Workplace Musculoskeletal Injuries in British Columbia

Transcription

1 Workplace Musculoskeletal Injuries in British Columbia Practicum Site: British Columbia Federation of Labour Student: Supervisor: Preceptor: Ochiobi, C.A Jude MPH Student, Environmental and Occupational Health Faculty of Health Sciences Simon Fraser University Dr Bruce Lanphear Professor, Faculty of Health Sciences Simon Fraser University Nina Hansen Director, Occupational Health & Safety and Climate Change B.C. Federation of Labour May 6, 2013 July 26,

2 OUTLINE INTRODUCTION - Overview of musculoskeletal injuries Ø Definition Ø Causes and risk factors Ø Signs and Symptoms Ø Treatment and Control of Musculoskeletal injuries BACKGROUND DISCUSSIONS - Picture of MSI in BC Ø Distribution by Nature of Injury Ø Distribution by Incidents giving rise to injury Ø Distribution by Age Ø Distribution by Gender Ø Distribution by Industry Sector/Subsector Introduction of musculoskeletal injury/ergonomic requirement in Occupational Health and Safety (OHS) regulation of BC in 1997: MSI before and after 1997 in BC. Crude comparison of MSI rate among British Columbia, Alberta, Manitoba and Ontario (Graphical comparison) Measures in BC and some other Jurisdictions to Control MSIs Insights from semi- structured interview and personal conversations with key informants, practices in some jurisdictions and relevant literatures. CONCLUSION AND RECOMMENDATIONS 2

3 INTRODUCTION Overview of Musculoskeletal Injuries Ø Definition Musculoskeletal injuries (MSIs) in the workplace are injuries and disorders of the musculoskeletal system (the muscles, tendons, tendon sheaths, nerves, bursa, blood vessels, bones, joints/spinal discs, and ligaments) that can be caused or aggravated by various hazards or risk factors in the workplace ( Canadian Standards Association 2012, p.6). There are other terms used for MSIs which include cumulative trauma disorders, repetitive motion injuries, repetitive strain injuries, soft tissue injuries and occupational overuse syndrome (WorkSafeSaskatchewan, 2010). MSIs include strains, sprains, carpal tunnel syndrome, tendonitis, low back injuries involving ligaments, muscles or spinal discs (Canadian Standards Association 2012 & University of British Columbia Health Promotion website, no date). Ø Causes and Risk Factors Musculoskeletal injuries from sustained awkward posture and tasks involving repetitive motion usually occur due to localized ischaemia in involved muscle (with subsequent accumulation of lactic acid) and tissue micro trauma respectively. Tissue micro trauma leads to inflammation and fibrotic tissue changes (Cheung J P, Fung B, Ip W and Chow S. 2008). The risk to MSI in the workplace arises from psychosocial factors and physical factors. The psychosocial predictors to MSI in the workplace include dissatisfaction with support from colleagues or supervisors, additional mental workload (multitasking), time pressure, stress/emotional distress and low level of interest in one s job (Cheung J P, Fung B, Ip W and Chow S. 2008). The physical risk factors for MSI usually arise from the physical demands of tasks which involve - 3

4 Excessive application of force, repetitive motions, sustained awkward work posture, local contact stress (prolonged pressure on body tissue), excessive vibration (WorkSafeBC, 2008 and WorkSafeSaskatchewan, 2010). The risk factors affecting these physical demands include: Layout and condition of the workplace. e.g. work surface that is too high or too low Organization of work tasks. E.g. a worker doing varieties of tasks is less prone to repetitive strain injuries than one who does one task over and over. Environmental conditions of the workplace. E.g. very low temperature. Characteristics of working tools (WorkSafeBC, 2008). Ø Signs and Symptoms of MSI MSIs may gradually or suddenly develop from a single incident. Though signs and symptoms may overlap, signs are what the health care provider would observe and they may include: tenderness (pain on touching the affected body part), colour change (e.g. redness), swelling, reduced passive movement across affected joint (stiff joint). The symptoms are what the individual with MSI experiences or complains of, and these include: burning sensation, feeling of pins and needles and numbness (paresthesia), pain, swelling, difficulty moving the affected body part and difficulty grasping or holding an object etc. ( WorkSafeBC 2008 and WorkSafeSaskatchewan 2010). Ø Treatment and Control of MSI Treatment of MSI are usually more effective when addressed at the early onset of symptoms and for this reason it is advisable for workers to report symptoms of MSI early to their supervisor and seek medical care as soon as possible. MSIs can be treated by warm or cold compress, medications, physical therapy and lastly surgery (WorkSafeBC, 2008). The control of MSI is most likely to be effective through primary prevention strategies in the workplace. This involves the application of sound ergonomic principles. Ergonomics is the study of work, including 4

5 workplace interventions to establish compatibility among the worker, the job, and the work environment (National Research Council and the Institute of Medicine, p.322). Primary prevention would entail proper design of equipment and tasks, organization of work and the work environment, training and education of workers/all staffs (on safety and ergonomics), development and enforcement of health and safety principles in the workplace (Cheung J P, Fung B, Ip W and Chow S. 2008). Primary intervention or prevention lies in the core of every sound occupational health and safety (OH&S) practice and is effectively carried by hazard identification, risk assessment and applying appropriate hierarchy of risk control (Australian Safety and Compensation council, 2006). In risk control measures, engineering control and administrative controls should take precedence over personal protective devices (WorkSafeBC, 2008). Secondary prevention interventions - - are initiated when injury has already occurred and is usually at the early stage. The aim is to reduce worker s exposure to risk factors and minimize symptoms. Secondary care includes non- specific exercises and educational programs aimed to relieve mild symptoms e.g. Stretch programs (Australian Safety and Compensation council, 2006). Tertiary Interventions are designed to enable functional recovery and early return to work for those whose injury has gone beyond early stages. Tertiary care usually involves health care professionals; tertiary prevention aims to reduce high costs associated with time- loss injuries by facilitating early return to work through rehabilitation, work modification and vocational training when needed (Australian Safety and Compensation council, 2006). BACKGROUND Musculoskeletal injuries in the workplace continue to pose serious challenge to workers as well as their employers in every sector of the workforce (Silverstein & Clark 2004). Although most MSI are minor and transient, severe MSI often result in prolonged absence from work, deformity and inability to return to the same job. All these have a negative ripple effect on the individual, his/her family, the employer, the workforce as a whole and pose a significant financial burden on an organization, province or state. Horsley, 2011 stated that, Long-term work absence, work disability and unemployment are harmful to physical and mental health and well-being. The negative impacts of remaining away from work not only affect the worker, but also families, 5

