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Abigail Shamp
Northland Community and Technical College
Occupational Therapy Assistant Program
Critically Appraised Topics Assignment
Focused Question:
How can Occupational Therapy help farmers with disabilities to continue to be successful with
farming?
Clinical Scenario:
Agriculture continues to rank as the most dangerous industry in the United States, with an
accidental work-related death rate six times that of all other industries combined (Conway,
McClune, & Nosel, 2007). This topic is important because there are so many farmers that live
with various disabilities each and every day. Nationally there are at least one to two million
farmers and ranchers with disabilities. According to the USDA, more than 200,000 farmers,
ranchers and agricultural workers acquire occupational injuries each year that limit their ability
to perform essential work tasks (Farmer, 2012). Farm accidents are among the most-prevalent
workplace injuries. These injuries include severe back, leg or arm impairments (including
amputations) and spinal cord injuries. Other forms of disability are chronic respiratory problems,
cardiovascular impairments and, among older farmers, arthritis (Farmer, 2012). For farmers with
these limiting disabilities their main goal is to be able to continue to work on the farm despite
their new limitations. Most farmers choose farming as their life-long career and being unable to
continue doing what they love can be devastating for them.
More than 30 million Americans are exposed to hazardous noises on a regular basis (Carruth,
Robert, Hurley, & Currie, 2007). Farmers and family members are at an increased risk of being
exposed to loud noises for prolonged amounts of time. Exposure to tractors, dairy pumps, post
pounders, chain saws, four wheelers and lawn mowers for long periods of time can lead to
hearing impairments. Hearing loss from farming can contribute to secondary hearing handicaps
including difficulties with social communication and participation.
In 1999, according to the National Agricultural Statistics Service, there were more than 2 million
farms in the United States, with 1.5 million children and adolescents living and/or working on
farms (Conway, et al., 2007). Children that live on farms also are susceptible to injuries. In the
United States, there was an estimated 1,930,306 youth under the age of 20 years who lived or
worked on a farm in 1998. Each year, it is estimated that there are approximately 100
unintentional farm-related deaths among children aged 19 years and younger in the United States
(Browning, Westneat, Donnelly, & Reed, 2003). Roughly 22,000 children suffer injuries that are
nonfatal, but severe enough to be seen in emergency departments. Approximately 78,000 injured

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children required other medical care or self-treated their injuries. The most common farm
injuries for children are from tractors, augers, power take offs, cattle, horses, falls from high
structures, and injuries from equipment and tools. During the spring, summer and harvest
seasons, injury risk factors are even higher. This is due to the fact that children are usually on
breaks from school during these times.
Summary of Key Findings:
Level I:
Efficacy of the North American Guidelines for Childrens Agricultural Tasks in
Reducing Childhood Agricultural Injuries, Gadomski, A., Ackerman, S., Burdick,
P., & Jenkins, P. (2006)
The aim of this study was to demonstrate the efficacy of the North American
Guidelines for Childrens Agricultural Tasks (NAGCAT). NAGCAT is a
collection of multiple guideline posters that are designed to assist parents and
other prominent farm members about age appropriate farm related chores for
children ages 7-16 in North America. These guidelines are based on an
understanding of a childs growth and development, agricultural practices,
principles of childhood injury and agricultural and occupational safety. The goal
of the NAGCAT guidelines is to prevent farm related injuries before they happen.
People who follow these guidelines will be at less of a risk for getting injured.
This study included face-to-face educational confrontation during a farm visit
followed by mode intervention boosters. There were 401 intervention farm
participants and 409 control farm participants in this study ranging in age from 0
to 19. In this study lay educators visited the intervention farms to review
NAGCAT and control farms were visited only to collect baseline data. This data
consisted of childhood injuries, tasks and hours worked that was obtained
quarterly for twenty-one months. Overall, 185 children were injured in the
reported seven quarters. One injury resulted in permanent disability, and 46
resulted in a temporary disability. 42.5 percent of the injuries were soft tissue
injuries including scrapes, bruises, abrasions, contusions, strains, torn ligaments,
and sprains. 22.1 percent of the injuries were fractures or dislocations. 22.8
percent of injuries were cuts, lacerations, stabs, or punctures and 4.2 percent were
burns. Eight percent of these injuries resulted in hospitalization. Intervention
farms were less likely than control farms to violate the NAGCAT age rules and
guidelines in the areas of the all-terrain-vehicle use and tractor and haying
operations. Through the use of the NAGCAT guidelines in this study, the workrelated childhood agricultural injuries were reduced.
Level II:

