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The Ergonomic Assessment Tool for Arthritis:Development and Pilot TestingCATHERINE L. BACKMAN,1 JUDY VILLAGE,2 AND DIANE LACAILLE1

Objective. Ergonomic assessment and recommendations may help people with arthritis maintain employment; however,most ergonomic tools are designed to assess injury risk in the general population and are not specific to the needs ofpeople with inflammatory arthritis (IA). Our objectives were to design and pilot test an ergonomic assessment tool forpeople with IA and to propose ergonomic modifications to prevent work loss and maintain at-work productivity.Methods. Relevant content was identified in a literature review by an interdisciplinary team. Respecting some clientsreluctance to disclose arthritis to employers, no work site visit was required. An initial assessment tool was reviewed bya 4-person expert panel, revised and pretested with 13 adults with IA by 3 occupational therapists (OTs). The final tool,

comprised of a self-assessment, an interview guide, and a solutions summary, was used in a pilot test of a multifacetedprogram designed to prevent work loss and maintain at-work productivity. One OT conducted all ergonomic consulta-tions and followed up with phone calls at 1 month. Implementation of recommendations was evaluated at 3, 6, and 12months.Results. Nineteen women (mean age 51 years) with IA (mean disease duration 12 years) completed ergonomic assess-ments. A range of risks were identified and 87 recommendations were made (mean 4.5 per participant). At 1 year, 85%of recommendations had been implemented by 74% of the participants.Conclusion. The Ergonomic Assessment Tool for Arthritis is a feasible and comprehensive process for identifyingergonomic job accommodations.

INTRODUCTION

Arthritis in the work place is relatively common. Popula-tion-based surveys of employed Americans indicate thatmore than 5% of the work force reports arthritis (1).Among employees ages 4064 years, this increases from

between 10% (1) to 15% (2,3). The economic costs aresubstantial: lost productivity due to arthritis has been val-

ued at $7,454 per person per year (3). In patients withrheumatoid arthritis (RA), work disability occurs early in

the course of the disease and continues at a steady rate(4,5). A review of work disability studies reported that theprevalence is approximately 10% in the first year afterdiagnosis of RA, progressing to 50% or greater after 10 15years, depending on the year and population studied (6).Prior to stopping work, individuals with arthritis reportproductivity losses such as working fewer hours, changingto less demanding jobs, or declining promotions (7). Ef-forts to reduce work and productivity losses have thepotential to make important contributions to both individ-uals and society (8).

Rehabilitation approaches aimed at preventing workloss or work disability may be preferred over return-to-work strategies, based on the principle that it is easier tomaintain employment than to reenter the employmentmarket after a prolonged absence. Such approaches at-tempt to address the modifiable risk factors associatedwith work disability. A job accommodation is defined aschanges made to a job to better match the abilities of aworker. Ergonomic modifications, which include physicalchanges to the work place and alternative methods forwork tasks, are one type of job accommodation applicableto people with arthritis (4).

Ergonomic assessment draws on multiple disciplinary

Supported by an operating grant from the Canadian In-stitutes for Health Research and from The Arthritis Societyof Canada. Dr. Lacaille is the Nancy and Peter Paul Saun-ders Scholar and is supported by an Investigator Awardfrom The Arthritis Society of Canada.

1Catherine L. Backman, PhD, OT(C), Diane Lacaille, MD,MHSc: University of British Columbia and Arthritis Re-search Centre of Canada, Vancouver, British Columbia,

Canada; 2Judy Village, MSc, CPE: University of British Co-lumbia, Vancouver, British Columbia, Canada.

Ms Village has received consultant fees (more than$10,000) for developing the Ergonomic Assessment Tool forArthritis.

Address correspondence to Catherine L. Backman, PhD,OT(C), Department of Occupational Science & OccupationalTherapy, The University of British Columbia, T325-2211Wesbrook Mall, Vancouver, British Columbia, Canada V6T2B5. E-mail: [email protected].

Submitted for publication February 2, 2008; accepted inrevised form July 8, 2008.

