In the first of four studies, Australian researchers surveyed O&P practitioners to identify the top physical and psychosocial issues that influence their work, with a goal of creating recommendations to improve the working environment for orthotists and prosthetists. Results were published recently in Prosthetics and Orthotics International.
The study was led by Sarah Anderson, lecturer in prosthetics and orthotics at LaTrobe University in Melbourne. Anderson is a former orthotist who developed an interest in the physical demands of the O&P field after a permanent injury reduced her ability to complete the tasks required by her job. As a teacher who continued working with orthotists and prosthetists, she noticed that others faced similar issues.
“Through my own experience, it became clear that orthotists and prosthetists were getting injured regularly; however, there were no statistics to support this. It was also something people did not discuss,” Anderson told O&P News. Anderson and colleagues wanted to measure the occupational health and safety of O&P professions and offer solutions for the most common challenges.
“The aim of this was two-fold. Firstly, to find out what orthotists and prosthetitsts identified as hazardous to them within their work. Secondly, to validate a survey that had been used in other aspects of allied health to ensure it encompassed the specific nature of the clinical and technical work that orthotists and prosthetists undertake,” Anderson said.
Anderson and colleagues carried out a qualitative cross-sectional study with focus groups among a total of 22 participants in four different sessions. Questions focused on job demands, physical and mental demands and the work environment. Rather than focusing on individual experiences, the focus groups were meant to determine a range of demands across all aspects of the O&P workplace.
Anderson and colleagues identified four main issues in the O&P workplace: demands of work practice, impacts on the individual, job design and perception of O&P.
“[The] demands of work practice [theme] incorporates factors that a person’s work places on them,” Anderson said. “This can be physical and psychosocial — physical like the need to bend and cast in strange positions, and psychosocial factors such as time pressures and high workloads.”
In terms of fabrication, practitioners consistently reported limited space and issues with access to the tools and machinery they needed. They also reported barriers to productivity such as a need for more access to natural light, ventilation and airflow.
Anderson noted these results may differ for American practitioners and apply more to technicians, as many Australian practitioners tend to serve a dual role that includes fabrication duties.
“There is little central fabrication [in Australia] and the number of technicians in facilities varies greatly,” she said.
Yet, the researchers noted while practice specifics may be different internationally, they believed the study results would resonate with practitioners working outside Australia.
Additional work practice concerns involved workloads and time pressures; broader system characteristics such as payment systems; mismatch between demand and resources; and staffing resources in terms of both quantity and consistency.
The theme of impacts on the individual refers to the ability of the individual to use coping resources to handle workplace demands; for example, “having to work harder to get a result due to restraints placed on a person due to procedures, funding and time can cause a stressed state to develop and lead to injury,” Anderson said.
Practitioners reported management issues varying from poor morale to uncomfortable discussions with patients about payment for devices to the “red tape” they faced in an allied health care setting for acquiring even basic equipment like a dustpan and broom.
The job design theme covers the way the practitioner works. Examples, according to Anderson, include “how much say they have over the work they do, when they do it and how they do it.”
Practitioners viewed autonomy as “both a blessing and a curse,” the researchers reported. Practitioners with more autonomy felt more in control of their work, but also had more responsibilities and pressures. Respondents said the first 5 years of work in O&P offered good opportunities for advancement, but opportunities quickly diminished thereafter. In addition, most participants indicated plans to leave the profession within the next 15 years with hopes of seeking more challenging work. Practitioners also reported the restrictions on funding undermined their job security and ability to provide timely, quality services.
Anderson said the fourth theme, perceptions of O&P, was not just a separate theme but also underpinned the first three themes. Lack of understanding among patients, health professionals and managers about O&P professions led to inappropriate expectations for the processes and time involved in creating an O&P device. In particular, O&P practitioners working in a hospital setting found managers had a poor understanding of the technical/supplier side of the role and the time required to create a device.
“This impacted almost all subthemes and was a major sticking point for many participants,” Anderson said.
Anderson said she and her colleagues were surprised by the influence of the fourth theme – perceptions of O&P – on the other three themes.
“Whilst there was an understanding that people do not know what orthotists and prosthetists do, the high degree to which this influenced all their other issues was very surprising,” she said.
To decrease demands of work practiced — particularly workload and time pressures — the researchers said O&P professionals need to educate others on their role and the requirements they need to complete tasks, in order to create more realistic expectations. In addition, the researchers said “multifactorial preventive interventions” are needed to address the various physical and psychosocial hazards that occur throughout a practitioner’s career.
“The results have led to the development of a survey that should quantify the injuries and risk factors for prosthetist and orthotists. This will allow some targeted prevention programs to be developed which will aim to educate [practitioners] and reduce those injuries,” Anderson said. “The biggest [takeaway] for practitioners is that we all have a role to educate patients, other allied health professionals, doctors and management about what we do, the process behind making a device from cast to supply.”
The researchers have conducted three additional studies on work and workplace experience, focusing on noise and chemicals in the fabrication workshop; work-related musculoskeletal injuries for Australian practitioners; and work-related musculoskeletal injuries across the international O&P community. Anderson said study results will be published later this year.
“With so few orthotists and prosthetists worldwide, it is vital that we can keep orthotists and prosthetists working in a healthy, pain-free environment,” Anderson said. – by Amanda Alexander
Anderson S, et al. Prosthet Orthot Int. 2015;doi:10.1177/0309364615592702.
Disclosure: The researchers report no relevant financial disclosures.