Association of work-time control with sickness absence due to musculoskeletal and mental disorders: An occupational cohort study

OBJECTIVES

Work-time control is associated with lower sickness absence rates, but it remains unclear whether this association differs by type of diagnosis and sub-dimension of work-time control (control over daily hours and control over time off) and whether certain vulnerable groups benefit more from higher levels of work-time control.

METHODS

Survey data from the Finnish 10-town study in 2004 were used to examine if baseline levels of work-time control were associated with register data on diagnose-specific sickness absence for 7 consecutive years (n = 22 599). Cox proportional hazard models were conducted, adjusted for age, sex, education, occupational status, shift work including nights, and physical/mental workload.

RESULTS

During follow-up, 2,818 individuals were on sick leave (≥10 days) due to musculoskeletal disorders and 1724 due to mental disorders. Employees with high (HR = 0.80, 95% CI 0.74-0.87; HR = 0.76, 95% CI 0.70-0.82, respectively) and moderate (HR = 0.83, 95% CI 0.77-0.90; HR = 0.85, 95% CI 0.79-0.91, respectively) levels of control over daily hours/control over time off had a decreased risk of sickness absence due to musculoskeletal disorders. Sub-group analyses revealed that especially workers who were older benefitted the most from higher levels of work-time control. Neither sub-dimension of work-time control was related to sickness absence due to mental disorders.

CONCLUSIONS

Over a 7-year period of follow-up, high and moderate levels of work-time control were related to lower rates of sickness absence due to musculoskeletal disorders, but not due to mental disorders.

Measuring Productivity Costs in Patients With Musculoskeletal Disorders: Measurement Properties of the Institute for Medical Technology Assessment Productivity Cost Questionnaire

BACKGROUND

The Institute for Medical Technology Assessment Productivity Cost Questionnaire (iPCQ) was recently developed to cover all domains of productivity costs; absenteeism, presenteeism and productivity costs related to unpaid work. The original iPCQ has not been tested with respect to neither content or construct validity, nor reliability, and there is no Norwegian version of the questionnaire.

OBJECTIVES

To translate and cross-culturally adapt the iPCQ into Norwegian and to test its measurement properties among patients with musculoskeletal disorders.

METHODS

Translation and cross-cultural adaptation was conducted according to guidelines, and measurement properties were investigated using a cross-sectional design including a test-retest assessment. Patients with musculoskeletal disorders were recruited from secondary care. Data quality, content validity (10 patients evaluated comprehensibility, 2 researchers and 1 clinician evaluated relevance and comprehensiveness), construct validity (factor analysis, internal consistency, divergent hypothesis testing), and test-retest reliability (intraclass correlation coefficient two-way random average agreement, Cohen's unweighted kappa) were assessed.

RESULTS

In total, 115 patients with a mean age (SD) of 46 (9) years were included, and 62 responded to the retest. The questionnaire was feasible, with little missing data and no floor or ceiling effects. Content validity displayed good comprehensibility and relevance and sufficient comprehensiveness. Factor analysis revealed a 3-component solution accounting for 82% of the total variance; items loaded as expected and supported the original structure of the iPCQ. Internal consistency was acceptable for the 3 components of productivity cost, with an inter-item correlation ranging from 0.42 to 0.62. Further, a total of 91% of our hypotheses were verified. The intraclass correlation coefficient values ranged from 0.88 to 0.99 for all items except one; kappa ranged from 0.61 to 0.92, indicating overall good reliability of the questionnaire.

CONCLUSIONS

The Norwegian iPCQ showed good measurement properties among patients with musculoskeletal disorders from secondary care in Norway. We therefore recommend the iPCQ as a useful tool for measuring productivity costs in patients with musculoskeletal disorders.

