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Why workplace injuries must be treated seriously

Too many CSP members are still suffering injuries at work. Warren Glover reports on some important research, and explains how things could be improved

Every year CSP members play a key role in the treatment and prevention of injury and illness for more than 10 million NHS patients, with the private and independent sectors accounting for millions more.

Unfortunately, from a survey of 3,661 CSP members (including physiotherapists, assistants and physiotherapy students on placements), we know that 68 per cent of CSP members have already suffered a work-related musculoskeletal injury during their career. That's an injury directly associated with their work helping patients to recover from illness or injury.

The low back is the area of greatest concern for CSP members, with 48 per cent having experienced work-related low back problems. 40 per cent have experienced work-related hand, wrist or thumb problems.

The CSP firmly believes that a significant proportion of these work-related injuries can be prevented. That's why we are calling on employers, managers, government and other stakeholders to work with us in developing a 'solution-based approach' to the problem of work-related musculoskeletal injury among physiotherapists.

We want all physiotherapy departments to have the right resources and assistance to put in place effective strategies to prevent work-related musculoskeletal injury. A first step is for departments to invest in a copy of an important new report from the CSP.

Work-related musculoskeletal disorders affecting members of the Chartered Society of Physiotherapy (ISBN: 1904400140) costs GBP10 for members and GBP12.50 non-members. The main findings have just been published in Physiotherapy (Volume 91, number 3, pp.138-147, September 2005), and a new CSP briefing paper is also available. Contact the enquiry handling unit on 020 7306 6666 or email enquiries@csp.org.uk for more details.

For this research study the CSP surveyed 3,661 members, and 2,688 replied (an excellent response rate of 73.4 per cent). It emerged that 32 per cent of members with a work-related musculoskeletal disorder are injured in the first few years after graduating.

Younger physios and newly qualified graduates are most at risk.

Employers can help newly qualified staff to stay injury-free through:

Training in injury prevention, which should be reinforced at work, particularly during rotations, where risk factors will vary - depending on the activities involved.

Induction programmes for new staff covering risk factors, where to go for help and good practice can help raise awareness, as can greater supervision and assistance through

Mentoring. It's better to learn from other people's experiences rather than learn the hard way through an injury.

The research revealed that 44 per cent of CSP members have not had a risk assessment in their current post, despite risk assessment being a legal requirement on behalf of the employer. Many employers are failing in their duty of care. Stewards and safety reps may need to remind their employers to ensure risk assessments are carried out; prevention is always better than cure.

Only a minority (16 per cent) of CSP members with a work-related musculoskeletal injury had reported their injury to their line manager. Even fewer had consulted occupational health (12 per cent), or completed a workplace accident form (10 per cent). This is an issue because under-reporting of injuries undermines efforts to make sure these risks are taken seriously by all employers: an 'invisible' problem is harder to solve. Reporting of injuries should be encouraged and any barriers to official reporting identified and dealt with.

Example A: one barrier to official reporting is the sheer size of the workplace accident form. A simplified accident form, with physio input into its design to help make it more user-friendly, may help to overcome this. We want a review of the design of accident forms, because reporting injuries not only helps us get a handle on the scale of the problem, it can identify where timely action can minimise injury and absence.

Example B: another barrier is a reluctance to have an injury 'on-the-record', in case this is seen as 'making a fuss' about an 'inevitable' aspect of the job. The CSP wants employers to help change this kind of thinking by introducing 'pain prompts', such as body mapping, where staff can log symptoms at the end of their working day. Early reporting may lead to an early diagnosis, and the timely introduction of interventions such as alternative duty programmes.

After an injury less than 10 per cent of CSP members reported that they subsequently decreased patient contact time, or changed duties, work setting or the type of patient they treat. This is largely because these elements are beyond the personal control of the individual physiotherapist or assistant.

Treating a large number of patients in one day is one of the main factors identified by CSP members as increasing their risk of an injury at work. Electronic booking systems are adding to the pressure already experienced to cut back treatment times in order to see more patients in one session. We call on employers to review booking-in systems, where possible adapting them so that the physiotherapist has the flexibility to see only 'light duty' patients when this is appropriate. Ensuring a variety of activities during the working day will help protect against cumulative injury from repetitive strain.

The sharing of good practice, and knowledge of effective preventive strategies to reduce the risk of injury, can underpin a new NHS-wide approach to workplace health and safety. We call on NHS employers and the Health and Safety Executive to formulate a communications strategy centred on promoting good practice. This may include a webpage on effective preventive strategies on the CSP, NHS employers and HSE Executive websites.

Physiotherapists are encouraged to engage in reflective practice as part of their continuing professional development (CPD). Risk factors for work-related injury could usefully be incorporated into CPD, encouraging reflection on risk as part of normal routine.

Over 60 per cent of  members who had suffered injuries sought treatment informally from a colleague. This has the effect of keeping the problem off-the-record, unofficial and invisible, and can reduce the likelihood of effective management action. We want physiotherapy treatment, and other occupational health services and support, to be made readily available from all employers. These should include access to phased return-to-work and 'light duty' programmes.

The lack of accessible and appropriate manual handling equipment is often a contributory factor to workplace injury. Treatment rooms that are too small are also not conducive to workplace safety, as they often force the physiotherapist into the wrong postures during treatment. Working in awkward or cramped postures was cited by 44 per cent of injured respondents in the survey as a particular problem. The Department of Health must ensure physiotherapy departments have sufficient funding to replace any broken or faulty equipment. We also call on the department and NHS employers to fund an ergonomic research project into the design of physiotherapy departments, aimed at identifying 'best practice' design features, and eliminating those poor working environments that contribute to bad posture.

More research is needed to investigate how best to tackle workplace injury in physiotherapy. The CSP's research study is a start, but we would now like to see more research, at academic level and at the local level of NHS trusts, to ensure that we have the best chance of reducing the risk of workplace injury to our members. There is a lot of innovation out there - we call on the Department of Health and NHS employers to fund appropriate research so that best practice can be disseminated more widely.

For more on the topics covered in this article please see www.csp.org.uk/topics  For advice on the issues arising please email gloverw@csp.org.uk

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