Students, UHS Struggle With RSI Epidemic

RSI. They're just three little letters, but over the past semester, they have struck fear in the hearts and pain in the hands and wrists of countless students.

For many of those students who either have or are concerned they may be developing RSI (Repetitive Strain Injury), the first place they turn for help is University Health Services (UHS).

But some students who have been treated at UHS have expressed concerns about the quality of RSI treatment and prevention efforts.

While UHS says it has been working hard to educate students about RSI prevention as well as providing quality care for those students suffering from RSI, some students say UHS has not done enough.

UHS officials agree, and over the past year have been stepping up efforts to improve all aspects of RSI care, including physician education, prevention seminars and more accessible physical therapy.

The Initial Stages

RSI is frequently associated with such activities as typing, something that many Harvard students spend much time doing, especially near the end of the semester when most papers and final projects are due.

Chief of Medicine at UHS Christopher M. Coley says during the peak times around reading period and final exams, between 12 and 14 students visit primary care physicians at UHS each day complaining of symptoms of RSI.

The signs as well as the severity of RSI can vary from case to case, but the most common symptoms are pain and tingling in the hands, wrists or arms.

According to the Harvard RSI Action Home Page (http://www.eecs.harvard.edu/rsi), a page put together by students at the Graduate School of Arts and Sciences (GSAS), RSI can be potentially debilitating, causing long-term soft tissue damage if not treated early.

Students suffering from RSI often find they have to either limit or completely stop engaging in such activities as typing or writing which could case further damage.

Coley says the normal procedure at UHS is for students to be seen first by a primary care physician. Depending upon the severity of a patient's symptoms, the primary care physician will either refer the patient to a specialist or to a physical therapist.

Those students with very minor symptoms or general concerns are directed to the Center for Wellness and Health Communication (CWHC) located on the second floor of UHS.

According to center Manager Christine A. Hollis, CWHC has a resource center to provide patients as well as any Harvard students with information on all sorts of diseases and syndromes, including RSI.

The center also offers RSI workshops which focus on prevention as well as help for those students already suffering from symptoms of the syndrome, Hollis says.

But, according to Vice President of RSI Action Joshua T. Goodman '92, a current GSAS student, the CWHC pamphlet which was distributed to all first years and some GSAS students at the beginning of the year needs to be updated to include more recent findings on RSI.

While Goodman says UHS' treatment of students suffering from RSI has "actually improved somewhat over the past few years," he says UHS still needs to do much more.

"My single biggest concern is the level of education," Goodman said.

A Rough Road to Recovery

But for those students who already have RSI, the issue is the quality of treatment available for patients.

For many RSI sufferers, their experience at UHS has involved primary care physicians with little knowledge about RSI.

And students with RSI treated at UHS said they waited about a month for a physical therapy appointment.

Janet E. Rosenbaum '98 developed RSI during finals period last semester and sought treatment at UHS.

She says the primary care physician she saw on her first visit was not that helpful, but did give her a referral to a specialist.

But Rosenbaum says she had to wait almost a month before getting an appointment with a physical therapist.

When she finally got to physical therapy, the specialist "seemed generally helpful" and suggested she lighten her backpack and do certain stretches, among other things.

But she says she found much more effective treatment at home with a different doctor over spring break.

The doctor at home specifically diagnosed her problem.

Rosenbaum says her new doctor also informed her that some of the stretches the specialist at UHS had recommended were actually exacerbating her condition.

"It turned out that some of the stretches [the physical therapist at UHS] had prescribed weren't good for me," Rosenbaum says.

She says she does not fault the UHS specialist for not having a detailed understanding of RSI, because the syndrome is relatively new.

"I think [the treatment at UHS] is about as effective as you might expect," she says. But she notes that each of the eight other RSI sufferers she knows has sought additional treatment off campus.

Clayton D. Scott '98 is much more critical in his assessment of UHS.

A patient at UHS for eight months, Scott says his condition did not improve, despite the fact that he stopped typing and regularly attended physical therapy.

"I was getting the exact same treatment every time I went in, and it wasn't working," Scott says.

After taking his case to the director of UHS, Scott was transferred to an outside doctor at the Spaulding Rehabilitation Center in Medford, Mass.

Scott says he has made noticeable improvements since starting his treatment at Spaulding.

"I'm positive that would not have happened it I had stayed with UHS," he adds.

But not all RSI patients treated at UHS are dissatisfied.

Rachel W. Podolsky '00 says despite a long wait for her initial physical therapy appointment, the treatment she has received has been quite good.

"I respect my physical therapist a lot," she says. "He really knows his stuff."

Working to Improve Care

Practice Manager for Surgical and Dental Services Laura L. Doyle says UHS is aware of complaints about long waits for physical therapy appointments and has been working to improve the situation.

"It was definitely a problem, so we added some time," she says.

According to Doyle, while the waits for appointments were as long as three weeks in January, since then UHS has hired additional physical therapists and increased their hours.

Therapists do have room in their schedules to accommodate patients with serious cases who need to be seen immediately, she says.

Doyle admits that there is still room for improvement. "I still think [the wait time] is probably not good," she says.

Patients who feel they are not getting the care they need can always turn to UHS Patient Advocate Kathleen Dias.

Dias says while she does occasionally get complaints about service from students, usually those complaints are not from RSI patients.

Not Just Harvard's Problem

According to Coley, patient complaints about physicians' limited knowledge about RSI reflect a gap in the field of medicine in general, not just at UHS.

In discussing the treatment of RSI at UHS, Coley emphasizes the fact that little research has been done on RSI.

"There are a lot of orthopedists and rheumatologists who believe this doesn't exist," he says.

While some similar phenomenons like carpal tunnel syndrome are well-documented, Coley says "Almost all students coming in with upper-extremity symptoms do not have carpal tunnel syndrome."

"We see an awful lot of people who have some vague symptoms" which are not necessarily associated with a pinched nerve as in carpal tunnel syndrome, Coley says.

Because RSI is so under-researched, Coley says it is unclear which treatments are actually effective.

While massage and physical therapy may help, he says it is not documented whether they are any more effective than complete abandonment of the actions which caused the RSI in the first place.

Coley says most RSI patients at UHS do not have cases severe enough to require surgery, but in some rare cases students are referred outside of UHS to facilities like Spaulding.

Student insurance plans allow three outside referrals a year.

And Coley and Hollis say they are working on increasing UHS physicians understanding of RSI.

Earlier this year Coley invited Emil Pascarelli, M.D., co-author of Repetitive Strain Injuries, a Computer User's Guide, to UHS to speak to physicians.

UHS has also brought two speakers on RSI to weekly "grand rounds"--meetings which most physicians regularly attend in order to meet recertification qualifications.

Coley says UHS has also been working to heighten campus awareness about RSI in the hopes that students will make the necessary changes in their work habits to prevent RSI.

"People don't listen and pay attention if they feel completely well," Coley says, adding that he believes UHS has done well if a student with the early stages of RSI comes in because of outreach efforts.

As part of the RSI prevention effort, UHS created an RSI mousepad which describes proper typing posture and stretches to avoid strain on the upper extremities, Coley says.

UHS officials have also met with members of RSI Action and members of the GSAS administration to discuss further prevention efforts such as ergonometric work stations in campus computer labs.

Despite all of UHS' recent efforts to increase RSI awareness, both Hollis and Coley agree that more needs to be done.

"We're doing a fair amount, but I'm hoping that we will do more next year," Hollis said, mentioning plans for more workshops and media campaigns.