WORK: A Journal of Prevention,Assessment & Rehabilitation

BACKGROUND: In relation to statistical analysis, studies to determine the validity, reliability, objectivity and precision of new measuring devices are usually incomplete, due in part to using only correlation coefficient and ignoring the data dispersion.

OBJECTIVE: The aim of this study was to demonstrate the best way to determine the validity, reliability, objectivity and accuracy of an electro-inclinometer or other measuring devices. Another purpose of this study is to answer the question of whether reliability and objectivity represent accuracy of measuring devices.

METHODS: The validity of an electro-inclinometer was examined by mechanical and geometric methods. The objectivity and reliability of the device was assessed by calculating Cronbach’s alpha for repeated measurements by three raters and by measurements on the same person by mechanical goniometer and the electro-inclinometer. Measurements were performed on “hip flexion with the extended knee” and “shoulder abduction with the extended elbow.” The raters measured every angle three times within an interval of two hours. The three-way ANOVA was used to determine accuracy.

RESULTS: The results of mechanical and geometric analysis showed that validity of the electro-inclinometer was 1.00 and level of error was less than one degree. Objectivity and reliability of electro-inclinometer was 0.999, while objectivity of mechanical goniometer was in the range of 0.802 to 0.966 and the reliability was 0.760 to 0.961. For hip flexion, the difference between raters in joints angle measurement by electro-inclinometer and mechanical goniometer was 1.74 and 16.33 degree (P<0.05), respectively. The differences for shoulder abduction measurement by electro-inclinometer and goniometer were 0.35 and 4.40 degree (P<0.05).

CONCLUSION: Although both the objectivity and reliability are acceptable, the results showed that measurement error was very high in the mechanical goniometer. Therefore, it can be concluded that objectivity and reliability alone cannot determine the accuracy of a device and it is preferable to use other statistical methods to compare and evaluate the accuracy of these two devices.

BACKGROUND: Work-related stress has been evaluated as one of the most important health risks in Europe. Prevention of work related stress and interventions to reduce risk factors for stress in the workplace are conducted together by the enterprise and occupational health services.

OBJECTIVE: The aim of the study was to examine the experiences of Finnish occupational physicians on the stress management with enterprises.

METHODS: From the Finnish Association of Occupational Health Physicians membership list 207 physicians responded to self-administered anonymous questionnaire. The data were analysed using SPSS 17.0.

RESULTS: The client enterprises contacted occupational health services frequently about work-related stress. Collaboration between occupational health and enterprises was strongest in companies’ own occupational health services and generally with most experienced physicians. Occupational health services and enterprises shared responsibility for managing work-related stress.

CONCLUSIONS: Professional experience and close contact with organisation management favours successful stress management between occupational health and enterprises.

BACKGROUND: The present study uses the RULA method to define the most favourable working conditions to lower climbing greenhouse plants, the most problematic task involved in trellising crops.

OBJECTIVE: The aim is to prevent potential musculoskeletal disorders to the upper limbs in workers performing this task.

METHODS: The variety of scenarios involving this task was simulated in the laboratory to evaluate different working heights, crop weights, and types of guides handled.

RESULTS AND CONCLUSIONS: From the 2,544 tests made, only some ergonomically favourable conditions were found to be met when the work was done at a height of 1.4 m, although heights of between 1.2 and 1.6 m could prove acceptable. Furthermore, the study shows the importance of the type of hanger needed to perform the work correctly, of the group of hangers tested; ergonomically acceptable handling was possible only with the new-generation ones having the lock device. In the case of using other types of hangers, it is recommended not to support weights greater than 2 kg. In addition to the above recommendations, it is considered vital to guarantee the correct organization of the workday to include recovery times from the earliest working hours, given the repetitive nature of the work, as well as to promote training sessions to avoid incorrect postures, especially regarding the limbs, trunk, wrist, and neck.