Repeated measures study of the association between musculoskeletal symptoms and mental health in subway workers

While the prevalence of musculoskeletal disorders has recently increased among Korean workers employed in highly physically and psychologically demanding jobs, the relation among these domains remains relatively unexplored. We examined 2,037 subway workers in Seoul, that collected data via questionnaire survey on musculoskeletal symptoms and the work environment, administered in 2009, 2012, and 2015. Generalized estimating equation (GEE) analysis was used for statistical analysis. After conducting GEE analysis by adjusting for the sociodemographic and occupational characteristics, we found the prevalence of musculoskeletal symptoms significantly increased in cases with high Depression, Anxiety and Stress Scales (DASS) scores compared with low DASS scores, especially on shift workers. An integrated management method that considers ergonomic and mental health factors, should be used to better manage musculoskeletal symptoms in subway workers.

The effects of behavioural counselling on the determinants of health behaviour change in adults with chronic musculoskeletal conditions making lifestyle changes: A systematic review and meta-analysis

OBJECTIVE

A systematic review and meta-analysis of controlled trials was carried out to examine the effect of behavioural counselling on determinants of behaviour change in adults with chronic, painful musculoskeletal conditions.

METHODS

Seven databases were searched up to January 2019. Two reviewers independently screened title/abstracts and full texts. Eligible trials included those including participants over 18 years of age with a chronic, painful musculoskeletal condition, a measurement of at least one behavioural determinant and lifestyle behaviour, and where behavioural counselling was the distinguishing intervention. Two reviewers independently extracted data and assessed for risk of bias using the Cochrane Risk of Bias Tool. Meta-analyses were conducted, using standardized mean differences and 95% confidence intervals (CIs) when at least two trials examined the same outcome. The quality of the evidence was evaluated using the Grades of Recommendation, Assessment, Development and Evaluation approach.

RESULTS

Fourteen unique trials, reported in 16 publications, were included. Low-quality evidence showed that behavioural counselling has a small effect on increasing self-reported physical activity (standardized mean difference 0.26; 95% CI 0.00, 0.53). Very-low-quality evidence showed that behavioural counselling has a moderate effect on self-efficacy related to physical activity (standardized mean difference 0.69; 95% CI 0.19, 1.18). Low-quality evidence suggested that behavioural counselling has no effect on symptoms of depression and anxiety.

CONCLUSIONS

Behavioural counselling may help to increase self-reported physical activity levels in adults with chronic painful musculoskeletal conditions. Self-efficacy may be a behavioural determinant in an underlying causal pathway explaining positive lifestyle change.

Job-related self-efficacy in musculoskeletal disorders - a questionnaire

BACKGROUND

The Return-To-Work Self-Efficacy Scale questionnaire maps self-efficacy upon return to work following acute lower back pain. We wished to translate and validate the questionnaire, as well as to assess the concordance between the translated form and two other forms.

MATERIAL AND METHOD

The questionnaire was translated into Norwegian according to recommended guidelines. Employees in the health and care service with musculoskeletal symptoms were recruited for the study. Cross-cultural validity was assessed by principal component analysis and internal consistency by Cronbach's alpha. Conceptual validity was assessed by correlation between the translated form and simultaneous measurements from two questionnaires that focus on closely related characteristics: the Tampa scale for kinesiophobia and the Demand-ControlSupport model.

RESULTS

The Norwegian questionnaire is called 'Job-related self-efficacy'. Of a sample of 229 persons, 206 (89.9 %) were included in the analyses. Principal component analysis supported cross-cultural validity through findings of a three-factor structure in accordance with the original questionnaire. Internal consistency was high for all questions in the questionnaire (0.95), as well as for each of the three factors: meet job requirements (0.99), communicate needs to others (0.97) and adapt work duties (0.96), after adjusting for the number of questions. There were low correlations (< 0.40) between Job-Related Self-Efficacy and the Tampa scale for kinesiophobia, and the various factors in the Demand-Control-Support questionnaire, respectively.

INTERPRETATION

The 'Job-Related Self-Efficacy' questionnaire has satisfactory cross-cultural validity after it was translated, and satisfactory internal consistency.

