Work-related thumb disorders in South African physiotherapists treating musculoskeletal conditions using manual therapy techniques
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Date
2014-03-31
Authors
Jenkins, Heather Theresa
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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.