BACKGROUND: An efficient team and a good organizational climate not only improve employee health but also the health and safety of the patients. Building up trust, a good organizational climate and a healthy workplace requires effective communication processes. In Sweden, workplace meetings as settings for communication processes are regulated by a collective labor agreement. However, little is known about how these meetings are organized in which communication processes can be strengthened.

OBJECTIVE: The aim of this study was to explore communication processes during workplace meetings in a Swedish healthcare organization.

METHODS: A qualitatively driven, mixed methods design was used with data collected by observations, interviews, focus group interviews and mirroring feedback seminars. Data were analyzed using descriptive statistics and conventional content analysis.

RESULTS: The communication flow and the organization of the observed meetings varied in terms of physical setting, frequency, time allocated and duration. The topics for the workplace meetings were mainly functional with a focus on clinical processes. Overall, the meetings were viewed not only as an opportunity to communicate information top down but also a means by which employees could influence decision-making and development at the workplace.

CONCLUSIONS: Workplace meetings have very distinct health-promoting value. It emerged that information and the opportunity to influence decisions related to workplace development are important to the workers. These aspects also affect the outcome of the care provided.

BACKGROUND: The popularity of mobile computing products is well known. Thus, it is crucial to evaluate their contribution to musculoskeletal disorders during computer usage under both comfortable and stressful environments.

OBJECTIVE: This study explores the effect of different computer products’ usages with different tasks used to induce psychosocial stress on muscle activity.

METHODS: Fourteen male subjects performed computer tasks: sixteen combinations of four different computer products with four different tasks used to induce stress. Electromyography for four muscles on the forearm, shoulder and neck regions and task performances were recorded.

RESULTS: The increment of trapezius muscle activity was dependent on the task used to induce the stress where a higher level of stress made a greater increment. However, this relationship was not found in the other three muscles. Besides that, compared to desktop and laptop use, the lowest activity for all muscles was obtained during the use of a tablet or smart phone. The best net performance was obtained in a comfortable environment. However, during stressful conditions, the best performance can be obtained using the device that a user is most comfortable with or has the most experience with.

CONCLUSIONS: Different computer products and different levels of stress play a big role in muscle activity during computer work. Both of these factors must be taken into account in order to reduce the occurrence of musculoskeletal disorders or problems.

BACKGROUND: Compared with traditional rehabilitation, gardening has been viewed as a more occupation-based intervention to help patients improve functional performance. However, there is still a need for evidence-based research into what factors interact to create the beneficial effects of gardening for people who have sustained a cerebral vascular accident (CVA).

OBJECTIVE: To explore how plant, gender, and the time after stroke onset influenced improvements in the quality of life of patients in a gardening program.

METHODS: One treatment of tending short-term plants, and another treatment of tending long-term plants were compared. Quality of life improvement was evaluated according to three factors: plant, gender, and the time after stroke onset. The data were analyzed with 2^k replicated factorial designs.

RESULTS: The 2^k factorial design with replication indicated significant effects on both the social role and the family role. For the social role, the interaction of plant and gender difference was significant. For the family role, the significant effects were found on interaction of plant with both gender and the time after stroke onset.

CONCLUSIONS: Tending plants with different life cycles has varied effects on the quality of life of people who have sustained a CVA. Factors related to gender and the time after stroke onset influenced role competency in this sample.

BACKGROUND: Parkinson’s disease (PD) is a neurodegenerative disease. Due to a constantly growing incidence rate and lowering age of PD patients it is becoming a more serious social problem.

OBJECTIVE: The aim of this study was to determine the effectiveness of physiotherapy procedure of patients with PD depending on their working status.

METHODS: The research was carried out on 89 people with diagnosed PD of IInd stage according to the Hoehn and Yahr classification. They were divided into two groups: working professionally and non-working. The Unified Parkinson’s Disease Rating Scale (UPDRS) was used to estimate patients’ clinical status while the PDQ-39 (Parkinson’s Disease Questionnaire) scale evaluated quality of life. Patients took part in rehabilitation activities twice a week for a period of 20 weeks. In both groups an improvement in physical activity and a quality of life were achieved.