Brief Counseling for Veterans with Musculoskeletal Disorder, Risky Substance Use, and Service Connection Claims

OBJECTIVE

High proportions of post-9/11 veterans have musculoskeletal disorders (MSDs), but engaging them in care early in their course of illness has been challenging. The service connection application is an ideal point of contact for referring veterans to early interventions for their conditions.

DESIGN

Among MSD claimants who reported risky substance use, we pilot-tested a counseling intervention targeting pain and risky substance use called Screening Brief Intervention and Referral to Treatment-Pain Module (SBIRT-PM). Veterans were randomly assigned in a 2:1:1 ratio to SBIRT-PM, Pain Module counseling only, or treatment as usual (TAU).

METHODS

Participants assigned to either counseling arm were offered a single meeting with a study therapist with two follow-up telephone calls as needed. Participants completed outcome assessments at four and 12 weeks after randomization.

RESULTS

Of 257 veterans evaluated, 101 reported risky substance use and were randomized. Counseling was attended by 75% of veterans offered it and was well received. VA pain-related services were used by 51% of participants in either of the pain-focused conditions but only by 27% in TAU (P < 0.04). Starting with average pain severity ratings of 5.1/10 at baseline, only minimal changes in mean pain severity were noted regardless of condition. Self-reported risky substance use was significantly lower over time in the SBIRT-PM condition relative to the two other conditions (P < 0.02). At week 12, proportions of veterans reporting risky substance use were 0.39, 0.69, and 0.71 for the SBIRT-PM, Pain Module counseling, and TAU conditions, respectively.

CONCLUSIONS

SBIRT-PM shows promise as a way to engage veterans in pain treatment and reduce substance use.

A qualitative study of the experiences and perceptions of adults with chronic musculoskeletal conditions following a 12-week Pilates exercise programme

INTRODUCTION

The aim of the present study was to explore the experiences and perceptions of adult patients with chronic musculoskeletal conditions following a Pilates exercise programme. A qualitative approach was taken to both data collection and analysis, with alignment to the philosophy of interpretive phenomenology. Participants included 15 women and seven men with a range of chronic musculoskeletal conditions, including nonspecific low back pain, peripheral joint osteoarthritis and a range of postsurgical conditions. The age range was from 36 years to 83 years, and the mean age was 57 years (standard deviation 14.1 years).

METHODS

Data were collected via digital recordings of four focus groups in three North-West of England physiotherapy clinics. The data were transcribed verbatim and then analysed using a thematic framework. Data were verified by a researcher and randomly selected participants, and agreement was achieved between all parties.

RESULTS

The results were organized into five main themes: physical improvements; Pilates promotes an active lifestyle: improved performance at work and hobbies; psychosocial benefits and improved confidence; increased autonomy in managing their own condition; and motivation to continue with exercise.

CONCLUSION

The study was the first to investigate individual perceptions of the impact of Pilates on the daily lives of people with chronic conditions. The Pilates-based exercise programme enabled the participants to function better and manage their condition more effectively and independently. Further to previous work, the study revealed psychological and social benefits which increase motivation to adhere to the programme and promote a healthier lifestyle.

A longitudinal investigation of the factors associated with increased RISk of playing-related musculoskeletal disorders in MUsic students (RISMUS): a study protocol

BACKGROUND

The achievement and improvement of skills in musical techniques to reach the highest levels of performance may expose music students to a wide range of playing-related musculoskeletal disorders (PRMDs). In order to establish effective solutions for PRMDs and to develop future preventive measures, it is fundamental to firstly identify the main risk factors that play a significant role in the development of musculoskeletal conditions and symptoms. The aim of the study is to identify those factors associated with increased risk of PRMDs among music students. A further goal is to characterise this population and describe the clinical features of PRMDs, as well as to determine the evolving course of PRMDs in music students during their training.

