Journey from clinic to workplace

Researcher Ann Marie Dale, PhD, helps improve workers' health

by Stephanie Stemmler  •  March 6, 2020

Jeff Reichmuth (left) asks Ann Marie Dale, PhD, OTR/L (center), and Marco Barrera, construction research specialist (right), what are the best methods to access pipe in overhead work.

In the Central West End neighborhood adjacent to Washington University School of Medicine, Ann Marie Dale, PhD, OTR/L, is “boots on the ground,” meeting with construction workers and managers on a floor of the new and strikingly designed 36-floor One Hundred apartment building.

The soon-to-be iconic structure is one place where Dale is conducting research on ergonomics and worker safety. “It’s incredibly challenging to do research on construction sites,” she says. “Unlike most other industries, construction is constantly changing. Therefore, if you want to do research and follow workers’ health, you have to chase them. And you really have to know about the actual construction projects themselves.”

Dale is focused on worker safety and productivity as part of her role in The Healthy Work Center at Washington University. Through the center, research is under way into the causes and prevention of work-related injuries
and musculoskeletal disorders. The center also promotes health education on worker safety and issues such as the impact of opioid abuse in the workplace. “My path has moved from a clinical occupational therapist role to epidemiology to public health,” Dale says. “We, as occupational therapists, can influence and impact the system upstream and downstream from a job through the implementation of evidence-based reforms.”

Dale, who earned a master’s degree through the Washington University Program in Occupational Therapy in 1996, started her career as a clinical occupational therapist, working first in a hospital setting and then as a certified hand therapist in an outpatient clinic. “I saw the revolving door of work-related injuries, with many of them originating from the workplace. I realized I could modify how a person works with their hands to tolerate the work better, but the problem was that their job didn’t change. I started to wonder if I could minimize injuries by educating workers and, especially, employers and contractors, on safer practices. That led me to the study of ergonomics.”

It also led to her returning to Washington University in a dual faculty appointment with the Division of General Medical Sciences and the Program in Occupational Therapy in 2010. She has been a long-time collaborator with Washington University physician Brad Evanoff, MD, MPH on ergonomics research. “We started in the airline industry, working with baggage handlers,” says Dale. “That ended when 9-11 occurred. Along the way, though, I started finding key contacts in the construction industry and with the local unions, which was key to jumpstarting our research in that sector.”

St. Louis is home to the largest pool of unionized residential construction workers in the country. It also has a very large number of unionized workers in commercial construction. As Dale reached out, connected and then demonstrated evidence-based results to improve worker safety and job productivity, the trust in her efforts resonated not only with the local Carpenters’ Union, but also with major contractors and subcontractors.
The relationships, which have grown steadily over the past 20 years, enabled Dale to successfully apply and win grants through the national Center for Construction Research and Training’s partnership with the National Institute for Occupational Safety and Health (NIOSH).

She, Evanoff and their colleagues have moved from worker safety education and prevention (how to protect the body, how to lift, etc.) to now working with almost 100 subcontractors and six contractors to enhance workplace productivity and safety. “It’s top-down influence, bottom-up participation,” Dale notes. “The result of the trust they have in our efforts is the buy-in from parties at all levels. That’s how we institute reforms that make a difference.”

One of the most transformative research projects started in 2004, when researchers recruited 1,100 workers in various occupations and industries who did not have carpal tunnel syndrome (CTS) and followed them for eight years to see who developed it and why. “We wanted to know how much force and repetition a person can be exposed to without increasing their risk of CTS,” Dale explains. “We had to contact 2,000 companies to get the original 1,100 workers so it was a major effort.”

The team published more than 40 papers from that research, which led to the American Conference of Governmental Industrial Hygienists (ACGIH) revising the Voluntary Threshold Limit Value (TLV) for Hand Activity in 2018, a tool used to screen and reduce the risk for CTS.

Clayco, the primary builder for One Hundred, has fully embraced and included ergonomics as a mandatory discussion in all of its construction projects. Now, from the first preplanning conversations with each subcontractor to regular meetings and daily observations on job sites, the company encourages workers to point out and speak up about safety issues.

Dale, who along the way earned a doctorate in epidemiology from Saint Louis University’s School of Public Health in 2009, has mentored and educated occupational therapy students since 1992. Currently, she serves as a faculty advisor to the Program in Occupational Therapy’s Rehabilitation and Participation Science (RAPS) PhD program, to guide those who are interested in evidence-based care and researching interventions that prevent injuries and promote workplace safety.

In her most recent efforts, Dale is tackling psychosocial issues and opioid use in the workplace. “Construction has one of the highest rates of overdose and fatalities among all industries,” she notes. “They start with taking prescription pain killers for an injury and become addicted. We’ve recognized that we can’t just treat workers for injuries on the job; we have to treat the whole person.”

She is in the process of developing new employer guidelines to help reduce the use of opioids and educate workers and management about the growing issue of opioid addiction. In a remarkable moment, Dale recalls when the Associated General Contractors of Missouri worked with her to have a “stand down” at a construction site as part of an organization-wide suicide prevention campaign. “They said to the workers, ‘We have an important conversation with all of you. Look out for your brother and tell them help is available.’ It was so powerful, we had people coming up and thanking us for starting to talk about a ‘hidden’ problem.”

For her long-standing work in community research outreach, Dale was awarded the 2020 Washington University Distinguished Faculty Award for Community Service. In reflecting on her own career path, Dale adds, “I can tell other occupational therapists that, yes, you can have an amazing influence no matter where you work. From the clinic to community health, we have a role in managing the system to see the whole person and, in the end, it’s so rewarding to effect change at so many levels.”