RESULTS: Better effects were observed in the group of working patients. Statistically significant differences were notice in part II UPDRS (p = 0.001), part I, II and III total of UPDRS (p = 0,001) and in the PDQ-39 test (p = 0.003).

CONCLUSIONS: Employment and participation in properly planned physiotherapy help reduce the symptoms and improve the quality of life in people with Parkinson’s disease.

BACKGROUND: The percentage of young people with disabilities who are employed is relatively low. Motivation is considered to be an important factor in facilitating or hindering their ability to obtain employment.

OBJECTIVE: We aimed to develop a topic list that could serve as an interview guide for professionals in occupational health care which would aid them in their discussion of work motivation-related issues with this group.

METHODS: We systematically searched Pubmed, PsychInfo and Picarta. Studies were included if they described aspects of work motivation and/or instruments that assess work motivation. Based on the results of our literature survey, we developed a list of topics that had been shown to be related to work motivation.

RESULTS: Our search resulted in 12 articles describing aspects of work motivation and 17 articles describing instruments that assess work motivation. The aspects that we found were intrinsic motivation, extrinsic motivation, goal setting, self-efficacy, expectancy, values and work readiness. Based on this information we developed an interview guide that includes seven topic areas: intrinsic motivation, extrinsic motivation, goal setting, expectancy, values, self- efficacy, and work readiness.

CONCLUSION: The topics within the interview guide and the literature survey data that is presented will shed light on the role that motivation plays on the work participation among young people with disabilities.

BACKGROUND: The APIC (Citizen Accompaniment Project for Community Integration) is an innovative program that seeks to increase the community integration of people with a traumatic brain injury (TBI) by offering the support of an accompanying citizen (AC) in the accomplishment of significant life activities.

OBJECTIVE: This article aims to better define the AC’s role in this process, by underlining the mental health risks they face, the strategies they use, and the impacts the role has on their own lives.

METHODS: This qualitative study is based on the analysis of interviews conducted with the AC following the first year of implementation. The data is part of a larger project aimed at the implementation and evaluation of APIC program. The data were analysed according to the rules of thematic content analysis, which encourages grouping main ideas into categories. This is an iterative process allowing for the constant emergence of new categories during the analysis.

RESULTS: Accompaniment is full of joys and positive moments for the AC and participants. However, some difficult situations are encountered and the AC are constantly faced with challenges and constraints. The emerging study themes are as follows: the environment, the characteristics of the person accompanied, the AC’s personal limits, and the ambiguities in the accompanier-accompanied relationship.

CONCLUSIONS: Five principles drawn from the results will help oversee this practice more efficiently and limit the mental health risks of accompaniers. These findings may permit further development of this type of program for people living with disabilities.

BACKGROUND: Construction workers have intensive contact with their workplace and are possibly susceptible to Nutritional and Food Insecurity.

OBJECTIVE: This paper assessed the Food Security status, diet and anthropometric measures of workers in the Construction Industry living in the city of João Pessoa, PB.

METHODS: This cross-sectional study included 59 workers housed at construction sites. The workers were given the Brazilian Scale for Measuring Food Insecurity and Nutrition, had anthropometric measures taken and completed the Diet Quality Index, comparing their eating at the construction site and at home. Statistical analyses described the mean, standard deviation, frequency and Pearson correlations.

RESULTS: Food Insecurity was reported by 71.2% of the workers, and 69.5% were overweight. The mean values of the Healthy Eating Index suggested that the workers’ diets were in need of modification. There were statistically significant inverse associations among the Healthy Eating Index and Body Mass Index, waist circumference, percentage of total fat and cholesterol.

CONCLUSIONS: Values obtained using the Scale showed Food Insecurity coupled with high excess weight and dietary inadequacies, revealing that these workers are at risk for health problems.

BACKGROUND: A job requiring stooping, lifting, carrying loads and multiple repetitions of the same movement patterns leads to overloading the musculoskeletal system.