METHODS

One hundred and ninety schools have been invited to participate in this study, sixty of which have already confirmed officially their support for the investigation's recruitment procedures, by means of a subsequent distribution of the link to a web-based questionnaire to their student groups (total potential student numbers available: n = 12,000 [based on ~ 200 students per school on average, and 60 volunteering schools]; expected number of students: n = 3000 [based on a 25% response rate from the 12,000 students attending the 60 volunteering schools]). The web-based questionnaire includes questions about any PRMD that students have experienced during their training, and different potential risk factors (i.e. lifestyle and physical activity, practice habits, behaviour toward prevention and health history, level of stress, perfectionism, fatigue and disability). Overall recurrence or new onsets of PRMDs will be assessed at 6 and 12 months after the first data collection to investigate and record the development of new incidents within a period of a year and to enable characterisation of the nature and the evolving course of PRMDs.

DISCUSSION

To the best of our knowledge, no other longitudinal studies on risk factors for PRMDs among music students have been conducted so far. Therefore, this study can be considered as an opportunity to begin filling the gaps within current research in this field and to generate new knowledge within musical contexts in education and employment.

TRIAL REGISTRATION

ClinicalTrials.gov ( NCT03622190 ), registration date 09/08/2018.

[Exposure to occupational biomechanical risk factors: The impact of the 2017 reform]

OBJECTIVE

We aimed to assess the number, the prevalence and the socio-occupational characteristics of the employees who were allowed to benefit from prevention measures due to their exposure to occupational biomechanical factors before and after the modification, by the reform (order n° 2017-1389), of the law dealing with occupational health and safety preventive measures.

METHODS

This study was based on the French national survey on occupational exposures (Sumer 2010). Almost 48,000 employees, representative of the French population, were included. Exposure to the four biomechanical factors, initially included in the law and associated with a minimum exposure threshold, were assessed during the employee's interview by the occupational physician.

RESULTS

Before the reform, 31.2% of men and 23.6% of women were likely to benefit from measures of prevention due to their exposure to occupational biomechanical factors. Following the reform, 11,6% of men and 13,7% of women employees are still able to benefit from these occupational preventive measures, leading to an overall decrease of 3.3 million of beneficiaries.

CONCLUSIONS

Although musculoskeletal disorders (MSD) remain the first cause of recognition as an occupational disease, the exclusion, by the reform, of three biomechanical occupational risk factors of MSDs from the preventives measures in occupational health and safety risk assessment will substantially decrease the number of employees exposed to biomechanical factors that could benefit from these preventive and compensatory occupational measures.

'Trying to put a square peg into a round hole': a qualitative study of healthcare professionals' views of integrating complementary medicine into primary care for musculoskeletal and mental health comorbidity

BACKGROUND

Comorbidity of musculoskeletal (MSK) and mental health (MH) problems is common but challenging to treat using conventional approaches. Integration of conventional with complementary approaches (CAM) might help address this challenge. Integration can aim to transform biomedicine into a new health paradigm or to selectively incorporate CAM in addition to conventional care. This study explored professionals' experiences and views of CAM for comorbid patients and the potential for integration into UK primary care.

METHODS

We ran focus groups with GPs and CAM practitioners at three sites across England and focus groups and interviews with healthcare commissioners. Topics included experience of co-morbid MSK-MH and CAM/integration, evidence, knowledge and barriers to integration. Sampling was purposive. A framework analysis used frequency, specificity, intensity of data, and disconfirming evidence.

RESULTS

We recruited 36 CAM practitioners (4 focus groups), 20 GPs (3 focus groups) and 8 commissioners (1 focus group, 5 interviews). GPs described challenges treating MSK-MH comorbidity and agreed CAM might have a role. Exercise- or self-care-based CAMs were most acceptable to GPs. CAM practitioners were generally pro-integration. A prominent theme was different understandings of health between CAM and general practitioners, which was likely to impede integration. Another concern was that integration might fundamentally change the care provided by both professional groups. For CAM practitioners, NHS structural barriers were a major issue. For GPs, their lack of CAM knowledge and the pressures on general practice were barriers to integration, and some felt integrating CAM was beyond their capabilities. Facilitators of integration were evidence of effectiveness and cost effectiveness (particularly for CAM practitioners). Governance was the least important barrier for all groups. There was little consensus on the ideal integration model, particularly in terms of financing. Commissioners suggested CAM could be part of social prescribing.