Arthritis & Rheumatism (Arthritis Care & Research)Vol. 59, No. 10, October 15, 2008, pp 14951503DOI 10.1002/art.24116 2008, American College of Rheumatology

SPECIAL ARTICLE: DISABILITY AND REHABILITATION IN THE RHEUMATIC DISEASES

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perspectives to examine the fit between individuals andtheir work. When risks or problems are noted, ergonomicprinciples may be applied to redesign the work place,tools, equipment, or work methods to prevent and reducework-related risks for injury and optimize work perfor-mance. Therefore, ergonomics is aimed at preventing workinjury and work loss, and ergonomists contribute to work

place health and safety in a range of industries. Ergonomicprinciples are also used by occupational therapists (OTs),physical therapists, and others working in arthritis reha-

bilitation when recommending joint protection tech-niques, assistive devices, and alternative methods to ac-complish work, leisure, and self-care tasks (9), but formalergonomic evaluations do not appear to be commonly usedin arthritis care. Ergonomic modifications may help peoplewith inflammatory arthritis (IA) to work more safely, effi-ciently, and in ways that minimize arthritis symptoms andactivity limitations.

A systematic review of work place ergonomic interven-tions indicates positive effects on reducing musculoskele-tal injuries, symptoms, and absence from work among

workers in general (10). Logically, these principles shouldalso improve work for people with arthritis, and indeedthere is some evidence demonstrating that ergonomicmodifications are associated with remaining employed. Ina study of predictors of work loss in patients with RA,people who received ergonomic modifications were 2.5times less likely to be work disabled (4). In another studyof people with IA, all of whom were employed at the timeof diagnosis, failing to adjust job demands or makechanges to the work environment was associated with lossof employment (11). However, the use of ergonomic mod-ifications by people with IA is low, at 9% in one study(12), whereas we found only 20% reported access to anergonomic assessment of their work (4).

In our review of ergonomic assessment tools, we foundlittle evidence that ergonomic assessments were offered topeople with IA, and we could not find a tool suited to theunique needs of people with arthritis (13). Most tools weredesigned to identify the risk for musculoskeletal injuriesin the general population and did not account for symp-toms associated with IA such as pain and fatigue, whichmay be exacerbated at lower thresholds of work than forhealthy populations. Some tools were limited to assessinginjury risk to a specific body part such as the upper ex-tremities (14,15), designed for a specific industry such asautomotive plants (16), or required work site observations(1417). IA affects multiple joints among workers in dif-ferent types of jobs, and some people with arthritis arereluctant to disclose their diagnosis to their employer(7,18). This suggests a need for a tool that considers IAsymptoms, is applicable to different jobs, and can be usedoutside of the work place. As part of a program aimed atpreventing work loss and maintaining work productivityamong people with IA, we designed an assessment tool toidentify ergonomic risk factors in the work place and gen-erate potential solutions. It is a practical guide to assess-ment and intervention, not an outcome measure. Thisarticle describes tool development, content, and resultsfrom a pilot test using the tool as part of the Employmentand Arthritis: Making it Work program (19).

MATERIALS AND METHODS

Development and pretesting of the ergonomic assess-ment tool. A review of published ergonomic assessmenttools was conducted by an interdisciplinary team (rheu-matology, ergonomics, occupational therapy) with experi-ence in arthritis, work disability, work site evaluation,

ergonomic risk assessment, and rehabilitation (13). Al-though none of the tools were appropriate for our purpose,some elements were applicable, including 1) a systemsapproach to considering risk factors that includes workstation, equipment/tools, work environment, and work or-ganization; 2) identification of tasks currently causingproblems or exacerbating symptoms; 3) proactive identifi-cation of risk factors not yet causing problems but that mayin the future; 4) use of a red, yellow, and green color-coding system (20) to indicate levels of risk; and 5) use ofdiagrams and photographs to illustrate postures and riskfactors when direct observation is not possible. Addition-ally, findings from our prior focus-group study (18) pro-vided the patient perspective, indicating that important

considerations for ergonomic assessment include attentionto arthritis symptoms, an assessment by a person knowl-edgeable about arthritis, and reluctance to disclose arthri-tis to employers.

