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Occupational Injuries in PTs

We are concerned with the approach to occupational injuries taken by Dr Hart in his Letter to the Editor in the November 1999 issue.¹ Specifically, to deny the existence of occupational injuries in physical therapists because of problems in defining the word "injury" is dangerous and out of touch with clinical realities. One danger is that the status quo, in which little is known of the extent and implications of work-related musculoskeletal disorders (WMSDs) affecting the profession, will continue. The clinical reality for many therapists is that aspects of their work cause them pain and force them to change how or where they practice physical therapy.

Whether or not we agree completely on the definition, English speakers have a shared understanding of the meaning of the word "injury." The difficulties in defining some words are well known. The classic example is that of the word "game," discussed by Wittgenstein in his book Philosophical Investigations.² Most people would agree that to deny the existence of games because of our problems in defining the word, for whatever purpose, is absurd. Similarly, it would be absurd to deny the existence of injuries because of problems in defining the word "injury."

We are also concerned with Dr Hart's statement that the "[r]easons for seeking medical treatment other than first aid are frequently associated with factors unrelated to medical conditions within the incentive-driven workers' compensation system."^1(p1084) Although we agree that there are many reasons for seeking medical treatment, the latter part of this statement implies that physical therapists who seek medical treatment for low back pain are driven by a monetary reward. In our study of the WMSDs of physical therapists,³ we found that the percentage of affected therapists who claimed workers' compensation is disproportionately small (7.4%) compared with those who moved their area of practice or left the profession because of a WMSD (17.7%). Interviews of physical therapists who moved their area of practice because of WMSDs indicated that the few who claimed workers' compensation did so reluctantly and encountered attitudes of disbelief and accusation (Cromie and colleagues, unpublished research). We would urge caution in suggesting that those who take time off from work or who seek medical treatment for back pain necessarily do so to benefit from the supposedly high incentives offered by workers' compensation.

Finally, we believe Hart's choice of words such as "myth" and "false credibility" is pejorative in this context. It is not conducive to constructive discussion and has the effect of belittling the experiences of those physical therapists who have had to make major changes in their lifestyles and work as a consequence of WMSDs. We would prefer that members of the profession encourage open and frank discussion of occupational health issues as they arise, enabling them to be dealt with before they become detrimental to anyone's well being. The publication of articles such as "Cause, Prevalence, and Response to Occupational Musculoskeletal Injuries Reported by Physical Therapists and Physical Therapist Assistants" by Holder et al⁴ is an essential part of that process.

Jean E Cromie, PT

PhD Candidate
School of Physiotherapy
La Trobe University
Bundoora, Victoria, Australia

Valma J Robertson, PT, PhD

Associate Professor
School of Physiotherapy
La Trobe University

Margaret O Best, PT, MPH

Senior Lecturer
School of Occupational Therapy
La Trobe University

References

1. Hart DL. Occupational injury [letter to the editor]. Phys Ther.1999; 79:1084, 1086.[Free Full Text]
2. Wittgenstein L. Philosophical Investigations. Anscombe GEM, trans. Oxford, England: Basil Blackwell;1968 .
3. Cromie JE, Robertson VJ, Best MO. Work-related musculoskeletal disorders in physical therapists: prevalence, severity, risks, and responses. Phys Ther.2000; 80:336–357.[Abstract/Free Full Text]
4. Holder NL, Clark HA, DiBlasio JM, et al. Cause, prevalence, and response to occupational musculoskeletal injuries reported by physical therapists and physical therapist assistants. Phys Ther.1999; 79:642–652.[Abstract/Free Full Text]

This article has been cited by other articles:

				J. E Cromie, V. J Robertson, and M. O Best Work-Related Musculoskeletal Disorders and the Culture of Physical Therapy Physical Therapy, May 1, 2002; 82(5): 459 - 472. [Abstract] [Full Text] [PDF]

				D. L Hart Too Many Variables, Not Enough Equations Physical Therapy, June 1, 2000; 80(6): 621 - 622. [Full Text]

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