CONCLUSIONS

CAM has the potential to help the NHS in treating the burden of MSK-MH comorbidity. Given the challenges of integration, selective incorporation using traditional referral from primary care to CAM may be the most feasible model. However, cost implications would need to be addressed, possibly through models such as social prescribing or an extension of integrated personal commissioning.

Psychological difficulties and parental well-being in children with musculoskeletal problems in the 2011/2012 National Survey of Children's Health

OBJECTIVE

This study compared children with and without current musculoskeletal (MSK) problems on key indices of child psychological adjustment and parental well-being.

RESEARCH METHOD

Prevalence estimates of psychological problems were compared for children ages 2-17 years with and without current MSK problems in the 2011/2012 National Survey of Children's Health. Multivariate logistic regression analyses examined the effects of MSK problem severity on the risk of psychological concerns.

RESULTS

Population level differences in prevalence estimates were observed in psychological difficulties. Children with MSK problems were disproportionally affected by anxiety problems, depression, behavioral/conduct problems, and ADHD compared to children without MSK problems. Compared to children with mild MSK problems, children with severe MSK problems were 2.74 times more likely to have anxiety problems (95% CI [1.35, 2.86], p < .05). No other significant differences were found among children with mild, moderate, or severe MSK problems. Regarding parental well-being, compared to children without MSK problems, children with MSK problems were more likely to have mothers and fathers who often experience parenting stress/aggravation and have poor physical and mental health.

CONCLUSIONS

Children with MSK problems are vulnerable to psychological difficulties that can affect their learning, development, and quality of life. Psychological screening and ensuring that these children receive effective mental health treatments should be a priority in pediatric health care settings. Consideration of parental physical and mental health is recommended in the assessment and treatment of children with MSK problems. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Exposure to Adverse Social Behavior in the Workplace and Sickness Presenteeism among Korean Workers: The Mediating Effects of Musculoskeletal Disorders

Adverse social behavior (ASB) by colleagues or superiors in the workplace is considered highly stressful for workers in South Korea. The authors investigate the mechanism by which ASB reduces productivity (measured in terms of sickness presenteeism (SP)), by examining the potential mediating role of musculoskeletal disorders (MSDs). All data are derived from the fourth Korean Working Conditions Survey, which investigated a representative sample of the working population. The authors analyze their general characteristics (age, gender, income, and education), work-related factors (job type, occupational ergonomic risk, job resource, employment contract, work schedule, working hour, and job demand), and health-related factors (self-rated health and MSDs). The authors use a two-step regression analysis to estimate the direct effect of ASB on SP and the indirect effect of SP via MSDs. The authors find that MSDs mediate 16.7% of the total effect of ASB on SP. When employment type and job conditions are considered, the role of the mediating variable in the group with a permanent contract, no shift or night work, and high working time is greater than the counterpart of each variable. Various strategies are needed to address MSDs according to the working environment, which might help limit the negative impact of ASB on SP.

