WORK: A Journal of Prevention,Assessment & Rehabilitation

{\it Objective:} Violent and disruptive acts committed by persons with developmental disabilities are a potential work environment problem for caregivers. This study developed and tested an instrument for describing and analyzing violence among persons with developmental disabilities.

{\it Methods:} Personnel from four units of one facility recorded daily on a simple form all violent and disruptive acts occurring in a limited range of situations.

{\it Results:} Acts of violence were associated with a small minority of individuals, but grossly underreported and unrecognized in formal reporting systems. None of the nearly 3000 incidents recorded during the six-week study required sick leave. Violent and disruptive acts occurred most often when an individual was requested to do something he or she did not want to do, when the individual was denied the opportunity to do something they did want to do and when waiting or under-stimulated. Personnel used the data in discussing countermeasures that could be integrated with the care and treatment of the individual.

{\it Conclusion:} Hitting, kicking, pinching etc. of personnel are a work environment problem due to their high frequency and effects upon employee morale. The instrument and procedures can be used to reduce incidents of violence, which would improve the working environment of employees and assist persons with developmental disabilities as they move from institutional environments.

Cumulative Trauma Disorders (CTDs) is the latest four-letter word for employees and employers. The purpose of this pilot study was to test the efficacy and cost effectiveness of ASTM, previously executed with Division I college athletes, in a work-related population. ASTM uses specially designed instruments to assist clinicians in rapid localization and effective treatment of soft tissue fibrosis/scar tissue. The protocol includes a flexibility and functional program that helps the worker adapt to the demands of the job. Physical and occupational therapists in both an outpatient clinic, and an industrial on-site setting, utilized ASTM. ASTM was considered successful, with symptoms resolved in over 70 percent of the patients. ASTM demonstrated impressive results in both settings and decreased medical and non-medical expenditures.

{\it Objective:} To measure test-retest reliability of physiological responses during submaximal wheelchair downhill and horizontal treadmill ergometry.

{\it Design:} A test-retest design was used on a convenience sample. Four male and three female non-wheelchair users, (22--43 years of age) propelled or coasted in a wheelchair under steady-state conditions. Four minute work bouts were performed at 1, 2, 3, and 4 km/hr. (0.62, 1.24, 1.86 and 2.5 mph, respectively) at 0 $^\circ$ , $-$ 2 $^\circ$ , and $-$ 4 $^\circ$ . Subjects were studied twice under each of the 12 conditions. Six tests were performed daily, with testing occurring over four days. Dependent variables included oxygen consumption, minute ventilation and heart. Intraclass correlation coefficients were determined for each set of paired tests.

{\it Results:} Intraclass correlation coefficients were high for absolute VO $_{2}$ ( $R= 0.84-0.99$ ), $V_{\rm E} (R= 0.86-0.98$ ) and HR ( $R= 0.95-1.0$ ) over the range of 4 speeds and 3 inclinations studied. On average, % to test 2 were less than 3%.

{\it Conclusion:} At the treadmill speeds and inclinations (positive and negative) studied in this investigation, untrained wheelchair users responded in a physiologically reliable manner.

A review of work hardening outcome research reveals a wide range of return to work statistics between 50% are forcing therapy services to objectively quantify their successes to ensure a future in health care. Work Venture has been maintaining program outcome statistics since 1994. In this report, 1997 and 1998 return to work statistics are documented and compared to multiple programs.

Work Venture's average annual return to gainful employment percentages for 1997 are 61.2% at 6 months, and in 1998, 76.8% discharge.

Many factors are involved in successful return to work with workers compensation claims. Due to these factors it is difficult to compare one program's results with another. It is recommended that a uniform method of collecting and presenting data be developed to ensure valid comparison.

{\it Objective:} The purpose of this prospective study was an exploration of the construct of the criterion-referenced multidimensional job-related model (CMVA) aimed for predicting patients' with chronic pain capability to perform occupations.