OBJECTIVE: The aim of the study was to assess the work-related load experienced by physiotherapists and the occurrence of the musculoskeletal system overload.

METHODS: The study included 108 young physiotherapists, 69 women and 39 men, aged from 25 to 35 years (mean 27.12 ± 3.72 years). The study used an anonymous questionnaire and Quick Exposure Check.

RESULTS: The most common musculoskeletal complaints were as follows: 70 physiotherapists (64.8%) reported low back pain, 60 (55.6%) cervical pain, and 34 (31.5%) pain in the wrists and fingers. Statistically significant positive correlations were revealed between the number of years worked in the profession and shoulder pain. The number of hours of work per week was positively correlated with the occurrence of pain in all analyzed body areas. Professional experience was negatively correlated with the level of stress felt. Physiotherapists dealing with manual therapy and exercise physiotherapy were particularly vulnerable to musculoskeletal overload.

CONCLUSIONS: Popularization of knowledge regarding ergonomics among physiotherapists could reduce the occurrence of musculoskeletal overload.

BACKGROUND: Estimating health and safety costs in the construction industry presents various difficulties, including the complexity of cost allocation, the inadequacy of data available to managers and the absence of an accounting model designed specifically for safety cost management. Very often, the costs arising from accidents in the workplace are not fully identifiable due to the hidden costs involved.

OBJECTIVE: This paper reviews some studies of occupational health and safety cost management and proposes a means of classifying these costs.

METHODS: We conducted an empirical study in which the health and safety costs of 40 construction worksites are estimated.

RESULTS: A new classification of the health and safety cost and its categories is proposed: Safety and non-safety costs.

CONCLUSIONS: The costs of the company’s health and safety policy should be included in the information provided by the accounting system, as a starting point for analysis and control. From this perspective, a classification of health and safety costs and its categories is put forward.

BACKGROUND: Human service professionals are concerned with the intervention and empowerment of vulnerable social populations. The human service industry is laden with employment-related stressors and emotionally demanding interactions, which can lead to deleterious effects, such as burnout and secondary traumatic stress. Little attention has been given to developing knowledge of what might enable human service workers to persist and thrive. Cultivating and sustaining resilience can buffer the impact of occupational stressors on human service professionals. One of the psychological factors associated with cultivating resilience is mindfulness.

OBJECTIVE: The aim of this current research is to improve our understanding of the relationship between resilience, mindfulness, burnout, secondary traumatic stress, and psychological distress among human service professionals.

METHODS: The current study surveyed 133 human service professionals working in the fields of psychology, social work, counseling, youth and foster care work to explore the predictive relationship between resilience, mindfulness, and psychological distress.

RESULTS: The results showed that higher levels of resilience were a significant predictor of lower levels of psychological distress, burnout and secondary traumatic stress. In addition, higher levels of mindfulness were a significant predictor of lower levels of psychological distress and burnout.

CONCLUSIONS: The findings suggest that cultivating resilience and mindfulness in human service professionals may assist in preventing psychological distress burnout and secondary traumatic stress. Limitations of this study are discussed together with implications for future research.

BACKGROUND: Electrical contact is a leading cause of occupational fatality in the construction industry. However, research on the factors that contribute to electricity-related fatality in construction is limited.

OBJECTIVES: To characterize, using an adapted Haddon’s Matrix, the factors that contribute to electricity-related occupational fatalities in the construction industry in Ontario, Canada.

METHODS: Coroner’s data on occupational electricity–related fatalities between 1997-2007 in the construction industry were acquired from the Ontario Ministry of Labour. Using an adapted Haddon’s Matrix, we characterized worker, agent, and environmental characteristics of electricity-related occupational fatalities in the province through a narrative text analysis.

RESULTS: Electrical contact was responsible for 15% of all occupational fatalities among construction workers in Ontario. Factors associated with said occupational fatalities included direct contact with electrical sources, lower voltage sources, and working outdoors.

