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An MSK model of care for hip and knee patients integrated with an electronic referral solution (eReferral) has been deployed within four subregions across Ontario. Referrals are sent from primary care offices to a central intake (CI), where the referral forms are reviewed and forwarded, if appropriate, to a rapid access clinic (RAC) where patients are assessed by an advanced practice clinician (APC). The pragmatic design of eReferral allows for a seamless flow of electronic orthopedic referrals from primary care to CI. It also enables CI to process and transcribe faxed referrals into the eReferral system for a smooth flow of data electronically to the RACs. In general, wait time is the time interval between receiving the patient's referral at CI or the surgeon's office until receiving the orthopedic surgeon's first consultation. Wait time is further broken down into wait 1 a and wait 1 b. Wait 1 a is the time between the receipt of the referral at CI until the date of the first initial assessment at the RAC. This study aimed at: a) assessing the processing time of orthopedic referrals at central intakes (CI) to be forwarded to the RAC, b) assessing the wait time (wait 1 a) of orthopedic referrals processed through the eReferral system to receive an initial assessment at the RACs. c) comparing the ability of the RACs to meet the target wait time for assessment (four weeks) by the method of referral (eReferrals vs. fax). d) evaluating patients' satisfaction with the length of time they waited to receive care at the RACs with eReferral. We used Ocean eReferral database to access MSK hip and knee referral data processed through the system. Patients whose referrals were initiated electronically through the system and opted to receive email notification of their referral status had the opportunity to take an online satisfaction survey embedded in the booked appointment notification message. There were 1,723 patients initially referred electronically for hip, and knee pain consults, while 13,780 referrals started as paper-based and transcribed into the system to be forwarded later electronically by CI to a RAC. Higher mean processing time at CI by 21.76 days for paper-based referral was detected as opposed to referrals received electronically (p<0.001). RACs took significantly less time to book appointments for referrals initiated electronically with a shorter average wait 1a of 21.42 days for eReferrals compared to paper-based referrals (p<0.001). RACs timeframe to book an appointment was significantly shorter for eReferrals versus fax referrals. A total of 393 patients completed the patient satisfaction survey with a response rate of 16%. Overall, 87.7% were satisfied with their experience with the eReferral process, and 81% agreed that they had waited a reasonable time to receive the needed care. eReferral can elicit faster processing of referrals and shorter wait time for patients, which improved patient satisfaction with the referral process., Competing Interests: The authors have declared that no competing interests exist.

Symptom surveys have been used extensively as part of workplace ergonomic screening programs and epidemiologic assessments of musculoskeletal disorders in groups of workers. This paper examines the reliability and validity of two musculoskeletal symptom surveys, the Nordic Musculoskeletal Questionnaire (NMQ) and a survey used in conjunction with epidemiologic assessments by the National Institute for Occupational Safety and Health (NIOSH). Journal articles assessing the validity and reliability of the NMQ were reviewed. A retrospective assessment combining two NIOSH cohorts with a total of 852 workers assessed the reliability and validity of that survey. Reliability was assessed through test-retest methods and interitem correlations between similar questions. Validity was assessed by comparison with results from physical examination assessments of workers and self-reports of workers seeking medical care. Both reliability and validity were found to be acceptable for the purposes of workplace ergonomics programs. Implications for use of these surveys for prevention and treatment outcomes research are discussed.

This paper reports on the findings of a cross-sectional study of 79 data entry clerks employed by an Ontario-based organization in five separate offices. The study was conducted to identify factors associated with physical complaints experienced by these office workers. A large percentage of the data entry clerks reported chronic physical complaints (eyestrain, musculo-skeletal pains, headache) as well as emotional or mental stress which they felt were associated with their occupation. Poorly designed overhead lighting systems in all offices contributed to both eyestrain and headache. Duration of employment as a data entry operator within the organization was not associated with stress or physical health complaints. The presence of an adjustable workstation did not in itself guarantee any protection from these conditions. Highly significant associations between occupational stress levels and some physical complaints were observed. The presence of these associations indicated that the management of both physical and stress complaints within these office environments should be tackled simultaneously.