Relationship between concealment of emotions at work and musculoskeletal symptoms: results from the third Korean working conditions survey

In this study, we explored the relationship between concealing emotions at work and musculoskeletal symptoms in Korean workers using data from a national, population-based survey. Data were obtained from the third Korean Working Conditions Survey in 2011. We investigated the prevalence of three musculoskeletal symptoms ("back pain", "pain in the upper extremities", and "pain in the lower extremities"). Multiple logistic regression analysis was also performed to determine odds ratios (ORs) for musculoskeletal symptoms according to concealing emotions at work, adjusting for socioeconomic factors. In both sexes, the emotion-concealing group showed a significantly higher prevalence of "pain in the upper extremities" and "pain in the lower extremities" than the non-emotion-concealing group. For back pain, male-but not female-workers who concealed their emotions showed a higher prevalence than their non-emotion-concealing counterparts; the difference was statistically significant. Adjusted ORs for musculoskeletal symptoms (excluding "back pain" for female workers) in the emotion-concealing group were significantly higher. Our study suggests that concealment of emotions is closely associated with musculoskeletal symptoms, and the work environment should operate in consideration not only of the physical health work condition of workers but also of their emotional efforts including concealing emotion at work.

Musculoskeletal complaints in healthcare personnel in hospital: An interdepartmental, cross-sectional comparison

The objective of this study is to investigate musculoskeletal complaints (MSCs) in healthcare workers (HCWs) in 3 community hospital-based departments [internal medicine (IM), general surgery (GS), and emergency department (ED)] and its effects on the quality of work life (QWL) of hospital HCW.This prospective cross-sectional study was performed in the 700-bed community training hospital. All HCW staffed in 3 departments (IM, GS, ED) of the hospital were asked to respond to items in the study data sheet. Enrolled personnel were inquired about their demographic data, work history and schedule, and medical history. The 16-item Cornell Musculoskeletal Discomfort Questionnaire (CMDQ) Turkish version was applied to evaluate MSC. A total of 216 HCW constituted the study sample and demographic characteristics, history, and clinical findings were analyzed.Among all, 103 personnel (47.7%) were women (n = 42, 41.1% in physicians, n = 57, 87.6% in nurses and n = 4, 8% in other HCW) (P = .000). A total of 173 personnel (79.7%) reported MSC in some part of their bodies. Female personnel had MSC significantly more commonly than males (chi-square = 40.7, P = .000). Numbers and percentages of the personnel with MSC in 3 departments (IM, GS, ED) were 51/61, 52/65, and 70/90, respectively (P = .67). Total QWL score of those without MSC was significantly higher than others (74.7 + -12 vs 63.2 + -15, respectively; t test, P = .000). Total frequency score of MSC as elicited via CMDQ was significantly higher in those without MSC compared to the others (8.1 + -7.6 vs 0.1 + -0.6, respectively, t test, P = .000).Female sex, high-income, university graduation, being a nurse or a physician, and older age impose risk for HCW in hospital with respect to having MSC. Presence of MSC affects QWL negatively.

Ergonomic conditions in manual harvesting in Swedish outdoor cultivation

INTRODUCTION AND OBJECTIVE

Ergonomic problems in manual labour in agriculture are well known worldwide. This study investigates the ergonomic conditions during manual work in Swedish outdoor vegetable/berry cultivation.

MATERIAL AND METHODS

A questionnaire on work and health conditions was sent to all growers of vegetables and strawberries in Sweden. Workplace studies with video recordings and observations of work operations and positions at harvest were performed. Calculations of back compression and risk assessment for harmful impact of work were made. Employers and employees were interviewed.

RESULTS

Working standing/walking instead of kneeling when harvesting vegetables was shown to decrease lumbar compression. Using a conveyor belt instead of carrying a plastic box into the field for the harvested vegetables reduced harmful forward bends and the risk of musculoskeletal disorders (MSD). When strawberries were grown in pots, the work position was a straight back and neck, with lowered arms. When grown on raised beds, the work position was either kneeling or bending forward with straight legs. When kneeling, the back was often bent or rotated, frequently with the arms far from the body. Bending forward with straight legs caused a harmful level of lumbar compression.

CONCLUSIONS

Harmful work postures arise during manual harvesting in Swedish outdoor cultivation. The risk can be reduced using mechanized work tools and optimal cultivation methods. Adequate work training, including instructions about optimal working postures and movements, may reduce the risk of MSD, but will most likely not eliminate it completely.

