Work-related thumb disorders in South African physiotherapists treating musculoskeletal conditions using manual therapy techniques

Abstract

Of all the structures in the hand, the thumb is the most vulnerable to biomechanical and work-related injuries in physiotherapists using manual therapy techniques. The objectives of the current study were to determine the prevalence and factors associated with work – related thumb problems (WRTP) in South African physiotherapists and establish the strategies they used in the management of the thumb problems. A cross-sectional, descriptive study design was used and data were collected using an internet-based questionnaire. The life-time prevalence of WRTP in South African physiotherapists using manual therapy techniques was 65.3% in survey one and 67.5% in survey two. The factors that were significantly associated with WRTP in all 395 respondents were hyperextension >10° of the knee on the non-dominant side (p=0.02), passive F of the thumb to the anterior forearm (p=0.04), hyperextension >30°of the nondominant IP joint of the thumb (p=0.02) and the treatment of more than six patients a day with manual therapy to the cervical spine (p=0.02). The factors that were significantly associated with WRTP in all 395 respondents in the univariate analysis were put in a regression analysis. The factors that remained significantly associated with WRTP were the cervical treatment of up to six patients a day (p=0.01) and hyperextension>30° of the non-dominant IP joint of the thumb (p=0.05). The factors that were significantly associated with WRTP in the 258 respondents who had WRTP were all grades of transverse glides applied to the spine (p<0.001), grade II-IV unilateral and central posterior-anterior pressures to the spine (p< 0.001), Additional occupational factors significantly associated with WRTP (p<0.001) included an increase in thumb use in the performance of manual techniques, inadequate training in injury prevention, a high, repetitive workload, working with a current injury, working in sustained, uncomfortable positions, inadequate rest periods, working at or near your physical limits and manual chest physiotherapy (p=0.005).The strategies most commonly used by the physiotherapists in the management of the WRTP were the modification of the technique and the use of a different technique. Randomised control trials are recommended to investigate the effectiveness of the preventative and management strategies of WRTP in physiotherapists.