CONCLUSIONS: This study provides a profile of electricity-related occupational fatalities among construction workers in Ontario, and can be used to inform safety regulations.

BACKGROUND: Dialogue between supervisor and employee is of great importance for occupational rehabilitation.

OBJECTIVE: To evaluate the effectiveness of a convergence dialogue meeting (CDM) of employee, therapist and supervisor aimed at facilitating return to work (RTW) as part of cognitive-behavioural treatment.

METHODS: Randomized controlled trial including 60 employees sick-listed with common mental disorders and referred for specialized mental healthcare. Employees were randomly allocated either to an intervention group (n = 31) receiving work-focused cognitive-behavioural therapy plus CDM or a control group (n = 29) receiving work-focused cognitive-behavioural therapy without CDM.

RESULTS: The time to first RTW was 12 days shorter (p = 0.334) in the intervention group, although full (i.e., at equal earnings as before reporting sick) RTW took 41 days longer (p = 0.122) than the control group. The odds of full RTW at the end of treatment were only 7% higher (p = 0.910) in the intervention group as compared to the control group.

CONCLUSIONS: CDM did not significantly reduce the time to RTW. We recommend that therapists who are trained on CDM focus on barriers and solutions for RTW.

BACKGROUND: Among workers with injuries who seek compensation, a general practitioner (GP) usually plays an important role in a person’s return to work (RTW) by advising if the worker is unfit for work (UFW), is able to work on alternate (ALT) duties or is fit for work and also providing referrals to other health service providers.

OBJECTIVE: To examine patterns of health service utilization (HSU) in workers with injuries by condition and type of certificate issued by GP.

METHODS: Zero-inflated negative binomial and logistic regressions were conducted for major healthcare services accessed over the 12-month period post-initial medical examination. Services included GP consultations, pharmacy, physiotherapy, occupational rehabilitation and psychology.

RESULTS: The average number of physiotherapy services was greater in workers with musculoskeletal disorders, back pain and fractures. In contrast, the median number of psychological services was greater in mental health conditions (MHC). Workers with ALT certificates were more likely to use GPs, pharmacy and physiotherapy services.

CONCLUSION: HSU in the 12 months post-initial medical certification varied substantially according to the worker’s condition, certificate type, age, gender and residential location. Understanding these factors can facilitate more appropriate resource allocation; strategic thinking on optimal use of particular health services and enables better targeting of particular provider groups for more education on the health benefits of RTW.

BACKGROUND: Previous research has demonstrated links between musculoskeletal injury risk and measures of obesity and movement efficiency among the firefighter population. However, the influence of obesity on movement efficiency among firefighter recruits remains uninvestigated.

OBJECTIVE: To investigate the influence of obesity on movement efficiency measures among firefighter recruits.

METHODS: Measures of obesity were collected among 73 male firefighter recruits. Participants were grouped into standard body mass index (BMI) categories (normal, overweight, obese). Differences in Total Functional Movement Screen (FMS) scores and Y-Balance Test (YBT) composite scores were examined between BMI categories. In addition, the relationships between measures of obesity and movement efficiency were also examined.

RESULTS: No significant differences in movement efficiency measures were identified between BMI categories (p > 0.05). However, significant bivariate correlations were identified between BMI (kg/m²) and Total FMS score (r = –0.235, p = 0.045), as well as between fat-free mass (FFM) and Total FMS score (r = –0.231, p = 0.049), when examined among all participants.

CONCLUSIONS: BMI may influence measures of movement efficiency among firefighter recruits to a lesser extent than among other previously examined populations. Future research should examine the influence of other unexamined physiological variables on movement efficiency.

BACKGROUND: Trips are common in and out of the workplace with most people recovering to avoid a subsequent fall. However, when the recovery attempt fails, a fall can be detrimental.

OBJECTIVE: The purpose of this exploratory study was to examine adaptations to the elevating response during obstacle tripping while walking on a treadmill. Additionally, the possible transfer effects from adapted responses in the lab to the worksite are explored.

