How can fire services support their firefighters during their physical rehabilitation following musculoskeletal injury?

During my PhD, I conducted a study to seek the perceived barriers and facilitators firefighters experienced during their return to work process following musculoskeletal (MSK) injury.

Two main themes were identified from the findings, barriers and facilitators. Nine sub-themes were identified; communication, confidence in physical activity participation, modified duties, physiotherapy, return to operational duties, support, inconsistency in the RTW process, use of station gyms and detachment from the watch.

I have provided a brief infographic (see below), to highlight the three main key takeaway topics I believe all fire and rescue services should focus on to improve a firefighters experience during their return to work following MSK injury.

Three main key takeaway topics include:

·        Social support from colleagues and management

·        Access to station gym facilities

·        Working as a multidisciplinary team

Social support from colleagues and management

The findings suggest that providing firefighters with station access to see their colleagues could increase social wellbeing whilst being off sick. The reported feelings of detachment and frustration from being away from the fire station and their firefighter colleagues in this study are similar to those experienced in other active populations including athletes (1, 2).

Previous research reported that low levels of social support from colleagues resulted in a strong negative correlation with a rehabilitating firefighters perceived stress levels (P<0.05) (3). In addition, support from a firefighter’s manager was perceived as significantly more important than support from colleagues in lowering perceived stress levels (P<0.05) (3, 4).

If a manager provided supportive contact with a firefighter during their injury rehabilitation, to assess the firefighter’s injury rehabilitation progression, it could increase the firefighters perceived feeling of support and could have a positive effect on their experience during their injury rehabilitation.

Supportive contact through text messages, phone calls or in person meetings have been found to increase an individual’s adherence to rehabilitation exercise program (5). Furthermore, providing access to see colleagues could provide social support for firefighters and help to decrease the feelings of detachment from the watch.

Examples could include joining meals or attending educational training lectures where no physical activity is required.

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Access to station gym facilities

Future practice should consider allowing injured firefighters access to gym facilities in their fire stations, where possible, to aid with their rehabilitation. An individual’s muscular strength and aerobic fitness levels can decrease with physical inactivity (6).  

The majority of fire services in the UK require their firefighters to achieve a maximal aerobic capacity level of 42.3ml/kg/min as a minimum standard to be considered safe to carry out operational duties (7). A strength standard of a 32kg shoulder press and a 60kg rope pull down has also been recommend (8).

Restricting access to gym facilities on station could result in physical training cessation (9), which could be a barrier to achieving these standards for returning to operational duties, especially as resistance training has been identified as critical for the recovery of MSK function following injury in athletic populations (10).

Following training cessation, it has been reported that muscular strength and power performance can decrease by 7% to 14% following 28 days of training cessation (11). Maximal oxygen uptake was reported to reduce by 9.2% (p<0.05) following 18 days of training cessation (12). Given the above observations, providing access to station gym facilities could be further enhanced with an exercise training plan.

Previous research has indicated that the provision of an individualised exercise training plan related to increased adherence to exercising and significant improvement in individuals’ fitness indicators, including weight, BMI, waist/hip ratio, body fat percentage, blood pressure and heart rate (P=0.05) (13). A fitness training programme provides firefighters with a structured routine to follow during their injury rehabilitation (14).

Additionally, it has been reported that insufficient support with fitness training reduces exercise adherence in firefighters (15). Previous research with professional athletes has demonstrated a negative correlation between exercise adherence and injury recovery time (5).

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Working as a multidisciplinary team

The use of a multidisciplinary team (MDT) has been shown to increase exercise adherence for individuals recovering from injury (16). Previous research has also highlighted that the use of a MDT during injury rehabilitation significantly improved function and disease status in patients with MSK conditions (P<0.05) (17).

 An MDT in a fire service, including physiotherapists, the occupational health department, the fitness team and senior management, should keep in regular contact with the firefighter to help support them during their injury rehabilitation.

The MDT should monitor firefighters’ progression through the fitness training programme and make amendments to the programme if required to help the firefighter stay motivated throughout their physical rehabilitation and increase their adherence to their training plan. Amendments can include exercise selection, the resistance weight used for an exercise, or the number of repetitions performed for an exercise.

To improve the development of an exercise plan for firefighters, good communication between physiotherapists and the fire service occupational health department is needed (18). Communication was a barrier reported in this study, specifically between physiotherapists, occupational health personnel, fitness advisors and senior managers. Findings from previous clinical rehabilitation research found that weekly meetings involving all members of the MDT working with the rehabilitating individual, significantly improved the considerations of the patients’ needs and provision of goal setting targets to aid with the patient’s rehabilitation (P<0.001) (19).