An iterative process was used to develop an ergonomicassessment tool involving client self-assessment at workand a semistructured interview by an OT. The first draft(version 1) incorporated the desired content and programpurpose outlined above, asking questions based on knownrisks for musculoskeletal injuries and factors likely to ex-acerbate IA symptoms. To enhance content validity, ver-sion 1 was reviewed by an independent panel of 4 experts,selected for their knowledge of ergonomics and work dis-ability as judged by publications and professional experi-ence. They evaluated the assessment process and content,responding to 13 questions about whether or not the toolwould lead to a good understanding of the clients worktasks, identify risks, lead to ergonomic recommendations,and be applicable to a range of occupations. The tool wasmodified based on the panels expert opinion (version 2).Version 2 was pretested with 12 women and 1 man with IA

by 3 different OTs (one practicing in an arthritis outpatientprogram, one providing ergonomic consultations in arehabilitation center, and one academic/researcher).A professional ergonomist observed 2 assessments. Theoccupations in this pretest included administrative andmanagement positions, school bus driver, flight attendant,laboratory technician, and dog groomer. Clients and OTscompleted feedback forms designed to elicit informationabout ease of use, applicability, and thoroughness of thecontent, and this formative feedback influenced ongoingrevisions to the tool. Specifically, after the first 3 pretests,minor improvements were made to clarify format and in-structions (version 3), and after 10 pretests, participantswere given a disposable camera to take photographs in thework place to supplement the self-report (version 4). Be-cause some people were reluctant to disclose arthritis toemployers or coworkers, a work site visit was not planned,and the photographs helped overcome the lack of directobservation. Final revisions were made based on observa-

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Table 1. Content of the self-assessment and interview components of the Ergonomic Assessment Tool for Arthritis*

Self-assessmentOccupational therapist interview

guide/checklist

1. Work diary and work layoutdiagram/photographs

Participant keeps diary for 1 work day,identifying main task during each halfhour, noting equipment, tools, ormaterials used and any difficulty ordiscomfort during the task. A sketch ofthe work station or general layout ofmain work space is completed at theend of the diary, and photographs aretaken of the worker doing key tasks.

A work task summary is documented,identifying the duration of maintasks. The sketch or photographs ofthe work station illustrating thephysical environment are reviewedprior to beginning thesemistructured interview.

2. Work organization Participant indicates if any of 6statements describe their work; e.g., Icontrol how fast or slow I do mywork.

12 items probe for details; e.g., Arethere opportunities for rotation oftasks? Is training provided on howto adjust the work station? Aresupervisors supportive?

3. Seated work A drawing is provided of a manikinseated with yes/no/sometimesquestions about posture; e.g., feetsupported? head upright and facing

forward? 11 questions inquire aboutfrequency of maintaining variouspostures, motions, and repetition, andany associated pain or discomfort.

10 items probe for details about thechair (e.g., adjustable armrests,lumbar support), workspace (e.g.,adjustable work surface, placement

of tools), and if applicable, 10additional items address computerwork (e.g., monitor height,keyboard type)

4. Standing work (includeswalking and kneeling)

A drawing is provided of a manikinstanding with yes/no/sometimesquestions about posture; e.g., forearmshorizontal? weight shared on bothfeet? 13 questions inquire aboutfrequency of maintaining variouspostures, repetition, and tasks likeoperating foot pedals, walking,climbing stairs or ladders, and floorsurface.

14 items probe for details about workspace and tasks; e.g., Is the worksurface height appropriate to thetask? Is the work station designedto reduce or eliminate bending andtwisting wrist, reaching above theshoulder or below the knee,reaching forward, working withelbows raised? Is the floor flat andfree of obstacles?

5. Upper extremity work,

gripping, grasping, andusing hand tools

5 questions about hand use; e.g., Do you

have to grip hard or squeeze with yourhand? Do you manipulate small objectsor do precise hand movements to usetools? Frequency and discomfort arenoted for each.

7 items describe hand movements

(e.g., During gripping tasks is theforce required judged acceptable?Can 2 hands be used?) Ifapplicable, 10 items inquire abouthand tools (e.g., Are tools poweredwhere necessary and feasible? Isthe tool weight evenly balancedand distributed?)

6. Lifting and carrying 2 questions address loads lifted close tothe body and away from the body,including approximate weight of theload and associated discomfort, if any.