6 including the children of parents out of work, who suffer consequences including poorer physical health, decreased educational opportunities and reduced long-term employment prospects. Work in general is good for health and well-being; work absence is not. (P.103). Work-related musculoskeletal disorders are the most common conditions for which claims are filed for in most industrialized countries (Australian Safety and Compensation Council, 2006). Approximately, one-third of all health-related absences from work in these industrialized nations are due to musculoskeletal disorders with back injuries constituting the highest proportion of these injuries followed, accordingly, by injuries of neck and the upper extremities, injuries of the knee, and hips (WHO no date. Work-related musculoskeletal disorders). The occurrence and persistence of these injuries are usually associated with some factors including workers working conditions and workload (WHO no date. Work-related musculoskeletal disorders). Low back pain ( a type of MSI), no doubt, has a negative impact on western society and among chronic medical conditions it is the one with the highest degree of health care use in Canada; hence constituting huge burden on Canada s economy (Kwon, Roffey, Bishop, Dagenais and Wai, 2011). In the United States, in 2007, musculoskeletal disorders comprised of 28.9% of all work- related injuries and illnesses involving lost work days, falling from a higher proportion of 34.7 % in The previous year (2006) had musculoskeletal injuries involving Sprains and Strains of the Shoulder and Back and Sacroiliac accounting respectively for 21.6% and 38.0% of the total visits to physicians in office- based practice (American Academy of Orthopaedic Surgeons, 2011). Also in Australia the impact of MSIs is very significant, almost three- quarters of all serious compensation claims in (preliminary data) were due to sprains and strains of joints and adjacent muscle accounting for 42% of all serious compensation claims (Work Safe Australia, 2013). In fact the total economic cost of work- related injury and illness from in Australia was 60.6 billion dollars with over one- third of the total number of cases and cost being due to musculoskeletal injuries arising from body stressing or manual handling (Safe work Australia, 2013). In Canada, though the national time loss injury rate declined from 4.3 to 3.7 injuries per 100 person- years since 1998; nevertheless, MSIs has consistently contributed to the majority of timeloss claims in each province (Yassi, Gilbert and Cvitkovich, 2005). 6

7 In the years 1997 to 2002, Alberta, Ontario and New Brunswick had MSI rates of less than or equal to 2.3 injuries per 100 person-years; Manitoba, Newfoundland/Labrador, Nova Scotia and Quebec had MSI rates from 3.0 to slightly above 4.0 while Saskatchewan, Prince Edward Island (PEI) and BC had average MSI rates that were above 5.0 injuries per 100 person-years (Yassi, Gilbert and Cvitkovich, 2005). From WorkSafeBC Statistics 2011 report, strains, a type of MSI, constituted 57% of workplace injuries among older workers and 60% among younger workers from 2002 to 2011 in British Columbia. Also in BC, musculoskeletal injuries (back strain, other strain, traumatic tenosynovitis, bursitis and related) in the workplace accounted for approximately 59.2 % of claims (short- term disability, long- term disability, and fatal claims) first paid from (WorkSafeBC Statistics 2012). Like in most other provinces Back strain injury is the commonest form of MSIs in BC; it accounts for 23% of all time- loss injuries (more than 140,000 claims) and affected 12,000 to 15,000 workers each year between 2003 and 2012 (WorkSafeBC Statistics 2012). Statistical reports from workers compensation board of most Canadian provinces - including Alberta, Manitoba, Saskatchewan and Ontario - shows that MSIs constitute huge proportions of time loss claims due to occupational injuries in most of these provinces. The scope of the problem posed by occupational injuries and particularly MSIs deserves keen attention and as such, regulatory bodies in various jurisdictions take the responsibility of creating occupational and environmental health policies/regulations to forestall or minimize MSIs as well as other injuries in the workplace. British Columbia have taken a commendable step by introducing a general MSI/ergonomic requirement in her OHS regulation in 1997 and might indeed be the only provincial jurisdiction with exception of Saskatchewan to have legislated ergonomic requirement or regulation (Health Canada, Office of Nursing Policy 2004 and Steelworkers District 3 Health and Safety Conference, 2005). In British Columbia, WorkSafeBC establishes and enforces occupational health and safety standards. It facilitates rehabilitation services for injured workers to ensure timely return to work and provides them with fair compensation (WorkSafeBC website, n.d). BCFED Health and Safety Centre (under British Columbia Federation of Labour--BCFED) helps to educate workers and workplace representatives of their legal rights and responsibilities as provided by the Occupational Health and Safety law. They also provide Occupational Health 7

8 and Safety training to workers and help workplace representatives in their attempts to achieve a hazard-free workplace (BCFED Health and safety centre web site, n.d). This report as a sum up of my practicum would look into the trends of MSI in BC portraying its picture before and after MSI regulation was introduced in BC. It will also portray MSI pictures in a few other provinces with comparable population and labour force as BC. Finally, it would offer some suggestions/recommendations based on information from discussions with key informants, practices and regulation from some other jurisdictions and insights from relevant literatures. DISCUSSIONS The Picture of MSI in BC: In British Columbia (BC) approximately 2.9 million days (exactly 2,889,324 days) were lost from work due to occupational injuries and diseases by Of the lost work days, 51.6% of them were due to workplace injuries that occurred in 2012, while 31.6% were due to injuries that occurred in 2011 and 16.8% were for injuries that occurred in 2010 and prior years (WorkSafeBC Statistics 2012). As statistics in the ensuing part of this section indicates, the greater proportion of all these work- related injuries and subsequent claims are due to incidents giving rise to musculoskeletal injuries or disorders. Also musculoskeletal injuries (considering back strain, other strain, traumatic tenosynovitis, bursitis and related) in the workplace accounted for approximately 59.2 % of claims ( short- term disability, long- term disability, and fatal claims) first paid from , 8.85 million work days lost and a total of about 1.55 million dollars paid for short- term disability, long- term disability and survivor benefits (excluding rehabilitation and health care cost) from (Calculations based on WorkSafeBC Statistics Other Strains comprise of MSIs and some other injuries to the musculoskeletal system, e.g. dislocation, which are not coded or classified as MSI under WorkSafeBC classification of injuries). 8