Towards living within my body and accepting the past: a case study of embodied narrative identity

This narrative case study, created from several qualitative sources, portrays a young woman's life experiences and an eight yearlong therapy process with Norwegian Psychomotor Physiotherapy (NPMP). It is analyzed retrospectively from an analytical angle, where NPMP theory is expanded with Løgstrup's phenomenology of sensation and Ricoeur's narrative philosophy. Understanding Rita's narrative through this window displayed some foundational phenomena in a singular way, illuminating embodied experiences in inter-subjective relationships in movement, sensation and time entwined. It illustrates how traumatic life experiences may cause pain, suffering and ruptured narratives with fragmented physical and sensuous reactions, chaos and loss of temporal coherence with consequences for a person's sense of identity. Rita's narrative also illuminates how intersubjective interaction has healing potentials when there is time and space for trust to emerge and to support new bodily-based experiences. Embodied sensuous experiences in present time may help clarify past and present and support chronology in narration and the sense of identity. With this exemplary case study, we argue that Løgstrup's and Ricoeur's thinking may add valuable perspectives to understanding suffering and healing processes in the field of embodied therapies like NPMP.

Distress and worry as mediators in the relationship between psychosocial risks and upper body musculoskeletal complaints in highly automated manufacturing

As a result of changes in manufacturing including an upward trend in automation and the advent of the fourth industrial revolution, the requirement for supervisory monitoring and consequently, cognitive demand has increased in automated manufacturing. The incidence of musculoskeletal disorders has also increased in the manufacturing sector. A model was developed based on survey data to test if distress and worry mediate the relationship between psychosocial factors (job control, cognitive demand, social isolation and skill discretion), stress states and symptoms of upper body musculoskeletal disorders in highly automated manufacturing companies (n = 235). These constructs facilitated the development of a statistically significant model (RMSEA 0.057, TLI 0.924, CFI 0.935). Cognitive demand was shown to be related to higher distress in employees, and distress to a higher incidence of self-reported shoulder and lower back symptoms. The mediation model incorporating stress states (distress, worry) as mediators is a novel approach in linking psychosocial risks to musculoskeletal disorders. Practitioners' Summary With little requirement for physical work in many modern automated manufacturing workplaces, there is often minimal management focus on Work-Related Musculoskeletal Disorders (WRMSDs) as important occupational health problems. Our model provides evidence that psychosocial factors are important risk factors in symptoms of WRMSD and should be managed.

Regional Rheumatic Disorders and Rehabilitation in Older Adults: An Update

Musculoskeletal problems are the most frequently reported complaints among older adults living in the community. The impact of the aging process on skeletal muscles and joints can have a profound effect on the ability of individuals to function. This article reviews the rehabilitation medicine approach to the evaluation of older adults with regional rheumatic disorders and the rehabilitation medicine considerations for clinical intervention. Future research is required to gain a greater understanding of the subject matter and its impact on the provision of care and patients' quality of life.

Associations of Family Demands and Work⁻Life Conflict with Musculoskeletal Disorders among Korean Workers

Although family-related demands play a role in the effect of psychosocial work characteristics on health, research on work-related health has neglected the family domain. The aim of the present study was to identify the effects of family demands and work⁻life conflict (WLC) on musculoskeletal disorders (MSDs) among Korean workers. We analyzed data from the nationally representative Korean Working Conditions Survey conducted with 50,007 workers in 2014. Logistic regression analyses stratified by gender were performed to identify gender differences, and interaction terms including WLCs and key covariates were also incorporated. Childcare demands (odds ratio (OR), 1.16) were related to MSD only in male workers, whereas homemaking (OR, 1.09) and eldercare (OR, 1.26) demands were related to MSDs only in female workers. WLC was also associated with MSDs among both male (OR, 1.50) and female (OR, 1.55) workers. We found no gender difference in the effect of WLC on MSDs (p = 0.91). Moreover, childcare demands may exacerbate the effect of WLC on MSDs. Our data suggest that family demands and WLC could be important targets of workplace interventions to prevent MSDs, and future research should evaluate the role of family demands and WLC as stressors in the workplace.