Additional information on lifting,carrying, pushing, and pulling iscombined with questions aboutfrequency and load, up to 16 items,depending on the job; e.g., Is thelift, push, or pull task performedinfrequently? For short/intermittent

periods? Over short distances? Freefrom pressure of time or at a pacecontrolled by a machine? Is helpavailable for heavy or awkwardtasks?

7. Pushing and pulling 3 questions about frequency of movingheavy loads (e.g., full 2-drawer filingcabinet), moderate loads (e.g., a fullshopping cart), and small loads (e.g., ashopping cart with 10 small items).

See component 6, lifting andcarrying.

* Components 1 and 2 are common to all workers; components 3 to 7 are selected if relevant to the worker, based on the screening questions.

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tions gathered throughout pretesting. Feedback from both

clients and OTs indicated that the ergonomic assessmentwas acceptable regarding time and effort and relevant interms of guiding a thorough review of work tasks.

The Ergonomic Assessment Tool for Arthritis. The finalversion, the Ergonomic Assessment Tool for Arthritis(EATA; available online at www.arthritisresearch.ca), has4 components. The first component is screening to matchthe assessment form to the persons job. The EATA isindividualized to each client by selecting only the relevantjob demand sections of the form, based on responses to 5screening questions: Does your work involve (a) pro-longed sitting? (b) prolonged standing, kneeling, walking,or stair climbing? (c) gripping or grasping objects or handtools? (d) frequent lifting or carrying? (e) pushing or pull-ing items (e.g., carts or dollies)?

Self-assessment was completed by the client prior to theconsultation visit (see Table 1 for content overview andFigure 1 for sample items and layout). Responses to the jobdemand questions in the self-assessment are color coded,indicating incremental levels of risk. Items checked in theyellow and red zones assist the OT to focus on the mostpertinent issues during the interview, probing for moredetail to understand the potential risk and make appropri-ate recommendations. The yellow and red levels of risk are

based on risk factors for musculoskeletal injuries, such as

prolonged static postures or repetitive motions, where in-

creased duration is associated with increased risk. Regard-less of level of exposure, if the worker experiences pain orproblems, this is coded red to trigger further evaluation(Figure 1), because people with IA may aggravate theirsymptoms even at low levels of risk.

An interview guide/checklist was completed by the OTduring the visit. The self-report and interview guide areparallel forms that begin with a description of work tasksand then assess up to 6 areas of job demands, from workorganization to pushing and pulling, with the interviewguide going into greater depth (Table 1). During the inter-view, the client and the OT collaboratively complete a jobtask summary, identify and prioritize issues, and generaterecommendations, leading to the fourth component, thesolutions summary page. Issues, recommendations, andresources for implementation (e.g., where to buy specificequipment, identifying human resources or occupationalsafety personnel who can help) are documented on a so-lutions summary page given to the client.

Pilot testing of the EATA. The Making it Work program(19,21), aimed at preventing work loss and maintainingat-work productivity, is a series of 5 group sessions and 2individual consultations, 1 with a vocational rehabilita-tion counselor and 1 with an OT for the ergonomic assess-ment described here. One group session introduces partic-

Any pain or

problem?

Question

Rarely

or never

Up to 2

hours

per day

2 hours

or more

per day NO YES

Neck

Do you have to bend or twistyour neck?

Back

Do you have to bend or twistyour back?

Shoulder/arm (sitting)

Do you work with your handsat or above your head?

Shoulder/arm (standing)

Do you work with your armsstretched out?

Grip

Do you have to grip hard orsqueeze with your hand whilelifting loads of 10 lbs. ormore?

Figure 1. Sample items from the self-report component of the Ergonomic Assessment Tool for Arthritis.Clients check the appropriate column for each item in the self-assessment. Items checked in yellow and redzones are the focus of the subsequent consultation with the occupational therapist.

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ipants to general ergonomic principles, suggestions for jobmodifications, and communicating with employers to im-plement modifications. The full program is described else-where (21), and the present article is limited to the ergo-nomic assessment/intervention.