BACKGROUND: Effective targeting of workplace upper extremity musculoskeletal disorder (MSD) prevention strategies requires the identification of demographic groups most at risk. Workers' compensation data provides an effective means of surveillance of MSDs at the population level. OBJECTIVE: The primary purpose of this study was to identify the effects of age and sex on rates of tendon injuries of the wrist and hand, carpal tunnel syndrome (CTS), epicondylitis, and soft tissue shoulder injuries in Ontario, Canada between 2000–2019 using workers' compensation data from the Association of Workers Compensation Boards of Canada (AWCBC). METHODS: Age and sex specific rates of lost-time injury claims from the four identified injury categories as well as "non-specific" upper extremity MSDs which did not fit into the four categories were calculated by standardizing injury claim totals with "at-risk" population estimates from the Canada Labour Force Survey. A multiple regression analysis was used to analyze the effects of age and sex on rates of specific injury claims. RESULTS: Statistically significant age and sex effects were identified for rates of claims from tendon injuries of the wrist and hand, CTS, and shoulder injuries, while only age effects were significant for epicondylitis. Between 2000–2019, rates of claims from the four injury categories studied and the magnitude of the age and sex effects declined substantially over time. CONCLUSION: Detailed surveillance of workplace ergonomic hazards in Ontario workplaces is needed to determine what is causing rates of upper extremity claims to decline. [ABSTRACT FROM AUTHOR]

Purpose: The objective of this study was to explore how workers' compensation policies related to healthcare provision for workers with musculoskeletal injuries can affect the delivery and trajectories of care for injured workers. The principal research question was: What are the different ways in which workers' compensation (WC) policies inform and transform the practices of healthcare providers (HCPs) caring for injured workers? Methods: We conducted a cross-jurisdictional policy analysis. We conducted qualitative interviews with 42 key informants from a variety of perspectives in the provinces of Ontario and Quebec in Canada, the state of Victoria in Australia and the state of Washington in the United States. The main methodological approach was Framework Analysis. Results: We identified two main themes: (1) Shaping HCPs' clinical practices and behaviors with injured workers. In this theme, we illustrate how clinical practice guidelines and non-economic and economic incentives were used by WCs to drive HCP's behaviours with workers; (2) Controlling workers' trajectories of care. This theme presents how WC policies achieve control of the workers' trajectory of care via different policy mechanisms, namely the standardization of care pathways and the power and autonomy vested in HCPs. Conclusions: This policy analysis shed light on the different ways in which WC policies shape HCP's day-to-day practices and workers' trajectories. A better understanding and a nuanced portrait of these policies' impacts can help support reflections on future policy changes and inform policy development in other jurisdictions. [ABSTRACT FROM AUTHOR]

Primary objective: To examine the extent and impact of musculoskeletal complaints in a TBI survivor population many years post-injury. Methods: A retrospective cohort design was used. Former patients of a rehabilitation programme who sustained a moderate-to-severe TBI 15 or more years prior ( n == 34) were interviewed by telephone. The mean age at follow-up was 48 years; mean time post-injury was 26 years. Main outcomes: Seventy-nine per cent reported some form of musculoskeletal complaint, defined as experiencing pain, stiffness or aching in or around a joint during the past 30 days. Compared with survivors with no reported musculoskeletal complaints, individuals reporting one or more complaints reported significantly more bodily pain and lower health status and function, based on sub-scales of the Medical Outcomes Study Short Form (SF-36) ( p < 0.001). Conclusions: These results suggest that musculoskeletal complaints may be highly prevalent in a long-term TBI survivor population and confer significant pain and disability. Future studies should be directed at elucidating modifiable risk factors associated with the development of musculoskeletal disorders following TBI. In the meantime, attention should be paid to the assessment and long-term management of these complaints among TBI survivors. [ABSTRACT FROM AUTHOR]