9 Ø Distribution by nature of injury Back strain injury is the commonest form of MSIs and in BC it accounts for 23% of all time- loss injuries (more than 140,000 claims) and affected the range of 12,000 to 15,000 workers each year between 2003 and 2012 (WorkSafeBC Statistics 2012). For the claims (short- term disability, long- term disability and fatal) first paid by 2008 to 2012, back strain constitutes about 23.5 percent of all the claims and 19.7% of days lost; Other Strains constitutes 34.1 percent and 39.5 percent of all claims and all days lost respectively; while Traumatic tenosynovitis, bursitis, and related accounts for 1.6 percent and 2.4 percent, respectively, of all the claims and days lost in this period (calculations based on data from WorkSAfeBC Statistics 2012). See Table 1 and Fig 3. Ø Distribution by incidents giving rise to injury Ergonomic related incidents constituted the highest proportion of the major incidents leading to workplace injuries among older (age 55 and above) and younger workers (age 54 and below) in BC from 2001 to 2011 (WorkSafeBC Statistics 2011). Approximately 41 % of claims ( Short- term disability, long- term disability, and fatal claims) first paid in 2012 in BC were for injuries arising from Overexertion and bodily motion which are mechanisms that give rise to musculoskeletal injuries/disorders (WorkSafeBC, 2012). For serious injury claims in 2012, claims for injuries arising from overexertion and bodily motion comprised of 45 percent of all claims with Back Strain injuries and Other Strains comprising 22 and 34 percent of all the serious injuries respectively (WorkSAfeBC Statistics 2012).Fig 1 &3, Table 2. Ø Distribution by Age Strains (a type of MSI) are the most common cause of work- related injuries for both older and the younger workers. From WorkSafeBC Statistics 2011 report, strains constituted 57% of major workplace injuries among older workers and 60% among younger workers from 2002 to 2011 in British Columbia. Among the older workers, strains constituted the largest category of injuries (32 percent for both back and other strains) resulting to long- term disability and in the younger workers; strains constituted about 42 percent of injuries resulting to long- term disability (WorkSafeBC statistics 2011). In consistence with the most common nature of injuries in both the older and younger workers, ergonomic incidents (including bodily reaction, overexertion and repetitive motions) were the most common incidents leading to injuries in both the older and the younger workers.(see Fig 2, Table 1 &2). 9

10 Ø Distribution by Gender From 2001 to 2010 Strains (including sprains and tears) were the most common major group of injuries among male and female workers in BC accounting for about 57 percent and 68 percent of injuries in males and females respectively (WorkSafeBC Statistics 2010). Ergonomic incidents ( including bodily reactions, overexertion and repetitive motion) were the leading major type of incident causing work- related injuries in both male and females from , accounting for 30 and 37 percent of incidents leading to injuries in males and females respectively (WorkSafeBC Statistics 2010). See Table 3 & 4 and Fig 4. Figure 1. WorkSafeBC, Statistics 2012 (p. 80) N/B: Due to rounding, numbers do not add up to 100 percent (WorkSafeBC Statistics 2012) 10

11 Figure 2. WorkSafeBC, Statistics (P.26) Table 1. The distribution of injuries by major group of injuries in older and younger workers over (Adapted from WorkSafeBC, Statistics P.25) Major group of injuries Older workers (%) Younger workers (%) Strains Impacts Hearing loss Other Total 100% 100% 11

12 Table 2. The distribution of injuries by major type of incidents in older and younger workers from (Adapted from WorkSafeBC, Statistics P.27) Major type of incident Older workers (%) Younger workers (%) Ergonomic Falls Struck Noise exposure Other Total 100% 100% Ø Distribution by Industry sector/subsector From analysis of claims ( Short- term disability, long- term disability and fatal) first paid in 2012 in British Columbia, the Health Care and Social Assistance subsector had the highest proportion (about 57.4%) of all claims due to injuries from over- exertion and bodily motion. This is followed by Canadian National railways, via Rail, Air Canada with a proportion of about 50.0%. Other Sectors/subsectors with remarkable high proportions of claims due to injuries arising from overexertion & bodily motion are Trade, Manufacturing and Transportation and Warehousing sectors. Analysis of the musculoskeletal injury data for MSIs for 2011 revealed that five subsectors with the highest MSI rate for this year were the following in decreasing order: Ware housing (2.12 injuries per 100 person- years), Health care and Social Assistance ( 1.80 ), Food and Beverage Products (1.60), Transportation and Related services (1.50) and Metal and Non- metallic Mineral Resources (1.45). For the average MSI rate across the WorkSafeBC covered industrial sectors for the years 1993 to 2011, the following subsectors in decreasing order are the 10 highest MSI rate industries: Warehousing, Food and Beverage Products, Metal and Non- Metallic Products, Health care and Social Assistants, Transportation and Related Services, Heavy Construction, General Construction, Public Administration, Wood and Paper Products, and Petroleum, Coal, Rubber, Plastic & Chemicals. (See Tables 5 &6 and Figures 5 & 6) 12

13 Figure 3. WorkSafeBC Statistics 2012 ( p.118) N/B: - Due to rounding, numbers do not add to 100 percent (WorkSafeBC Statistic 2012). - The 2012 results are based on November YTD (WorkSafeBC Statistic 2012). 13

14 Table 3. Adapted from WorkSafeBC Statistics 2010 (p.20) Major group of injuries Female Male Strains 68% 35% Impacts 23% 34% Other 9% 9% Total 100% 100% Table 4. Adapted from WorkSafeBC Statistics 2010 (p.20) Major type of incidents Female Male Ergonomic 37% 30% Struck 21% 25% Falls 21% 19% Other 21% 26% Total 100% 100% 14