METHODS: Fourteen healthy participants that covered the general working age range (20–70 yrs.) were presented with two different types of tripping obstacles while walking.

RESULTS: Elevating the foot over the obstacle was expected due to all trips being induced during early swing phase (first 33% of the swing phase). However, in addition to the elevating strategy, a novel “push” strategy was observed in all but three participants.

CONCLUSION: The current study provided support that obstacle type influences the behavioral response after a trip. Therefore, obstacles that catch the shoe should be considered when designing functional fall programs. Furthermore, information from the current study is useful for establishing guidelines when developing a fall prevention program in the workplace.

BACKGROUND: Immigrants engage in complex integration processes that are mediated through daily occupations. A central element of socio-economic integration relates to labor market preparation and participation, including job searching, learning cultural values in the workplace, pursuing credential recognition and engaging in volunteering roles and paid employment.

OBJECTIVE: To examine how immigrants experienced occupations relating to preparing for, seeking, and gainingemployment.

METHODS: A secondary analysis using whole text analysis and line-by-line coding of twenty verbatim transcripts from interviews held with ten recently arrived immigrants to London, Ontario, Canada. Sessions consisted of a narrative interview, creation of an occupational map and a semi-structured follow-up interview.

RESULTS: The participants’ employment related occupations were characterized by the overarching theme of ‘making difficult decisions’. This main theme was connected to four related sub-themes: 1) mechanisms of exclusion, 2) learning the host country’s culture, 3) the influence of one’s outlook on the decisions made, and 4) accessing support.

CONCLUSIONS: This study identifies factors influencing immigrants’ experiences of labor market preparation and participation. ‘Making difficult decisions’ was faced by all participants throughout the process of becoming part of the Canadian workforce and, ultimately, society at large.

BACKGROUND: Electrical injuries are a common cause of work-related injury in male dominated skilled trades.

OBJECTIVES: In this study we explored how issues of gender, masculinities and institutional workplace practices shape expectations of men and their choices when returning to work following a workplace electrical injury.

METHODS: Twelve workers, who suffered an electrical injury, and twelve employer representatives, completed semi-structured interviews. Using thematic analysis we identified key themes related to how masculinities influenced men’s health and safety during the return to work process.

RESULTS: Strong identification with worker roles can influence injured workers decisions to return to work ‘too early’. A desire to be viewed as a strong, responsible, resilient worker may intersect with concerns about job loss, to influence participants’ decisions to not report safety issues and workplace accidents, to not disclose post-injury work challenges, and to not request workplace supports. Institutionalized workplace beliefs regarding risk, de-legitimization of the severity of injuries, and the valorization of the “tough” worker can further re-enforce dominant masculine norms and influence return to work processes and health and safety practices.

CONCLUSIONS: Workplaces are key sites where gender identities are constructed, affirmed and institutionalized. Further research is warranted to examine how established masculine norms and gendered workplace expectations can influence workplace health and safety in male dominated high risk occupations. Future research should also evaluate strategies that encourage men to discuss post-injury work challenges and request supports when work performance or health and safety issues arise during the return to work process.

BACKGROUND: Employment is central to recovery in schizophrenia, but little attention has been paid to its relationship with cognitive functioning.

OBJECTIVE: This cross-sectional study adds to the knowledge base of relationships between cognitive functioning and gaining competitive employment, work hours per week, and monthly income among people with schizophrenia in vocational rehabilitation. It also examines which area of cognitive function may be decisive for gaining employment.

METHODS: Thirty-nine vocational rehabilitation participants were administered a cognitive battery based on MATRICS Consensus Cognitive Battery. Socio-demographic, clinical, and vocational data were gathered and analyzed with nonparametric statistics.

RESULTS: Individuals with competitive employment differed from those without competitive employment in attention and psychomotor speed, delayed verbal recall, immediate visual recall, and planning, reasoning, and problem-solving. Higher scores in immediate and delayed verbal recall and planning, reasoning, and problem-solving correlated with more work hours per week and higher income. Immediate visual recall was related to higher income. Higher scores in planning, reasoning, and problem-solving was an indicator of competitive employment (OR = 1.48).