Eligible participants consisted of employed adults withIA (RA, psoriatic arthritis, lupus), fluent in English, and

ages 1860 years. A research assistant asked the screeningquestions and provided applicable sections of the EATAself-assessment form and camera when booking the partic-ipants OT appointment. All ergonomic consultationswere conducted by the same OT, experienced in arthritisand trained in ergonomic principles by means of a 2-hourself-study module on CD, developed by a certified ergon-omist (JV). The OT phoned participants 1 month later toreview progress toward implementing recommendations,provide clarification, and if necessary, discuss ways toovercome barriers to implementation or suggest alternativerecommendations. When changes had been made, partic-ipants were asked about their effect, and if they wereineffective, trouble shooting was offered.

Data on usefulness of the ergonomic assessment andimplementation of recommendations were collected by astudy coordinator conducting telephone interviews at 3, 6,and 12 months. Questions included How useful for youwas the ergonomic assessment by the OT? and if ergo-nomic changes had been made, How useful were thechanges? (measured on a 5-point response scale, where1 very useful and 5 not at all useful).

Ethical approval for the project was obtained from theResearch Ethics Board of the University of British Colum-

bia, and all participants gave informed consent.

RESULTSNineteen women met eligibility criteria and participatedin the proof-of-concept study of the Making it Work pro-gram. All participants completed the ergonomic assess-ment and 1-month telephone call to discuss ergonomicmodifications. Participant characteristics are shown in Ta-

ble 2.Participants reported that the ergonomics content of the

Making it Work program prepared them for their consul-tation with the OT (35% stated very well prepared, 41%well prepared, and 24% somewhat prepared). The assess-ment forms were individualized based on job demands;none of the participants had jobs that required completionof all 5 sections, but all sections were applicable to at least7 participants (Table 3). Table 4 shows results from imple-mentation of the EATA. Time required to complete theself-assessment and consultation visit varied dependingon the complexity of the job and problems reported. TheOT made 87 recommendations relating to either worktechniques or modifications to the physical environmentand equipment purchase (Table 4). The most frequentrecommendations related to supporting a well-alignedposture when seated, such as obtaining an adjustablechair, changing the height of the computer monitor and/orkeyboard, or using a footstool. Five recommendationswere for future planning (designing a new work station to

be integrated into upcoming renovations or requesting eas-ier-to-use equipment in the course of routine replacementof capital equipment). The assessment process triggered 14non-ergonomic recommendations for problems affectingperformance of work tasks, and appropriate referrals weremade to address the problems, such as obtaining handsplints, foot orthoses, supportive shoes, or eye examina-tion.

Implementation of ergonomic recommendations tooktime (Table 3), and by 12 months, 85% of recommenda-tions had been implemented by 14 (73%) participants.Five participants did not complete any changes. An addi-tional 9% of recommendations were still in progress; thatis, equipment had been ordered or accommodations re-quested from the employer, but had not yet been imple-mented. Participants reported an additional 10 self-initi-ated changes, implemented as they became more aware ofergonomics and how to problem solve on their own. One-third of the changes involved making a request of theemployer; i.e., supervisors, human resources, or occupa-tional health and safety.

Participants stated that they were experiencing less painand stiffness, had more energy, less stress, or felt better atwork. When asked what was helpful about the ergonomicintervention, comments pertained to easing of symptomsor difficulty with tasks, and when recommendations were

Table 2. Participant characteristics*

Characteristic Value

Age, years 51 7.1Diagnosis, no. (%)

Rheumatoid arthritis 17 (89)Systemic lupus erythematosus 1 (5)Psoriatic arthritis 1 (5)

Disease duration, years 12 11.7HAQ disability index 0.41 0.37Marital status, no. (%)

Single 2 (11)Married or living with a partner 15 (79)Divorced 2 (11)

Education, no. (%)High school diploma 4 (21)Technical/trade/vocational college 5 (26)Some university 3 (16)University degree 4 (21)Graduate or postgraduate training 3 (16)

Years employed 28 8Years in present job 12 11

Hours of work per week 34 8.6Type of work, no. (%)

Administrative/clerical 9 (47)Health sector occupations 4 (21)Education and child care 2 (11)Other# 4 (21)

* Values are the mean SD unless otherwise indicated. HAQHealth Assessment Questionnaire. Range 03, where 3 worse. Receptionist, administrative assistant, events coordinator, man-ager. Laboratory technician, home health case manager. Elementary school teacher, nanny.# Library assistant, fabric artist, building caretaker, buyer.



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ergonomic changes for all participants, and 73% of partic-ipants had implemented at least 1 change at 1 year offollowup. It was observed that it takes time, and in some

cases persistence, to complete ergonomic changes, empha-sizing the importance of sufficient support and followup toevaluate the effectiveness of ergonomic interventions atwork. This is consistent with evaluations of participatoryergonomics programs in the general work force, whichfound that a similar proportion of recommendations wereimplemented (22,23) and noted a need for supervisorysupport (24,25) to make work place modifications.

The EATA was designed to be a practical assessment ina typical clinical setting with access to an OT. To becompleted in a single visit, however, it requires additionalsteps prior to the OT encounter: 5 screening questionsdetermine which sections of the self-assessment form theclient should complete, instructions need to be providedfor the work diary and for taking photographs of the workstation, the self-assessment must be sent, and a single-usecamera must be provided for those who do not have oneavailable. In this study, participants also had a group ses-sion on ergonomics as part of the overall Making it Workprogram. One advantage is that the client is actively in-volved in preparing for the consultation by completing theself-assessment component, and this may enhance theevaluation by encouraging the client to observe their workand engage in a collaborative problem-solving processleading to practical solutions. In our pilot test, a 1-monthfollowup phone call to discuss recommendations and en-courage changes supplemented the in-person consulta-tion. Keeping in mind the relatively lengthy time requiredto implement job accommodations, a plan for followupvisits or phone calls is advisable.

A strength of the EATA is that it aims to identify poten-tial risks associated with work tasks or the environment

before they cause pain or aggravate IA, as well as identi-fying the motions, positions, or tasks that are already as-sociated with pain or fatigue. The tool helps the client andthe OT focus on basic ergonomic risk factors and elicitsoptions for resolving problems encountered at work. Someparticipants reported considerable support from their em-ployers and coworkers, and noted that suggestions they

brought to the work place resolved a general ergonomic

concern for all employees. However, like ergonomics pro-grams in general (22,23), not all recommendations wereimplemented, and future research might more fully ex-

plore why suggestions were not viewed as helpful or nec-essary.

The approach described here relies on self-report ratherthan observation at the work site. It has been reportedelsewhere that workers may be poor judges of the magni-tude of their exposure to risks (26). Lack of direct obser-vation by a skilled evaluator and relying on a report ofcurrent difficulties at work may miss detecting risk factorsin the job that are not obvious to the client but may presentdifficulties in the future (13). On-site work visits wouldalso enable the OT to communicate directly with employ-ers and encourage support for changes. Two-thirds of thepresent sample was willing to consider an on-site ergo-nomic assessment, but one-third did not want to disclosetheir arthritis to employers or coworkers, and would de-cline an on-site visit. Given the time (and therefore cost) toconduct, some OT practices may not find work site visitsfeasible for all clients. Therefore, there is a place for a toollike the EATA to facilitate an ergonomic consultation forall people with IA. When indicated and agreeable to bothparties, the EATA can be augmented with a work site visit.

Just over half of the recommended solutions for ergo-nomic risk factors were simple, technique-based solutionsthat centered on the person making changes to the waythey did things, rather than engineering solutions to mod-ify the work place. This solution preference may reflect thetraining and experience of OTs compared with ergono-mists, but because only 1 OT was involved in the presentevaluation, this is speculation. It may also be related to thetype of jobs assessed. Engineering-based ergonomic mod-ifications may improve the work site for all workers, aperspective that is sometimes lost when clients and healthprofessionals focus on managing illness symptoms.

The use of the color-coded levels of risk in the self-assessment is based on the guide for preventing musculo-skeletal injuries by the Swedish National Board of Occu-pational Safety and Health (20). Cutoffs in the Swedishguide are based on scientific evidence of increased risk ofmusculoskeletal injuries in otherwise healthy workers. Toovercome the lack of available cutoffs for people with IA,

Table 5. Sample participant comments on usefulness of ergonomic modifications and reasons for notimplementing recommendations

Usefulness of ergonomic modificationsRemoving my armrests allowed my chair to be closer to my deskposture is important and self-awareness of posture is

difficult. I didnt know I was poking my head forward.Instead of stooping or squatting to work with children, I have a wheeled stool I can sit on and a slanted desktop to use.