15 Figure 4. WorkSafeBC Statistics 2010 (p.22) 15

16 Table 5 MSI rate in 2011(Injury per 100 Subsector Name person-years) Warehousing 2.12 Health Care and Social Assistance 1.80 Food and Beverage Products 1.60 Transportation and Related Services 1.50 Metal and Non-Metallic Mineral Products 1.45 Public Administration 1.39 General Construction 1.29 Fishing 1.00 Forestry 1.00 Retail 0.97 Wood and Paper Products 0.96 Heavy construction 0.90 Other Services (not elsewhere specified) 0.95 Petroleum, Coal, Rubber, Plastic & Chemi 0.80 Road Construction or Maintenance 0.82 Other Products (not elsewhere specified) 0.65 Wholesale 0.65 Agriculture 0.50 Accommodation, Food, and Leisure Service 0.39 Education 0.38 Oil & Gas 0r Mineral Resources 0.30 Utilities 0.30 Professional, Scientific, & Tech Service 0.14 Business Services

17 Figure 5 17

18 Table 6 18

19 Figure 6 19

20 Introduction of musculoskeletal injury/ergonomic requirement in Occupational Health and Safety (OHS) regulation of BC in 1997: MSI before and after 1997 in BC Musculoskeletal injury/ergonomic requirement was introduced into the OHS regulation of BC in Prior to this year in 1993 the total MSI rate (adding MSI rates for Back Strain, Bursitis & Related, Carpal Tunnel Syndrome, Other Strains and Tendinitis & Tenosynovitis ) was approximately 1.85 per 100 person- years then declined gradually until 1997 where it increased from 1.33 to 1.41 in After 1998, MSI rate continued on a downward trend then went up again in 2001 at 1.20 per 100 person- years, thereafter it generally continued on a downward trend, with very few and slight variations, up to 2012 where the level was at 0.75 injuries per 100 person- years. (Figs 7 & 8) Figure 7 20

21 Figure 8 The different categories of MSI with data available from WorkSafeBC includes: Back Strain, Bursitis & Related, Carpal Tunnel Syndrome, Other Strains and Tendinitis & Tenosynovitis. Analyzing each of these categories, shows a similar downward trend as observed with the Overall MSI with the most decline seen in Tendinitis & Tenosynovitis which had about 80 percent decline from its rate in 1993 compared to The least decline was in Other Strains with about 43 percent decrease from its rate in 1993 compared to Back Strain had a decline of 63 percent. (See fig 9 14) 21

22 Figure 9 22

23 Figure 10 Figure 11 23

24 Figure 12 Figure 13 24

25 Figure 14 This downward trend is not just peculiar to musculoskeletal injuries (MSIs), in fact there s has been a downward trend in overall timeloss injury rate across Canada since 1998 (Yassi, Gilbert and Cvitkovich, 2005). This could be attributed to the prevention measures undertaken by various provinces initiated either by the government or individual sectors which included practices like use of safer equipments (lifts, electric beds,etc.), return- to- work programs, and violence prevention initiatives (Yassi, Gilbert and Cvitkovich, 2005). What this suggests is that the introduction of the MSI/ergonomic regulation in 1997 might not, on its own, have played a significant role in the observed downward trend of MSI in BC. In fact looking closely at the proportions of injuries that are MSIs over the years, there has been very little variation. Particularly back strains, which constitute a huge proportion of the MSIs and all injuries, have remained fairly constant over the years ( ) in terms of its proportion to all injuries resulting to claims. The proportion of all injuries accepted as MSI claims for rateable sectors (sectors covered by WorkSafeBC) in BC has been in the range of 28.7% and 34.3% in the last 26 years (1987 to 2012). See Table 7 and Figure

26 Table 7. Adapted from WorkSafeBC Statistics 2011 & 2012 (p.83 & p.89). Figure 15 Looking at the available data for the proportions of all injuries resulting to accepted MSI claims prior to and after 1997, the year MSI regulation was introduced, the lowest proportion before 1997 was in 1987 (29.33%) and the highest was in 1994 (33.37%). So far the lowest after 1997 was in 1999 & 2000 with proportions of all injuries resulting to accepted MSI claims being 29.00% and 28.73% respectively, while 2010 to 2012 comprised the highest proportions at 34.06%, 34.10% and 34.25% respectively.(see Fig 16) 26

27 Figure 16 It is notable that MSI proportion of all injury claims was 30.68% in 1997 and rose remarkably the following year, 1998, to a proportion of 33.86% before plunging in 1999 and The proportion peaked the next year, 2001, at 33.83% then continued a downward trend until 2007 when it began an upward trend again reaching the highest level so far in It is difficult to ascribe the observed marked decline in MSI proportion of all injuries in 1999 and 2000 to the introduction of MSI regulation because the decline was not sustained in the following years and in fact there was an abrupt rise in MSI proportion in the immediate year following the introduction of MSI regulation (30.68% in 1997 and 33.86% in 1998). It appears that some adjustment in adjudication processes and acceptance of claims may have resulted in the abrupt decline in MSI proportion observed in rateable sectors in 1999 and 2000 (communication with informants, 2013). It is important to note that the number of workers in all sectors covered by WorkSafeBC have been increasing significantly over the years. There has been approximately 64 percent increase in the number of workers covered by WorkSafeBC in 2012 compared to what it was in 1993 (approximately 1.28 million in 1993 and approximately 2.10 million in Data from WorkSafeBC). See Fig

