Workplace-based Rehabilitation for Upper Limb Conditions in the South African context

Abstract

COMMENTARY INTRODUCTION Work rehabilitation refers to a structured therapeutic programme facilitating improvement in work performance for workers whose participation in work has been compromised by ill-health or disability, whether related or unrelated to work. Where this programme occurs at least partly at the place of employment, it can be referred to as workplace-based rehabilitation (WBR). WBR is often multidisciplinary in nature, but may also be practiced by occupational therapists or other rehabilitation practitioners in isolation. WBR may have inherent benefits over traditional rehabilitation based at clinics, hospitals or work rehabilitation centres. These include:  Early identification of loss of function related to ill-health/ disability.  Inclusion of workplace supervisors and managers in the therapeutic process.  Collaboration with on-site occupational health doctors and nurses.  Reduced travel time and costs for workers, with resultant reductions in loss of work time.  Use of the worker's actual job tasks in rehabilitation.  Customisation of rehabilitation programme to the industry.  Early return to work with reduction in sick leave 1. Upper limb conditions are amongst the most common causes of ill-health and disability in the workplace, both internationally 2,3 and locally 4. A cross-sectional field survey of South African employees (n=15663) in 2012 found that 47% of employees experienced repetitive strain injury (RSI)-related symptoms in their neck, shoulder and upper back 5. While all provinces and races were represented, the sample consisted of educated participants, ranging from a Grade 8 to a doctoral degree. This is unlikely to be fully representative of the South African workforce. The incidence of upper limb pain amongst South African workers with lower educational levels could

Return to Work for People with Hand Injuries in South Africa: Occupational Therapy Strategies

“…Considering that manual labour requires strong and dextrous hand function, sustaining a hand injury typically requires medical intervention and rehabilitation which impacts on the person's capacity to work 19 . The high prevalence of unemployment within South Africa has been shown to adversely impact unskilled workers' rehabilitation as they can easily be replaced 20 .…”

“…Adding complexity to this picture is the lack of occupational therapists employed within the Department of Labour in South Africa which impacts on the services and resources available for addressing the final stages of rehabilitation which specifically focus on work-related transitions 20 . The majority of South Africans are reliant on the public sector for healthcare as they do not have healthcare insurance 21 .…”