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Agricultural Tasks and Injuries among Kentucky Farm Children: Results of the
Farm Family Health and Hazard Surveillance Project, Browning, S. R., Westneat, S.
C., Donnelly, C., & Reed, D. (2003).
This study analyzed injuries among Kentucky children that live and work on
farms. 1,189 children were eligible for the 30-minute telephone survey that was
conducted in this study. This telephone survey was administered by proxy
respondents that were primarily the childrens mothers. The survey included
questions about work tasks and exposure to agriculture, injury prevalence, risk
factors, and demographic characteristics of the child and farm environment.
Exactly 999 interviews were completed resulting in a response rate of 84%. The
results showed that the primary farm work related injuries included machines,
animals, falls from high places, and contact with nonliving objects (rocks, sticks,
hay). Of the 999 children, 163 sustained at least one injury in the previous year;
133 children were injured once, 18 twice, and 12 children had three or more
injuries, yielding a total of 231 reported injuries. Around 20% of all injured
children obtained these injuries during farm work or farm chores. Farm work
related injury rates showed an increase as the child got older. The researchers
found that boys were more than three times more likely to be injured during farm
related chores than girls.

Level III:
The Impact of Hearing Impairment, Perceptions and Attitudes About Hearing Loss,
and Noise Exposure Risk Patterns on Hearing Handicap Among Farm Family
Members, Carruth, A., Robert, A., Hurley, A., & Currie, P. (2007)
This study describes the degree of hearing impairment, attitudes and perceptions
about hearing loss, noise exposure patterns and use of barriers, and the
relationship of hearing loss, risk exposure, protective barrier use, and attitudes and
perceptions to self-perceived communication performance among members of the
farming community. Through the recent advances of farming technology, noise
exposure has also increased, leading to the potential rise of hearing loss. Noise
exposure on the farm includes, but is not limited to, four-wheelers, tractors,
pumps, discharging rifles, loud radios in enclosed tractor cabs, squealing pigs,
chain saws and post pounders. Hearing loss has been reported to impairing an
individuals communication performance while engaging in activities of daily
living. For farmers, hearing loss impacts the quality of life and the ability to
communicate with others while performing farm tasks. There were 56 adults (25
woman and 31 men) that participated in this study. Participants completed three
surveys. The first survey, exposure risk and protective barriers, considered the
degree of exposure to loud noises and the types of barriers used. The second
survey, perceptions of hearing ability and attitudes toward hearing loss, looked at
how participants thought their hearing was based off of being good, fair, poor, or

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if they could hear better in one ear verses the other. The third and final survey,
self-perceived communicative performance, acknowledged the communication
abilities and perceptions of sounds in daily life. Results noted hearing loss among
80.4% of the participants. Exactly thirty-two of the participants stated that they
were frequently around loud machinery or noise. This study also looked at how
many individuals actually wear hearing protection. Only four of the participants
reported wearing protection more than fifty percent of the time during farm work.
Ear plugs were the only hearing protection that was stated being used. It was
found that farmers and their families tend to use hearing protection sporadically.
Half of the farmer participants stated that it was difficult for them to hear warning
signals when they were using hearing protection. Roughly twenty percent of the
participants thought that hearing loss was unavoidable when it came to farm
work.
Level III:
Musculoskeletal Disorders in Australian Dairy Farming, Ev Innes and Casey Walsh
(2009)
The main objective of this study was to explore the musculoskeletal discomfort
Australian dairy farmers experience on a day to day basis. Dairy farmers have a
physically demanding occupation that wears on their bodies significantly. There
was a 21 percent response rate to the survey that was conducted. This mail-out
survey covered musculoskeletal discomfort, physical workload, and muscular
recovery time and task frequency. Farmers reported that tasks they performed
repetitively in their daily routines caused more musculoskeletal discomfort than
heavier tasks that were performed on a seasonal basis. Males were found to
perform heavier manual work that involved the use of heavy farm machinery.
Females tended to perform more of the administration work.
Level III:
Ergonomics in agriculture: workplace priority setting in the nursery industry,
Meyers JM, Miles JA, Faucett J, Janowitz I, Tejeda DG, Kabashima JN (1997)
The overall goal of this study was to develop and assess preventative measures for
agriculture related work by looking at previous ergonomic applications. The
nursery industry was chosen for this study for three main reasons, nursery work is
stable from year to year, nurseries have similar ergonomic characteristics as work
place settings do, and nurseries are a major part of Californias agriculture. There
are four main tasks a nursery worker must complete. The first task is propagation
which is when new plants are planted in a specific area. Propagation is defined by
a high level of repetitive hand motions. The second task is called canning which is
when the growing plants have to be replanted into containers called cans. Canning
requires repetitive pinching, upper extremity lifting, and bending. The third task is