28 Figure 17 Considering this remarkable increase in the BC s labour force over the last 20 years ( ) it could be that the introduction of MSI regulation in 1997 played a major role in enlightening workers and employers about MSIs without which there would have been an escalating proportions of workplace injuries affecting the musculoskeletal system compared to what is obtainable at present. This suggests that the introduction of the MSI/ergonomic regulation is a commendable initial step as it may have relatively served to prevent appreciable rise in MSIs and should serve as a gateway for more specific/targeted initiatives that would actually bring down the proportions of MSIs in BC. MSI picture in some other provinces (Ontario, Alberta): Ø Ontario In Ontario, for schedule1 sectors the leading nature of injury in 2012 were Sprains and Strains (43% of all injuries), the leading injury event was Overexertion (19%), the part of the body most involved is the low back (20%), the leading gender affected were males while the leading body part affected was the low back; and the leading age group were years. Sprains and Strains have consistently been the leading nature of injury over the last 10 years among schedule 1 workers in Ontario (Workplace Safety and Insurance Board - WSIB, 2013). See Figs and table 8. 28

29 Figure 18. By the Numbers: 2012 WSIB Statistical Report (p.29). WSIB, Figure 19. By the Numbers: 2012 WSIB Statistical Report (p.29). WSIB,

30 Table 8. Adapted from By the Numbers: 2012 WSIB Statistical Report (p.71). WSIB, % of Lost Time Claim injuries due to Bodily reaction and exertion 44.2% 44.9% 45.2% 45.5% 45.6% 45.7% 46.6% 44.5% 43.0% 41.9% Figure 20 N/B: Schedule 1 employers are those for which the WSIB is liable to pay benefit compensation for workers claims and are required by the legislation to pay premiums to WSIB (WSIB, 2013). Ø Alberta: Like in most provinces MSIs constitute the largest chunk of claims due work- related injuries in Alberta. Loss time claims (LTCs) due to injuries arising from Sprains/Strains constitute about 49.6% of all LTCs from 2008 to March Also at this time period Overexertion and Bodily Reaction & Exertion comprised of 22.5% and 11.9% respectively of the type of accidents resulting in injuries with LTCs. Like in most other province the Back was the most affected body part, constituting 24.0% of all LTCs from 2008 to March 2013 (Workers Compensation Board WCB, Alberta 2013). See figs

31 Figure 21 Figure

32 Figure 23. Crude comparison of MSI rate among British Columbia, Alberta, Manitoba and Ontario (Graphical comparison) Due to different coding system, classification of injuries and mode of reporting injury data across most provinces it is quite difficult to make an objective or accurate comparison of MSIs across provinces. However, from reports/data available at compensation boards of most provinces, MSIs were the most common work- related injuries and the most common event leading to injury claims in most of the provinces where bodily reaction and exertion. Using the available information on the workers compensation board of some provinces and direct data from WorkSafeBC a rough comparison of the estimated MSIs of BC and some other provinces, in a given year, can be drawn (Table 9, Fig 24). 32

33 Table 9 # Employed in 2012 (as retrieved on July, 2013 from Statistics Canada) No. of workers covered by the Allowed Lost province's time Claims compensation from MSIs in 2012 (2012) Loss time MSIs per 100workers (WCB Covered) % of covered Loss time MSIs Workforce in 2011 per as retrieved on workers(wcb July, 2013 from Covered) AWCBC KSM Province Alberta % British Columbia % Manitoba % Ontario % Saskatchewan % Figure 24 N/B: MSI counts and the number of the board insured workers for BC were gotten directly from WorkSafeBC. Manitoba MSI Lost time claims count is as reported in WCB Manitoba annual injury 33

34 Statistics report In the rest of the provinces the lost time claims count by injury event for Bodily reaction, exertion and/or overexertion were used as the MSI claims count. For Ontario and Alberta the number of covered workers were obtained from the 2012 statistical report of WSIB and WCB of Ontario and Alberta respectively. For Manitoba and Saskatchewan, the 2012 covered work force was calculated from the reported percentage of covered workforce as of 2011 (presently the most current) in Association of Workers Compensation Board of Canada (AWCBC) Key Statistical Measures (KSM). Measures in BC and some other Jurisdictions to Control MSIs British Columbia and various other jurisdictions have develop various measures to control MSIs (and injuries as a whole. These measures are initiated by either the government, government agencies, non- governmental organizations, private sectors or some specific industries or workplaces. Some of these measures include: v The Introduction of the MSI/Ergonomic requirement in the OHS regulation in 1997 (Province of BC OH&S Regulation. Part 4 General Condition, sections WorkSafeBC s website). This is a generic requirement with the goal of eliminating or minimizing the risk of MSIs in workplaces in BC. v Publications by WorkSafeBC to educate employers, Joint health and Safety Committees as well as employees or workers on understanding the risks of MSIs, applying the ergonomic requirement of the OHS regulation and hence preventing or minimizing the occurrence of MSIs v WorkSafeBC and Ontario Safety Association for Community and Health have an MSI prevention guide Handle with Care, for manual handling of patients in the health care facilities. This is aimed to enable health facilities to be able to adopt an effective patient handling practices and policies that would reduce MSIs (Work Safe Alberta, n.d - No Unsafe lift and WorkSafeBC, Handle with Care). v WorkSafeBC establishes and enforces occupational health and safety standards. Thus they oversee the enforcement of the OHS regulation as well its MSI requirement in workplaces in BC and issues ergonomic orders to defaulting workplaces. They also facilitates rehabilitation 34

35 services for injured workers to ensure timely return to work and provides them with fair compensation (WorkSafeBC website, n.d). v Organizations like British Columbia Federation of Labour (BCFED) through its Health and Safety Centre organizes workshop to train and educate workers on their rights and on prevention of Workplace injuries including MSIs. BCFED in affiliation with various workers union in BC pursues the welfare of workers which include ensuring fair treatment of workers, safe work and safe working condition. v Increased mechanized handling of loads in various sectors. This is well noted in health care facilities particularly with long term care facilities with increasing and encouraging trend in use of patient lifting devices (e.g. Ceiling lifts). This is much welcomed as the health sector has a high burden of MSIs - particularly back strain injuries - in BC and also in most other provinces (WorkSafeBC Statistics 2012). v The development of documented policies targeted at reducing MSIs in some Workplaces. This ensures development of a general MSI prevention policy for employers and workers in any given facility and also encourages a more focused policy for high- risk activities. An example of a focused MSI policy is the No- lift policy for patient handling in health facilities especially long term care facilities. This is to encourage the use of mechanical lifting equipment in patient handling and thus reduces exertion injuries (WorkSafeBC 2006 patient Handling in Small Facilities, and personal Communication with informants, 2013). v In Alberta, the Continuing Care Safety Association (CCSA) organizes injury prevention programs for workplaces as well as specific programs like musculoskeletal injury prevention program. CCSA has significantly contributed to lowering injuries and WCB premiums in Alberta (BC Care Providers Association, 2013). v Work Safe Alberta is an initiative of the government of Alberta designed to prevent workplace injuries and fatalities (Work Safe Alberta, 2012). The government of Alberta has developed strategies for healthy workplaces and these include: ü hiring additional OH&S officers 35

