Psychosocial influences in the development of cumulative trauma disorders

• Published in: Journal of hand therapy 2021-04, Vol.34 (2), p.217-236
• Main Authors: King, James W., Neville, Marsha, Schultz, Sally W., Hersch, Gayle, Stegink-Jansen, Caroline W.
• Format: Article
• Language: English
• Subjects: Carpal tunnel syndrome; Context; Cumulative trauma disorder; Cumulative trauma disorders; Data analysis; Design; Employers; Employment; Grounded theory; Health risks; Health services; Medical personnel; Musculoskeletal diseases; Occupational adaptation; Occupational therapy; Pain; Physical therapy; Psychological aspects; Psychosocial factors; Rehabilitation; Risk analysis; Risk factors; Signs and symptoms; Social interactions; Social support; Supervisors; Therapists; Trauma; Work stations; Workers
• ISSN: 0894-1130; 1545-004X
• DOI: 10.1016/j.jht.2021.04.018

This study is a single-phase, qualitative study using grounded theory methodology. Cumulative trauma disorders (CTDs) are musculoskeletal disorders that impact health and productivity. CTD risk factors are present in the workplace, home, and community. Occupational and physical therapists specializing in hand and upper extremity rehabilitation (hand therapists) are widely involved with this population. Hand therapists often employ a medical model in the assessment and treatment of these conditions; however, the medical model has not proven to be consistently effective in relieving symptoms or producing a durable return to daily living activities. The purpose of this study was to explore the lived experiences of individuals diagnosed with CTD, and investigate the psychosocial phenomena influencing CTD development as an impediment to occupational performance. The principal investigator recruited 11 participants who met specific inclusion criteria, then used semi-structured interviews aimed at exploring the lived experiences of the participants while investigating the psychosocial phenomenon influencing CTD development. Interviews were transcribed and analyzed using a process of constant comparison, up until saturation occurred. Trustworthiness techniques were used in the data analysis phase and included peer reviews and member checking. The findings suggest that many psychosocial factors contribute to the development and impact of CTDs, at both onset of symptoms and throughout the duration of the condition. A significant number of contextual factors influence participants’ function, behavior, relationships, and the course of medical care. Themes derived from the participants’ expressions, included the following: 1) an initial strategy of “work through the pain,” can be detrimental to symptom resolution and leads to progressive failure to meet role expectations, 2) a pervasive notion of CTDs as “an invisible disability,” leaving participants feeling isolated and frustrated when significant others fail to offer support or reject them, 3) participants often delayed reporting symptom development to employers, family members, and medical personnel, risking permanent injury and disability, 4) a “stigma” is attached to CTDs that encourages isolation; however, the social support of even one significant other in a person's life can facilitate adaptation. All participants experienced hardship because of their conditions; however, two of the eleven participants capably