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field work which is where the plants grow and mature and they have to be
watered, pruned, fertilized and weeded. Field work requires prolonged stooping,
lifting and repetitive hand motions. Shipping is the final stage where plants are
moved to the shipping area, labeled, organized by type of plant order, and loaded
onto trucks. Shipping requires continuous lifting, stooping and carrying. Through
triangulation the researchers assessed the managers and supervisors first, since
they had the most experience, then they screened the workplace and looked for
ergonomic risk factors, and finally they looked at the work-related injury and
illness records. The researchers found the main risk factors to be repetitive hand
work, and stooped working postures; which included awkward postures while
lifting and moving loads. These risk factors were looked at by a group of
engineers and the engineers came up with prototypes on how to ergonomically
reduce the incidence of nursery work-related injuries.
Level V:
AgrAbility: Doctor of Physical Therapy (DPT) Students Learning to Advocate for
Farmers and Ranchers with Disabilities; Millee Jorge (2006)
There is evidence in the research literature that farmers and ranchers who
undergo rehabilitation after injury are dissatisfied with the rehabilitation outcomes
because the physical rehabilitation process does not necessarily assist them to
return to farm life and agricultural work. Farmers are profound symbols of the
American culture and the work of farmers is both rewarding and possibly
dangerous. Agricultural lifestyle and occupations are such that individuals who
grow old on the farm will continue to live within the farm environment.
AgrAbility will help make this happen for those farmers who want to continue to
live on their farms for as long as they possibly can. AgrAbility projects provide
education, assist with accommodations, and prevent secondary injuries for
persons with disabilities working in agriculture or wanting to work in agriculture.
Level V:
Ergonomic Intervention for preventing Musculoskeletal Disorders among Farm
Women; Surabhi Singh & Renu Arora (2010).
In this article the authors reviewed and examined numerous types of farm work
related musculoskeletal disorders. The musculoskeletal disorders the authors
looked at included back and neck pain, tendon disorders, shoulder disorders,
cumulative trauma disorders, repetitive motion disorders, carpal tunnel syndrome,
nerve entrapment syndromes, and low back disorders. This article also looked at
ergonomic ways in which farm tasks could be changed or modified to benefit the
farmer. Three general risk factors were covered including lifting and carrying

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heavy loads, sustained or repeated full body bending and stooping, and very
highly repetitive hand work such as clipping and cutting. The authors also looked
at how to design women friendly farm tools and equipment. Most of the tools and
equipment out in the farm work force is designed for men assuming that they will
automatically work for women as well. This is not the case due to the fact that
women are built differently than men. Fulfilling this need for designing tools and
equipment appropriately for women would greatly reduce musculoskeletal
disorders and increase efficiency and worker productivity. Another intervention
the authors focused on was the improvement of work station and work methods
for farm women. In this study an example of top dressing of fertilizer was
mentioned. Top dressing of fertilizer can be a grueling task due to the fact that this
task is performed in a standing posture stooping over field crops, such as wheat.
During this task, farm women must carry the fertilizer in plastic bags or tie the
fertilizer filled cloth bag to their waist and then apply the fertilizer near the root of
each plant. The stooping and bending required for this task leads to pain in the
lower back and cervical region. Due to the complaints from the women
completing this task they introduced the handy fertilizer trolley. This handy
fertilizer trolley allowed the fertilizer load to be shifted from the womens
shoulders to the trolley. There was a significant reduction in the percentage of
farm women complaining about the musculoskeletal problem. Thus, evidence
shows that cost-effective ergonomic interventions aid in reducing musculoskeletal
problems in agriculture. Incorporating rest periods throughout the day can also be
beneficial in reducing musculoskeletal disorders in farming women. This study
showed that micro-pauses can minimize discomfort and pain by reducing muscle
and nerve tension. Reduction in muscle and nerve tension can be achieved
through allowing employees short rests and allowing them to complete a range of
stretches to relieve the discomfort they may be experiencing.
Level V:
Using ergonomics in the prevention of musculoskeletal cumulative trauma injuries
in agriculture: Learning from the mistakes of others, Meyers J, Bloomberg L,
Faucett J, Janowitz I, Miles JA (1995)
In this article the researchers reviewed how Cumulative Trauma Disorders
(CTDs) are becoming significant health issues among employers today, more
specifically agriculture workers. The researchers looked at how ergonomics can
be integrated into reducing agriculture work-related injuries. The authors looked
at how ergonomics in the nursery industry could benefit nursery workers and
prevent future work-related injuries. In California nurseries alone 1634 out of
31,000 workers reported having nonfatal disabling injuries that were categorized
as sprains, strains and back injuries. The researchers found that simple changes in

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nursery work performance could result in less stress being put on the body. The
researchers made ergonomic suggestions for lemon orchard workers; which
included the use of different tools such as lighter work gloves with flexible
material to protect the workers hands from thorns and to use a picking bag that fit
the worker as a vest rather than falling off one shoulder.
Bottom Line for Occupational Therapy Practice:
Numerous physical risk factors are associated with farming, such as high workloads,
heavy lifting, bending and twisting, exposure to vibration from farm equipment, and
performing tasks while in awkward postures. These have been associated with an
increased risk of acquiring musculoskeletal diseases such as osteoarthritis, low back pain,
neck and upper limb complaints (Cha, Kong, Moon, & Lee, 2009). Occupational therapy
professionals can educate farmers on proper lifting techniques and the importance of
having appropriate posture while completing farm duties. Proper lifting techniques would
include wearing appropriate footwear, getting a firm footing while keeping feet shoulder
width apart, bend knees, lift with legs, keep load close and keep back upright to avoid
twisting.
Physical therapy students from Oklahoma investigated the use of adaptive and assistive
devices, such as stair extenders that lower the first step leading up to the tractor,
mechanical lifts that facilitate access to the cab of the tractor, hand-controlled devices for
operating farm machinery, different options for accessing outbuildings, and mobility
options for navigating the varied terrains (Jorge, 2006). The students found that simple
modifications can be made around the farmers working environment, purchasing
commercial adaptive equipment and/or obtaining customized equipment can assist
farmers to be independent with farming. Occupational therapy practitioners can help
farmers obtain adaptive equipment that will enable them to continue to be independent
with farming. Occupational therapy professionals can assist farmers with writing grants
and finding resources that will give them the ability to obtain the adaptive equipment that
they may need. Some assistive technology devices could include big round bale spinner,
tractor control modifications, tractor person lift, and pickup pilot lift; add on tractor lifts,
and many more. An individual that has a spinal cord injury would benefit from a tractor
wheelchair lift and tractor control modifications so that that individual could continue to
do the farming that he or she loves to do. Simple modifications include rearrangement of
a physical space for better wheelchair access, purchasing commercially adaptive
equipment, and/or obtaining customized solutions such as equipment modification that
include adding a platform lift to a tractor for access to the cab (Jorge, 2006).
The best vocational rehabilitation and occupational therapy practitioners connect farmers
with the tools they need to continue to be productive and independent (Farmer, 2012).