36 ü implementing updated compliances and enforcement procedures ü Posting the records of injuries and fatalities of all companies in Alberta online (Alberta Human Services, 2012). This is a good idea and should not be seen as punitive measure but rather a deterrent to discourage employers developing laissez faire attitude to MSIs and other workplace injuries Other Work Safe Alberta initiatives include: ü Implementing injury and illness prevention program to provide focused inspections and proactive initiatives for industries and employers with highest rate of occupational injuries and illnesses. ü Implementing focused inspection campaigns to raise the awareness of known workplace hazards, promote employers compliance and enforce legislated standards. ü Issueing Certificate of Recognition (COR) to industries/employers who partnered with WCB s Injury Reduction Program and have met established health and safety standards. By achieving and maintaining a COR the employers earns financial incentives through the WCB s Partnership in Injury Reduction program (Alberta Human Services, 2012). v In Ontario, the Centre of Research Expertise for the Prevention of Musculoskeletal disorders (CRE- MSD) which are funded by Workplace Safety and Insurance Board of Ontario have the mandate to develop through research, effective ways of preventing work- related musculoskeletal injuries and disabilities in Ontario (CRE- MSD, University of Waterloo. No date). v As part of its various strategies to curb musculoskeletal injuries or disorders (MSD) the Ministry of labour (MOL), Ontario conducts MSD enforcement blitz which are part of ministry s Safe At Work Ontario strategy (Ontario Ministry of Labour, 2010). This strategy focuses on enforcement, compliance and partnership. This MOL s Strategy focuses on workplaces with higher than average lost- time injuries (Ontario Ministry of Labour, 2009). - The identification criteria for workplaces to be inspected under the Safe At Work Ontario include the following: rates of injuries and associated costs, compliance history, inherent hazards associated with the work, size of businesses, new businesses, presence of new or vulnerable workers, spectacular events or incidents e.g. fatal injuries etc (Ontario Ministry of Labour, 2009). v In Australia, WorkSafe Victoria s Worksafe Compliance and Enforcement Policy is carried out through a Constructive Compliance Strategy. This strategy emphasizes the importance of active 36

37 involvement of employers and employees in identification, management, and elimination of hazards and also it utilizes balanced combination of positive motivators and deterrents in order to encourage safe and healthy workplaces (WorkSafe Victoria, 2005). Insights from semi- structured interview, personal conversations with key informants, practices in some jurisdictions and relevant literatures. MSIs as have been illustrated in earlier sections above, constitute huge economic cost to British Columbia and most other jurisdictions though significant efforts are geared towards preventing them. Semi- formal interviews and personal communications with key informants, other jurisdictional practices and relevant literatures reveal important insights about work- related musculoskeletal injuries or disorders as pointd out below: Though, it is widely accepted that delivering classes to workers on body mechanics, training on safe lifting, use of back belts and manual residents lifting procedures prevent job- related injuries. Comprehensive review of Evidenced- Based Practices for Safe Patient Handling and Movement to identify successful interventions for injury prevention or reduction for caregivers reveals that these practices, though common in long term care facilities, have not been successful in reducing resident- handling injuries (Work Safe Alberta, n.d No unsafelift ). This suggests that there are loop holes to be covered and there is a need in change of approach. It is been noted that even in facilities with patient or resident lifting devices like ceiling lifts and a no lift policy, strains from patient lifting is quite significant (Communication with informant, 2013).The reasons include the fact that the use of the ceiling lifts (and some other lifting devices) still require significant manual handling of patient before the patient is properly positioned and ready for lifting. Also because of shortage of caregivers, high workload and time pressures, caregivers often times cannot easily get other hands to assist in preparing patients for machine lifts even when this is the required practice and hence, they attend to patient maneuvering or lifting made for more than one worker. Due to time constraint some care givers find it difficult to adhere to no lift policy as it takes some time to get the lifting devises set for lifting and to summon colleagues for help (Communication with informant, 2013). What these entail is to make major shifts towards evidenced- based practices with improved ergonomic assessment tools, extensive use of lifting devices, training on effective use of lifting devices, true or enforced no lift policies and mandatory use of lifting teams whenever necessary (Work Safe Alberta, n.d No unsafe lift). 37

38 It is very likely that most MSIs are usually not reported as workers tend to report mostly those that warrants taking sick off or claims (Communication with informant/semi- structured interview, 2013). Sometimes patients or their relatives refuses the use of these lifting devises and in some other situations the demands from relatives or patient to get off and on the bed increases remarkably due to the presence of lifting devises, thereby increasing workload and subsequent risk of MSIs to the caregiver(communication with informant, 2013). Some studies have indicated that various lifting and handling equipment are not equally effective and some may actually increase injuries in users (Work Safe Alberta, n.d No unsafe lift ). This means that mechanizing the work process does not always equate to reduced injuries and it is therefore, important to ergonomically assess devises. It is also likely that as preventive and other interventional measures for MSIs are instituted in a given workplace the MSI rate or frequency may seem to increase initially due to increase awareness and consequently increase reporting of MSIs (Badii, Keen, Yu and Yassi 2006). However, It would be expected that with ongoing preventive measures, early interventions after injury and other relevant measures, musculoskeletal injuries in a given workplace or jurisdiction would be substantially reduced within a reasonable time frame. Generic MSI/ergonomic regulation, though well intended and has the merit of applying to all industrial sectors, leaves room for differing interpretation of the same regulation as well as differing practices among various industries or sectors that are similar in terms of profession, job descriptions and workforce. Interpretation of the regulation becomes subjective to an employer s understanding which can be influenced by preferences and interests that are not necessarily in line with the primary objective of effectively controlling work- related MSIs. This subjective atmosphere around this MSI regulation makes it very challenging to enforce and suggests a need for further actions by workplace regulatory bodies (Communication with informant/semi- structured interview, 2013). Although MSIs constitute the majority of lost time claims in almost all Canada s provinces, British Columbia and probably some other provinces have quite few ergonomists in the provincial compensation boards and/or workplace regulatory bodies (Communication with informant/semi- structured interview, 2013). This would likely pose a further challenge in controlling work- related MSIs in British Columbia. It is not uncommon to have worker health and safety representatives or supervisors, in some work places within BC, that have not had any training or regular training in occupational health and safety with regards to ergonomics (Communication with informants 2013). 38