Dr Liam Noll

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References

1.         Crossman J. Psychological rehabilitation from sports injuries. Sports medicine. 1997;23:333-9.

2.         Barber-Westin S, Noyes FR. Common symptom, psychological, and psychosocial barriers to return to sport. Return to Sport after ACL Reconstruction and Other Knee Operations: Limiting the Risk of Reinjury and Maximizing Athletic Performance. 2019:25-35.

3.         Varvel SJ, He Y, Shannon JK, Tager D, Bledman RA, Chaichanasakul A, et al. Multidimensional, threshold effects of social support in firefighters: Is more support invariably better? Journal of Counseling Psychology. 2007;54(4):458.

4.         Stanley IH, Hom MA, Chu C, Dougherty SP, Gallyer AJ, Spencer-Thomas S, et al. Perceptions of belongingness and social support attenuate PTSD symptom severity among firefighters: A multistudy investigation. Psychological services. 2019;16(4):543.

5.         Paraskevopoulos E, Gioftsos G, Georgoudis G, Papandreou M. Perceived barriers and facilitators of sports rehabilitation adherence in injured volleyball athletes: a qualitative study from Greece. Journal of Clinical Sport Psychology. 2021;17(1):86-105.

6.         Prang K-H, Berecki-Gisolf J, Newnam S. Recovery from musculoskeletal injury: the role of social support following a transport accident. Health and quality of life outcomes. 2015;13(1):1-17.

7.         Siddall AG, Stevenson RD, Turner P, Stokes K, Bilzon JL. Development of role-related minimum cardiorespiratory fitness standards for firefighters and commanders. Ergonomics. 2016;59(10):1335-43.

8.         Stevenson RD, Siddall AG, Turner PF, Bilzon JL. Physical employment standards for UK firefighters: Minimum muscular strength and endurance requirements. Journal of occupational and environmental medicine. 2017;59(1):74.

9.         Derebery VJ, Tullis WH. Delayed recovery in the patient with a work compensable injury. Journal of Occupational Medicine. 1983:829-35.

10.       Wayda VK, Armenth-Brothers F, Boyce BA. Goal setting: a key to injury rehabilitation. International Journal of Athletic Therapy and Training. 1998;3(1):21-5.

11.       Mujika I, Padilla S. Physiological and performance consequences of training cessation in athletes: detraining. Rehabilitation of sports injuries: Scientific basis. 2003:117-43.

12.       Sketch Jr MH, Sullivan MJ, O'Dorisio TM, Leier CV. Catecholamine, Renin-Aldosterone, and Glucoregulatory Responses to Maximal Exercise in Humans: Effects of Prolonged Bedrest. Journal of Cardiopulmonary Rehabilitation and Prevention. 1987;7(2):91-102.

13.       Carpenter R, Gilleland D. Impact of an exercise program on adherence and fitness indicators. Applied Nursing Research. 2016;30:184-6.

14.       Rasteiro A, Santos V, Massuça LM, editors. Physical Training Programs for Tactical Populations: Brief Systematic Review. Healthcare; 2023: MDPI.

15.       Mayer JM, Lane CL, Chen H, Lu Y, Johnson BV, Dagenais S. Comparison of supervised and telehealth delivery of worksite exercise for prevention of low back pain in firefighters: A cluster randomized trial. Journal of Occupational and Environmental Medicine. 2020;62(10):e586-e92.

16.       Collado-Mateo D, Lavín-Pérez AM, Peñacoba C, Del Coso J, Leyton-Román M, Luque-Casado A, et al. Key factors associated with adherence to physical exercise in patients with chronic diseases and older adults: an umbrella review. International journal of environmental research and public health. 2021;18(4):2023.

17.       McCuish WJ, Bearne LM. Do Inpatient Multidisciplinary Rehabilitation Programmes Improve Health Status in People with Long‐Term Musculoskeletal Conditions? A Service Evaluation. Musculoskeletal Care. 2014;12(4):244-50.

18.       Andersen LL, Vinstrup J, Villadsen E, Jay K, Jakobsen MD. Physical and psychosocial work environmental risk factors for back injury among healthcare workers: prospective cohort study. International journal of environmental research and public health. 2019;16(22):4528.

19.       Monaghan J, Channell K, McDowell D, Sharma A. Improving patient and carer communication, multidisciplinary team working and goal-setting in stroke rehabilitation. Clinical rehabilitation. 2005;19(2):194-9.