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Occupational therapy professionals can work with farmers with disabilities and can help
them to be able to be as independent as possible. If farmers are unable to continue doing
the farming that they do, they could modify and change the complexity of what they do to
something more simplistic. Occupational therapy professionals can assess other interests
of farmers and could help them find a farm related job that is not as complex as what they
did before. There is hardly any job that cannot be performed by persons with disabilities
(Narayan, 2013).
The National AgrAbility Project (NAP) is an organization that aims to enhance the
quality of life for farmers, ranchers, and other agricultural workers with disabilities. NAP
is sponsored by the U.S. Department of Agriculture (USDA), land grant universities and
various nonprofit disability service organizations that currently serve 24 states (NAP,
2013). The NAP provides training and educational information to farmers with
disabilities about various disabilities and assistive technology that can help them succeed
in rural America. Occupational therapy professionals can use the NAP as a resource for
getting assistance for their farming patients.
Farmers and family members were found to use hearing protection devices sporadically
(Carruth et al., 2007). Occupational therapy professionals can educate farmers and their
families on the importance of wearing hearing protection. Skilled occupational therapy
professionals can also encourage farmers and their families to spend a minimal amount of
time around loud machinery. If farmers must spend long periods of time around loud
machinery, they should wear hearing protection and schedule breaks away from the loud
noise exposure to reduce their risk of obtaining a hearing impairment. Hearing
impairments can have an impact on a persons quality of life and can cause them to have
a communication handicap in work and social settings (Carruth et al., 2007).
Of the children who got farm related injuries, relatively half of those injuries could have
been prevented (Gadomski, Ackerman, Burdick, & Jenkins, 2006). Occupational therapy
professionals can work with or utilize the North American Guidelines for Childrens
Agricultural Tasks (NAGCAT). NAGCAT is a collection of multiple guideline posters
that are designed to assist parents and other prominent farm members about age
appropriate farm related chores for children ages 7-16 in North America. These
guidelines are based on an understanding of a childs growth and development,
agricultural practices, principles of childhood injury and agricultural and occupational
safety. The goal of the NAGCAT guidelines is to prevent farm related injuries before they
happen. People who follow these guidelines will be at less of a risk for getting injured
(NAGCAT, 2014). Occupational therapy professionals can educate farming family
members about the benefits of NAGCAT, and how it can help prevent farm related
injuries. Occupational therapy professionals can educate parents and children on how
they can better protect their children around the farm environment. Some strategies

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occupational therapy professionals can assist farm families with are setting limits for the
amount of time a child does a task, providing more supervision, and making safety
related changes and modifications around the farm. Some farmers have young preschool
aged children along with them when they are working on the farm. This puts these young
children at a higher risk for injury. Preschoolers (0-6 years) have the highest incidence of
farm related injuries among the other pediatric age groups (Gadomski et al., 2006).
Skilled occupational therapy practitioners can educate parents of young preschoolers
about how important it is for them to be constantly supervised when they are with their
parents during farm work.
Occupational therapy professionals can also assist women farmers by ergonomically
adjusting their farm work stations and work requirements, encouraging frequent rest
periods, and by helping them obtain farm tools and equipment that appropriately fits
them. Ergonomics examines the physical capabilities of the human body and the
limitations of the human body in relation to a persons work tasks, the tools used and the
job environment (Singh & Arora, 2010). Field jobs (harvesting, weeding, irrigating,
cultural practices, etc.) remain demanding physical tasks, involving stooped postures,
lifting and carrying, and repetitive hand work (Singh & Arora, 2010). Occupational
therapy professionals can educate farming women on how the physical stress that is
associated with farm work tasks can be minimized or prevented with the appropriate
ergonomic interventions. An ergonomic intervention skilled occupational therapists could
use for female farmers could be as simple as adjusting production standards and work
equipment so that it fits the body size and capacity of the female farmer. Musculoskeletal
disorders on the farm are mainly due to the inconvenient work postures (Singh & Arora,
2010). There is evidence which shows that an improved work station reduces postural
stress and musculoskeletal problems of farm women (Singh & Arora, 2010). Skilled
occupational therapists can use work station ergonomic checklists as a guide in assessing
farm work stations and environments to improve comfort and productivity for female
farmers. Appropriate rest periods should be allowed to the farm workers to prevent
musculoskeletal injuries. The minimal duration of rest pauses for farmers should be of 15
minutes and the duration of a lunch break should be more than 45 minutes (Singh &
Arora, 2010). Occupational therapy professionals should assist female farmers with
setting up an appropriate rest period schedule with them and plan out their work day
according to their specific needs and interests.
Occupational therapy professionals can work alongside engineers in developing
ergonomic interventions for nursery workers. Engineering strategies in the prototype
stage for nurseries include (1) lightweight handles for lifting and carrying cans that
eliminate pinch grip and minimize stooping; (2) handles for cans mounted on hand trucks
for larger cans and greater through-put; (3) raised working platforms in the canning
offloading area to facilitate use of handles; (4) hydraulic tilting trailers to minimize can

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lifting when loading and unloading; and (5) powered clippers and cutters for use in
pruning and cutting tasks (Meyers, Miles, Faucett, Janowitz, Tejeda, & Kabashima,
1997).
Occupational therapy professionals can provide simple ways in which nursery farmers
can ergonomically change their work environment. For example, with lemon orchard
workersnew work tools were recommended, such as work gloves of lighter, more
flexible material that could still protect the workers hand from thorns, and a picking bag
that fit the worker as a vest rather than falling off one shoulder (Meyers, Bloomberg,
Faucett, Janowitz, & Miles, 1995). Changing the way the work was performed is also
recommended-changing the order in which the worker picked the fruit so that the bag
would be heaviest when the worker was in the least stressful working posture (picking at
waist level) (Meyers et al., 1995).Occupational therapy professionals can encourage
changes such as using an easily portable cart that could be used to transport picked fruit
from the base of each tree to the orchards central loading area (Meyers et al., 1995). It is
recommended that new tools that enable workers to safely handle multiple small plants
needs to be developed, remodeling work stations to accommodate individual worker
height and reach, and reorganization of work tasks (Meyers et al., 1995).
Occupational therapy professionals can help farmers with disabilities in so many ways.
Skilled occupational therapists can instruct farmers on proper lifting techniques,
encourage farmers to take breaks to reduce repetitive strains, provide assistance with
obtaining assistive technology through grants and various resources, instruct farmers on
ways to ergonomically modify tasks and their environment, provide education on hearing
protection and use the North American Guidelines for Childrens Agricultural Tasks
(NAGCAT) for preventing children from getting injured on the farm.
Review Process:
Inclusion Criteria:
Male and female farmers
All Ages
Farm settings
Peer reviewed articles 1995 to present
Exclusion Criteria:
Non-farmers
Journals/documents prior to 1995
Search Strategy:
Categories

Key Search Terms

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Patient/Client Population
Intervention
Comparison
Outcome

Farmers with disabilities

Occupational therapy and AgrAbility
Farmers who do not use Occupational Therapy
services
For farmers with disabilities to successfully
continue working on the farm

Databases and Sites Searched:

Databases:
All of EBSCO Host databases
Sites: http://www.agrability.org,
http://www.iowafarmertoday.com/feature/columnists/family_life/helping-farmers-withdisabilities/article_2c68e1e2-6f7c-11e1-86d4-0019bb2963f4.html
http://www.nagcat.org/nagcat/?page=nagcat_welcome and
http://www.agrability.org/Toolbox/index.cfm
Quality Control/Peer Review Process:
A PICO (Patient/Population, Intervention, Comparison, and Outcome) question was formed by
looking at the emerging niches on the AOTA website and based off of the fact that farmers are
prominent figures in society and they often have the desire to work as long as they possibly can.
To build a critically appraised topic, Northlands Online Library Databases were searched for
articles 1995 or newer. Only full text PDF articles were considered. The key terms used to search
were farmers and occupational therapy, farmers with disabilities, and farm-related child
injuries Eight articles were found using EBSCO host. After this document was completed, it
was peer-reviewed by an Occupational Therapy Assistant (OTA) student who also attends
Northland Community and Technical College and peer reviewed more than once by the program
instructor. The suggested corrections made by the OTA student and the program instructor were
looked at and applied to this document.
Results of Search:
Summary of Study Designs of Articles Selected for Appraisal:
Level of
Study Design/Methodology of Selected
Number of Articles Selected
Evidence
Articles
Level I
Systematic reviews, meta-analysis,
1
randomized controlled trials
Level II
Two groups, nonrandomized studies (e.g.,
1
cohort, case-control)
Level III
One group, nonrandomized (e.g., before
3
and after, pretest, and posttest)
Level IV
Descriptive studies that include analysis
0

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Level V

of outcomes (single subject design, case

series)
Case reports and expert opinion, which
include narrative literature reviews and
consensus statements

Qualitative
Limitations of the Studies Appraised:

