2017;18(6):901-911.
- Kuijer PP, Gouttebarge V, Brouwer S, Reneman MF, Frings-Dresen MH. Are performance-based measures predictive of work participation in patients with musculoskeletal disorders? A systematic review. Int Arch Occup Environ Health. 2012;85(2):109-123.
- King PM, Tuckwell N, Barrett TE. A critical review of functional capacity evaluations. Phys Ther. 1998;78(8):852-866.
- Csuka M, McCarty DJ. Simple method for measurement of lower extremity muscle strength. Am J Med. 1985;78(1):77-81.
- Tsekoura M, Anastasopoulos K, Kastrinis A, Dimitriadis Z. What is most appropriate number of repetitions of the sit-to-stand test in older adults: a reliability study. Journal of Frailty, Sarcopenia and Falls. 2020 Dec;5(4):109.
- American Academy of Orthotists and Prosthetists. Five Time Sit to Stand Test (FTSST). Available from https://www.youtube.com/watch?v=_jPl-IuRJ5A [last accessed 15/08/2020]
- Dodds RM, Syddall HE, Cooper R, et al. Grip strength across the life course: normative data from twelve British studies. PLoS One. 2014; 9(12):e113637.
- Leong DP, Teo KK, Rangarajan S, et al. Prognostic value of grip strength: findings from the Prospective Urban Rural Epidemiology (PURE) study. Lancet. 2015;386(9990):266-273.
- Paul Potter PT. Grip Strength Test. Available from https://www.youtube.com/watch?v=hBPfDbUW7Iw [last accessed 15/08/2020]
- Matheson System. Progressive Isoinertial Lift Evaluation (PILE – Frequent) for Functional Capacity Evaluation. Available from https://www.youtube.com/watch?v=W5MzJxvgntw [last accessed 15/08/2020]