Physical therapy in occupational health and ergonomics: practical applications and innovative research approaches (2024)

This letter to the editor aims to enlighten the readers of the Brazilian Journal ofPhysical Therapy (BJPT) on the relevance and conceptual framework, practicalapplications, current scenario, and advances of physical therapy in occupational health andergonomics. Additionally, this letter presents challenges to be overcome and perspectivesfor physical therapists as well as the scientific community.

We have witnessed the progress and achievements of the BJPT over the last two decades1. These advances have been supported by the researchers’ expertise, the quality ofpublications, and the scientific evolution of the physical therapy professionworldwide.

It is well known that the physical therapy profession has a diversity of knowledge relatedto its specialties and public health demands. This diversity can be attributed to aspectssuch as relevant clinical outcomes, target populations, and a wide variety of settings inwhich physical therapists can work2.

In terms of historical context, physical therapy has been influenced by economic, cultural,and educational aspects3 of public and research policies that prioritize some fields of expertise overothers. Among physical therapy’s specialties, occupational health and ergonomics is a novelexample which is both increasing in clinical relevance and dissemination by professionalsin a range of settings. This relevance can be easily seen by the increasing number ofphysical therapists involved in occupational health and ergonomics initiativesworldwide.

The impact of this relevance has also been reflected by an increase in demand forimprovements in worker health and company productivity. It is important to point out thatadvanced skills and clinical competencies are necessary to improve our professionalcapabilities and to expand the presence of physical therapists in different occupationalsettings. However, our professional practice is still guided by weak scientific evidenceregarding the effectiveness of intervention strategies and the validity of instruments usedfor the identification of workplace risk factors, as well as for the evaluation of physicaland functional worker health. Why is this so? Some reasons are presented below in order tounderstand this scenario.

Contrasting with the broad spectrum of professional activities promoted by physicaltherapists in occupational health and ergonomics, scientific research is only at anincipient stage. Although research within occupational health and ergonomics has beenconducted worldwide, there are few physical therapists in this field, which has resulted ina limited number of published studies compared with other specialties such asmusculoskeletal and cardiorespiratory physical therapy.

The World Confederation for Physical Therapy (WCPT) supported the creation of a physicaltherapy network4 composed of an international research group to integrate physical therapists whoare working in occupational health and ergonomics. The initial goal of this network was toengender discussion among professionals and to organize a meeting during the World PhysicalTherapy Congress. We can thus point out that physical therapy in occupational health andergonomics in Brazil and worldwide share similar aspects and need to expand andsolidify.

In Brazil, the duties of physical therapists working in occupational health and ergonomicswere approved by COFFITO Resolution no. 403 in 20115, which provided clarity on the roles of physical therapists within this specialty.This Resolution5^,6, which is similar to those used in other countries such as Australia, TheNetherlands, Canada, and the United States, sets out the skills and competencies requiredfor physical therapists to implement health education programs, physical capacity andfunctional assessments, job and workplace analysis, training of motor abilities, riskcontrol, and physical exercise programs6^,7. Resolutions such as these demonstrate the importance of this specialtyinternationally.

Although recognized and represented by a large number of physical therapists in theworkplace, the specialty is still small in terms of number of publications. The lack ofresearch conducted by physical therapists in occupational health and ergonomics confirmsthe low representation compared to more consolidated fields in the scientific context. Thisscenario has a direct impact on the scientific output in the field of occupational healthand ergonomics2^,8. As an example, we can emphasize the small number of clinical trials registered inthe PEDro database, which includes less than 600 publications on occupation health andergonomics (search conducted in March 2016), making it the smallest sub-discipline withinall fields of physical therapy. Nevertheless, this does not mean that occupational healthand ergonomics in physical therapy does not have an impact on scientific research. Afundamental question is related to the characteristics of this field of research, whichfocuses on studies analyzing determinants of work with cross-sectional and longitudinaldesigns using epidemiological and biomechanical approaches.

A recent discussion paper presented the challenges faced by researchers from occupationalhealth and ergonomics attempting to conduct randomized controlled trials (RCT) as thisresearch design is the “gold standard” for evidence-based practice9 in the workplace. The main challenges are related to organizations, many of whichhave concerns about RCT research design, such as: 1) the organization objects to randomlyallocating their employees to an intervention or control group; 2) the organization wantsto target all employees with an intervention; 3) the organization wants to adjust theintervention protocol; and 4) the organization is subject to internal or external changes.The consequences of these challenges may produce confounding results due to unreliablerandomization, selection bias, or lack of a control group. Consequently, to overcome theseconcerns, certain study designs are preferable, such as stepped-wedge, propensity scores,instrumental variables, multiple baseline design, interrupted time series,difference-in-difference, and regression discontinuity9. These suboptimal designs are much more likely to be biased compared with highquality, randomized controlled trials, but given the impossibility of conducting clinicaltrials, these research designs can be very useful.

Therefore, this letter calls upon professionals and researchers to strengthen the relevanceand quality of research within this field. Additionally, it seeks to make editors andresearchers aware of the importance of high quality studies for physical therapy inoccupational health and ergonomics and of other study designs for the advancement ofscientific knowledge. This awareness is corroborated by current health demands such asaging of the population, functional assessment of workers, increased participation of womenin the workplace and its impact on work design and daily life activities, humanfunctionality and the influence of workplace risk factors, the growth of chronic diseases,and the importance of the discussion of the physical therapist’s role in prevention,health, and well-being programs. Collaboration between professionals and researchers iscrucial to redirect and change the national scenario in the long term.

Our intent with this letter has been to focus on the demands and scientific progress ofphysical therapy in occupational health and ergonomics and to raise awareness in theacademic community concerning the role of the physical therapist and of research withinthis field. Moreover, we intend to encourage the development of further studies withdifferent designs and highlight the applicability and potential of each model forevidence-based physical therapy and the interface with occupational health andergonomics.

We believe that our involvement and experience is innovative, therefore we invite ourresearch fellows and colleagues to contribute to this field in order to help the physicaltherapy profession to broaden the body of knowledge and increase its research productivityand impact, taking into account the peculiarities and characteristics of each field ofresearch.

References