3
0

Level I: Efficacy of the North American Guidelines for Childrens Agricultural Tasks in
Reducing Childhood Agricultural Injuries, Gadomski, A., Ackerman, S., Burdick, P., &
Jenkins, P. (2006)
The written documentation by the parents or caregivers could have not been one hundred
percent accurate. Loss of a working telephone resulted in children having to withdraw
from this study. Relocation of families also required some of the children to have to be
taken out of the study as well.
Level II: Agricultural Tasks and Injuries among Kentucky Farm Children: Results of the
Farm Family Health and Hazard Surveillance Project, Browning, S. R., Westneat, S. C.,
Donnelly, C., & Reed, D. (2003).
Potential underestimation of injuries due to poor recall from proxy respondents could
have altered the results of this study. Due to the fact that most of the proxy respondents
were mothers, who usually are not involved in overseeing farm chores, could have been
unaware of the severity of some of the injuries. Lack of reported injuries could have also
affected the number of injuries and the data that was available for this study.
Level III: The Impact of Hearing Impairment, Perceptions and Attitudes About Hearing
Loss, and Noise Exposure Risk Patterns on Hearing Handicap Among Farm Family
Members, Carruth, A., Robert, A., Hurley, A., & Currie, P. (2007).
The small sample of participants limits the ability for generalization to other farmers and
their families. Self-reported hearing competence was found to be predictive for the
communication performances of the participants. Bilateral verses unilateral hearing loss
was not used in the testing.
Level III: Musculoskeletal Disorders in Australian Dairy Farming, Ev Innes and Casey
Walsh (2009)
A low response rate from the surveys could have demonstrated a participation bias. The
farmers who are actively concerned about agricultural health and safety are the ones who
responded. These individual are most likely wanting farmers with disabilities to be able

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to get the assistance they may need. Some farmers may not have had time to sit down and
fill out the twelve page survey or they simply did not want to participate. Because of time
constraints for the data collection there was not a follow-up reminder for the survey
distributed resulting in a lower response rate.
Level III: Ergonomics in agriculture: workplace priority setting in the nursery industry,
Meyers JM, Miles JA, Faucett J, Janowitz I, Tejeda DG, Kabashima JN (1997)
This article was published in February 1997. It was also geared toward California nursery
workers since that is where most of the plant nurseries are located. This study took place
over a three year time frame. This article did not show how the engineered interventions
worked and at the time this project was just getting started.
Level V: AgrAbility: Doctor of Physical Therapy (DPT) Students Learning to Advocate for
Farmers and Ranchers with Disabilities Millee Jorge (2006)
One limitation would include that this focuses on Physical Therapy and farmers with
disabilities. Another limitation would be that they could have included more details about
AgrAbility and how they would incorporate it in their physical therapy treatments.
Level V: Ergonomic Intervention for preventing Musculoskeletal Disorders among Farm
Women; Surabhi Singh & Renu Arora (2010).
In this article the authors did not conduct a study but rather looked at ways to reduce
musculoskeletal disorders in women farmers. Throughout this article the authors realized
the significant need that is present for designing farm equipment for women specifically
and changing their farm work station environments in order to reduce the risks of
musculoskeletal disorders. The authors know that much more research needs to be done
in this area and that research on this topic should be a priority when considering the
safety and health of women farmers.
Level V: Using ergonomics in the prevention of musculoskeletal cumulative trauma injuries
in agriculture: Learning from the mistakes of others, Meyers J, Bloomberg L, Faucett J,
Janowitz I, & Miles JA (1995)
In this article the authors did not conduct a study but they looked at how they could use
ergonomics as a way to reduce Cumulative Trauma Disorders. This article was published
in 1995. The researchers mainly focused on California nurseries and generalization about
other nurseries was present.
Articles Selected for Appraisal:

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Browning, S. R., Westneat, S. C., Donnelly, C., & Reed, D. (2003). Agriculture Tasks and
Injuries among Kentucky Farm Children: Results of the Farm Family Health and Hazard
Surveillance Project. Southern Medical Journal, 96(12), 1203-1212.
Carruth, A., Robert, A., Hurley, A., & Currie, P. (2007). The impact of hearing impairment,
perceptions and attitudes about hearing loss, and noise exposure risk patterns on hearing
handicap among farm family members. AAOHN Journal, 55(6), 227-234.
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