{\it Methods:} The study samples were 1) participants ( $n=84$ ) who at present were not performing employed work (median sick-listing period 12 months) because of chronic pain and 2) participants ( $n =$ 104) who at present were performing employed work at least 20 hours of a workweek. The participants had experiences of 40 different occupations classified into five of the occupational categories of Jist's Enhanced Dictionary of Occupational Titles. Data were collected through ten assessment instruments and a structured interview, comprising 54 variables and 465 items. Data were analyzed using multiple regression with forward entering of variables.

{\it Results:} The CMVA model (Adjusted $R^2 0.777, F (4, 183) = 164.067; p<0.001$ ) was able to explain 78% CMVA contained the aspects; ``the work demands-variable, the person-variable of work life values, the environment-variable of social support and the two occupational performances-variables; self-perceived capability to perform work tasks/the simulated work tasks''.

{\it Conclusions:} The construct of CMVA was robust suggesting that among persons with chronic pain, the predictors focusing on their capability to perform occupations are of great importance.

{\it Objective.} Comparisons of the results of a multidimensional criterion-referenced vocational assessment (CMVA) were performed between a group of patients with chronic pain (group P; $n =$ 86) and individuals working (group W; $n =$ 106). The participants had experience of five job categories.

{\it Methods.} The participants' capability to work was assessed from the aspects of personal factors, background data, present work experience, personal and work environmental factors probably influencing work capacity and capacity to perform occupations. Eleven instruments comprising 407 items were used.

{\it Results.} The results of the comparisons suggest that group P participants' work capacity was significant decreased by how they perceived their present work experience ( $X^2; p <$ 0.001), self-assessed or observed capability to perform daily and work occupations ( $t; p <$ 0.000). Among the factors which probably influenced their work capability, group P participants significantly ( $t; p <$ 0.05) more often used confrontive, emotive, palliative and covert coping strategies and had attained work and other life values to a less extent. Moreover, group P participants perceived that they had had a significant ( $t; p <$ 0.000) higher degree of psychosocial demands and more strain incurred from the psychosocial work environment.

A shift toward a psychophysiological view of pain appears to be gaining ground as the cost of health care continues to increase. Billions of dollars are expended in America due to persistent pain. Psychotherapist involvement in the treatment of pain may be an effective form of intervention. People injured within and outside the bounds of compensation systems may display different pain patterns. Variables affecting pain, alternative treatment methods and needs, and return to gainful work are discussed.

The article examines the underlying assumptions, applications, and interpretations of Analysis of Variance (ANOVA) in rehabilitation research. ANOVA is presented as a widely used and highly versatile statistical tool for assessing the performance of two or more groups on a broad range of dependent variables. Examples from the contemporary rehabilitation literature are used to demonstrate how ANOVA can be applied and interpreted in a number of scientific contexts.

The population of people who use wheelchairs has been increasing due to technological advances. With this increase, there has also been an increase in participation in wheelchair sports. The incidence of upper extremity injury in wheelchair users has been reported to be between 31 and 73% risk for upper extremity injury due to increased upper extremity use with sport.

The purpose of this paper is to ascertain whether proper seating and positioning have an impact on the prevention of repetitive strain injuries (RSI) of the soft tissues, including peripheral nerve entrapments and muscle injury, of the upper extremity in wheelchair athletes. A review of current research on wheelchair propulsion and RSI revealed several hazards for wheelchair athletes to develop RSI's. These include duration of impairment, muscle imbalance, awkward positioning, inadequate rest breaks, repetition of muscle use in daily activities and in sport participation, the degree of force needed for propulsion, and fatigue. Current research does not provide conclusive information on optimal seating. Suggestions of preventative measures are given including suggestions with regard to positioning in the wheelchair.

This literature review investigates females in the male-dominated field of firefighting. Various psychological and physical stressors are identified which are unique to women in this occupation. Psychological stressors include: self-doubt, skepticism of their abilities by others, performance pressure, sexual harassment, and social ostracism. Physical stressors include: ineffective physical conditioning, improper training in the use of power tools, and ill-fitting personal protective equipment. Proactive solutions are suggested as methods to remediate these problems, such as: sensitivity and social skills training, education, stress management and assertiveness training, task specific physical conditioning, proper training in the use of power tools, and the availability of personal protective equipment in sizes to fit women. Occupational therapy practitioners are identified as professionals qualified to carry out much of this training.