39 In BC it is required for workplaces with 20 or more workers to have a joint health and safety committee and this usually have an equitable representation of workers as well as the management or employer (BCFED Health & Safety Centre, Workers Compensation Act of British Columbia, Division 4 ( ). The practice of creating joint health and safety committee is commendable as it involves participation of workers and employers in health and safety interventions. This approach is crucial in ergonomic interventions as participation within an ergonomics management program at work entails, The involvement of people in planning and controlling a significant amount of their own work activities, with sufficient knowledge and power to influence both processes and outcomes in order to achieve desirable goals (Norman and Wells, 1998 p.17).this defines participatory ergonomics which has been shown to be effective in reducing musculoskeletal disorders (and their symptoms), injury claims, lost work days and provides psychosocial benefits by encouraging communication among workers and management/employers(norman and Wells, 1998 & Dwayne, Keown, Irvin, Cole and Village, 2007). Participatory ergonomics, by involving all stakeholders, also encourages compliance to health and safety standards (Norman and Wells, 1998) CONCLUSION AND RECOMMENDATIONS Although there are a good number of commendable initiatives within the province of British Columbia to control workplace musculoskeletal injuries and the overall injury rate has gone down in line with the national injury rate, MSI proportion in BC has remain fairly constant over the years - - comprising the greatest proportion of all time- loss injuries. The economic burden on BC due to work- related MSIs demands that more need to be done to control the incidence of MSI. Further steps need to be taken to further strengthen the areas of success and effectively tackle weak areas. The following are recommendations worth considering: 1. Considering the ergonomic or MSI regulation in BC is generic and poses significant challenge for compliance and enforcement. There is need for tailoring specific codes, standards or guidelines (with clause in the regulation to enable their enforcement) for specific groups of similar industries or subsectors with more focus on those more at risk or known to have high rates of MSIs and claims. This should involve participatory approach, incorporating all stakeholders and an ergonomist specialists who initiates and guides the process. The whole process should be re- evaluated from time to time - - taking considerations of evidenced- based best practices - - with adjustments when necessary. 39

40 This is further explained by the National Research Council and the Institute of Medicine (2001) - - The practice of ergonomics relies on a process that tailors interventions to specific circumstances currently found effective, continues to assess the effectiveness of these interventions in the face of changing workplace and worker factors, and evaluates new interventions. It is therefore neither feasible nor desirable to propose generic interventions expected to apply to every industry, job, and worker, nor once for all interventions whose effectiveness need not be regularly assessed. It is, rather, both feasible and desirable to encourage application with continued assessment of interventions found useful and promising to date, and to encourage cooperative endeavor and information exchange among researchers, practitioners, and workers/managers in industry/labor, government, and academia..any ergonomics program benefits when the scientific method is applied by researchers and practitioners in those programs who collect and analyze data, propose and implement interventions, and assess their effectiveness pp.304 & WorkSafeBC should develop strategies to strengthen enforcement of MSI/ergonomic regulation (or standards). One such strategy would be constructive compliance strategy as practiced in Australia and similar practices in Alberta and Ontario. This involves collaboration among all stake holders (workers, employers, health and safety bodies and government) and balanced utilization of positive motivators and deterrents to achieve and maintain safe and healthy workplace. 3. Serious efforts should be made to have adequate number of ergonomic experts in WorkSafeBC. This would facilitate better outreach to workplaces, workers and employers. 4. There should be strong emphasizes on proactive ergonomics. This will include educating and training workers, supervisors, Health & Safety representatives and employers on ergonomics. Workers should be encouraged to report all work- related MSIs whether associated with work day loss, claims or not. 5. Just like it is the practice in Ontario, British Columbia should be conducting MSI enforcement blitz which should be focused at industries or subsectors prone to injuries and those with highest rates of MSIs and claims. 6. There should be common definition and classification system of musculoskeletal injuries or disorders (as well other injuries) and also common classification system of workplaces across all the provinces. This would enhance research, knowledge transfer and sharing of evidenced- based best practices across the province (Ontario Ministry of Labour, 2005). 7. In Ontario, WSIB have a commendable practice of identifying and grouping some injury claims as high impact claim - - which are claims that have been shown to have a significant impact (High percentage of loss time claims, high % of benefit payments) on workers and employers. 40

41 MSIs claims in British Columbia should be classified as high impact claims considering its quota in the overall claims over the past several years. The implication of this, is to strategically prioritize and put more efforts/resources in primary interventions to prevent MSIs in workplaces (MSI prevention programs, better enforcement of MSI regulations), and also apply secondary interventions through initiatives including the use of specialized case management teams, new evidence- based health services and early access to expert medical intervention (Workplace Safety and Insurance Board WSIB, Statistical Report 2012). This approach is yielding results in Ontario as reported by WSIB - - Recognizing that appropriate and timely medical care is important to an injured worker's recovery and return to work, the WSIB continues to invest in health care. We have expanded the network of specialized assessment and treatment services across the province for low back and shoulder injuries, resulting in better health care outcomes for injured workers in Ontario. Our Health Care Strategy is getting injured workers the right treatment sooner helping them to get back to work. As a result of our health care investments, Schedule 1 and 2 health care payments are down from $528 million in 2011 to $516 million in Our overall costs are down, even though the average spend per worker has actually increased (WSIB, Statistical Report 2012, Schedule1 p.4 & 41). References: Alberta Human Services, Occupational Injuries And Diseases In Alberta, 2011 Summary Occupational- Injuries- Diseases- Alberta- Summary.pdf American Academy of Orthopaedic Surgeons, United States Bone and Joint Initiative: The Burden of Musculoskeletal Diseases in the United States, Second Edition. Rosemont, IL: American Academy of Orthopaedic Surgeons;

