Naturally the focus of physiotherapy interventions is to target MSDs, however Physiotherapy can have a beneficial effect of overall health also.
With the high prevalence of MSDs in the UK workforce, it is imperative that we find an effective solution to reduce these figures. Physiotherapists are very well equipped to be this solution. Physiotherapists are experts in human movement and function. The nature of their job, has them develop great skills in the assessment and management of MSDs. The Chartered Society of Physiotherapy (CSP) states that “Physiotherapists can be a perfect match for occupational interventions.” They feel physiotherapists are ideally placed to tackle ill health, through early interventions and play a key role in the prevention of workplace ill health.
Occupational health physiotherapists have a proactive and reactive role in health and wellbeing in the workplace.12
A Cochrane review by Van Vilsteren et al in 201513 reviewed workplace interventions, and their ability to reduce work disability in workers on sick leave. This review included 14 studies in total, 8 of those studies included workers suffering with MSDs. Van Vilsteren et al found positive evidence in these 8 studies that workplace interventions reduce sickness absence, resulting in a sooner return to work versus usual care. Pain reduction and improved functional status were also noted in some of these 8 studies.
Two RCTs by Lambeek, in 2010 researched integrated care and it’s cost effectiveness at reducing work disability in workers with chronic low back pain 16,17. In these studies, integrated care (coordinated MDT intervention combining ergonomics and a graded activity programme) was assessed versus normal care. The integrated intervention consisted of input from an occupational physician, physiotherapist and an occupational therapist. The integrated care group significantly reduced disability due to chronic low back pain, and had an earlier sustained return to work. Interestingly, there was no difference between the groups in terms of pain at 12 months follow-up, but there was a significant difference in functional status in the integrated group. The second RCT published evaluated the cost effectiveness of these two interventions. The authors found that the cost of the integrated based approach was lower than usual care over 12 months. The integrated group had lower total and indirect costs, however it did have higher primary care costs due to the nature of the intervention and the MDT approach. It is worth noting that both groups cited a loss of productivity as the biggest contributor to costs.
In CSP’s ‘Fitness Profits – The role of physiotherapy in keeping staff healthy and productive at work’21, they highlight a handful of companies, who’ve put in Place physiotherapy interventions or well-being programmes, and flag the success these companies have had. Another report conducted by PricewaterhouseCoopers named “building the case for wellness’ 22in 2008 noted that the most successful interventions were those that were specific to the company and met the employers need. The wellbeing programmes ranged from physiotherapy intervention to ergonomic improvements and physical wellbeing initiatives. They found a varied, but overall positive cost effectiveness of interventions.
Optimal interventions are ones that are company specific, integrated with other members of the MDT (Occupational Therapist, Occupational Physician) where possible and involving active interventions (ergonomics, exercise, lifestyle change). Adding an on site physiotherapist as an adjunct to these interventions for some clinical sessions with employees already or at risk of suffering from MSDs is beneficial.