Shawn C. Roll PhD, OTR/L, RMSKS, FAOTA, FAIUM
Director of the PhD in Occupational Science Program and Associate Professor
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Shawn C. Roll received his B.S. in Occupational Therapy from The Ohio State University, graduating magna cum laude with distinction. He continued his post-secondary education at OSU, obtaining an M.S. in Allied Health Professions with a Minor in Research Methods in Human Resources Development, and received his Ph.D. degree in Health and Rehabilitation Sciences with an Interdisciplinary Specialization in College and University Teaching. Dr. Roll’s clinical experience is in work and industry, focusing on promoting worker health and well-being and the assessment, prevention, and rehabilitation of work-related injuries. Dr. Roll is a registered and licensed occupational therapist (OTR/L) and a registered musculoskeletal sonographer (RMSKS). He was named a Fellow of the American Occupational Therapy Association (FAOTA) in 2015, a Fellow of the American Institute of Ultrasound in Medicine (FAIUM) in 2019, and inducted into the American Occupational Therapy Foundation’s Academy of Research in 2021.
Dr. Roll has developed an interdisciplinary research career combining his clinical occupational therapy skills with specialization in musculoskeletal sonography and industrial engineering/ergonomics. Through his research, he collaborates with rehabilitation sciences; radiologic sciences; industrial, systems, and civil engineering; and orthopedics. Dr. Roll’s research strives to advance the understanding of worker health and well-being using a holistic approach. His research focus includes:
- Investigating, measuring, and intervening to optimize interactions among environments (built, organizational, social) and occupational performance (e.g., praxis, engagement, productivity) to support the health and well-being of workers
- Understanding how individual behaviors, physical exposures, stress, psychosocial factors, and personality traits relate to the development of musculoskeletal disorders or other work-related injuries, and how each factor mitigates or promotes successful prevention (e.g., ergonomics) and rehabilitation (e.g., hand therapy) efforts
- Advancing the use of sonographic imaging for the evaluation, prevention, and treatment of musculoskeletal disorders with a primary focus on the upper extremities
Doctor of Philosophy (PhD)
in Health & Rehabiliation Sciences
2011 | The Ohio State University
Master of Science (MS)
in Allied Health Professions
2006 | The Ohio State University
Bachelor of Science (BS)
in Allied Health Professions (Occupational Therapy)
2002 | The Ohio State University
Roll, S. C., Fukumura, Y. E., Sommerich, C. M., Stigall-Weikle, A. N., & Evans, K. D. (2023). Cross-disciplinary prevalence and associated factors for work-related discomfort in users of ultrasonography: Implications for sonography professionals and health care administrators. Journal of Diagnostic Medical Sonography. Advance online publication. https://doi.org/10.1177/87564793231170016 Show abstract
Objective. Work-related discomfort is a pervasive issue among ultrasonography users. The Sonography Work Systems (SWS) framework was constructed as a means of examining relationships within and across components of the sonography work systems, work processes, and work/worker outcomes. A database of ultrasonography users was established as a foundation for a longitudinal survey study to examine worker health and well-being and explore the most salient work systems and process factors associated with work-related discomfort.
Materials and Methods. An estimated 100 000 unique ultrasonography users were invited to complete the online questionnaire through an e-mail campaign. Snowball sampling occurred through social media posts and encouragement for respondents to share the survey link with colleagues. The questionnaire included items that examined participant demographics, selected constructs from the SWS, and the prevalence of work-related musculoskeletal discomfort, visual discomfort, and headaches. Individual and multi-factorial regression models were conducted to examine SWS factors associated with the likelihood of experiencing the three types of work-related discomfort.
Results. A total of 3659 valid responses were included in the analysis, with 86% of respondents reporting that they regularly experienced musculoskeletal discomfort that they directly attributed to their work. About half (54.2%) of the respondents have engaged in sonography-related ergonomics training, and respondents indicated using adjustable equipment approximately 74% of the time. Workplace culture was rated as primarily positive, but respondents indicated that employers implement only two of seven commonly recommended ergonomic policies and procedures. Working in an organization with more policies, using adjustable equipment more frequently, taking more work breaks, engaging in a positive work culture, and minimizing interruptions to workflow were key factors associated with reduced likelihood of work-related discomfort.
Conclusion. This study provides a new framework for examining and addressing factors that contribute to ultrasonography users’ experience of work-related discomfort. Despite increased participation in ergonomics training and the use of adjustable equipment, the prevalence of work-related discomfort remains high among ultrasonography users. The findings highlight the need for attention to be directed at organizational factors and work processes to identify and implement evidence-based solutions to improve the health and well-being of medical ultrasound users.
Yao, B., Takata, S. C., Mack, W. J., & Roll, S. C. (2023). Modeling extracurricular activity participation with physical and mental health in college students over time. Journal of American College Health, 71(4), 1232-1240. https://doi.org/10.1080/07448481.2021.1926263 Show abstract
Objective. To describe extracurricular activity participation and explore its relationship with college students’ health.
Participants. 159 college students majoring in dental hygiene or occupational therapy.
Methods. Data were collected prospectively at baseline, one- and two-year follow-ups. Self-reported participation in extracurricular activities over the past six months was grouped into eight categories: Fitness, Sports, Creative arts, Leisure, Social, Work, Caregiving, and Animal care. Physical and mental health were measured using SF-36, a valid tool measuring general health.
Results. Participation in fitness, sports, creative arts, and work significantly decreased at one-year and two-year follow-ups (p < 0.01). Work/volunteer activity participation was associated with poorer physical health (β = –1.4, 95% CI: (–2.2, −0.5), p < 0.01), but a change from nonparticipation to some participation in work/volunteer activity was associated with better mental health (β = 2.6, 95% CI (0.3, 4.9), p = 0.04).
Conclusions. Educators should consider the potential impact of maintaining extracurricular activities on college students’ health when designing academic courses.
Keywords. College student; extracurricular activity; health; SF-36; well-being
Henningsen , C., Sayeed, Y., Bagley, J., Fields, C., Marroquin, J., Quevedo, M., Robinson, K., Roll, S. C., Wolfman, D., Kummer, T., Mastrobattista, J., Russo, M., Turner, T., Levitan, B., Joshua, F., Perez, M., Hutchisson, M., Rybyinski, A., Dall’Asta, A., Hill, J., Collins, D. E., Barahona, O. J., Sterns, T., & Swartz, A. E. (2023). AIUM practice principles for work-related musculoskeletal disorder. Journal of Ultrasound in Medicine, 42(5), 1139-1157. https://doi.org/10.1002/jum.16124 Show abstract
The prevalence of Work-Related Musculoskeletal Disorders (WRMSDs) among ultrasound professionals has been significant. National and international efforts to create industry standards have focused primarily on injuries in sonographers. In addition, the Centers for Disease Control and Prevention (CDC) and National Institute for Occupational Safety & Health (NIOSH) have published documents related to this occupational exposure. There has also been significant attention on equipment utilization and design to help reduce the prevalence of WRMSDs. The American Institute of Ultrasound in Medicine (AIUM) developed the AIUM Practice Principles for Work-Related Musculoskeletal Disorder in collaboration with other organizations whose members use ultrasound [see Collaborating Societies and Representatives]. This document supports the “Industry Standards for the Prevention of Work-Related Musculoskeletal Disorders in Sonography” and aims to expand on these Standards to include safety practices for all health care professionals who utilize ultrasound. These professionals include members of the scientific community, a wide variety of medical professionals, and dental professionals. These ultrasound users and operators will collectively be referred to in this document as “operator(s)” except in those instances where data addressed those holding a specific job title, such as sonographer. In addition, this document will support guidance for quality improvement specific to preventing and reducing injury rates.
Keywords. Ergonomics; occupational exposure; work-related musculoskeletal disorders; WRMSD
Roll, S. C. (2023). Work and industry. In E. A. Pyatak & E. S. Lee (Eds.), 50 studies every occupational therapist should know (pp. 103-105). Oxford, UK: Oxford University Press. Full text
Fukumura, Y. E., & Roll, S. C. (2023). Injury prevention through ergonomic assessment, education, and intervention: Healthy backpack wearing in school-aged children. In E. A. Pyatak & E. S. Lee (Eds.), 50 studies every occupational therapist should know (pp. 107-112). Oxford, UK: Oxford University Press. https://doi.org/10.1093/med/9780197630402.003.0015 Show abstract
Occupational therapists apply a holistic and transactional approach that differentiates them from other professionals who provide injury prevention services. The study reviewed in this chapter provides one example of how occupational therapists can provide an ergonomics intervention to promote healthy habits and postures, even in non-work settings. Specifically, the study by Feingold and Jacobs describes how a 30-minute ergonomics education session tailored to middle school children resulted in a change in backpack-wearing habits and reports of discomfort. This study is related to a national campaign led by occupational therapists for backpack safety awareness that includes an annual backpack awareness day at the start of each school year in the fall. Additional studies are noted that provide support for occupational therapy’s role in promoting healthy behaviors and reducing occupational and work-related injuries both within the profession and in other areas through ergonomic assessments, education, intervention, and product design.
Keywords. ergonomics, posture, school-aged child, trunk, musculoskeletal, occupational therapy, health education, prevention
Awada, M., Becerik-Gerber, B., Liu, R., Seyedrezaei, M., Lu, Z., Xenakis, M., Lucas, G., Roll, S. C., & Narayanan, S. (2023). Ten questions concerning the impact of environmental stress on office workers. Building and Environment, 229, 109964. https://doi.org/10.1016/j.buildenv.2022.109964 Show abstract
We regularly face stress during our everyday activities, to the extent that stress is recognized by the World Health Organization as the epidemic of the 21st century. Stress is how humans respond physically and psychologically to adjustments, experiences, conditions, and circumstances in their lives. While there are many reasons for stress, work and job pressure remain the main cause. Thus, companies are increasingly interested in creating healthier, more comfortable, and stress-free offices for their workers. The indoor environment can induce environmental stress when it cannot satisfy the individual needs for health and comfort. In fact, office environmental conditions (e.g., thermal, and indoor air conditions, lighting, and noise) and interior design parameters (e.g., office layout, colors, furniture, access to views, distance to window, personal control and biophilic design) have been found to affect office workers' stress levels. A line of research based on the stress recovery theory offers new insights for establishing offices that limit environmental stress and help with work stress recovery. To that end, this paper answers ten questions that explore the relation between the indoor office-built environment and stress levels among workers. The answers to the ten questions are based on an extensive literature review to draw conclusions from what has been achieved to date. Thus, this study presents a foundation for future environmental stress related research in offices.
Keywords. Stress; Indoor environmental quality; Stress recovery; Office; Interior design
Becerik-Gerber, B., Lucas, G., Aryal, A., Awada, M., Bergés, M., Billington, S., Boric-Lubecke, O., Ghahramani, A., Heydarian, A., Höelscher, C., Jazizadeh, F., Khan, A., Langevin, J., Liu, R., Marks, F., Mauriello, M. L., Murnane, E., Noh, H., Pritoni, M., Roll, S., Schaumann, D., Seyedrezaei, M., Taylor, J. E., Zhao, J., & Zhu, R. (2022). The field of human building interaction for convergent research and innovation for intelligent built environments. Scientific Reports, 12, 22092. https://doi.org/10.1038/s41598-022-25047-y Show abstract
Human-Building Interaction (HBI) is a convergent field that represents the growing complexities of the dynamic interplay between human experience and intelligence within built environments. This paper provides core definitions, research dimensions, and an overall vision for the future of HBI as developed through consensus among 25 interdisciplinary experts in a series of facilitated workshops. Three primary areas contribute to and require attention in HBI research: humans (human experiences, performance, and well-being), buildings (building design and operations), and technologies (sensing, inference, and awareness). Three critical interdisciplinary research domains intersect these areas: control systems and decision making, trust and collaboration, and modeling and simulation. Finally, at the core, it is vital for HBI research to center on and support equity, privacy, and sustainability. Compelling research questions are posed for each primary area, research domain, and core principle. State-of-the-art methods used in HBI studies are discussed, and examples of original research are offered to illustrate opportunities for the advancement of HBI research.
Keywords. Civil engineering; Environmental impact; Mechanical engineering; Occupational health; Quality of life
Becerik-Gerber, B., Lucas, G., Aryal, A., Awada, M., Bergés, M., Billington, S. L., Boric-Lubecke, O., Ghahramani, A., Heydarian, A., Jazizadeh, F., Liu, R., Zhu, R., Marks, F., Roll, S., Seyedrezaei, M., Taylor, J. E., Höelscher, C., Khan, A., Langevin, J., Mauriello, M. L., Murnane, E., Noh, H., Pritoni, M., Schaumann, D., & Zhao, J. (2022). Ten questions concerning human-building interaction research for improving the quality of life. Building and Environment, 226, 109681. https://doi.org/10.1016/j.buildenv.2022.109681 Show abstract
This paper seeks to address ten questions that explore the burgeoning field of Human-Building Interaction (HBI), an interdisciplinary field that represents the next frontier in convergent research and innovation to enable the dynamic interplay of human and building interactional intelligence. The field of HBI builds on several existing efforts in historically separate research fields/communities and aims to understand how buildings affect human outcomes and experiences, as well as how humans interact with, adapt to, and affect the built environment and its systems, to support buildings that can learn, enable adaptation, and evolve at different scales to improve the quality-of-life of its users while optimizing resource usage and service availability. Questions were developed by a diverse group of researchers with backgrounds in design, engineering, computer science, social science, and health science. Answers to these questions draw conclusions from what has been achieved to date as reported in the available literature and establish a foundation for future HBI research. This paper aims to encourage interdisciplinary collaborations in HBI research to change the way people interact with and perceive technology within the context of buildings and inform the design, construction, and operation of next-generation, intelligent built environments. In doing so, HBI research can realize a myriad of benefits for human users, including improved productivity, health, cognition, convenience, and comfort, all of which are essential to societal well-being.
Keywords. Building lifecycle; Human-centered; Occupants; Built environment; Well-being; Interaction; Quality of life
Hernandez, R., Jin, H., Pyatak, E. A., Roll, S. C., Gonzalez, J. S., & Schneider, S. (2022). Perception of whole day workload as a mediator between activity engagement and stress in workers with type 1 diabetes. Theoretical Issues in Ergonomics Science. Advance online publication. https://doi.org/10.1080/1463922X.2022.2149878 Show abstract
Associations between various forms of activity engagement (e.g. work, leisure) and the experience of stress in workers have been widely documented. The mechanisms underlying these effects, however, are not fully understood. Our goal was to investigate if perceived whole day workload accounted for the relationships between daily frequencies of activities (i.e. work hours and leisure/rest) and daily stress. We analysed data from 56 workers with type 1 diabetes (T1D) who completed approximately two weeks of intensive longitudinal assessments. Daily whole day workload was measured with an adapted version of the National Aeronautics and Space Administration Task Load Index (NASA-TLX). A variety of occupations were reported, including lawyer, housekeeper and teacher. In multilevel path analyses, day-to-day changes in whole day workload mediated 67% (p < .001), 61% (p < .001), 38% (p < .001), and 55% (p < .001) of the within-person relationships between stress and work hours, rest frequency, active leisure frequency, and day of week, respectively. Our results provided evidence that whole day workload perception may contribute to the processes linking daily activities with daily stress in workers with T1D. Perceived whole day workload may deserve greater attention as a possible stress intervention target, ones that perhaps ergonomists would be especially suited to address.
Keywords. Workload, stress, rest, work hours, type 1 diabetes
Shomer, L., & Roll, S. C. (2022). Lifestyle Redesign® intervention for psychological well-being and function in people with fibromyalgia: A retrospective cohort study. American Journal of Occupational Therapy, 76(6), 7606205060. https://doi.org/10.5014/ajot.2022.049243 Show abstract
Importance. Fibromyalgia is a complex chronic pain condition for which effective nonpharmacological treatment interventions are lacking. Objective: To explore the effects of an occupational therapy intervention for fibromyalgia on client-reported outcomes of pain interference, self-efficacy, mood, and function.
Design. Retrospective cohort study using a chart review method.
Setting. Outpatient clinic.
Participants. Twenty-one adults with fibromyalgia (M age = 54 yr).
Intervention. A 10-wk occupational therapy group intervention using a Lifestyle Redesign® (LRD) approach.
Outcomes and Measures. The Brief Pain Inventory, Pain Self-Efficacy Scale, Beck Depression Inventory (BDI), and the Fibromyalgia Impact Questionnaire (FIQ) or the Revised Fibromyalgia Impact Questionnaire were administered at the first and last sessions of the program.
Results. Between 2015 and 2018, 37 clients entered the program, and 21 completed it. Changes in group averages exceeded the minimal clinically important difference for the BDI and the FIQ. Eighty-one percent of clients who completed the program had a clinically significant improvement on one or more of the outcome measures.
Conclusions and Relevance. The findings demonstrate the potential benefit of occupational therapy as a complementary approach to pharmacological treatment for people with fibromyalgia. Preliminary evidence suggests that a 10-wk occupational therapy group intervention using an LRD approach may reduce symptoms of depression and decrease the impact on daily function for people with fibromyalgia.
Keywords. fibromyalgia, pain, clients, personal satisfaction, self efficacy, life style, depressive disorders
Evans, K. D., Sommerich, C. M., Bloom, I. W., Roll, S. C., & Stigall-Weikle, A. N. (2022). The value of conducting a longitudinal study on well-being and risk for work-related musculoskeletal injuries in ultrasound users. Journal of Diagnostic Medical Sonography, 38(5), 474-480. https://doi.org/10.1177/87564793221091255 Show abstract
This article discusses the importance of conducting a longitudinal data collection concerning well-being and the risk for work-related musculoskeletal injuries (WRMSI) among sonographers and vascular technologists. There is a need for changes in the manner that sonographic work is done, but this should be nested in empirical evidence. This gives the rational for conducting the study titled Documenting the overall wellness of ultrasound users and the risk of progressive WRMSI: A national longitudinal study. The objective of this longitudinal work is to better understand collective practice patterns and examine the relationship of sonographic work conditions and performance to the user’s health and well-being. This symposium provides the foundational understanding of the strength of this type of study and how it may help to influence behavior and organizational change.
Awada, M., Becerik-Gerber, B., Lucas, G., & Roll, S. (2022). Cognitive performance, creativity and stress levels of neurotypical young adults under different white noise levels. Scientific Reports, 12, 14566. https://doi.org/10.1038/s41598-022-18862-w Show abstract
Noise is often considered a distractor; however recent studies suggest that sub-attentive individuals or individuals diagnosed with attention deficit hyperactivity disorder can benefit from white noise to enhance their cognitive performance. Research regarding the effect of white noise on neurotypical adults presents mixed results, thus the implications of white noise on the neurotypical population remain unclear. Thus, this study investigates the effect of 2 white noise conditions, white noise level at 45 dB and white noise level at 65 dB, on the cognitive performance, creativity, and stress levels of neurotypical young adults in a private office space. These conditions are compared to a baseline condition where participants are exposed to the office ambient noise. Our findings showed that the white noise level at 45 dB resulted in better cognitive performance in terms of sustained attention, accuracy, and speed of performance as well as enhanced creativity and lower stress levels. On the other hand, the 65 dB white noise condition led to improved working memory but higher stress levels, which leads to the conclusion that different tasks might require different noise levels for optimal performance. These results lay the foundation for the integration of white noise into office workspaces as a tool to enhance office workers’ performance.
Roll, S. C., & Yo, S. H. (2022). (Re-)Defining ergonomics in hand therapy: Applications for the management of upper extremity osteoarthritis. Journal of Hand Therapy, 35(3), 400-412. https://doi.org/10.1016/j.jht.2022.06.006 Show abstract
Background. Arthritis is the leading cause of disability in adults, and research shows that people living with arthritis experience work instability, loss of independence, financial difficulties, and overall decreased quality of life. Current nonpharmacological treatments can be beneficial for short term relief; however, the evidence on these long-term treatments is limited. Ergonomic modifications have been used in the workplace to address musculoskeletal conditions to ensure proper fit of one's environment, and research shows that these modifications can decrease pain and injury and increase work productivity. A broader perspective on ergonomic approaches may be important to supporting individuals with arthritis within hand therapy.
Purpose of the Study. This review proposes an expanded perspective on ergonomic approaches within hand therapy and explores published literature to identify potential benefits of applying ergonomic approaches for individuals with upper extremity arthritis.
Methods. A systematic search and screening process was conducted to identify articles that implemented an ergonomic approach for the support of individuals with upper extremity osteoarthritis or rheumatoid arthritis.
Results. A total of 34 articles described interventions that employed ergonomics including task-based or general ergonomics (n = 17), contextualized supports (n = 8), or holistic, lifestyle approaches (n = 9). Only one study focused solely on individuals with osteoarthritis, whereas interventions for individuals with rheumatoid arthritis showed positive outcomes across these categories. Situational learning, building of patient self-efficacy, and development of new habits and routines are vital for carryover and implementation to support performance in daily life.
Conclusion. There is an opportunity for hand therapists to extend the scope of interventions provided as part of an ergonomic approach to supporting patients. Specifically, therapists can consider use of emerging technologies and telehealth that promote contextualization and follow-up for long-term outcomes.
Keywords. Ergonomics, Osteoarthritis, Rheumatoid arthritis
Loomis, K., Roll, S. C., & Hardison, M. (2022). Therapist–patient relationships in outpatient upper extremity rehabilitation: Facilitating engagement & adherence. American Journal of Occupational Therapy, 76(Supplement_1), 7610505027p1. https://doi.org/10.5014/ajot.2022.76S1-PO27 Show abstract
This multimethod study identified four themes within the therapist-patient relationship that affect the provision of holistic and collaborative care. Therapists developed a complex relationship with their patients, leading to high scores on measures of adherence and engagement. These findings provide a preliminary understanding of the impact of therapeutic relationships on engagement and collaborative care to produce effective outcomes.
Purpose. Holistic and collaborative treatment planning and patient care are essential components of best practice occupational therapy (OT). This approach to care must consider patient factors and therapeutic techniques, but success will also be dependent on the therapist-patient relationship itself. There has been limited examination of this relationship within OT settings, particularly related to core concepts such as engagement and adherence. This study identified factors within the therapist-patient relationship that impacted the provision of holistic and collaborative services within an outpatient setting.
Design. A multi-method study design was used to obtain quantitative and qualitative data to describe therapists’ perspectives of their patients’ adherence and engagement, and the relative role of therapist-patient relationship. The study participants were a convenience sample of four OTs working at a hospital-based outpatient upper extremity rehabilitation clinic.
Method. Data were collected over three months. A series of weekly group interviews (n = 13) were conducted using a semi-structured guide. Interviews explored the interaction between therapist and patient roles within the therapeutic environment, including balances of power and barriers/facilitators to therapeutic engagement and adherence. Therapists completed surveys following visits from a sub-sample of patients receiving treatment during the study period (n = 16). Specifically, the Sport Injury Rehabilitation Adherence Scale (SIRAS) and the Rehabilitation Therapy Engagement Scale (RTES) were used to assess therapists’ perspectives of patient adherence and engagement. Descriptive statistics were generated from the survey data. Principles of constructivist grounded theory were used to analyze interview transcripts through an iterative process of initial and focused coding until saturation was reached. Themes connecting the codes were created by the primary coder. Two additional researchers who conceptualized the study and conducted the interviews engaged with the coder in iterative discussions to refine the qualitative themes and situate these findings within the context described by the quantitative results.
Results. Therapists consistently rated their patients highly on SIRAS and RTES measures. SIRAS scores averaged 14.4/15 (SD: 1.0, range: 10-15) and RTES scores averaged 42.5/45 (SD: 3.4, range: 23-45). These high scores may have been facilitated by complex and dynamic interactions across multiple factors within the therapist-patient relationship. Four themes emerged from therapist interviews: (1) Power within the therapist-patient relationship was fluid, often impacted by patient preference, personal contexts, and medical environment restrictions; (2) engagement was reciprocal and co-constructed between the therapist and patient; (3) therapist-patient interaction modulated emotional states to influence mutual engagement; and (4) the therapist-patient relationship is defined by different spatial and temporal contexts within the therapy process.
Conclusion. This study found that, in a highly engaged and adherent treatment setting, the therapist-patient relationships were complex, intimate, and dynamic, and extended beyond patient education and physical interventions. Careful management of this relationship was central to facilitating active patient participation and engagement.
Keywords. arm, outpatients, rehabilitation
Yao, B., Takata, S. C., & Roll, S. C. (2022). OT student health and extracurricular activity participation: A need to support well-being in OT education. American Journal of Occupational Therapy, 76(Supplement_1), 7610505056p1. https://doi.org/10.5014/ajot.2022.76S1-PO56 Show abstract
We examined the relationships between participation in different extracurricular activities and the overall physical and mental health of OT students across a 2-year period. Participation in certain occupations was associated with positive mental health, and other occupations were linked to poorer physical health. Exploration and promotion of participation in extracurricular occupations may be considered to support OT students’ health.
Purpose. Engagement in meaningful occupations is crucial to achieving health and well-being (Pemberton & Cox, 2015; Stewart, Fischer, Hirji, & Davis, 2016). Occupational therapy (OT) students learn to promote occupational engagement and health in their educational programs. However, support for monitoring and managing OT students’ own occupational participation and health is often overlooked. No literature exists that describes extracurricular activity participation nor examines the effect of occupational participation on health in OT students. Thus, the purpose of this study was to describe changes in OT students’ participation in extracurricular activities and health across their educational programs and explore the relationship between participation and health. DESIGN: A descriptive longitudinal study design was used to obtain data from students who enrolled in a two-year OT program and a comparator group of dental hygiene (DH) students with similar demographics. Students with recent histories of acute injury or ongoing chronic medical conditions were excluded.
Method. Self-reported surveys were completed three times, at program admission and at the end of the first and second academic years. Overall physical and mental health was measured by the 36-Item Short Form Health Survey (SF-36), which resulted in Physical Component Summary (PCS) and Mental Component Summary (MCS) scores. An activity checklist was used to record the total hours of participation in various activities over the past six months. A total of 62 activities were grouped into eight occupational categories: Fitness, Sports, Creative arts, Leisure, Social, Work, Caregiving, and Animal care. Repeated measures analyses of covariance (ANCOVA) were used to analyze changes in PCS and MCS across the three timepoints. Friedman-Kendall-Smith tests analyzed the changes in participation in extracurricular activities across time. Mixed linear models were constructed to examine the relationship of each occupational category with PCS and MCS, as well as the change of participation with the change of PCS and MCS.
Results. Data were obtained from 136 participants, including 51 OT and 85 DH students. MCS significantly decreased over time across all students (50.4, 47.4, and 48.2, p<0.001), and OT students always had a lower MCS than DH students. A decreasing trend in PCS was noted in OT students (58.8, 57.9, 57.1, p = 0.06), compared to increased PCS in DH students (57.0, 58.0, 58.8, p<0.01). While there was no significant change in participation in social, leisure, animal care, and caregiving activity; the average time in sports, fitness, social, and work decreased across time for both groups (all p<0.01). Of these activities, initiating participation in work/volunteer activities was associated with a decrease in PCS and an increase in MCS (both p<0.05), and initiating participation in animal care was associated with a decrease in PCS (p<0.05).
Conclusion. OT students had decreasing physical health across time and worse mental health than DH students. OT students engaged in a smaller variety of activities for shorter durations over the course of their programs. Initiating work/volunteer or animal care activity was associated with worse physical health, while initiating work/volunteer activity was also associated with better mental health.
Keywords. health, personal satisfaction, mental health
Hernandez, R., Roll, S. C., Jin, H., Schneider, S., & Pyatak, E. A. (2022). Validation of the National Aeronautics and Space Administration Task Load Index (NASA-TLX) adapted for the whole day repeated measures context. Ergonomics, 65(7), 960-975. https://doi.org/10.1080/00140139.2021.2006317 Show abstract
Our objective was to investigate the validity of four-item and six-item versions of the National Aeronautics and Space Administration Task Load Index (NASA-TLX, or TLX for short) for measuring workload over a whole day in the repeated measures context. We analyzed data on 51 people with type 1 diabetes from whom we collected ecological momentary assessment and daily diary data over 14 days. The TLX was administered at the last survey of every day. Confirmatory factor analysis fit statistics indicated that neither the TLX-6 nor TLX-4 were a unidimensional representation of whole day workload. In exploratory analyses, another set of TLX items we refer to as TLX-4v2 was sufficiently unidimensional. Raw sum scores from the TLX-6 and TLX-4v2 had plausible relationships with other measures, as evidenced by intra-person correlations and mixed-effects models. TLX-6 appears to capture multiple factors contributing to workload, while TLX-4v2 assesses the single factor of “mental strain.”
Rodrigues, P. B., Xiao, Y., Fukumura, Y. E., Awada, M., Aryal, A., Becerik-Gerber, B., Lucas, G., & Roll, S. C. (2022). Ergonomic assessment of office worker postures using 3D automated joint angle assessment. Advanced Engineering Informatics, 52, 101596. https://doi.org/10.1016/j.aei.2022.101596 Show abstract
Sedentary activity and static postures are associated with work-related musculoskeletal disorders (WMSDs) and worker discomfort. Ergonomic evaluation for office workers is commonly performed by experts using tools such as the Rapid Upper Limb Assessment (RULA), but there is limited evidence suggesting sustained compliance with expert’s recommendations. Assessing postural shifts across a day and identifying poor postures would benefit from automation by means of real-time, continuous feedback. Automated postural assessment methods exist; however, they are usually based on ideal conditions that may restrict users’ postures, clothing, and hair styles, or may require unobstructed views of the participants. Using a Microsoft Kinect camera and open-source computer vision algorithms, we propose an automated ergonomic assessment algorithm to monitor office worker postures, the 3D Automated Joint Angle Assessment, 3D-AJA. The validity of the 3D-AJA was tested by comparing algorithm-calculated joint angles to the angles obtained from manual goniometry and the Kinect Software Development Kit (SDK) for 20 participants in an office space. The results of the assessment show that the 3D-AJA has mean absolute errors ranging from 5.6° ± 5.1° to 8.5° ± 8.1° for shoulder flexion, shoulder abduction, and elbow flexion relative to joint angle measurements from goniometry. Additionally, the 3D-AJA showed relatively good performance on the classification of RULA score A using a Random Forest model (micro averages F1-score = 0.759, G-mean = 0.811), even at high levels of occlusion on the subjects’ lower limbs. The results of the study provide a basis for the development of a full-body ergonomic assessment for office workers, which can support personalized behavior change and help office workers to adjust their postures, thus reducing their risks of WMSDs.
Keywords. Ergonomic assessment; RULA; Engineering office environments; Depth camera; Computer vision; Machine learning
Hardison, M. E., Unger, J., & Roll, S. C. (2022). Hand therapy patients’ psychosocial symptomology and interests in mindfulness: A cross-sectional study. Canadian Journal of Occupational Therapy, 89(1), 44-50. https://doi.org/10.1177/00084174211060120 Show abstract
Background. Psychosocial sequelae are common for individuals with physical injuries to the upper extremity. However, psychosocially oriented interventions are not common in this occupational therapy practice area.
Purpose. This study implemented an online survey of hand therapy patients’ psychological symptoms. Second, it explored patients’ interest in one psychosocially oriented intervention: mindfulness meditation.
Methods. The design was a cross-sectional survey of 120 consecutively recruited hand therapy patients. Survey measures included functioning, psychosocial factors, and trait mindfulness.
Findings. Anxiety was prevalent in this sample, and moderately correlated with trait mindfulness (r = −0.542, p < .001). While most participants (77%) indicated mindfulness meditation would be an acceptable intervention, women were 2.8 times as likely to be interested (p = .044).
Implications. Psychosocially oriented interventions are indicated in hand therapy based on the prevalence of these symptoms. Further examination of using mindfulness meditation in hand therapy is warranted due to patient interest.
Fang, Y., Baker, N. A., Dole, J., & Roll, S. C. (2022). Quality of carpal tunnel syndrome patient education handouts available on the Internet: A systematic analysis of content and design. Archives of Physical Medicine and Rehabilitation, 103(2), 297-304. https://doi.org/10.1016/j.apmr.2021.08.010 Show abstract
Objective. To evaluate the quality of carpal tunnel syndrome (CTS) patient education handouts and identify the best resources for patients and clinicians.
Design. A document content analysis of handouts identified through a systematic internet search using 8 search terms on Google and Bing and a hand search of professional association websites.
Setting. Not Applicable.
Participants. Documents were identified from the top 50 search results across 16 individual searches. Included documents provided general patient education for CTS; descriptive websites, videos, and research studies were excluded.
Interventions. Not applicable.
Main Outcome Measures. Content analysis was conducted using the Information Score (IS) tool to evaluate completeness of information [0%-100%], and misleading treatment recommendations were identified. Design analysis was conducted using the Patient Material Assessment Tool (PEMAT-P) [0-100%] and two widely-used readability formulas, Flesch Reading Ease (FRE) and Flesch Kincaid Grade Level (FKGL). Using these results, all handouts were rated with a summative 12-point scale.
Results. Of 805 unique search results, we included 56 CTS handouts. The average IS was 74.6% ± 17.9%. 78.6% of the handouts mentioned non-evidence-based treatment recommendations. The average PEMAT-P score was 70.2% ± 10.9% and the average readability grade level was 7.7 ± 1.7. Only 3 handouts were identified as high quality based on the 12-point summative scores, while 22 handouts had mixed quality and 17 handouts had low quality on both content and design.
Conclusions. Findings of this study suggest a lack of high-quality and easily understandable CTS patient education handouts. Most handouts contained unreliable treatment information. Improvements are needed to ensure patients’ ability to understand and manage this condition.
Keywords. Carpal Tunnel Syndrome; Health Literacy; Patient Education
Pozzi, F., Sousa, C. O., Plummer, H. A., Andrade, B., Awokuse, D., Kono, N., Mack, W. J., Roll, S. C., & Michener, L. A. (2022). Development of shoulder pain with job-related repetitive load: mechanisms of tendon pathology and anxiety. Journal of Shoulder and Elbow Surgery, 31(2), 225-234. https://doi.org/10.1016/j.jse.2021.09.007 Show abstract
Background. The paucity of longitudinal clinical studies limits our understanding of the development of shoulder pain with repetitive shoulder tasks, and its association with underlying mind and body mechanisms. Tendon thickening characterizes painful shoulder supraspinatus tendinopathy, and the perception of pain can be affected by the presence of psychological factors such as anxiety and depression. This study determined the incidence of shoulder pain in novice individuals exposed to repetitive shoulder tasks, and the associated change in outcomes of supraspinatus tendon morphology and measures of anxiety and depression.
Methods. We recruited dental hygiene (DH) students (N = 45, novice and exposed to shoulder repetitive tasks) and occupational therapy (OT) students (N = 52, novice, but not exposed to shoulder repetitive tasks), following them over their first year of training. We measured shoulder pain, supraspinatus morphology via ultrasound, psychosocial distress via the Hospital Anxiety and Depression Scale. We compared the incidence of shoulder pain (defined as a change of visual analog pain scale greater than minimal clinically important difference) between DH and OT students using Fisher’s exact test. We used mixed-effects models to longitudinally compare the change in outcomes between three groups: DH students that develop and did not develop shoulder pain, and OT students.
Results. The incidence of shoulder pain is higher in DH students [relative risk = 4.0, 95% confidence interval (CI): 1.4, 11.4]. After one year, DH students with pain had the greatest thickening of the supraspinatus (0.7mm, 95%CI: 0.4, 0.9). The change in supraspinatus thickness of DH students with pain was greater than both DH students with no pain (0.4mm, 95%CI: 0.1, 0.8) and OT students (0.9mm, 95%CI: 0.5, 1.2). Anxiety score increased 3.8 points (95%CI: 1.6, 5.1) in DH students with pain, and 43% of DH students with pain had abnormal anxiety score at one-year (relative risk = 2.9, 95%CI: 1.0; 8.6).
Conclusion. Our results provide support for the theoretical model of repetitive load as a mechanism of tendinopathy. The supraspinatus tendon thickens in the presence of repetitive tasks, and thickens the most in those who develop shoulder pain. Concurrently, anxiety develops with shoulder pain, indicating a potential maladaptive central mechanism that may impact the perception of pain.
Keywords. supraspinatus; tendinopathy; anxiety; pain; shoulder
Yao, B., & Roll, S. C. (2022). An ultrasound study of the mobility of the median nerve during composite finger movement in the healthy young wrist. Muscle and Nerve, 65(1), 82-88. https://doi.org/10.1002/mus.27437 Show abstract
Introduction/Aims. There is a lack of consensus regarding median nerve movement in the carpal tunnel during composite finger flexion in healthy individuals. This study aimed to examine the amount and direction of median nerve movement and differentiate nerve mobility between dominant and non-dominant sides in a large healthy young adult cohort.
Methods. Sonographic videos of the median nerve during composite finger motion from extension to full flexion were analyzed in 197 participants without median nerve pathology. Displacement of the nerve’s centroid was calculated based on a change in the relative location of the nerve. Longitudinal nerve sliding was categorized as none, independently from the tendons, or with the tendons.
Results. In short axis, median nerves moved within 1 mm vertically and 3 mm horizontally; no direction was predominant. About half of the nerves (52.5%) slid independently while 26.9% slid with the tendons; 21.3% did not slide at all. On the non-dominant side, median nerves that slid with the tendons had a larger absolute vertical displacement than nerves that slid independently or did not slide at all (p<0.01). Nerves on the dominant side moved in a radial direction more frequently than on the non-dominant side (p=0.02).
Discussion. Transverse nerve movement during composite finger flexion in healthy individuals varies widely with no clear pattern in the direction of transverse movement or amount of longitudinal sliding. These data provide a foundation for future research to better understand the biomechanical contribution of nerve movement to median nerve pathologies.
Baker, N. A., Dole, J., & Roll, S. C. (2021). Meta-synthesis of carpal tunnel syndrome treatment options: Developing consolidated clinical treatment recommendations to improve practice. Archives of Physical Medicine and Rehabilitation, 102(11), 2261-2268. https://doi.org/10.1016/j.apmr.2021.03.034 Show abstract
Carpal tunnel syndrome (CTS) treatment contains ambiguities across and within disciplines. This meta-synthesis of professional guidelines consolidates clinical treatment recommendations for CTS treatment and classifies them by strength of evidence. We conducted a search of Google, Google Scholar, and PubMed for published clinical treatment recommendations for CTS. A systematic hand search was completed to identify additional professional organizations with published recommendations. We extracted any mentioned treatment from all sources but developed our final consolidated clinical treatment recommendations only from select rigorous guidelines based on the Institute of Medicine (IOM) criteria for trustworthy guidelines. We translated rating systems of the primary guidelines into a universal rating system to classify recommendations for consolidated clinical treatment recommendations. Our search yielded 30 sources that mentioned a total of 55 CTS treatments. Six of the sources met the IOM inclusion criteria. These primary guidelines provided recommendations for 46 of the 55 treatments, which were consolidated into 12 broad treatment categories. Surgery, positioning, and steroids were strongly supported. Conservative treatments provided by rehabilitation professionals were conditionally supported. Pharmaceuticals, supplements, and alternative treatments were not generally supported. CTS is a complex condition with a wide variety of treatments provided by a multitude of disciplines. Our consolidated clinical treatment recommendations offer a comprehensive outline of available treatments for CTS and contributes to the process of developing best practices for its treatment.
Keywords. Carpal tunnel syndrome; Guideline; Rehabilitation; Systematic review
Awada, M., Becerik-Gerber, B., Lucas, G., & Roll, S. (2021). Associations among home indoor environmental quality factors and worker health while working from home during COVID-19 pandemic. Journal of Engineering for Sustainable Buildings and Cities, 2(4), 041001. https://doi.org/10.1115/1.4052822 Show abstract
The outbreak of SARS-CoV-2 virus forced office workers to conduct their daily work activities from home over an extended period. Given this unique situation, an opportunity emerged to study the satisfaction of office workers with indoor environmental quality (IEQ) factors of their houses where work activities took place and associate these factors with mental and physical health. We designed and administered a questionnaire that was open for 45 days during the COVID-19 pandemic and received valid data from 988 respondents. The results show that low satisfaction with natural lighting, glare and humidity predicted eye related symptoms, while low satisfaction with noise was a strong predictor of fatigue or tiredness, headaches or migraines, anxiety, and depression or sadness. Nose and throat related symptoms and skin related symptoms were only uniquely predicted by low satisfaction with humidity. Low satisfaction with glare uniquely predicted an increase in musculoskeletal discomfort. Symptoms related to mental stress, rumination or worry were predicted by low satisfaction with air quality and noise. Finally, low satisfaction with noise and indoor temperature predicted the prevalence of symptoms related to trouble concentrating, maintaining attention or focus. Workers with higher income were more satisfied with humidity, air quality and indoor temperature and had better overall mental health. Older individuals had increased satisfaction with natural lighting, humidity, air quality, noise, and indoor temperature. Findings from this study can inform future design practices that focus on hybrid home-work environments by highlighting the impact of IEQ factors on occupant well-being.
Fukumura, Y. E., Schott, J. M., Lucas, G. M., Becerik-Gerber, B., & Roll, S. C. (2021). Negotiating time and space when working from home: Experiences during COVID-19. OTJR: Occupation, Participation and Health, 41(4), 223-231. https://doi.org/10.1177/15394492211033830 Show abstract
Stay-at-home mandates following the COVID-19 pandemic increased work from home (WFH). While WFH offers many benefits, navigating work in nontraditional contexts can be a challenge. The objective of this study was to explore the benefits and challenges of WFH during COVID-19 to identify supports and resources necessary. Comments from two free-response questions on a survey regarding experiences of WFH (N = 648, N = 366) were analyzed using inductive qualitative content analysis. Four themes emerged: time use, considerations of working in the home space, intersections between work-life and home-life, and temporality of WFH as situated within a pandemic. Across all themes were concerns related to participation in both work and home roles, work performance, and well-being. Findings highlight the importance of support during times of disruption of occupational patterns, roles, and routines. Despite challenges, many individuals hoped to continue WFH. Organizations should consider the complex intersections of work-life and home-life to develop supportive policies and resources.
Keywords. work; survey; context; health; occupational balance
Hernandez, R., Pyatak, E. A., Vigen, C. L., Jin, H., Schneider, S., Spruijt-Metz, D., & Roll, S. C. (2021). Understanding worker well-being relative to high-workload and recovery activities across a whole day: Pilot testing an ecological momentary assessment technique. International Journal of Environmental Research and Public Health, 18(19), 10354. https://doi.org/10.3390/ijerph181910354 Show abstract
Occupational health and safety is experiencing a paradigm shift from focusing only on health at the workplace toward a holistic approach and worker well-being framework that considers both work and non-work factors. Aligned with this shift, the purpose of this pilot study was to examine how, within a person, frequencies of high-workload and recovery activities from both work and non-work periods were associated with same day well-being measures. We analyzed data on 45 workers with type 1 diabetes from whom we collected activity data 5–6 times daily over 14 days. More frequent engagement in high-workload activities was associated with lower well-being on multiple measures including higher stress. Conversely, greater recovery activity frequency was mostly associated with higher well-being indicated by lower stress and higher positive affect. Overall, our results provide preliminary validity evidence for measures of high-workload and recovery activity exposure covering both work and non-work periods that can inform and support evaluations of worker well-being.
Keywords. workload; recovery; ecological momentary assessment; type 1 diabetes; workweek; healthy work design and well-being; future of work
Roll, S. ., Lucas, G. M., & Becerik-Gerber, B. (2021). Authors’ response to “Work from home (WFH) during COVID-19: Is virtual reality (VR) a new solution to new problems?”. Journal of Occupational and Environmental Medicine, 63(10), e757-e758. https://doi.org/10.1097/JOM.0000000000002340 Show abstract
Awada, M., Lucas, G., Becerik-Gerber, B., & Roll, S. (2021). Working from home during the COVID-19 pandemic: Impact on office worker productivity and work experience. Work, 69(4), 1171-1189. https://doi.org/10.3233/WOR-210301 Show abstract
Background. With the COVID-19 pandemic, organizations embraced Work From Home (WFH). An important component of transitioning to WFH is the effect on workers, particularly related to their productivity and work experience.
Objectives. The objective of this study is to examine how worker-, workspace-, and work-related factors affected productivity and time spent at a workstation on a typical WFH day during the pandemic.
Methods. An online questionnaire was designed and administered to collect the necessary information. Data from 988 respondents were included in the analyses.
Results. Overall perception of productivity level among workers did not change relative to their in-office productivity before the pandemic. Female, older, and high-income workers were likely to report increased productivity. Productivity was positively influenced by better mental and physical health statuses, having a teenager, increased communication with coworkers and having a dedicated room for work. Number of hours spent at a workstation increased by approximately 1.5 hours during a typical WFH day. Longer hours were reported by individuals who had school age children, owned an office desk or an adjustable chair, and had adjusted their work hours.
Conclusion. The findings highlight key factors for employers and employees to consider for improving the WFH experience.
Fang, Y., Roll, S. C., Baker, N., & Dole, J. E. (2021). Quality of patient education handouts for carpal tunnel syndrome available on the Internet. American Journal of Occupational Therapy, 75(Supplement_2), 7512510265. https://doi.org/10.5014/ajot.2021.75S2-RP265 Show abstract
Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations.
This study systematically located and evaluated 56 patient education handouts for carpal tunnel syndrome. Handouts were reviewed for overall quality on the basis of completeness and accuracy of the content and readability for patients. Our findings point to strengths and limitations of educational materials and identified the best patient resources for OT practitioners.
Fukumura, Y. E., McLaughlin Gray, J., Lucas, G., Becerik-Gerber, B., & Roll, S. C. (2021). Office worker perspective on an artificial intelligence workstation: A qualitative study. American Journal of Occupational Therapy, 75(Supplement_2), 7512505154. https://doi.org/10.5014/ajot.2021.75S2-RP154 Show abstract
Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations.
This study explored office workers' perspectives on including artificial intelligence (AI) in their office workspace. Following an iterative analysis of six focus-group interviews with a total of 45 participants, three constructs emerged. Rich discussions demonstrated how acceptability of an AI workstation is complex and affected by the person, context, and their occupations.
Randolph, S., Liu, J., Roll, S. C., & Dylla, J. (2021). Validation of an ergonomic assessment tool for dental hygienists. American Journal of Occupational Therapy, 75(Supplement_2), 7512500043. https://doi.org/10.5014/ajot.2021.75S2-RP43 Show abstract
Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations.
Although multiple robust ergonomics tools are available to assess postural risk, these tools are often too general and do not consider nuances of specific jobs. This study examined the concurrent validity of a postural assessment tool tailored to dental professionals. Findings provide support for use of this tool to assess risk and identify areas for intervention by OT practitioners.
Yao, B., & Roll, S. C. (2021). Effect of functional hand use on compression and displacement of the median nerve. American Journal of Occupational Therapy, 75(Supplement_2), 7512505196. https://doi.org/10.5014/ajot.2021.75S2-RP196 Show abstract
Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations.
Repetitive wrist and hand movement is a risk factor for carpal tunnel syndrome. During daily functional hand use, some people develop carpal tunnel syndrome. However, the exact mechanism of injury remains unknown. We evaluated the effect of functional hand use on the median nerve and assessed the compression and displacement of the median nerve using state-of-the-art sonography.
Yao, B., Takata, S., & Roll, S. C. (2021). Relationship between extracurricular occupations and health in college students: A longitudinal study. American Journal of Occupational Therapy, 75(Supplement_2), 7512505178. https://doi.org/10.5014/ajot.2021.75S2-RP178 Show abstract
Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations.
We examined the relationships between participation in different extracurricular activities and the overall physical and mental health in college students across a 2-year period. Participation in certain occupations was associated with positive mental health, whereas other occupations were linked to poorer physical health. Exploration and promotion of participation in extracurricular occupations should be considered to support student health.
Dole, J. E., Baker, N., & Roll, S. C. (2021). Carpal tunnel treatment options: Developing consolidated guidelines for best practice — A meta-synthesis. American Journal of Occupational Therapy, 75(Supplement_2), 7512510275. https://doi.org/10.5014/ajot.2021.75S2-RP275 Show abstract
Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations.
OTs have a major role in the conservative care of carpal tunnel syndrome (CTS) before surgery; however, best treatment practices are unclear as a result of conflicting recommendations among professional disciplines. We collected and analyzed professional guideline recommendations to construct a consolidated guideline with clear ratings for the available treatments. This guideline will inform treatment procedures and develop more universal best practices for remedying CTS.
Roll, S. C., Hardison, M. E., Forrest, J. L., Colclazier, N. L., Sumi, J. Y., & Baker, N. A. (2021). A standardized protocol for the comprehensive assessment of dental hygiene work. Work, 69(3), 1041-1052. https://doi.org/10.3233/WOR-213534 Show abstract
Background. Work-related musculoskeletal disorders are prevalent in dental hygienists. Although engineering controls and ergonomic training is available, it is unclear why this intransigent problem continues. One possible barrier is that a comprehensive, standardized protocol for evaluating dental hygiene work does not exist.
Objective. This study aimed to generate a valid and reliable observational protocol for the assessment of dental hygiene work.
Methods. An iterative process was used to establish and refine an ecologically valid video acquisition and observation protocol to assess key activities, tasks, and performance components of dental hygiene work.
Results. Good inter-rater reliability was achieved across all variables when the final coding scheme was completed by three independent raters.
Conclusions. This work provides an exemplar of the process required to generate a comprehensive protocol for evaluating the work components of a particular job, and provides standardized nomenclature for use by scientists and practitioners interested in understanding and addressing the pervasive issue of work-related disorders in dental hygienists.
Keywords. Dental hygienists; clinical; ergonomics; research protocol.
Krause, D., Roll, S. C., Javaherian-Dysinger, H., & Daher, N. (2021). Comparative efficacy of the dorsal application of Kinesio tape and splinting for carpal tunnel syndrome: A randomized controlled trial. Journal of Hand Therapy, 34(3), 351-361. https://doi.org/10.1016/j.jht.2020.03.010 Show abstract
Background. Carpal tunnel syndrome (CTS) symptoms are problematic especially when signs and symptoms are not substantial enough to require surgical intervention. Conservative treatments have mixed effectiveness, yet are one of the best options for mild to moderate CTS. Kinesio tape is an emerging modality, as it provides biomechanical support while allowing movement.
Purpose. The purpose of this study was to determine the efficacy of dorsal application of Kinesio tape on occupational performance as measured by pain and function in individuals with mild to moderate CTS, as compared with the accepted nonsurgical intervention of general cockup orthosis and lumbrical stretching exercises versus sham tape.
Study Design. Single-blind randomized controlled trial.
Methods. Forty-four participants (68 wrists) with CTS were randomized to one of three interventions: Kinesio tape group, sham group, or standard protocol group. Each completed baseline and four subsequent measurements of numeric pain rating scale, visual analog scale (VAS), Boston Carpal Tunnel Questionnaire (BCTQ), grip and pinch, with application of intervention every three days. Daily symptom journals were completed, standard protocol group recorded wearing schedule and exercises.
Results. In the forearm and wrist, a significant reduction in median numeric pain rating scale pain scores in Kinesio tape group was observed (r = 0.76, P = .01; r = 0.77, P = .01; respectively), but not in the standard protocol group (r = 0.51, P = .17; r = 0.53, P = .11) and sham group (r = 0.46, P = .30; r = 0.39, P = .43) with a minimal clinically important difference of 1.0. In the Kinesio tape group, the forearm (24%) and wrist (36%) reached the clinical significance as compared with the standard protocol forearm (18%) and wrist (32%).
The minimal clinically important difference for pain reduction on the visual analog scale was 1.64. Kinesio tape and sham group had significant improvement in function, but not the standard protocol group.
Discussion. This study provides promising evidence for the use of Kinesio tape as a possible conservative intervention for management of symptoms in individuals with mild to moderate CTS. The study also illuminates new considerations of younger, active individuals reporting signs and symptoms of CTS as well as mechanism of effects on pain reduction.
Conclusions. Kinesio tape provided additional improvement in pain and function as compared to the standard approach.
Keywords. Carpal tunnel syndrome, Kinesio tape, Conservative interventions, Functional performance
Aryal, A., Becerik-Gerber, B., Lucas, G. M., & Roll, S. C. (2021). Intelligent agents to improve thermal satisfaction by controlling personal comfort systems under different levels of automation. IEEE Internet of Things Journal, 8(8), 7089-7100. https://doi.org/10.1109/JIOT.2020.3038378 Show abstract
Heating, ventilation, and air conditioning (HVAC) systems account for 43% of building energy consumption, yet only 38% of commercial building occupants are satisfied with the thermal environment. The primary reasons for low occupant satisfaction are that HVAC operations do not integrate occupant comfort requirements nor control the thermal environment at the individual level. Personal comfort systems (PCS) enable local control of the thermal environment around each occupant. However, full manual control of PCS can be inefficient, and fully automated PCS reduces an occupant’s perceived control over the environment, which can then lead to lower satisfaction. A better solution might lie somewhere between fully manual and fully automated environmental control. In this paper, we describe the development and implementation of an internet of things (IoT) based intelligent agent that learns individual occupant comfort requirements and controls the thermal environment using PCS (i.e., a local fan and a heater). We tested different levels of automation where control is shared between an intelligent agent and the end user. Our results show that PCS use improves occupant satisfaction and including some level of automation can improve occupant satisfaction further than what is possible with manually operated PCS. Among the levels of automation investigated, Inquisitive Automation, where the user approves/declines the control actions of the intelligent agent before execution, led to highest occupant satisfaction with the thermal environment.
Keywords. building automation, thermal comfort, smart systems, smart buildings, indoor environments
Xiao, Y., Becerik-Gerber, B., Lucas, G., & Roll, S. C. (2021). Impacts of working from home during COVID-19 pandemic on physical and mental well-being of office workstation users. Journal of Occupational and Environmental Medicine, 63(3), 181-190. https://doi.org/10.1097/JOM.0000000000002097 Show abstract
Objective. To understand impacts of social, behavioral and physical factors on well-being of office workstation users during COVID-19 work from home (WFH).
Methods. A questionnaire was deployed from April 24 to June 11, 2020 and 988 responses were valid. Linear regression, multinomial logistic regression and chi-square tests were used to understand factors associated with overall physical and mental health statuses and number of new physical and mental health issues.
Results. Decreased overall physical and mental well-being after WFH were associated with physical exercise, food intake, communication with coworkers, children at home, distractions while working, adjusted work hours, workstation set-up and satisfaction with workspace indoor environmental factors.
Conclusion. This study highlights factors that impact workers’ physical and mental health well-being while WFH and provides a foundation for considering how to best support a positive WFH experience.
Keywords. COVID-19 pandemic, home office, mental well-being, physical well-being, work from home
Fukumura, Y. E., McLaughlin Gray, J., Lucas, G. M., Becerik-Gerber, B., & Roll, S. C. (2021). Worker perspectives on incorporating artificial intelligence into office workspaces: Implications for the future of office work. International Journal of Environmental Research and Public Health, 1(4), 1690. https://doi.org/10.3390/ijerph18041690 Show abstract
Workplace environments have a significant impact on worker performance, health, and well-being. With machine learning capabilities, artificial intelligence (AI) can be developed to automate individualized adjustments to work environments (e.g., lighting, temperature) and to facilitate healthier worker behaviors (e.g., posture). Worker perspectives on incorporating AI into office workspaces are largely unexplored. Thus, the purpose of this study was to explore office workers’ views on including AI in their office workspace. Six focus group interviews with a total of 45 participants were conducted. Interview questions were designed to generate discussion on benefits, challenges, and pragmatic considerations for incorporating AI into office settings. Sessions were audio-recorded, transcribed, and analyzed using an iterative approach. Two primary constructs emerged. First, participants shared perspectives related to preferences and concerns regarding communication and interactions with the technology. Second, numerous conversations highlighted the dualistic nature of a system that collects large amounts of data; that is, the potential benefits for behavior change to improve health and the pitfalls of trust and privacy. Across both constructs, there was an overarching discussion related to the intersections of AI with the complexity of work performance. Numerous thoughts were shared relative to future AI solutions that could enhance the office workplace. This study’s findings indicate that the acceptability of AI in the workplace is complex and dependent upon the benefits outweighing the potential detriments. Office worker needs are complex and diverse, and AI systems should aim to accommodate individual needs.
Keywords. workspace; office work; computer workstations; artificial intelligence
Murphy, S. L., Krause, D., Roll, S. C., Gandikota, G., Barber, M., & Khanna, D. (2021). Development of a musculoskeletal ultrasound protocol to examine upper extremity rehabilitation outcomes in systemic sclerosis. Journal of Diagnostic Medical Sonography, 37(1), 13-23. https://doi.org/10.1177/8756479320965210 Show abstract
Objectives. This study developed a musculoskeletal ultrasound (MSUS) protocol to evaluate rehabilitation outcomes in systemic sclerosis.
Materials and Methods. Three MSUS methods (gray-scale, Doppler, strain elastography) and two acquisition techniques (long- vs short-axis; transducer on skin vs floating on gel) were examined in the forearm before and after rehabilitation treatment. For gray-scale, tissue thickness measures and intrarater and interrater reliability were calculated (intraclass correlation coefficients [ICCs]), and paired t tests examined differences among techniques.
Results. Five people with diffuse cutaneous systemic sclerosis participated. The most valid and reliable gray-scale technique was with the transducer in long-axis, floating on gel. Doppler and strain elastography did not detect changes. Both dermal and subcutaneous thickness measurement error was small; intrarater and interrater reliability was good to excellent. Preliminary data indicate that treatment may lead to dermal thinning.
Conclusion. A replicable protocol was established and may be an adjunct to rehabilitation outcome measurement in systemic sclerosis.
Keywords. musculoskeletal ultrasound, scleroderma, rehabilitation, protocol
Fang, Y., Tung, K. D., Beleno-Sanchez, J., Forrest, J. L., & Roll, S. C. (2020). Characterization of tasks and time efficiency of dental hygiene students during clinical training. Journal of Dental Hygiene, 94(5), 30-37. Full text Show abstract
Purpose. Dental hygiene graduates often experience significant psychological stress while transitioning from the educational setting to clinical practice environments. The purpose of this study was to characterize the duration of dental hygiene activities and tasks and explore efficiency within appointments, by students in educational programs.
Methods. Right-handed female dental hygiene students were recruited from two dental hygiene education programs. Each participant was video recorded while providing patient care during 3 sessions, once per term, over 3 consecutive terms. Activities, tasks, and student postures and positions were coded across the patient visit. Descriptive analyses were conducted to characterize overall durations and distributions across each category. Time spent on non-dental hygiene related activities was compared to other durations, as well as across the education/training time points and by patient type.
Results. Fifty-three videos were analyzed from nineteen participants. The average patient visit length was 155.06 ± 35.63 minutes; approximately half the visit was dedicated to instrumentation activities. Nearly 20% of the visit was categorized as activities or tasks unrelated to education or patient care. Although most participants completed the patient visit more quickly by the third time point, the percentage of non-dental hygiene activities did not decrease, and there were no associations between patient category type and the duration of the patient visit.
Conclusion. Patient visits were roughly three times the length of the typical dental hygiene care appointment, indicating a disconnect between training and practice. In addition to spending more time on hand scaling tasks, participants spent a lot of time on equipment setup and interacting with or waiting for faculty members. These findings have implications for improving efficiency in educational settings, particularly to facilitate a successful transition to clinical practice.
Saldana, D., Neureither, M., Schmiesing, A., Jahng, E., Kysh, L., Roll, S. C., & Liew, S.-L. (2020). Applications of head-mounted displays for virtual reality in adult physical rehabilitation: A scoping review. American Journal of Occupational Therapy, 74(5), 7405205060. https://doi.org/10.5014/ajot.2020.041442 Show abstract
Importance. Head-mounted displays for virtual reality (HMD–VR) may be used as a therapeutic medium in physical rehabilitation because of their ability to immerse patients in safe, controlled, and engaging virtual worlds.
Objective. To explore how HMD–VR has been used in adult physical rehabilitation.
Data Sources. A systematic search of MEDLINE, Embase, Cochrane Library, CINAHL, Web of Science, PsycINFO, and ERIC produced 11,453 abstracts, of which 777 underwent full-text review.
Study Selection and Data Collection. This scoping review includes 21 experimental studies that reported an assessment or intervention using HMD–VR in a physical rehabilitation context and within the scope of occupational therapy practice.
Findings. HMD–VR was used for assessment and intervention for patients with a range of disorders, including stroke, multiple sclerosis, spinal cord injury, and Parkinson’s disease.
Conclusions and Relevance. HMD–VR is an emerging technology with many uses in adult physical rehabilitation. Higher quality clinical implementation studies are needed to examine effects on patient outcomes.
What This Article Adds. We review existing research on how immersive virtual reality (e.g., using head-mounted displays) has been used for different clinical populations in adult physical rehabilitation and highlight emerging opportunities in this field for occupational therapists.
Roll, S. C., Hardison, M. E., Vigen, C., & Black, D. S. (2020). Mindful body scans and sonographic biofeedback as preparatory activities to address patient psychological states in hand therapy: A pilot study. Hand Therapy, 25(3), 98-106. https://doi.org/10.1177/1758998320930752 Show abstract
Introduction. Translational evidence for mind–body interventions in hand therapy is limited. This pilot study aimed to determine potential benefits of including a mindful body scan or sonographic biofeedback at the outset of a hand therapy session on key psychological states.
Methods. A randomized, repeated-measures, cross-over design was used to evaluate a mindful body scan and sonographic biofeedback at the outset of a hand therapy session. Measures of pain, anxiety, and stress (i.e. salivary cortisol) were obtained from 21 hand therapy patients at the start, after 20 min, and at the end of each of three 60-min treatments. Trends were examined, and mixed-effects regression compared effects across time within and across the sessions for each of the outcome measures.
Results. For all intervention types, anxiety and stress decreased across the treatment session (p < 0.001); no statistically significant changes were noted in pain. Using either mind–body intervention before standard care resulted in a meaningful decrease and statistical trend toward improvement in stress. The use of a mindful body scan produced an immediate, statistically significant reduction in anxiety (β = − 0.14, p = 0.03), a lowered level that was maintained throughout the therapy session.
Discussion. These data provide preliminary support for integrating mind–body interventions as preparatory activities in hand therapy. Mindful body scans may prepare patients for therapeutic interventions by more quickly reducing anxiety, and the use of either intervention may reduce patient stress more than would occur during a standard care session. These effects should be evaluated in an adequately powered clinical trial.
Keywords. Therapeutics, integrative health, sonography, mindfulness.
Yao, B., Gan, K., Lee, A., & Roll, S. C. (2020). Comparing shape categorization to circularity measurement in the evaluation of median nerve compression using sonography. Journal of Diagnostic Medical Sonography, 36(3), 224-232. https://doi.org/10.1177/8756479319898471 Show abstract
Purpose. This study aimed to develop a subjective categorization of nerve shape and to examine the relationship of shape categorizations to measurement of nerve circularity.
Methods. Wrists were evaluated with sonography in healthy participants. Images of the median nerve were obtained in the transverse plane at the level of pisiform with the fingers resting, gripping, and pinching. Nerves were categorized as ovoid, angular, or irregular, and the cross-sectional area and perimeter were measured to calculate nerve circularity.
Results. Across 167 participants, the median nerve shifted from being primarily ovoid at rest to angular shaped when the fingers were in a full fist or pinching. Approximately three-quarters of subjects exhibited a shape change during dynamic movement. Irregular nerves had the lowest circularity values; however, the majority of nerves had similar circularity measures despite having different shapes.
Conclusions. Subjective categorization of shape has the potential to be a valid technique for evaluation of the median nerve using sonography, and this evaluation may provide additional information regarding nerve compression that is not fully captured by a circularity measure. Further investigation is needed to determine how these two techniques may be best used individually or together to advance clinical diagnosis, prevention, and rehabilitative interventions.
Keywords. sonography, carpal tunnel syndrome, median nerve, circularity
Takata, S. C., Hardison, M. E., & Roll, S. C. (2020). Fostering holistic hand therapy: Emergent themes of client experiences of mind–body interventions. OTJR: Occupation, Participation and Health, 40(2), 122-130. https://doi.org/10.1177/1539449219888835 Show abstract
Mind–body interventions are a viable holistic approach to rehabilitation; however, evidence for mind–body approaches in hand therapy is lacking. This study explored the experiences of clients with musculoskeletal disorders undergoing two mind–body interventions within hand therapy. Qualitative data were obtained from clients who received mindfulness meditation and sonographic biofeedback as part of hand therapy. Semi-structured interviews conducted after four therapy sessions elicited participants’ experiences and acceptability. Emergent themes were identified through an iterative, qualitative descriptive process. The following three themes emerged as results: insight on the body, relaxation and relief, and I am in control. A fourth theme was identified in the acceptability data, that is, mindfulness as a meaningful activity. At least one of the interventions was acceptable to each participant. Positive participant experiences support further consideration of mind–body interventions as a useful holistic approach in hand therapy to support wellness, quality of care, and participation in recovery.
Keywords. therapeutics, hand therapy, integrative medicine, mindfulness, biofeedback
Tung, K. D., Fukumura, Y. E., Baker, N. A., Forrest, J. L., & Roll, S. C. (2019). Identifying an optimal sampling method to estimate postural risk in a dynamic work task. Proceedings of the Human Factors and Ergonomics Society Annual Meeting, 63(1), 1028-1033. https://doi.org/10.1177/1071181319631180 Show abstract
Introduction. The Rapid Upper Limb Assessment (RULA) is an ergonomic assessment tool used to screen for risk of musculoskeletal injury due to working posture. The RULA is traditionally applied once during a work task to approximate overall risk. No method exists for estimating a RULA score for work requiring frequent shifts in posture across an extended period of time.
Purpose. The goal of this study was to identify an optimal sampling method for applying the RULA across a long time-period that accurately represents overall risk.
Methods. Four right-handed female dental hygiene students were video recorded from three angles while performing hand scaling during patient clinic visits (88.97 minutes on average). RULA was continuously scored across the entire session, updating the score when a significant postural shift lasting for more than 15 seconds occurred. A time-weighted average (TWA) RULA score was calculated. Three sampling methods were evaluated: equivalent interval samples, random samples, and random samples selection weighted within “clock positions.” Each method was compared to the TWA using a paired samples t-test and percent difference.
Results. TWA RULA across the four students ranged from 3.4 to 4.3. Preliminary sampling averages using 10 samples were all within 0.2 of the TWA. Further iterations evaluating various sample sizes is ongoing.
Discussion. Preliminary results suggest that all three sampling methods provide a reasonably accurate approximation of the TWA score at the sampling rate tested. Future iterations of this analysis will be continued to identify the minimum required sampling rate to meet our TWA criterion.
Roll, S. C., Tung, K. D., Chang, H., Sehremelis, T. A., Fukumura, Y. E., Randolph, S., & Forrest, J. L. (2019). Prevention and rehabilitation of musculoskeletal disorders in oral health care professionals: A systematic review. The Journal of the American Dental Association, 150(6), 489-502. https://doi.org/10.1016/j.adaj.2019.01.031 Show abstract
Background. The authors’ objective in this systematic review was to describe the evidence for preventive and rehabilitative interventions for musculoskeletal disorders in oral health care.
Types of Studies Reviewed. The authors conducted systematic search, screening, and eligibility processes to identify experimental, quasiexperimental, observational, and survey research studies in which the investigators either directly evaluated or predicted the effects of preventive or rehabilitative interventions on the reduction of musculoskeletal symptoms in oral health care professionals.
Results. The authors identified and screened 3,571 unique abstracts, assessed 256 full-text articles for eligibility, and included 34 articles in the review. Investigators in 17 experimental studies described the results of preventive or rehabilitation interventions and in 17 survey research studies predicted or correlated preventive or protective techniques to a reduction in musculoskeletal symptoms. The primary techniques evaluated in the studies included equipment modification, ergonomic training, and physical exercise.
Conclusions and Practical Implications. The evidence suggests that magnification loupes and indirect-vision techniques have a positive effect on the reduction of musculoskeletal symptoms. In terms of evaluating intervention efficacy, other techniques have mixed evidence or are limited by low-level study design.
Keywords. Ergonomics; injury prevention; musculoskeletal disorders; dentists; dental hygienists
Krause, D., Ryan, S., Krpalek, D., Roll, S. C., Javaherian-Dysinger, H., & Daher, N. (2019). Participants’ perceptions of Kinesio tape for carpal tunnel syndrome: A qualitative study. Hand Therapy, 24(2), 37–47. https://doi.org/10.1177/1758998319841646 Show abstract
Introduction. Kinesio tape is an alternative non-surgical treatment approach for addressing symptoms of carpal tunnel syndrome. The purpose of the study was to investigate individuals’ experiences with the dorsal application of Kinesio tape for carpal tunnel syndrome management and its impact on pain and function.
Method. The study design was a limited phenomenological design study embedded in a randomized controlled trial. Daily symptom journals and semi-structured interviews were completed with 15 participants who were purposefully recruited and randomly allocated to the intervention group of a single blind randomized controlled trial. Kinesio tape was applied dorsally on the affected forearm, wrist, and digits for a duration of two weeks. Transcribed data were analyzed using descriptive coding, coding schemes, and frequency charts to identify emerging themes.
Results. Three themes emerged: Kinesio tape was positively perceived to be effective on decreasing pain, increasing self-efficacy, and improving daily functional performance on tasks previously avoided or abandoned. The most common problem identified was maintaining Kinesio tape on the hands and fingers, to which the majority of participants expressed a desire to learn application.
Discussion. Results of this study suggest that Kinesio tape is a positively perceived intervention for decreasing pain and increasing function for individuals with carpal tunnel syndrome and warrants further consideration as an alternative conservative intervention for carpal tunnel syndrome.
Keywords. Carpal tunnel syndrome, Kinesio tape, qualitative, functional performance
Aryal, A., Becerik-Gerber, B., Anselmo, F., Roll, S. C., & Lucas, G. (2019). Smart desks to promote comfort, health and productivity in offices: A vision for future workplaces. Frontiers in Built Environment, 5, 76. https://doi.org/10.3389/fbuil.2019.00076 Show abstract
People spend most of their day in buildings, and a large portion of the energy in buildings is used to control the indoor environment for creating acceptable conditions for occupants. However, majority of the building systems are controlled based on a ‘one size fits all’ scheme which cannot account for individual occupant preferences. This leads to discomfort, low satisfaction and negative impacts on occupants’ productivity, health and well-being. In this paper, we describe our vision of how recent advances in Internet of Things (IoT) and machine learning can be used to add intelligence to an office desk to personalize the environment around the user. The smart desk can learn individual user preferences for the indoor environment, personalize the environment based on user preferences, and act as an intelligent support system for improving user comfort, health and productivity. We briefly describe the recent advances made in different domains that can be leveraged to enhance occupant experience in buildings and describe the overall framework for the smart desk. We conclude the paper with a discussion of possible avenues for further research.
Keywords: Personalized environments, Smart desks, IoT (internet of things), Smart buildings, Indoor environment quality (IEQ)
Takata, S. C., Kysh, L., Mack, W. J., & Roll, S. C. (2019). Sonographic reference values of median nerve cross-sectional area: A protocol for a systematic review and meta-analysis. Systematic Reviews, 8(1), 2. https://doi.org/10.1186/s13643-018-0929-9 Show abstract
Background. Median nerve cross-sectional area (CSA) is the primary sonographic parameter for assessing and diagnosing median nerve pathology, such as carpal tunnel syndrome. However, variability in the sensitivity of diagnostic thresholds exists, which may be due to a lack of standardized normative reference values. Current estimates of normal median nerve CSA stem largely from small studies using a local pool of healthy controls. A systematic review and meta-analysis will be conducted to identify all available data for median nerve CSA in healthy, asymptomatic individuals to create a comprehensive set of normative reference values.
Methods. Articles that include sonographic measures of median nerve CSA will be identified through a rigorous search of published evidence, a hand search through tables of contents of key journals, and the gray literature, including ClinicalTrials.gov and conference abstracts. Each abstract and full text will be reviewed by multiple raters to identify studies from 2000 to present that include original data. Any study that provides median nerve CSA values from healthy individuals will be included (e.g., reference value study, control participants in a diagnostic study). Studies will be assessed for quality using a modified version of the National Institute of Health Study Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies, with primary focus on the use of a detailed and acceptable image acquisition and analysis protocol. Using data from included studies, reference values will be calculated for median nerve CSA by anatomical regions, including the distal forearm, wrist, and carpal tunnel at the level of the pisiform. Reference values will be stratified by gender, ethnicity, and age based upon the specificity of the data provided by the included articles.
Discussion. A comprehensive set of normative reference values of median nerve CSA will reduce variability across studies, allowing future research to more accurately evaluate and establish diagnostic thresholds. Additionally, normative values can serve as a reference for evaluating treatment outcomes and provide a means to investigate and understand minor nuances in CSA changes that may be indicative of preclinical stages of median nerve pathology.
Systematic review registration. PROSPERO 2016 CRD42016037286
Keywords. Meta-analysis, Systematic review, Musculoskeletal sonography, Median nerve, Reference values
Takata, S. C., & Roll, S. C. (2019). Identification of aberrant muscle bellies in the carpal tunnel using sonography. Journal of Diagnostic Medical Sonography, 35(1), 62–68. https://doi.org/10.1177/8756479318807469 Show abstract
Musculoskeletal sonography is being widely used for evaluation of structures within the carpal tunnel. While some anatomical variants, such as bifurcated median nerves and persistent median arteries, have been well documented, limited literature describes the sonographic appearance of aberrant muscle bellies within the carpal tunnel. Multiple examples of the sonographic appearance of flexor digitorum superficialis and lumbrical muscle bellies extending into the carpal tunnel are provided. Techniques for static image acquisition and analysis are discussed, and the use of dynamic imaging to confirm which specific muscle belly is involved is described. Knowledge of the potential presence of muscle bellies in these images and ability to identify these structures is vital to avoid misclassification or misdiagnosis as abnormal pathology. The case examples are situated among current published evidence regarding how such anomalies may be related to the development of pathologies, such as carpal tunnel syndrome.
Keywords. carpal tunnel, aberrant muscle, musculoskeletal sonography
Takata, S. C., Wade, E. T., & Roll, S. C. (2019). Hand therapy interventions, outcomes, and diagnoses evaluated over the last 10 years: A mapping review linking research to practice. Journal of Hand Therapy, 32(1), 1–9. https://doi.org/10.1016/j.jht.2017.05.018 Show abstract
Study Design. Mapping review.
Introduction. Although published literature and evidence to support medical practice is becoming more abundant, it is not known how well available evidence supports the full spectrum of hand therapy practice.
Purpose of the Study. The aim of this mapping review was to identify strengths and/or gaps in the available literature as compared with the hand therapy scope of practice to guide future research.
Methods. A systematic search and screening was conducted to identify evidence published from 2006 to 2015. Descriptive data from 191 studies were extracted, and the diagnoses, interventions, and outcomes used in the literature were compared with the hand therapy scope of practice.
Results. Osteoarthritis, tendon surgeries, and carpal tunnel syndrome were most frequently studied. Exercise, education, and orthotic interventions were most common, each used in more than 100 studies; only 12 studies used activity-based interventions. Primary outcome measures included range of motion, pain/symptoms, strength, and functional status.
Discussion. Abundant high-quality research exists for a portion of the hand therapy scope of practice; however, there is a paucity of evidence for numerous diagnoses and interventions.
Conclusions. More evidence is needed for complex diagnoses and activity-based interventions as well as behavioral and quality-of-care outcomes.
Level of Evidence. Not applicable.
Roll, S. C. (2019). Workers’ compensation. In K. Jacobs (Ed.), Occupational Therapy Manager (6th ed.). Bethesda, MD: AOTA Press.
Takata, S., Roll, S., & Wade, E. (2018). Linking research to practice for upper extremity musculoskeletal disorders: Interventions, outcomes, and diagnoses examined over 10 years [Presentation at the 2018 AOTA Annual Conference & Expo, Salt Lake City, UT]. American Journal of Occupational Therapy, 72(4, Suppl. 1), 7211505144p1. https://doi.org/10.5014/ajot.2018.72S1-RP302D Show abstract
This mapping review describes the scope of literature published over 10 years on the rehabilitation of upper extremity musculoskeletal disorders. Cross comparisons of diagnoses, interventions, and outcomes illuminate priorities for future work (e.g., occupation-based interventions and outcomes).
Takata, S., & Roll, S. C. (2018). Patient experiences of participating in mind–body interventions in an outpatient rehabilitation setting [Presentation at the 2018 AOTA Annual Conference & Expo, Salt Lake City, UT]. American Journal of Occupational Therapy, 72(4, Suppl. 1), 7211515237p1. https://doi.org/10.5014/ajot.2018.72S1-RP203C Show abstract
This study explored the experiences of eight patients with upper extremity disorders who participated in mind–body interventions in outpatient rehabilitation. Using a qualitative descriptive method, four themes emerged, alluding to multiple benefits of holistic practice.
Hardison, M., Black, D., & Roll, S. C. (2018). Effects of mind–body interventions on stress, anxiety, and pain in hand therapy patients [Presentation at the 2018 AOTA Annual Conference & Expo, Salt Lake City, UT]. American Journal of Occupational Therapy, 72(4, Suppl. 1), 7211515280p1. https://doi.org/10.5014/ajot.2018.72S1-RP302C Show abstract
This randomized, crossover pilot study explored the acute effects of mindfulness and visual biofeedback on pain, stress, and anxiety in hand therapy. Reduction in anxiety and trending reduction in stress within the experimental conditions indicate that a future, fully powered trial is warranted.
Roll, S., Hardison, M. E., & Colclazier, N. (2018). Risk assessment for musculoskeletal strain among dental hygienists: Validity and reliability of a video observation technique [Presentation at the 2018 AOTA Annual Conference & Expo, Salt Lake City, UT]. American Journal of Occupational Therapy, 72(4, Suppl. 1), 7211500023p1. https://doi.org/10.5014/ajot.2018.72S1-RP202B Show abstract
Upper extremity musculoskeletal injuries are common in dental hygienists. To enhance prevention, an ecologically valid observational technique for evaluating risks in dental hygiene practice is needed. This study describes a new video observation technique and reliability results.
Roll, S., Cristino, A., & Mitchell, J. (2018). Characterizing changes in the median nerve during hand grip using dynamic sonographic imaging [Poster presented at the 2018 ACR/ARHP Annual Meeting, Chicago, IL]. Arthritis & Rheumatology, 70(Suppl. 9). https://doi.org/10.1002/art.40700 Show abstract
Background/Purpose. Sonography is used to evaluate inflammation, identify joint changes, and measure morphology; dynamic assessment of tissue movement is an additional benefit. Dynamic sonographic identification of median nerve entrapment at the wrist during finger motion could improve understanding of carpal tunnel syndrome (CTS) etiology, as well as inform strategies to avert secondary CTS in patients with inflammatory conditions. This study aimed to evaluate a method for identifying and characterizing median nerve entrapment during functional grasp.
Methods. Healthy participants sat with their forearm on a table, palm up, and fingers in a relaxed position. A 12-MHz, linear transducer was placed in cross-section of the wrist at the level of the pisiform. Dynamic videos were obtained while the participant flexed the fingers until the tips touched the palm. Any compression of the median nerve was noted, nerve shape was identified at beginning and end of motion, and direction and distance of nerve displacement was measured. Frequencies/averages were calculated and chi-square/t-tests were used to compare right to left hands.
Results. Participants (N=51) were predominantly right-handed (92.5%) females (88.7%) with an average age of 24.4 years (SD, 3.5). During gripping, 72.5%/68.6% of participants had compression of the nerve in the right/left hands. From rest to grip, the frequency of angular or irregular shapes nearly doubled from 13.7% to 25.4%. Maximum nerve movement (mm) ranged from 0.76-1.08, 2.70-4.02, and 0.06-4.07 for vertical, horizontal, and endpoint displacement respectively; in 20% of hands, essentially no movement occurred. There were no significant differences between left and right, and no direction of movement predominated.
Conclusion. Despite being young and healthy, most participants had nerve compression during finger movement; some with significant entrapment (e.g., angular/irregular shapes). Longitudinal studies are needed to determine if these measures are a CTS predictor or risk factor. These methods can also be translated to clinical practice to inform personalized care for reducing or preventing symptoms in individuals with CTS and other inflammatory conditions.
Dhyani, M., Roll, S. C., Gilbertson, M. W., Orlowski, M., Anvari, A., Li, Q., Anthony, B., & Samir, A. E. (2017). A pilot study to precisely quantify forces applied by sonographers while scanning: A step toward reducing ergonomic injury. Work, 58(2), 241-247. https://doi.org/10.3233/WOR-172611 Show abstract
There is a significantly high rate of work-related musculsokeletal injuries in sonography professionals. To date, assessment of risk factors for work- related injuries in sonographers has been based primarily on surveys, subjective reports, and observational methods. There is a need to develop quantitative techniques to better understand risk factors and develop preventive interventions.
Objective. We pilot tested a high-resolution force-measuring probe capable of precisely measuring forces applied through the transducer by sonographers and used this novel direct measurement technique to evaluate forces during abdominal imaging.
Methods. Twelve sonographers with varied experience, ranging from 1-33 years, performed routine abdominal scans on 10 healthy volunteers who had varied body mass indices (BMI). Imaging was conducted using the force-measuring probe, which provided real-time measurement of forces, and angles. Data were compared by sonographer years of experience and subject BMI.
Results. In total, 47 abdominal examinations were performed as part of this study, and all images met standards for clinical diagnostic quality. The mean contact force applied across all exams was 8.2±4.3 Newtons (N) (range: 1.2-36.5 N). For subjects in the high BMI group (BMI>25, n = 4) the mean force was 10.5 N (range: 8.9-13.2 N) compared to 7.9 N (range: 5.9-10.9 N) for subjects with normal BMI (BMI = 18.5-25, n = 6). Similarly, the mean maximum force applied for subjects with high BMI (25.3 N) was significantly higher than force applied for subjects with normal BMI (17.4 N). No significant difference was noted in the amount of force applied by sonographers with more than 5 years of experience (n = 6) at 8.2 N (Range: 5.1-10.0 N) compared to less experienced sonographers (n = 6), whose forces averaged 8.1 N (Range: 5.8-10.0 N).
Conclusions. It is feasible to directly measure forces applied by sonographers using a high-resolution force measurement system. Forces applied during abdominal imaging vary widely, are significantly higher when scanning subjects with high BMI, and are not related to sonographer years of experience. This force measurement system has the potential to provide an additional quantitative data point to explore the impact of applied forces on sonographer related musculoskeletal injury, particularly in conjunction with various body positions, exam types and force durations.
Dhyani, M., Roll, S. C., Gilbertson, M. W., Orlowski, M., Anvari, A., Li, Q., Anthony, B., & Samir, A. E. (2017). Direct and precise quantification of forces applied by sonographers during abdominal imaging. Work, 52(2), 241-247. https://doi.org/10.3233/WOR-172611 Show abstract
Background. There is a significantly high rate of work-related musculsokeletal injuries in sonography professionals. To date, assessment of risk factors for work-related injuries in sonographers has been based primarily on surveys, subjective reports, and observational methods. There is a need to develop quantitative techniques to better understand risk factors and develop preventive interventions.
Objective. We pilot tested a high-resolution force-measuring probe capable of precisely measuring forces applied through the transducer by sonographers and used this novel direct measurement technique to evaluate forces during abdominal imaging.
Methods. Twelve sonographers with varied experience, ranging from 1-33 years, performed routine abdominal scans on 10 healthy volunteers who had varied body mass indices (BMI). Imaging was conducted using the force-measuring probe, which provided real-time measurement of forces, and angles. Data were compared by sonographer years of experience and subject BMI.
Results. In total, 47 abdominal examinations were performed as part of this study, and all images met standards for clinical diagnostic quality. The mean contact force applied across all exams was 8.2±4.3 Newtons (N) (range: 1.2-36.5N). For subjects in the high BMI group (BMI>25, n=4) the mean force was 10.5N (range: 8.9-13.2N) compared to 7.9N (range: 5.9-10.9N) for subjects with normal BMI (BMI=18.5-25, n=6). Similarly, the mean maximum force applied for subjects with high BMI (25.3N) was significantly higher than force applied for subjects with normal BMI (17.4N). No significant difference was noted in the amount of force applied by sonographers with more than 5 years of experience (n=6) at 8.2N (Range: 5.1-10.0N) compared to less experienced sonographers (n=6), whose forces averaged 8.1N (Range: 5.8-10.0N).
Conclusions. It is feasible to directly measure forces applied by sonographers using a high-resolution force measurement system. Forces applied during abdominal imaging vary widely, are significantly higher when scanning subjects with high BMI, and are not related to sonographer years of experience. This force measurement system has the potential to provide an additional quantitative data point to explore the impact of applied forces on sonographer related musculoskeletal injury, particularly in conjunction with various body positions, exam types and force durations.
Roll, S. C. (2017). Embracing the expanding horizons of diagnostic medical sonography: Clinical innovation, interdisciplinary growth, and scientific discovery. Journal of Diagnostic Medical Sonography, 33(2), 81-82. https://doi.org/10.1177/8756479317698665
Hardison, M. E., & Roll, S. C. (2017). Factors associated with success in an occupational rehabilitation program for work-related musculoskeletal disorders. American Journal of Occupational Therapy, 71(1), 7101190040p1-7101190040p8. https://doi.org/10.5014/ajot.2016.023200 Show abstract
Work-related musculoskeletal disorders are a significant burden; however, no consensus has been reached on how to maximize occupational rehabilitation programs for people with these disorders, and the impact of simulating work tasks as a mode of intervention has not been well examined. In this retrospective cohort study, the authors used logistic regression to identify client and program factors predicting success for 95 clients in a general occupational rehabilitation program and 71 clients in a comprehensive occupational rehabilitation program. The final predictive model for general rehabilitation included gender, number of sessions completed, and performance of work simulation activities. Maximum hours per session was the only significant predictor of success in the comprehensive rehabilitation program. This study identifies new factors associated with success in occupational rehabilitation, specifically highlighting the importance of intensity (i.e., session length and number of sessions) of therapy and occupation-based activities for this population.
Marik, T. L., & Roll, S. C. (2017). Effectiveness of occupational therapy interventions for musculoskeletal shoulder conditions: A systematic review. American Journal of Occupational Therapy, 71(1), 7101180020p1-7101180020p11. https://doi.org/10.5014/ajot.2017.023127 Show abstract
People with musculoskeletal disorders of the shoulder commonly experience pain, decreased strength, and restricted range of motion (ROM) that limit participation in meaningful occupational activities. The purpose of this systematic review was to evaluate the current evidence for interventions within the occupational therapy scope of practice that address pain reduction and increase participation in functional activities. Seventy-six studies were reviewed for this study-67 of Level I evidence, 7 of Level II evidence, and 2 of Level III evidence. Strong evidence was found that ROM, strengthening exercises, and joint mobilizations can improve function and decrease pain. The evidence to support physical modalities is moderate to mixed, depending on the shoulder disorder. Occupational therapy practitioners can use this evidence to guide daily clinical decision making.
Roll, S. C., & Hardison, M. E. (2017). Effectiveness of occupational therapy interventions for adults with musculoskeletal conditions of the forearm, wrist, and hand: A systematic review. American Journal of Occupational Therapy, 71(1), 7101180010p1-7101180010p12. https://doi.org/10.5014/ajot.2017.023234 Show abstract
Occupational therapy practitioners are key health care providers for people with musculoskeletal disorders of the distal upper extremity. It is imperative that practitioners understand the most effective and efficient means for remediating impairments and supporting clients in progressing to independence in purposeful occupations. This systematic review provides an update to a previous review by summarizing articles published between 2006 and July 2014 related to the focused question, What is the evidence for the effect of occupational therapy interventions on functional outcomes for adults with musculoskeletal disorders of the forearm, wrist, and hand? A total of 59 articles were reviewed. Evidence for interventions was synthesized by condition within bone, joint, and general hand disorders; peripheral nerve disorders; and tendon disorders. The strongest evidence supports postsurgical early active motion protocols and splinting for various conditions. Very few studies have examined occupation-based interventions. Implications for occupational therapy practice and research are provided.
Gray, J. M., Frank, G., & Roll, S. C. (2017). Integrating musculoskeletal sonography into rehabilitation: Therapists' experiences with training and implementation. OTJR: Occupation, Participation and Health, 37(1), 40-49. https://doi.org/10.1177/1539449216681275 Show abstract
Musculoskeletal sonography is rapidly extending beyond radiology; however, best practices for successful integration into new practice contexts are unknown. This study explored non-physician experiences with the processes of training and integration of musculoskeletal sonography into rehabilitation. Qualitative data were captured through multiple sources, and iterative thematic analysis was used to describe two occupational therapists' experiences. The dominant emerging theme was competency, in three domains: technical, procedural, and analytical. In addition, three practice considerations were illuminated: (a) understanding imaging within the dynamics of rehabilitation, (b) navigating nuances of interprofessional care, and (c) implications for post-professional training. Findings indicate that sonography training for rehabilitation providers requires multi-level competency development and consideration of practice complexities. These data lay a foundation on which to explore and develop best practices for incorporating sonographic imaging into the clinic as a means for engaging clients as active participants in the rehabilitation process to improve health and rehabilitation outcomes.
Roll, S. C. (2016). Current evidence and opportunities for expanding the role of occupational therapy for adults with musculoskeletal conditions. American Journal of Occupational Therapy, 71(1), 7101170010p1-7101170010p5. https://doi.org/10.5014/ajot.2017.711002 Show abstract
Musculoskeletal conditions are the second greatest cause of disability worldwide, and chronic musculoskeletal conditions affect nearly the same percentage of the general population as chronic circulatory and respiratory conditions combined. Moreover, people with musculoskeletal conditions experience a significant decline in independence with daily activities and occupational performance, key areas targeted by occupational therapy interventions. This special issue of the American Journal of Occupational Therapy provides comprehensive summaries of evidence for the care of common musculoskeletal conditions, highlights important implications that support evidence-informed practice, and proposes ways to advance the practice of occupational therapy to improve the lives of people with musculoskeletal conditions.
Hardison, M., & Roll, S. C. (2016). Mindfulness for physical rehabilitation in occupational therapy: A scoping review [Poster presented at the 2016 AOTA Annual Conference & Expo, Chicago, IL]. American Journal of Occupational Therapy, 70(4, Suppl. 1), 7011505137p1. https://doi.org/10.5014/ajot.2016.70S1-PO4041 Show abstract
This scoping review describes how mindfulness interventions are being used for rehabilitation of physical disorders. Mindfulness interventions fit within the scope of occupational therapy for physical disorders, but there is a dearth of research translating this to practice-based settings.
Hardison, M. E., & Roll, S. C. (2016). Mindfulness interventions in physical rehabilitation: A scoping review. American Journal of Occupational Therapy, 70(3), 7003290030p1-7003290030p9. https://doi.org/10.5014/ajot.2016.018069 Show abstract
A scoping review was conducted to describe how mindfulness is used in physical rehabilitation, identify implications for occupational therapy practice, and guide future research on clinical mindfulness interventions. A systematic search of four literature databases produced 1,524 original abstracts, of which 16 articles were included. Although only 3 Level I or II studies were identified, the literature included suggests that mindfulness interventions are helpful for patients with musculoskeletal and chronic pain disorders and demonstrate trends toward outcome improvements for patients with neurocognitive and neuromotor disorders. Only 2 studies included an occupational therapist as the primary mindfulness provider, but all mindfulness interventions in the selected studies fit within the occupational therapy scope of practice according to the American Occupational Therapy Association's Occupational Therapy Practice Framework: Domain and Process. Higher-level research is needed to evaluate the effects of mindfulness interventions in physical rehabilitation and to determine best practices for the use of mindfulness by occupational therapy practitioners.
Roll, S. C., Asai, C., & Tsai, J. (2016). Clinical utilization of musculoskeletal sonography involving non-physician rehabilitation providers: A scoping review. European Journal of Physical and Rehabilitation Medicine, 52(2), 253-262. Full text Show abstract
Background. Musculoskeletal sonography use in point-of-care physical medicine and rehabilitation is rapidly expanding, not only by physiatrists, but also by non-physician rehabilitation providers.
Aim. To evaluate the current range, extent and nature of literature and to identify emerging areas of evidence for the use of musculoskeletal sonography involving non-physician rehabilitation providers to guide research and clinical practice.
Design. Scoping Review
Setting. Inpatient, Outpatient, Other
Population. Musculoskeletal conditions
Methods. Five databases were searched and 578 unique abstracts were identified and screened for eligibility. Three raters independently read 68 full texts and 36 articles that reported on applied uses of sonography by non-physician rehabilitation providers were included.
Results. Eighteen studies described direct clinical use, primarily for outcomes measurement (n=12) or as a biofeedback intervention (n=10). Twelve laboratory studies were included that related morphology to patient reports or validated clinical interventions. Six additional studies, although not involving non-physician providers, were included as they presented potential valuable uses that were not noted in the other included studies, such as monitoring bone healing, tendon repair, and evaluation of idiopathic symptom reports or non-specific primary diagnoses.
Conclusion. This review indicates that non-physician rehabilitation providers use sonography for outcomes measurement and biofeedback interventions. Research is needed to evaluate effects of these uses on patient outcomes and to explore additional potential uses for clinical reasoning, treatment planning, and monitoring of tissue healing related to intervention.
Clinical Rehabilitation Impact. Implementation of musculoskeletal sonography by non-physician rehabilitation providers has the potential to be a critically advantageous addition to improve care.
Hegmann, K. T., Melhorn, J. M., Ausfahl, J., Freshwater, M. F., Prezzia, C. P., Rempel, D. M., Roll, S. C., Rollins, R. J., Werner, R. A., & Zaremski, J. (2016). ACOEM hand, wrist, and forearm disorders guideline. Westminster, CO: Reed Group. Full text
Roll, S. C., McLaughlin Gray, J., Frank, G., & Wolkoff, M. (2015). Therapist perceptions of the utility of sonographic imaging in the rehabilitation of musculoskeletal disorders [Poster presented at the 2015 AOTA Annual Conference & Expo, Nashville, TN]. American Journal of Occupational Therapy, 69(Suppl. 1), 6911515064p1. https://doi.org/10.5014/ajot.2015.69S1-PO2093 Show abstract
Sonography is a relatively inexpensive imaging modality that provides real-time, dynamic views of anatomical structures. This session will discuss the results of a qualitative descriptive study that revealed a wide range of uses for sonography by occupational therapists.
Roll, S. C., Gray, J. M., Frank, G., & Wolkoff, M. (2015). Exploring occupational therapists' perceptions of the usefulness of musculoskeletal sonography in upper-extremity rehabilitation [Brief report]. American Journal of Occupational Therapy, 69(4), 6904350020p1-6904350020p6. https://doi.org/10.5014/ajot.2015.016436 Show abstract
Objective. To identify the potential utility of musculoskeletal sonographic imaging in upper-extremity rehabilitation.
Method. Two occupational therapists in an outpatient hand rehabilitation clinic were recruited by convenience, were trained in the use of sonography, and implemented sonographic imaging in their clinical practice. Qualitative data were obtained during and after the implementation period by means of questionnaires and interviews. Data collection, analysis, and interpretation were completed in an iterative process that culminated in a thematic analysis of the therapists' perceptions.
Results. The data indicate four potential areas of utility for musculoskeletal sonography in upper-extremity rehabilitation: (1) mastering anatomy and pathology, (2) augmenting clinical reasoning, (3) supplementing intervention, and (4) building evidence.
Conclusion. Numerous potential uses were identified that would benefit both therapist and client. Further exploration of complexities and efficacy for increasing patient outcomes is recommended to determine best practices for the use of musculoskeletal sonography in upper-extremity rehabilitation.
Roll, S. C., Volz, K. R., Fahy, C. M., & Evans, K. D. (2015). Carpal tunnel syndrome severity staging using sonographic and clinical measures. Muscle & Nerve, 51(6), 838-845. https://doi.org/10.1002/mus.24478 Show abstract
Introduction. Ultrasonography may be valuable in staging carpal tunnel syndrome severity, especially by combining multiple measures. This study aimed to develop a preliminary severity staging model using multiple sonographic and clinical measures.
Methods. Measures were obtained in 104 participants. Multiple categorization structures for each variable were correlated to diagnostic severity based on nerve conduction. Goodness-of-fit was evaluated for models using iterative combinations of highly correlated variables. Using the best-fit model, a preliminary scoring system was developed, and frequency of misclassification was calculated.
Results. The severity staging model with best fit (Rho 0.90) included patient-reported symptoms, functional deficits, provocative testing, nerve cross-sectional area, and nerve longitudinal appearance. An 8-point scoring scale classified severity accurately for 79.8% of participants.
Discussion. This severity staging model is a novel approach to carpal tunnel syndrome evaluation. Including more sensitive measures of nerve vascularity, nerve excursion, or other emerging techniques may refine this preliminary model.
Roll, S. C. (2015). Role of sonographic imaging in occupational therapy practice [In brief]. American Journal of Occupational Therapy, 69(3), 6903360010p1-6903360010p8. https://doi.org/10.5014/ajot.2015.015941 Show abstract
Occupational therapy practice is grounded in the delivery of occupation-centered, patient-driven treatments that engage clients in the process of doing to improve health. As emerging technologies, such as medical imaging, find their way into rehabilitation practice, it is imperative that occupational therapy practitioners assess whether and how these tools can be incorporated into treatment regimens that are dually responsive to the medical model of health care and to the profession's foundation in occupation. Most medical imaging modalities have a discrete place in occupation-based intervention as outcome measures or for patient education; however, sonographic imaging has the potential to blend multiple occupational therapy practice forms to document treatment outcomes, inform clinical reasoning, and facilitate improved functional performance when used as an accessory tool in direct intervention. Use of medical imaging is discussed as it relates to occupational foundations and the professional role within the context of providing efficient, effective patient-centered rehabilitative care.
Roll, S. C., Gray, J. M., & Frank, G. (2015). Competency development and complexities of clinical integration of musculoskeletal sonography by non-physician rehabilitation providers [Paper presented at the 2015 AIUM Annual Convention and Preconvention Program Hosting WFUMB Congress]. Ultrasound in Medicine and Biology, 41(Suppl. 4), S20. https://doi.org/10.1016/j.ultrasmedbio.2014.12.124 Show abstract
Objectives. Non-physician rehabilitation providers (e.g., occupational/physical therapists) have requisite expertise for effective use of point-of-care musculoskeletal sonography (MSKUS); however, professional curriculums provide only introductory-level image interpretation, at best. This multi-method study evaluated post-professional competency development and the complexities of clinical integration of MSKUS by non-physician rehabilitation providers.
Methods. Three occupational therapists (OTs) received weekly, 2-3 hour, hands-on training from a RMSK-credentialed OT for 3 months. Training included ultrasound physics, imaging protocols, image acquisition, optimization and analysis. Prior to implementing MSKUS in the hand therapy clinic, minmum competency for selecting protocols, acquiring and interpreating images was determined using patient scenerios. During a 10-month implementation, therapists self-rated competency in image acquisition and interpretation on a 10-point visual analogue scale following each MSKUS use. Data were divided into early, mid, and late time periods to evaluate competency development. Semi-structured interviews throughout and following implementation provided deeper understanding of the complexities of clinical integration. Three researchers identified themes through interative anlaysis of interview transcripts and multiple consensus meetings.
Results. Competency for acquiring images significantly increased (p < .05) between the early and mid phase (4.9 to 6.9), whereas competency for image interpretation did not show a significant increase until the late phase (5.8 to 7.6). Qualitative themes included numerous technical competencies nested within real-time interaction with the client, as well as perceived clinical use and professional constraints.
Conclusions. Utilization of MSKUS by non-physician rehabilitation providers diverged from diagnostic techniques to patient-centered applications (e.g., education, biofeedback). Post-professional MSKUS training programs for these providers will require an unique approach to address the various nested competencies and clinical considerations that differ from training provided to physicians and sonographers.
Roll, S. C., Rana, M., Sigward, S., Yani, M., Kirages, D., & Kutch, J. (2015). Cadaveric validation and in-vivo measurement reliability of a novel linear-array transperineal sonographic evaluation of male pelvic floor structures [Electronic poster presented at the 2015 AIUM Annual Convention and Preconvention Program Hosting WFUMB Congress]. Ultrasound in Medicine and Biology, 41(4, suppl.), S103. https://doi.org/10.1016/j.ultrasmedbio.2014.12.426 Show abstract
Objectives. Rigorous reliability and validity data for emerging male pelvic floor imaging protocols has not been reported. This study validated and examined reliability of a novel linear-array, transperineal sonographic approach for evaluating superficial male pelvic floor structures.
Methods. The superficial pelvic muscles (bulbospongiosus (BS), ischiocavernosus (IC), bony landmarks, and the bulb of the penis were identified via dissection of two embalmed male cadavers. Relative depth and orientation of these structures were compared to sonograms obtained from two male participants, resulting in standardization of the imaging protocol and providing face validity for image analysis. Transverse images were then obtained from 20 male participants (GE Logiq E9, 11-Linear) at two time points. Three raters measured cross-sectional area (CSA) and linear thickness of the bulb of the penis, urethra, BS and IC muscles in three seperate trials for each of 38 images (2 participants lost to follow-up). Two-way, mixed effects intra-class correlation coefficients (ICC) were calculated within repeated trials by rater (intra-rater) and across raters (inter-rater). Minimum acceptable reliability for this study was set at 0.60.
Results. Measures of the bulb of the penis had excellent reliability (ICC > 0.90), CSA of all muscles had good reliability (ICC [0.70-0.92]), and thickness of the BS near its central tendon had good reliability (ICC > 0.80). For rater identified thickest region of the muscles and all urethra measures, reliability was poor-to-fair (ICC [0.50-0.85]) and varied widely, with most lower bounds of confidence intervals falling below the acceptability threshold (<0.60). Intra-rater reliability was similar across the three raters who had varied sonography experience and pelvic knoweldge.
Conclusions. The superficial structures of the male pelvic floor can validly identified and CSAs can be reliably measured using this sonographic approach. This approach can be used to advance knoweldge and practice for patients with pelvic disorders through the investigation of morphologic differences from healthy controls and the evaluation of clinical intervention effects.
Roll, S. C., Rana, M., Sigward, S. M., Yani, M. S., Kirages, D. J., & Kutch, J. J. (2015). Reliability of superficial male pelvic floor structural measurements using linear-array transperineal sonography. Ultrasound in Medicine & Biology, 41(2), 610-617. https://doi.org/10.1016/j.ultrasmedbio.2014.09.008 Show abstract
This study evaluated reliability of measures for superficial structures of the male pelvic floor (PF) obtained via transperineal sonography. Two embalmed cadavers were dissected to identify positioning of muscles on and around the bulb of the penis and to confirm the PF protocol. Cross-sectional area (CSA) and linear thickness of the bulb of the penis, urethra, bulbospongiosus (BS) muscles, and ischiocavernosus (IC) muscles were measured on 38 transverse images from 20 male patients by three raters with varied study knowledge and sonographic experience. Intra- and inter-rater reliability were calculated with two-way, mixed effects intra-class correlation coefficients. Measures of the bulb of the penis had the best reliability. CSA of all muscles and sagittal thickness of the BS near the central tendon had good reliability. Reliability varied for rater-identified thickest muscle region and measures of the urethra. Our study suggests that structures of the male PF can be reliably evaluated using a transperineal sonographic approach.
Roll, S. C. (2015). Carpal tunnel syndrome: Improving intervention effectiveness. Brockton, MA: Specialty Commerce Publishing. Full text
Roll, S. C., Darragh, A. R., O'Brien, J. C., & Fosjer, T. F. (2014). In memoriam: Jane Douglas Case-Smith (September 5, 1953 – July 30, 2014). OTJR: Occupation, Participation and Health, 34(4), 171-175. https://doi.org/10.3928/15394492-20141006-03
Evans, K. D., Volz, K. R., Pargeon, R. L., Fout, L. T., Buford, J., & Roll, S. C. (2014). Use of contrast enhanced sonography to investigate intraneural vascularity in a cohort of macaca fascicularis with suspected median mononeuropathy. Journal of Ultrasound in Medicine, 33(1), 103-109. https://doi.org/10.7863/ultra.33.1.103 Show abstract
Objectives. The purpose of this study was to provide clinical evidence of the use of contrast-enhanced sonography in detecting and quantifying changes in intraneural vascularity due to median mononeuropathy.
Methods. Five Macaca fascicularis monkeys were exposed to 20 weeks of repetitive work to increase their risk of developing median mononeuropathy. Contrast-enhanced sonograms were obtained in 30-second increments for 7 minutes while a contrast agent was being delivered. Data were collected immediately at the conclusion of the 20-week work exposure and then again during a recovery phase approximately 3 months after the completion of work. Quantitative analysis and trend graphs were used to analyze median nerve perfusion intensity. This study also compared the use of both manual counting of pixels and semiautomatic measurement using specialized software.
Results. Based on the average data, maximum intensity values were identified as the best indicators of nerve hyperemia. Paired t tests demonstrated significantly higher maximum intensities in the working stage for 4 of the 5 subjects (P < .01).
Conclusions. This study provides preliminary evidence that (1) in a controlled exposure model, a change in intraneural vascularity of the median nerve between working and recovery can be observed; (2) this vascular change can be measured using an objective technique that quantifies the intensity of vascularity; and (3) contrast-enhanced sonography may improve the ability to reliably capture and measure low-flow microvascularity.
Roll, S. C., Selhorst, L., & Evans, K. D. (2014). Contribution of positioning to work-related musculoskeletal discomfort in diagnostic medical sonographers. Work, 47(2), 253-260. https://doi.org/10.3233/WOR-121579 Show abstract
Background. Musculoskeletal pain and discomfort due to work exposure is experienced by 90% of sonographers. Survey research has provided a wealth of information to document this problem, but few studies have attempted to directly measure and identify the source of these disorders.
Objective. This pilot observational study was conducted to obtain direct measures of the relationship of sonographers to their environment during the completion of sonographic examinations.
Methods. The Rapid Upper Limb Assessment (RULA) was used to evaluate the positions of five sonographers during 24 sonographic examinations. The observed positions were compared among the various examinations and the association of these observed postures to discomfort, sonographer height, and exam table height was evaluated.
Results. All participants reported an increase in musculoskeletal discomfort at the end of the workday. Overall RULA scores ranged from 3.11 to 5.00 with upper extremity venous Doppler and transvaginal pelvic examinations averaging the highest. Increasingly poor upper extremity positioning was positively associated with increased musculoskeletal discomfort (r = 0.53, p < 0.01).
Conclusions. Regardless of the examination being performed, sonographers are working in positions that require further evaluation and intervention. Longitudinal studies are needed that evaluate the inter-relationship of biopsychosocial risk factors of musculoskeletal injuries.
Roll, S. C., Evans, K. D., Volz, K. R., & Sommerich, C. M. (2013). Longitudinal design for sonographic measurement of median nerve swelling with controlled exposure to physical work using an animal model. Ultrasound in Medicine & Biology, 39(12), 2492-2497. https://doi.org/10.1016/j.ultrasmedbio.2013.08.008 Show abstract
In the study described here, we examined the feasibility of a longitudinal design to measure sonographically swelling of the median nerve caused by controlled exposure to a work task and to evaluate the relationship of changes in morphology to diagnostic standards. Fifteen macaques, Macaca fascicularis, pinched a lever in various wrist positions at a self-regulated pace (8 h/d, 5 d/wk, 18–20 wk). Nerve conduction velocity (NCV) and cross sectional area (CSA) were measured every 2 wk from baseline through working and a 6-wk recovery. Trending across all subjects revealed that NCV slowed and CSA at the carpal tunnel increased in the working arm, whereas no changes were observed in CSA either at the forearm or for any measure in the non-working arm. There was a small negative correlation between NCV and CSA in the working arm. This study provides validation that swelling can be observed using a longitudinal design. Longitudinal human studies are needed to describe the trajectory of nerve swelling for early identification of median nerve pathology.
Evans, K. D., Volz, K. R., Roll, S. C., Hutmire, C. M., Pargeon, R. L., Buford, J. A., & Sommerich, C. M. (2013). Establishing an imaging protocol for detection of vascularity within the median nerve using contrast enhanced ultrasound. Journal of Diagnostic Medical Sonography, 29(5), 201-207. https://doi.org/10.1177/8756479313503211 Show abstract
This preclinical study was conducted to develop discrete sonographic instrumentation settings and also safe contrast dosing that would consistently demonstrate perineural vascularity along the median nerve. This set of imaging studies was conducted with a convenience cohort of young adult female monkeys (Macaca fascicularis). Sonographic equipment settings and dosing were refined throughout the imaging series to ensure consistent contrast-enhanced ultrasound imaging. A mechanical index of 0.13 was consistently used for imaging. Perineural vessels were imaged with a suspension solution of 0.04 mL Definity/0.96 mL saline introduced over 5 minutes for a total dose of 0.8 mL of contrast solution. Blinded studies of high and low dose contrast, along with saline injections, were correctly identified by two experienced sonographers. This preclinical study established adequate equipment settings and dosing that allowed for a valid demonstration of vascularity surrounding the median nerve.
Roll, S. C., Evans, K. D., Volz, K. R., & Sommerich, C. M. (2013). Longitudinal analysis of grayscale imaging and electromyography in an animal model of carpal tunnel syndrome. Journal of Ultrasound in Medicine, 32(Suppl), S49.
Evans, K. D., Roll, S. C., Volz, K. R., & Freimer, M. (2013). [Reply] Nerve Blood Flow. Journal of Ultrasound in Medicine, 32(1), 188-189. Full text
Roll, S. C., Evans, K. D., Li, X., Sommerich, C. M., & Case-Smith, J. (2013). Importance of tissue morphology relative to patient reports of symptoms and functional limitations resulting from median nerve pathology. American Journal of Occupational Therapy, 67(1), 64-72. https://doi.org/10.5014/ajot.2013.005785 Show abstract
Significant data exist for the personal, environmental, and occupational risk factors for carpal tunnel syndrome. Few data, however, explain the interrelationship of tissue morphology to these factors among patients with clinical presentation of median nerve pathology. Therefore, our primary objective was to examine the relationship of various risk factors that may be predictive of subjective reports of symptoms or functional deficits accounting for median nerve morphology. Using diagnostic ultrasonography, we observed real-time median nerve morphology among 88 participants with varying reports of symptoms or functional limitations resulting from median nerve pathology. Body mass index, educational level, and nerve morphology were the primary predictive factors. Monitoring median nerve morphology with ultrasonography may provide valuable information for clinicians treating patients with symptoms of median nerve pathology. Sonographic measurements may be a useful clinical tool for improving treatment planning and provision, documenting patient status, or measuring clinical outcomes of prevention and rehabilitation interventions.
Roll, S. C., & Kutch, J. J. (2013). Transperineal sonography evaluation of muscles and vascularity in the male pelvic floor. Journal of Diagnostic Medical Sonography, 29(1), 3-10. https://doi.org/10.1177/8756479312472394 Show abstract
Idiopathic chronic male pelvic pain is difficult to diagnose and treat. Currently, diagnosis relies on subjective symptoms; objective measures of neuromuscular mechanisms have not been investigated. Sonographic imaging has been used to investigate these neuromuscular mechanisms in the female pelvic floor, but neither research nor books describe sonography evaluation of the male pelvic floor. The purpose of this study was to develop and evaluate a perineal sonographic technique for the examination of the male pelvic floor muscles. Anatomic landmarks were identified with images collected from two subjects, one with intermittent reports of pelvic pain and one with no history of pain in the pelvic region. A description of the equipment settings, the examination protocol, and the resulting comparative image analysis is included. A validated protocol such as this may be useful in documenting differences in the soft tissue structures between asymptomatic individuals and patients with chronic pelvic pain to aid in diagnosis and treatment. This is the first known study to report sonographic findings of the individual muscles in the male pelvic floor, and additional research is needed to validate the techniques that have been deemed feasible.
Roll, S. C. (2012). Injuries and prevention in health care providers. Work, 42(3), 309-310. https://doi.org/10.3233/WOR-2012-1439
Roll, S. C., Evans, K. D., Hutmire, C. D., & Baker, J. P. (2012). An analysis of occupational factors related to shoulder discomfort in diagnostic medical sonographers and vascular technologists. Work, 42(3), 355-365. https://doi.org/10.3233/WOR-2012-1434 Show abstract
Objective. Three-fourths of diagnostic medical sonographers (DMS) and vascular technologists (VT) experiencing discomfort due to job demands indicate having discomfort in the shoulder region. An analysis of factors related to shoulder discomfort highlighted salient factors requiring further investigation and intervention.
Methods. The responses of 2,163 DMS and VT from a survey of a representative sample were analyzed to determine personal factors, work demands, and workstation design characteristics of those experiencing discomfort in the shoulder region. Frequencies and response distributions were calculated and cross tabulation with chi-square analysis was completed.
Results. A majority of respondents with shoulder discomfort have co-morbid reports of discomfort in other locations. While overall sonographer discomfort is linked to age and years of experience, shoulder discomfort was also noted to be linked to specific workstation characteristics. A lack of adjustability in equipment, PACS workstations, and positions required to complete bedside exams contributes to discomfort due to sustained and repetitive shoulder abduction and twisting of the neck and trunk.
Conclusions. There is a need for studies investigating redesign of equipment and workstations or interventions with DMS and VT specifically focused on improving adjustability and improved positioning of sonographers in order to reduce shoulder discomfort while performing job demands.
Evans, K. D., Roll, S. C., Volz, K. R., & Freimer, M. (2012). Relationship between intraneural vascular flow measured with sonography and carpal tunnel syndrome diagnosis based on electrodiagnostic testing. Journal of Ultrasound in Medicine, 31(5), 729-736. Full text Show abstract
Objectives. The purpose of this study was to document and analyze intraneural vascular flow within the median nerve using power and spectral Doppler sonography and to determine the relationship of this vascular flow with diagnosis of carpal tunnel syndrome based on electrodiagnostic testing.
Methods. Power and spectral Doppler sonograms in the median nerve were prospectively collected in 47 symptomatic and 44 asymptomatic subjects. Doppler studies were conducted with a 12-MHz linear transducer. Strict inclusion criteria were established for postexamination assessment of waveforms; routine quality assurance was completed; electrodiagnostic tests were conducted on the same day as sonographic measurements; and the skin temperature was controlled. Included waveforms were categorized by location and averaged by individual for comparative analysis to electrodiagnostic testing.
Results. A total of 416 waveforms were collected, and 245 were retained for statistical analysis based on strict inclusion criteria. The mean spectral peak velocity among all waveforms was 4.42 (SD, 2.15) cm/s. At the level of the pisiform, the most consistent data point, mean peak systole, was 3.75 cm/s in symptomatic patients versus 4.26 cm/s in asymptomatic controls. Statistical trending showed an initial increase in the mean spectral peak velocity in symptomatic but diagnostically negative cases, with decreasing velocity as diagnostic categories progressed from mild to severe.
Conclusions. An inverse relationship may exist between intraneural vascular flow in the median nerve and an increasing severity of carpal tunnel syndrome based on nerve conduction results. Randomized controlled trials are needed to determine whether spectral Doppler sonography can provide an additive benefit for diagnosing the severity of carpal tunnel syndrome.
Evans, K. D., Volz, K. R., Hutmire, C., & Roll, S. C. (2012). Morphologic characterization of intraneural flow associated with median nerve pathology. Journal of Diagnostic Medical Sonography, 28(1), 11. https://doi.org/10.1177/8756479311426777 Show abstract
A prospective cohort of 47 symptomatic patients who reported for nerve conduction studies and 44 asymptomatic controls was examined with sonography to evaluate the median nerve. Doppler studies of the median nerve were collected with handheld sonography equipment and a 12-MHz linear broadband transducer. Strict inclusion criteria were established for assessing 435 waveforms from 166 wrists. Two sonographers agreed that 245 waveforms met the a priori criteria and analyzed the corresponding data. Spectral Doppler waveforms provided direct quantitative and qualitative data for comparison with indirect provocative testing results. These Doppler data were compared between the recruitment groups. No statistical difference existed in waveforms between the groups (P < .05). Trending of the overall data indicated that as the number of positive provocative tests increased, the mean peak systolic velocity within the carpal tunnel (mid) also increased, whereas the proximal mean peak systolic velocity decreased. However, by using multiple provocative tests as an indirect comparative measure, researchers may find mean peak spectral velocity at the carpal tunnel inlet a helpful direct measure in identifying patients with carpal tunnel syndrome.
Roll, S. C., Evans, K. D., Li, X., Freimer, M., & Sommerich, C. M. (2011). Screening for carpal tunnel syndrome using ultrasonography. Journal of Ultrasound in Medicine, 30(12), 1657-1667. Full text Show abstract
Objective. The use of ultrasonography in musculoskeletal research and clinical applications is increasing; however, measurement techniques for diagnosing carpal tunnel syndrome (CTS) with ultrasonography continue to be inconsistent. Novel methods of measurement utilizing internal comparisons to identify swelling of the median nerve (MN) require investigation and comparison to currently used techniques.
Methods. Flattening ratio of the MN, bowing of the flexor retinaculum, and cross-sectional area (CSA) of the MN were collected at the forearm, at the radio-carpal joint, and at the level of the pisiform in both symptomatic patients and asymptomatic controls. Electrodiagnostic testing (EDX) was completed in symptomatic patients as a diagnostic standard.
Results. MN measurements were collected from 166 wrists of symptomatic and asymptomatic subjects. Flattening ratio did not show any correlation to EDX and was identical between both symptomatic and asymptomatic subjects. Moderate to strong correlations were noted between EDX results and ultrasonographic measures of CSA at the pisiform, retinacular bowing, and both ratio and change of CSA between the forearm and pisiform. Area under the curve was large for all receiver operating curves for each measure [.759-.899] and sensitivity was high [80.4%-82.4%].
Conclusions. Measurement of swelling through a ratio or absolute change had similar diagnostic accuracy as individual measurement of CSA within the carpal tunnel. These measures may be useful to improve accuracy in more diverse clinical populations. Further refinement of protocols to identify the largest CSA within the carpal tunnel region and statistical methods to analyze clustered, multi-level outcome data is recommended to improve diagnostics.
Roll, S. C., Case-Smith, J., & Evans, K. D. (2011). Diagnostic accuracy of ultrasonography versus electromyography in carpal tunnel syndrome: A systematic review of literature. Ultrasound in Medicine and Biology, 37(10), 1539-1553. https://doi.org/10.1016/j.ultrasmedbio.2011.06.011 Show abstract
A plethora of research evaluates the utility of ultrasonography versus electrodiagnostic testing for diagnosis of carpal tunnel syndrome. Two limited reviews of literature were completed, but a full, systematic review has not been completed. We identified 582 abstracts published 1999-2009 through database searches, hand searches, and communication with authors, resulting in 23 high quality studies that met our inclusion criteria based on a rigorous, independent review. Significant discrepancies and methodological limitations in the description of ultrasonography protocols and diagnostic thresholds limited the ability to combine data and identify specific thresholds. The cross-sectional area of the median nerve within the carpal tunnel is the most stable measure and has high potential to correctly diagnose severe carpal tunnel syndrome. Further investigation of measures, especially those that can diagnose mild cases of CTS, is needed. Suggestions for clinical protocols and the utility of ultrasonography as a screening tool to compliment electrodiagnostic testing are reviewed.
Evans, K. D., Roll, S. C., Volz, K. R., & Sommerich, C. M. (2011). Spectral Doppler measurement of perineural flow within the median nerve compared to nerve conduction studies [Paper presented at the 13th World Congress of the World Federation for Ultrasound in Medicine and Biology, Vienna, Austria]. Official proceedings of the 13th Congress of the WFUMB 2011, 37(8S), S6. https://doi.org/10.1016/j.ultrasmedbio.2011.05.052 Show abstract
Purpose. To document and analyze perineural vascular flow within the median nerve utilizing power Doppler (PD) and spectral Doppler (SD) to determine a relationship with a nerve conduction study (NCS), for carpal tunnel syndrome (CTS) screening.
Material & Methods: PD and SD in the median nerve were prospectively collected with 47 symptomatic and 44 asymptomatic subjects. Doppler studies were conducted using GE Logiq i ultrasound equipment and a 12 MHz linear transducer. Strict inclusion criteria were established for post-examination assessment of waveforms. Median systolic peak measurements taken proximal, mid, and distal to the carpal tunnel inlet were categorized by location and averaged by individual for comparative analysis to NCS results.
Results. The data from all groups were statistically comparable with 27 waveforms at proximal, 42 at the mid, and 54 at the distal portion of the wrist. Control and negative NCS subjects had a mean spectral peak of 4.0 cm/sec. and severe NCS subjects had a spectral peak of 2.3 cm/sec. Statistical trending demonstrated that mean spectral peak data dropped as the diagnostic categories progressed from negative to severe.
Conclusion. An inverse relationship may exist between perineural vascular flow in the median nerve and increasing severity of nerve conduction, at the carpal tunnel inlet and distally. Further research is needed to determine if SD is a non-invasive alternative for diagnosing the severity of CTS.
Evans, K. D., Roll, S. C., Volz, K. R., Buford, J. A., & Sommerich, C. M. (2011). Ultrasound contrast-enhanced interrogation of the median nerve to document peripheral vascular flow in an animal model [Paper presented at the 13th World Congress of the World Federation for Ultrasound in Medicine and Biology, Vienna, Austria]. Official proceedings of the 13th Congress of the WFUMB 2011, 37(8S), S6. https://doi.org/10.1016/j.ultrasmedbio.2011.05.054 Show abstract
Purpose. To identify dosing and instrumentation while conducting contrast sonography to visualize perineural vascular flow, within the median nerve, in a group of Macaca fascicularis recovering from carpal tunnel syndrome (CTS).
Material & Methods. A pilot dosing study was conducted with Macaca fascicularis, which were trained to complete a repetitive task. Nerve conduction and gray-scale sonography data were collected on 8 subjects with documented CTS. The dosing study facilitated the capture of vascular fill time within both large and small vessels. Dosing and instrumentation were set using the subclavian and radial artery, to determine a mean vascular fill time. The Doppler studies were conducted with a GE Logiq 9 and a 9 MHz linear array transducer. Definity(R) was mixed with saline to provide an infusion contrast injection. Four injections and booster shots were administered while the subject was closely monitored.
Results. A transmit frequency of 6.0 MHz, MI of 0.13, and 7% output power was coupled with an infusion of 0.04 ml of Definity(R) and 0.8 ml saline. Booster infusions of 0.05 facilitated the capture of a vascular fill time of 1:30 mins in the subclavian and radial artery. The perineural vascular fill time was similar with these same infusion and equipment settings.
Conclusion. Although data was collected on 8 subjects, more subject results would provide convincing results on the vascular fill time associated with perineural vascular flow, post CTS diagnosis.
Roll, S. C., Evans, K. D., Freimer, M. L., Case-Smith, J., & Sommerich, C. M. (2011). Relationship of median nerve ultrasonographic measures to anthropometric and demographic factors for diagnosis of carpal tunnel syndrome [Paper presented at the 13th World Congress of the World Federation for Ultrasound in Medicine and Biology, Vienna, Austria]. Official proceedings of the 13th Congress of the WFUMB 2011, 37(8S), S6-7. https://doi.org/10.1016/j.ultrasmedbio.2011.05.055 Show abstract
Purpose. Numerous anthropometric measures, demographic characteristics, and occupational exposures have been suggested as contributory factors in development of carpal tunnel syndrome (CTS). This study investigated the relationship of these factors and physiologic changes in the median nerve (MN) measured with grey-scale ultrasonography (US) to symptoms of MN pathology.
Material & Methods. Age, gender, body mass index (BMI), wrist ratio, education, occupation, and MN US measures were collected (n = 88). The Boston Carpal Tunnel Questionnaire (BCTQ) identified complaints of MN pathology. Binary stepwise logistic regression was used to determine the contribution of US measures of cross-sectional area at the pisiform (CSAp), CSA change (forearm-pisiform), and retinacular bulge when considered with known factors in a model for predicting CTS complaints.
Results. Symptoms of MN pathology were reported by 56 subjects. BMI, education and CSAp were significant predictors of complaints in this exploratory regression model (r2 = 0.26, p = 0.001). CSAp odds ratio was 1.35 (p = .001) and BMI odds ratio was 1.10 (p = .04). Odds of complaints decreased as subjects moved from high school education to graduate education (0.535, p = .08).
Conclusion. This preliminary study indicates that changes in US measures of the MN nerve may provide more relevant information for predicting MN pathology than other previously studied factors. While larger homogeneous samples are required to validate these findings, these data provide evidence for continued investigation of US as a screening tool for MN pathology.
Roll, S. C., & Evans, K. D. (2011). Sonographic representation of bifid median nerve and persistent median artery. Journal of Diagnostic Medical Sonography, 27(2), 89-94. https://doi.org/10.1177/8756479311399763 Show abstract
Bifid median nerve and persistent median arteries are natural anatomic variants that exist in a small percentage of the population. This case describes a young woman who was referred for electrodiagnostic (EDX) testing of her right upper extremity because of a one-year history of numbness, tingling, and discomfort in her right upper extremity consistent with carpal tunnel syndrome. Careful sonographic scanning (gray scale and power Doppler) and dynamic investigation revealed a bifid median nerve and associated persistent median artery (PMA). The awareness of a bifid median nerve and PMA is important when evaluating patients sonographically for diagnosis of upper extremity pathology, including enlargement due to carpal tunnel syndrome. Furthermore, as musculoskeletal sonography increases in clinical practice, it is important to raise awareness of this dual anatomic variant to ensure that appropriate evaluation and treatment are provided. The sonographic presentation of anatomic variations in this case along with a review of these anomalies is provided for translational clinical use.
Evans, K. D., Roll, S. C., Hutmire, C. D., & Baker, J. P. (2010). Factors that contribute to wrist-hand-finger discomfort in diagnostic medical sonographers and vascular technologists. Journal of Diagnostic Medical Sonography, 26(3), 121-129. https://doi.org/10.1177/8756479310366471 Show abstract
A cross-sectional representative sample of 1722 sonographers and vascular technologists was analyzed using quantitative/qualitative methods to reveal that 60% are experiencing wrist-hand-finger discomfort, believed to be from work-related repetitive injury. The years of scanning accumulated by the participants was chosen as a variable to determine the relationship to the range of discomforts reported. A strong statistical correlation was noted between years of experience and the side of discomfort as well as the severity of hand-wrist-finger discomfort. In this study, a strong statistical association was also noted between increasing years of scanning and decreasing aggravation due to the transducer. A complete linkage between work-related exposure and hand-wrist-finger discomfort is difficult to make because of the contribution of leisure-time activities. A controlled experimental study is needed to determine the contribution that grip and pushing on the transducer may have on the incidence of hand-wrist-finger discomfort, leading to diagnoses such as carpal tunnel syndrome.
Evans, K. D., Roll, S. C., Li, X., & Sammet, S. (2010). A holistic evaluation of risk factors for work related musculoskeletal distress among asymptomatic sonographers performing neurosonology: A pilot study. Journal of Diagnostic Medical Sonography, 26(2), 64-78. https://doi.org/10.1177/8756479309352360 Show abstract
A pilot study was conducted to gather holistic data points on female sonographers who executed neonatal neurosonography over four portable scanning sessions. The hypothesis was that specific risk factors contributed to work-related musculoskeletal distress in the hand and wrist as a result of neonatal neurosonography. A preexperimental pre-post research design was used to gather data on work demands, self-rated physical and mental health, posture/position during scanning, physiologic change, and pain scores. No statistically significant changes were detected between pre-post measures for work demands, physical and mental health, or pain scores as a result of portable scanning sessions. The physiologic changes, between scanning sessions, were recorded with the use of a hand-carried sonographic unit. Sonographic measures were less than the published criteria for carpal tunnel syndrome with a proximal cross-sectional area ≥10 mm2 and an anterior bulge of the retinaculum of >4 mm. Sonography documented a statistically significant cross-sectional area change, within the median nerve, at the distal radius only after the first scanning session. Power and spectral Doppler was used to document perineural vascular flow within the median nerve, but it was not consistently obtained to allow for a rigorous comparison between pre- and post-scanning sessions. This is the first pilot study to explore using a hand-carried sonographic unit to document change in the median nerve for an isolated sonographic examination. The results are only reflective of these particular participants, but much larger N and shorter scanning sessions are needed to confirm the hypothesis proposed.
Evans, K. D., Roll, S. C., & Baker, J. (2009). Work-related musculoskeletal disorders (WRMDS) among registered diagnostic medical sonographers and vascular technologists: A representative sample. Journal of Diagnostic Medical Sonography, 25(6), 287-299. https://doi.org/10.1177/8756479309351748 Show abstract
Literature indicates a significant history of workr-elated musculoskeletal disorders (WRMSD) among diagnostic medical sonographers (DMS) and vascular technologist (VTs). To gather current data related to this historical trend, the authors administered a survey to a random and convenient sample of 5200 registered DMS and VTs. The invitation to complete the survey on a secure Web site yielded the largest participant sample to date of 2963 completed surveys (57% response). Data relative to the prevalence of WRMSD were analyzed and compared to other WRMSD research over the past decade. Results indicated that 90% of respondents were scanning in pain, a 9% increase since the last large scale survey in 1997. Across all demographics, shoulder pain is most common, with older and more experienced sonographers having more finger, hand, and wrist pain than other groups. Pain continues to be related to pressure applied to the transducer, abduction of the arm, and twisting of the neck and trunk. Ergonomic equipment and education are provided by application specialists, but the incidence of WRMSD appears to be unabated. Higher order research, including randomized trials, with education and ergonomic interventions is needed to protect DMS and VTs who are necessary to meet increasing health care demands.
Roll, S. C., & Evans, K. D. (2009). Feasibility of using a hand-carried sonographic unit for investigating median nerve pathology. Journal of Diagnostic Medical Sonography, 25(5), 241-249. https://doi.org/10.1177/8756479309345284 Show abstract
Numerous research studies describe the prevalence of work-related musculoskeletal disorders (WRMSD) in diagnostic medical sonographers, but little research has investigated contributing factors and biological changes in symptomatic individuals. Improved image quality and portability, combined with lower cost and dynamic capabilities, have led to increased use of sonography over magnetic resonance imaging (MRI) in musculoskeletal evaluations. The purpose of this pilot study was to develop a valid and reliable sonographic protocol for the evaluation of work-related median nerve pathology with a hand-carried sonographic unit. A GE Logiq I (Milwaukee, Wisconsin) hand-carried unit with a 12-MHz linear transducer was used to collect nine longitudinal and transverse images of the median nerve at various anatomical locations in the distal upper extremity of three healthy volunteers. Doppler waveforms were also collected in the median nerve sheath. Qualitative review indicated high-quality images with well-defined structures, resulting in valid measures between multiple researchers of anteriorposterior diameter, cross-sectional area, anterior transverse carpal ligament bulge, and Doppler flow. The use of a hand-carried sonographic unit appears to be a feasible alternative to MRI to detect musculoskeletal changes in symptomatic sonographers. Additional basic and clinical studies are necessary to validate the use of hand-carried sonography as a measure of biological changes in longitudinal WRMSD research.
Sommerich, C. M., Gumpina, R., Roll, S. C., Le, P., & Chandler, D. (2009, May). Investigating effects of controller algorithm on torque tool operator. Paper presented at the 2009 Industrial Engineering Research Conference, Miami, FL.
Mitigating on-the-job stress: Stress mapping with artificial intelligence >
USC Chan’s Shawn Roll leading interdisciplinary team on $1.1M National Science Foundation grant for managing, mitigating on-the-job stress.
March 29, 2023
Four new, early-stage projects selected for internal research funding >
Aims of projects include increasing social connections in mental health clubhouses, improving return-to-work, developing trauma-informed framework for minoritized families of autistic girls and better understanding autistic sensory strengths
February 3, 2023
Work-from-home survey reveals pandemic’s impacts upon employees’ physical and mental health, productivity and daily routines >
How to support office workers’ health and wellness, when the “office” can be located anywhere.
November 17, 2021
USC faculty win 2021 AOTF honors >
Three USC Chan faculty members have been honored with annual awards from the American Occupational Therapy Foundation. Shawn Roll PhD Program Director and Associate Professor Shawn Roll was named to the AOTF Academy of Research in Occupational Therapy. Inclusion in the academy recognizes exemplary,…
February 8, 2021
Video: Intelligent desk that promotes office worker health, wellness and productivity >
When you think of an intelligent machine, what comes to mind? Associate Professor Shawn Roll, co-principal investigator of the "Coadaptation of Intelligent Office Desks and Human Users to Promote Worker Productivity, Health and Wellness" study, helps explain the future of intelligent workspaces in…
November 21, 2019
Shawn Roll named Fellow of the American Institute of Ultrasound in Medicine >
The honor recognizes Roll's scholarly contributions to advancing sonography beyond traditional medical uses.
November 15, 2019
Five years in the making: My experiences in the Occupational Science PhD program and my advice for new and prospective students >
By Mark Hardison PhD ’19 Mark Hardison PhD ’19 Deciding to get a PhD is a big decision; at the USC Chan Division of Occupational Science and Occupational Therapy, it is a life-changing opportunity. It has completely transformed my understanding of science and clinical practice. More importantly,…
April 16, 2019
Delegation from PUHSC Visits Salt Lake City and Los Angeles | April 2018 >
Purpose In April, the USC Chan Division once again hosted a delegation from PUHSC at the annual conference of the American Occupational Therapy Association, held in April 2018 in Salt Lake City, Utah. In addition to conference-related educational and social activities, the delegation visited the…
July 23, 2018
China Initiative Visits Hong Kong, Beijing, and Fuzhou | December 2017 >
Purpose In December, a USC Chan China Initiative delegation visited Hong Kong, Beijing and Fuzhou. In Hong Kong, members of the team visited and dined with Mrs. T.H. Chan and her family including USC Trustee Ronnie C. Chan MBA ’76. In Beijing, team members attended and delivered presentations at…
February 15, 2018
The people who make you look good are suffering >
By Monica Luhar/Vice.com "For tattoo artists, hair stylists or anybody holding a device with the tendons contracted and potentially flexing or holding against resistance, that nerve might be getting compressed over time," says Shawn Roll, assistant professor of Occupational Science and Occupational…
March 7, 2017
Shawn Roll is guest editor of latest AJOT on musculoskeletal conditions >
Research journal issue kicks off profession's centennial anniversary celebrations
January 23, 2017
68 Trojans presenting at 2014 AOTA conference >
Congratulations to the 68 USC Trojan faculty, alumni, students and staff who presented at the 2014 Conference of the American Occupational Therapy Association, March 3-6 in Baltimore. Additionally of special note, alumnae Dottie Ecker Cert. ’58, MA ’68 and Sue Knox MA ’68, PhD ’97 were…
March 26, 2014
128 Trojans Presenting at 2013 AOTA Conference >
128 USC alumni, faculty, and students are scheduled to present at the 2013 Conference of the American Occupational Therapy Association, April 25-28 at the San Diego Convention Center. Presentation formats include a pre-conference institute, workshops, short courses, research and professional posters…
April 23, 2013
Assistant professor Shawn Roll publishes in latest issue of AJOT >
Assistant professor Shawn C. Roll is the lead author of Importance of Tissue Morphology Relative to Patient Reports of Symptoms and Functional Limitations Resulting From Median Nerve Pathology, published in the January/February 2013 issue of the American Journal of Occupational Therapy.…
January 14, 2013
46 Trojans Presenting at OTAC 2012 >
46 USC faculty, alumni, and students are scheduled to present lectures and/or posters during the Occupational Therapy Association of California 2012 Conference, October 4-7 in Pasadena. Click below to view the full list of USC presenters, to plan your conference accordingly, and remember to reunite…
October 1, 2012
USC Trojans Shine at 92nd AOTA Conference >
Division Associate Dean and current American Occupational Therapy Association President Florence Clark PhD (’82), OTR/L, FAOTA, presided over the 92nd annual AOTA conference, April 26-29, in Indianapolis, Ind. Conference highlights included a rousing Opening Ceremony, Clark's Presidential Address…
May 1, 2012
The Nature of Dangerous Construction Work is Radically Changing >
A new study spearheaded by the USC Sonny Astani Department of Civil & Environmental Engineering shows how on-site construction can go remote.
Matilda Bathurst, in USC Viterbi School of Engineering | March 13, 2023
Hybrid work can be healthy at home and the office >
Shawn Roll discusses the health tradeoffs of hybrid work arrangements.
Michael Precker, in American Heart Association News | April 27, 2022
Krank durchs Homeoffice [Home office sickness] >
Ob Rücken oder Seele – das Arbeiten im Homeoffice hat manche Bürokrankheit verschlimmert. Doch es gibt Auswege. Hier einige Tipps zur Vorbeugung. [Whether you're back to the workplace or only back in spirit, working from the home office has aggravated a number of health conditions. But keeping healthy at home is still possible, with some of these prevention tips.]
Felicitas Witte, in Frankfurter Allgemeine Zeitung [Frankfurt General Newspaper] | July 26, 2021
Survey reveals all the ways remote work is ruining the health of Americans >
A new survey, co-conducted by USC Chan Professor Shawn Roll, of nearly 1,000 people reports more than 64 percent of working Americans have developed new physical health problems while working from home during the pandemic, and nearly 75 percent are dealing with at least one new mental health issue.
John Anderer, in The Ladders | December 10, 2020
How intelligent workstations will use AI to improve health and happiness >
Do you want to be warm or cold? Is it time to stand rather than sit? An interdisciplinary team — made up of designers and USC professors — is using AI to create tech-savvy desks with health and well-being in mind.
Jamie Wetherbe, in USC News | April 25, 2019
Can pictures prevent carpal tunnel syndrome? >
Using sonographic imaging, a USC professor seeks to detect the earliest signs of the disorder
Breanne Grady, in USC News | January 21, 2016
Five Scholars Join Faculty at Division of Occupational Science and Occupational Therapy >
The USC Division of Occupational Science and Occupational Therapy has appointed five new members to junior tenure-track faculty positions, bolstering its profile both in occupational science research and in occupational therapy clinical evidence expertise.
Alix Sleight, in USC News | October 19, 2011