So I did complete my jobsite analysis long ago, and it was actually simpler than I expected. I was evaluating a worker in the microbiology lab with a diagnosis of writer's cramp. I am finally getting this written up for the blog carnival on clinical reasoning, so make sure that you check that out. If you're new to this blog, perhaps forwarded from the carnival, please be patient since I tend to write long entries :)
OK, background information, since this happened so long ago. As a hospital OT, I was asked as a courtesy to perform a worksite evaluation of a woman ("Wilma") who was having difficulty at work due to a diagnosis of writer's cramp. Before I was asked to do this, I had no experience in work hardening outside of school classes, virtually no experience in hand therapy, or any idea what life was like in the microbiology lab. I was a little bored and willing to take on a challenge, so that's how the eval fell to me. Please note- there is a significant difference between the clinical reasoning used by novice, intermediate, and experienced practitioners; that was all fleshed out in a recent OT Practice CE article. I am not claiming to have an experienced level of reasoning, I just did my best.
My first thought was shock that "writer's cramp" was an actual neurological diagnosis. I mean, I have played Operation, and have had significant pain after essay tests in college filling up Blue Books, but I had no idea that this was real. So I looked online for information on the diagnosis from reliable sites, which included eMedicine, Merck Manual Medical Library, and Medpedia. I learned that this was a focal dystonia and a repetitive strain injury (RSI) that would likely cause increased pain and decreased grip force on small objects.
Next, I went back to my OT bookshelf. I still have many of my texts, but especially those for topics that I found interesting or complex. (I have found it unfortunate how much I have already forgotten from school in topics that have been outside my realm of practice) From my book, I was able to review environmental factors that exacerbate RSIs and go through case studies involving worksite evaluations for desk workers. My book was nice in that it also came with some ready-made forms to record measurements of various workstation pieces (example- depth of chair pan, height of chair from floor). I also asked my coworker if I could review a writeup that he had done for a different person, so I could get an idea of what was expected.
I was feeling more prepared, but still didn't know what to expect in Wilma's office. What does a person in a microbiology lab do? Where to find out? My favorite source for torturing my Girl Scouts when they're doing a career badge- The O*Net. If you haven't used the O*Net before, it's a great resource that has cataloged thousands of jobs, the skills required for each, the expected salary and job outlook for each. So I was able to pull up "Biological Technician," which gave me a few brief ideas aobut what to expect.
After gathering all this information, I spent some time trying to brainstorm possible problems that Wilma might be having. Writing, obviously, but I also thought that she might have some difficulty with manipulating other small-diameter tools, keyboarding, opening or stirring containers.
The morning of the evaluation, I got my tools together- a notebook, copies of the measurement forms from my book, digital camera, tape measure, and a goniometer.
I met with Wilma at the beginning of the day since that is when the bulk of her work was done. I asked her to describe the problem, describe the pain she was having, what made it better or worse and what she had already tried to do to fix the problem. I also asked about what she had done medically- neurologist visit, MRI, EMG, etc. Then I let Wilma go ahead and start her workday, trying to see as many of her essential job functions as possible, and asking her to report anything that caused discomfort or decreased grip. I observed the tools that she interacted with, and any time I saw something that was on my list of possible pain causers or looked like it would aggravate the RSI, I asked specifically aobut that. That included vibration, twisting, squeezing, of various tools including pipettes and cotton swabs. I also took some measurements (not a full spectrum of them) related to the position of Wilma's UE to the work surfaces.
My client was quite reticent throughout the eval, and had relatively few issues. She really only complained of difficulty writing, not with any of the other tools. I knew from my education on RSIs, phyical disabilities and assistive technology that to decrease problems from a tight grip on a small object, that the person would need to change the shape of the grip or the amount of force taken to maintain the grip. I tried to include a variety of high and low tech solutions in my suggestions, and also address other issues that I felt could potentially be a problem to Wilma.
I have the summary writeup in a google document (as always, please be respectful and do not plagiarize my work). All the photos are from Sammons/Preston to give the reader a better idea of the different tools. If it had been me, I would have pushed for a label maker, because I think that would be best for efficiency sake (that and I love labelmakers anyway). I also found a $0.49 pen shaped similar to the PenAgain in a drugstore months later, so there are other options out there in the mainstream. I didn't get any follow up from this client, so I don't know what she chose to do, but I did leave the door open so that if she had any questions or problems later she could contact the department.
So that's the thought process that carried me, an inexperienced practitioner, through my first worksite eval. If anything, I think it was worth it just to get the experience and learn that I do have the foundation for a different type of practice.