42 Australian Safety and Compensation Council, 2006: Work- Related Musculoskeletal disorders in Australia, April tedmusculoskeltaldisorders_2006australia_2006_archivepdf.pdf letaldisorders Badii, M., Keen, D., Yu, S., and Yassi, A., Evaluation of a Comprehensive Integrated Workplace- Based Program to Reduce Occupational Musculoskeletal Injury and Its Associated Morbidity in a Large Hospital. Journal of Occupational and Environmental Medicine. Vol 48(11), Nov. 2006, pp a/ovidweb.cgi?T=JS&PAGE=fulltext&D=ovft&AN= &NEWS=N&CSC=Y&CHANNEL=PubMed DOI: /01.jom c8 BC Care Providers Association, March Alberta s CCSA Preventing Injuries and lowering WCB premiums. ccsa- preventing- injuries- and- lowering- wcb- premiums/ BCFED Health and Safety Centre, Provincial and Federal Health and safety Health and Safety Committee resource book. Canadian Standard Association, Workplace ergonomics A management and implementation Standard, March Cheung J., Fung B., Ip W., and Chow S., Occupational repetitive strain injuries in Hong Kong Hong Kong Medical Journal. Vol 14, No 4. August

43 (Retrieved July 9, 2013) CRE- MSD, University of Waterloo. No date msd.uwaterloo.ca/about_us.aspx Kwon B., Roffey D., Bishop P., Dagenais S., and Wai E., Systematic review: occupational physical activity and low back pain. Occupational Medicine 2011; 61: Health Canada, Office of Nursing Policy; Trends in Workplace Injuries, Illnesses, and Policies in Healthcare across Canada. March 31, Prepared by: Occupational Health and Safety Agency for Healthcare in BC (OHSAH), Nova Scotia Association of Health Organizations (NSAHO), Association paritaire pour la santé et la securité du secteur affaires sociales (Québec), ASSTSAS Health Care Health and Safety Association of Ontario (HCHSA) Horsley R. (2011): Factors that affect the occurrence and chronicity of occupation- related musculoskeletal disorders Best Practice & Research Clinical Rheumatology 25 (2011) Ontario Ministry of Labour, Recommendations on Strategies to Reduce Work- Related Musculoskeletal Disorders in Ontario. Issued: Sept Ontario Ministry of Labour, About Safe at Work Ontario. Ontario Ministry of Labour, McGuinty Government Working to Prevent Musculoskeletal Disorders. 43

44 National Research Council and the Institute of Medicine (2001). Musculoskeletal Disorders and the Workplace: Low Back and Upper Extremities. Panel on Musculoskeletal Disorders and the Workplace, Commission on Behavioral and Social Sciences and Education. Washington, DC: National Academy Press. Norman R., Wells R., Ergonomic Interventions for Reducing MSDs: An Overview, Related Issues and Future Directions. wells- interventions.pdf Safe Work Australia, Compendium of Workers Compensation Statistics Australia ium% pdf Safe Work Australia, The cost of of workrelated injury and illness for Australian employers, workers and the community March injury- illness of%20work- related%20injury%20and%20disease.pdf Silverstein B., Clark R. (2004): Interventions to reduce work- related musculoskeletal disorders Journal of Electromyography and Kinesiology 14 (2004) University of British Columbia (no date): Musculoskeletal Injuries Prevention 44

45 prevention/ Health Promotion at UBC. WHO no date: Objectives; Work- related musculoskeletal disorders Workers Compensation Board Alberta, Provincial Synopsis Workplace Safety and Insurance Board, Ontario By the Numbers: 2012 WSIB Statistical Report. Schedule 1. Published June Work Safe Alberta, no date. No Unsafe Lift. Workbook PUB_nounsafelift_workbook.pdf Work Safe Alberta, Occupational Injuries and Diseases in Alberta, 2011 Summary. humanservices.alberta.ca/documents/oid- construction- industries.pdf WorkSafeBC, no date. OHS Regulation & Related Material WorkSafeBC, Handle with Care: Patient Handling and the Application of Ergonomics 45

46 WorkSafeBC, Patient Handling In Small Facilities: A Companion Guide to Handle with Care. dling_small_facilities.pdf WorkSafeBC Understanding The Risks of Musculoskeletal Injury: An educational guide for workers on sprains, strains, and other MSIs. WorkSafeBC, Statistics WorkSafeSaskatchewan, Musculoskeletal Injuries: Recognition Symptoms Causes/Risk Factors Prevention. Injuries WorkSafe Victoria, 2005: WorkSafe Compliance and enforcement policy data/assets/pdf_file/0004/10597/compliance_enforcement _policy.pdf Yassi A., Gilbert M., and Cvitkovich Y., Trends in Injuries, Illnesses, and Policies in Canadian Healthcare Workplaces. Canadian Journal of Public Health. September October ACKNOWLEDGEMENTS 46

47 My gratitude goes to all the staffs of British Columbia federation of Labour BCFED and various union members including Hospital employee Unions of BC, who helped one way or the other to add to my insights and knowledge of work in BC, MSIs and other work- related injuries. All the information you gave were helpful. I am grateful to the staffs at WorkSafeBC including Peter Goyert - Senior Ergonomist, Colin Murray Ergonomist, Rachel Fisher and every other person who contributed to the information I needed to complete my practicum and make this report. Special thanks to my Practicum Preceptor, Nina Hansen Director of Occupational Health & Safety and Climate Change, BCFED. To my Senior Supervisor, Dr Bruce Lanphear Professor, Faculty of Health Sciences, Simon Fraser University thanks for your support and helpful advice all the way through. 47