If I do things a little differently I experience less pain.I pace myself and think about my actions more.Headphones have eased my fatigue.Higher surface makes it easier on back and shoulders to work.

Reasons for delays or not implementing ergonomic recommendationsMy boss said that instead of ordering a new desk that I should move to another area to work where there are ergonomic

desks available. However, I didnt want to do that because it means losing my office. One year later, I moved.After accomplishing some of the occupational therapy suggestions, I now have a new job where the suggestions no longer

apply.Done all I can with the current work setup, the rest can wait because a new library is being built. I was asked specifically

what I needed: counters on 2 different levels, laminators with hoods, computer placed so I can sit or stand.



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we included a column in the EATA to indicate pain oraggravation of symptoms. Future research is needed toexamine the thresholds for risk factors for vulnerable pop-ulations, including IA, because current occupationalhealth and safety guidelines are based on the repetition,reach, force, and loads that precipitate injury in the gen-eral population. Pathologic changes such as joint instabil-ity, muscle weakness, and systemic fatigue suggest thatpeople with arthritis are prone to exacerbations of injury atmuch lower levels.

This pilot test had its limitations. Only women partici-pated, so the acceptability and applicability of the tool tomen with IA is unknown. A limited number of occupa-tions were assessed, although there was a reasonable sam-pling of different types of work. The most physically de-manding occupation among this sample was that of

building caretaker. The EATA needs to be tested withother occupations, especially those with more physicaldemands such as pushing and pulling, because no prob-lems were identified in this area during the pilot test. The

tool is best used by OTs who have prior experience ortraining in both arthritis care and ergonomics, whichmeans that some users may need to participate in continu-ing education to update their skills in one or both areas

before using this kind of assessment. A background inarthritis care helps the assessor to probe during the inter-view to elicit information about the fluctuating nature ofsymptoms or problems experienced at work and to framerecommendations in the context of managing this chronicillness. Our pilot testing of the tool did not include anassessment of intrarater or interrater reliability. However,5 subjects participated in both the pretesting of the EATAand the proof-of-concept study, and therefore had the tooladministered twice. In 3 clients, no changes were imple-mented in the interim period and the assessment led to theidentification of the same issues and recommendations. In2 cases, recommendations had been implemented and newissues were identified. Reliability should be evaluated infurther studies.

Previous research shows that more than one-third ofpeople with RA report limitations in their work as a resultof their arthritis (27), and more than one-quarter will leavework prematurely within 10 years of diagnosis (4). Ergo-nomic assessments and interventions are one approachthat can be used by rehabilitation practitioners to facilitatejob accommodations aimed at preventing work loss andmaintaining at-work productivity. The ergonomic tool in-

troduced here adds to the repertoire of rehabilitation toolsand services for people living and working with arthritis.Given the cost of work loss or reduced productivity atwork, the time spent assessing and implementing ergo-nomic recommendations is relatively minimal, and maymake an important contribution to reducing work disabil-ity. The EATA is specifically designed for people with IA,can be used without a work site visit, is completed in asingle consultation (with advance planning for self-assess-ment), and fosters collaboration between clients and OTsin identifying ergonomic risks and solutions aimed at en-hancing work performance.

ACKNOWLEDGMENTSThe authors thank Cheryl Sheffield, OT and Gillian Pale-jko, OT, for testing the ergonomic assessment tool, CoryAnderson for taking photographs and assisting in the de-sign of the first draft of the EATA, and Pam Rogers forcoordinating the pilot test.

AUTHOR CONTRIBUTIONS

Dr. Backman had full access to all of the data in the study andtakes responsibility for the integrity of the data and the accuracyof the data analysis.Study design. Backman, Village, Lacaille.Acquisition of data. Backman, Village, Lacaille.Analysis and interpretation of data. Backman, Village, Lacaille.Manuscript preparation. Backman, Village, Lacaille.Statistical analysis. Backman.

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