CONCLUSIONS: Higher order cognitive functioning of planning, reasoning, and problem-solving may have a central role in gaining employment. The findings should be considered in compensation for or improving cognitive functions for vocational rehabilitation participants.

BACKGROUND: This paper introduces the concept of Deep Breathing and its applications as one of the means towards stress management through regulation of blood pressure among Indian College Engineering students. The underlying concept of deep breathing is that the relation between emotions and breathing is two way, i.e. not only do emotions affect the breathing, but controlled deep breathing also has an effect on emotions.

OBJECTIVE: The objective of the paper is to find out whether deep breathing technique is able to control blood pressure, and in turn, the level of stress.

METHODS: Sample students had a selection through initial screening and the students who reported high mental stress during interview were selected for the main drills. All the readings are taken using a sphygmomanometer (digital blood pressure meter). Students’ t test are used for the purpose of hypothesis testing.

RESULTS: The results indicated that the deep breathing technique provided significant results.

CONCLUSION: It is recommended that this amazingly simple and yet highly effective ancient technique of deep breathing become part of students’ routine curriculum. The paper aims at spreading the awareness of this yogic technique as one of the modes of Stress Management amongst Indian college students.

BACKGROUND: The accuracy of instruments such as questionnaires and the goniometer are critical for measuring the severity of musculoskeletal disorders among office workers.

OBJECTIVE: To determine the reliability of the Cornell questionnaire, goniometer and Borg questionnaire, which are commonly used instruments to assess the severity of musculoskeletal disorders in office workers.

METHODS: One hundred twenty healthy office workers, body mass: 87.1 ± 10.3 (kg), age: 27 ± 5.1 (years), height: 1.78 ± 0.16 (m), (mean ± SD), who had at least 1 year of experience in office working, were chosen randomly. A plastic goniometer (30" height) was used three times to measure the range of motion in the neck, hip, knee and shoulder area, with a period of one hour between measurements to evaluate the test-retest accuracy. The Cornell questionnaire was used to measure the severity of musculoskeletal disorders and the Borg scale was used to measure perceived exertion. The questionnaires were filled out twice with a gap of 2 weeks between measurements.

RESULTS: The Inter-class Correlation Co-efficient (ICC) indicated that all instrument sub-scales showed high levels of repeatability. The ICC coefficient was (0.805–0.954, p <0.001) for the Borg scale, (0.785–0.978, p <0.001) for the goniometer and (0.883–0.975, p <0.001) for the Cornell questionnaire.

CONCLUSIONS: The Cornell questionnaire, goniometer and Borg questionnaire all exhibit high reliability when used for the evaluation of the severity of musculoskeletal disorders in office workers.

The story of Hakan profoundly calls attention to the dialectical relationship between the macro and the micro influences on the social and political situated nature of disability, work life expectations and the transformative power of life-long learning. All of these are reflected in Hakan’s journey and his capacity to self-manage his needs and adapt in spite of disability adversity and impairment challenges at the turning points in his life. He used his ingenuity when faced with challenges by tapping into non-disabling environments (finding a university program that fit with his needs and he was able to meet standard examination expectations) and familiar human relationships (finding friends or family that agreed to read to him). His early experiences in the formal and informal labour markets that were available to him provided grounding into various workplace acumen and social requirements. In effect these experiences were part of his early employment socialization that are often overlooked as essential to being ready to shift from a job to deciding on a career in a changing labour economy. While Hakan developed his capacity and competencies to be ready for work in a viable career, the policy’s of prescriptive employment for the disabled shifted slightly to open up the door to more persons with impairments. Read on to find out the details of Hakan’s numerous experiences with turning points, shifts and his efforts to persist in becoming a teacher. Following this article there are reflective questions for deeper consideration and contemplation of the many relationships that shaped the journey.