title: A 13-year cohort study of musculoskeletal disorders treated in an autoplant, on-site physiotherapy clinic.
abstract: BACKGROUND
  The purpose of this study was to describe the rate and distribution of treatment visits provided in an on-site, automotive plant, physiotherapy clinic over a 13-year period.
  
  
  METHODS
  A retrospective cohort study was conducted using data collected at an on-site physiotherapy clinic (1990-2002, 65,977 visits; n = 2,636 workers).
  
  
  RESULTS
  The average age of workers was 43 +/- 9 years; most remained at work (85%) when treated. Disorders most commonly affected the shoulder, lumbar, and cervical regions; the median number of visits for these was 7, 6, and 5, respectively. Elbow disorders occurred commonly only for work-related complaints and required a median of eight visits. Rate of utilization was higher for women, with 47% of the plant's female workers attending physiotherapy in 1 year. Women had higher rates of cervical spine (12 vs. 22%) and wrist (5 vs. 10%) disorders. The two most common causes of injury reported by workers with an industrial injury were "frank injury arising out of normal employment" (51%) and "gradual onset/no frank injury" (37%). The diagnosis most often reported by the physiotherapist after initial assessment was "strain" which was similar for both industrial (43%) and non-industrial (49%) injuries. The six main departments in this automotive plant account for 93% of all industrial injuries reported. Final Assembly accounted for the largest number and highest rate of injury, although shift variability was noted in utilization rates (13 vs. 26%), despite the same tasks, shift schedules, and demographics. Although there was no control group, the number of visits to discharge was lower than reported in the literature for off-site physical therapy; there was a large reduction in claims (441-275) following introduction of the clinic and reduced duration/costs of lost time were identified by the employer as a rationale to continue and enhance the service over time.
  
  
  CONCLUSIONS
  On-site physiotherapy services can provide early, cost-effective management of WRMSD in the automotive sector. Service utilization reflects the influence of gender, job task, and shift-dynamics on rates and location of WRMSD.
authors.affiliation: School of Physical Therapy, University of Western Ontario, London, ON, Canada. jsadi2@uwo.ca
authors.forename: Jackie
authors.initials: J
authors.lastname: Sadi
authors.forename: Joy C
authors.initials: JC
authors.lastname: MacDermid
authors.forename: Bert
authors.initials: B
authors.lastname: Chesworth
authors.forename: Trevor
authors.initials: T
authors.lastname: Birmingham
mesh_terms: D000328:Adult; D001336:Automobiles; D005260:Female; D006801:Humans; D007221:Industry; D008297:Male; D009140:Musculoskeletal Diseases / Q000453:epidemiology* / Q000628:therapy; D009784:Occupational Diseases / Q000453:epidemiology* / Q000628:therapy; D016272:Occupational Health; D009864:Ontario / Q000453:epidemiology; D026741:Physical Therapy Modalities; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome