Occupational medicine (Philadelphia, Pa.)
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In addition to improvements in spirometry instrumentation, the availability and quality of mechanical pump-testing equipment have also improved. These devices have largely relied on the ATS 24 standard waveforms and appear to simulate human FVC maneuvers reasonably well, at least with respect to testing using room air. Testing using mechanical pumps filled with heated and humidified air to better simulate the human FVC maneuver is still evolving. ⋯ The use of quality assessment software appears to significantly improve the quality of the spirometry data through feedback to technicians. Spirometry hardware is also advancing as several hand-held devices are being developed to measure not only peak flow but also FEV1, FVC, and other parameters. These battery-powered portable spirometers will continue to decrease in size and cost and may eventually displace the hand-held peak flow meters in current use.
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Low-back pain and back injuries are of such a complex nature that any one criterion cannot be applied by itself to give a valid assessment of the risk associated with manual materials-handling jobs. There is no question that low-back pain is an extremely significant cause of disability and has a major socioeconomic impact, but many different personal and job factors are associated with the incidence and prevalence of these complaints. There is a need for ongoing systematic investigations of the multiple risk factors that may be causally related to low-back pain and may possibly be amendable to preventive interventions. ⋯ If, however, such lifting is performed repetitively, the medical hazard extends beyond low-back problems to other musculoskeletal strain and sprain injuries and to fatigue-related injuries, particularly for weaker workers. In this latter regard, gender, age, anthropometry, and previous history of back pain are known to modify these risks for populations of workers. The inherent variability between workers and within any worker over time precludes the use of such factors to assign risk to any particular individual.
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Back schools have been proved to be one of the most effective methods of treatment for patients with chronic back pain and disability, and almost every physical therapy clinic now offers some form of education to their back patients. This chapter has attempted to establish what basic information should be available to a person dealing with a back injury, and to offer a logical manner of presenting this information.