Workstation Ergonomics & Clinical Assessment – Case Study 2.
We were asked to conduct a combined Workstation Ergonomics & Clinical Assessment of Miss G, a 34 year old lady who was employed by a large company in the North West. She had been in their employ for 14 years, spending the last eight years in the role of production assistant, which involved editing, logging VT and general administration. She divided her working day between a dedicated workstation and designated hot-desks.
Summary of Miss G’s symptoms: Pain / stiffness / restricted range of motion through the upper back and cervical spine. Waking with headaches which generally increased during the working day, worse by evening.
She related how her lifestyle was dramatically affected in a number of ways; at work she described reduced concentration span which made her work more difficult. This disruption extended to her social life and many evenings Miss G went to bed early due the severity of her symptoms. When she experienced prolonged severe symptoms Miss G was unable to work and had regular prolonged absences on sick leave.
Miss G had returned to her GP on a number of occasions and was prescribed medication that failed to control her symptoms. Day to day Louise states that she requires frequent painkillers. She uses the following on a rotational basis. Syndol, Solpadeine & Diclofenac Sodium (Voltarol). Eventually she was referred for an MRI scan and a Neurological assessment. These did not provide an explanation for her symptoms.
In 2004 the company organised a Display Screen Equipment (DSE) assessment which was conducted by independent Occupational Health Adviser. A number of recommendations were made, including the purchase of a “specialist” chair. This was supplied by the same company, but during Miss G’s holidays. A demonstration of its features was given to a colleague and this was passed two weeks later. There were some improvements in comfort but her symptoms remained generally unaltered. In following year Miss G was referred to the company’s in-house Health & Safety department based on a different site. A member of the team went to her workplace and conducted a second DSE assessment.
In 2008 we were asked to conduct a combined Clinical and Workplace Assessment. The assessment was in two parts; a Clinical Assessment (history taking and examination) and workstation observation (informal and formal interview techniques with continual observation).
We provided Miss G with feedback from both the Workplace and Clinical Assessments, outlining the recommendations.
Workstation Ergonomics Assessment – We focused on several areas:
- Correct use of seat (particularly head rest angle).
- Position of monitor, keyboard and mouse.
- How to quickly assess and readjust hot desk.
- Recognising and reacting to fatigue.
Clinical Assessment –
- Recommended Physiotherapy or Osteopathy to help address chronic muscular tension, reduced range of motion and poor posture.
- Recommended exercise program (e.g. Pilates) that encouraged stretching and postural awareness.
We also discussed with Miss G. that she would benefit from a further Neurological Consultation to exclude any pathological origin for her current condition. We introduced the prospect that there was a possibility that much of her symptoms may be due to Analgesic Rebound Headaches (* see below for overview). We were cautious to introduce the subject as patients, understandably, feel that they are being told that their symptoms are either ‘in their head’ or that they have ‘developed an addiction’.
Miss G was pleased with the overall assessment and welcomed all the recommendations. Initially she was concerned about being referred for a further Neurological Assessment but understood that it was important to exclude the possibility of Analgesic Rebound Headaches.
We received feedback from her employers several months after our report was submitted that the Neurological Assessment confirmed that Miss G had been experiencing Analgesic Rebound Headaches and had commenced a regime of treatment.
*Rebound Analgesic Headaches
About 20% of patients with chronic headaches and most with daily headaches are thought to have analgesic rebound headaches. Patients are most commonly migraine or tension headache sufferers in the 30-40 year age group affecting women more than men (5:1).
Rebound headaches after analgesics are common. They are usually intermittent tension-type headaches. Patients with frequent headaches (e.g. tension headaches or migraine) self-medicate to pre-empt or cure headache and a vicious cycle occurs, of analgesia, rebound headache and more analgesia. All simple analgesics, especially those with narcotic content, and probably non-steroidal anti-inflammatory drugs, ergotamine, caffeine and tryptans are implicated. Rebound headaches may occur after only a few days of analgesic dosing per week.
This involves patient education and withdrawal of the offending drug and psychological support. Most respond fairly rapidly to the withdrawal of the offending agent. The rate of success is about 60% at 5 years. Some patients can be resistant to the change and concept of rebound headaches. Early intervention is important because the long term prognosis depends on the duration of medication overuse.
Workstation Ergonomics & Clinical Assessment