A detailed description of the short-term musculoskeletal and cognitive effects of prolonged standing for office computer work

Due to concerns about excessive sedentary exposure for office workers, alternate work positions such as standing are being trialled. However, prolonged standing may have health and productivity impacts, which this study assessed. Twenty adult participants undertook two hours of laboratory-based standing computer work to investigate changes in discomfort and cognitive function, along with muscle fatigue, movement, lower limb swelling and mental state. Over time, discomfort increased in all body areas (total body IRR [95% confidence interval]: 1.47[1.36-1.59]). Sustained attention reaction time (β = 18.25[8.00-28.51]) deteriorated, while creative problem solving improved (β = 0.89[0.29-1.49]). There was no change in erector spinae, rectus femoris, biceps femoris or tibialis anterior muscle fatigue; low back angle changed towards less  lordosis, pelvis movement increased, lower limb swelling increased and mental state decreased. Body discomfort was positively correlated with mental state. The observed changes suggest replacing office work sitting with standing should be done with caution. Practitioner Summary: Standing is being used to replace sitting by office workers; however, there are health risks associated with prolonged standing. In a laboratory study involving 2 h prolonged standing discomfort increased (all body areas), reaction time and mental state deteriorated while creative problem-solving improved. Prolonged standing should be undertaken with caution.

Common Upper Extremity Disorders and Function Affect Upper Extremity-Related Quality of Life: A Community-Based Sample from Rural Areas

PURPOSE

Upper extremity musculoskeletal disorders (UEMDs), such as rotator cuff tear, epicondylitis, and hand osteoarthritis, have a negative impact on quality of life (QOL). In this study, we evaluated the prevalence of rotator cuff tear, lateral and medial epicondylitis, and hand osteoarthritis in the dominant side and the impact of these UEMDs on the disabilities of the arm, shoulder, and hand (DASH) outcome measure, which assesses upper extremity-related QOL.

MATERIALS AND METHODS

In 2013-2015, 987 participants from rural areas completed a questionnaire and underwent physical examinations, laboratory tests, simple radiographic evaluations of bilateral upper extremities, and magnetic resonance imaging studies of bilateral shoulders. Based on data from these participants, researchers evaluated DASH and performed a functional assessment of each region of the dominant side and related UEMDs.

RESULTS

The prevalences of epicondylitis, rotator cuff tear, and hand osteoarthritis were 33.7%, 53.4%, and 44.6%, respectively. Univariate regression analysis results revealed that epicondylitis, epicondylitis+rotator cuff tear, epicondylitis+hand osteoarthritis, and epicondylitis+rotator cuff tear+hand osteoarthritis were significantly associated with DASH score. Multiple regression analysis, including DASH, UEMD, and regional functional assessments, showed that only epicondylitis and epicondylitis+rotator cuff tear were associated with DASH score.

CONCLUSION

Epicondylitis significantly affected QOL, while other UEMDs, such as hand osteoarthritis and rotator cuff tear, had no significant impact. When a patient's QOL is affected by a UEMD, there is an increased possibility of the simultaneous presence of other UEMDs.

Validation of the Readiness for Return-To-Work Scale in Outpatient Occupational Rehabilitation in Canada

Purpose To examine construct and concurrent validity of the Readiness for Return-To-Work (RRTW) Scale with injured workers participating in an outpatient occupational rehabilitation program. Methods Lost-time claimants (n = 389) with sub-acute or chronic musculoskeletal disorders completed the RRTW Scale on their first day of their occupational rehabilitation program. Statistical analysis included exploratory and confirmatory factor analyses of the readiness items, reliability analyses, and correlation with related scales and questionnaires. Results For claimants in the non-job attached/not working group (n = 165), three factors were found (1) Contemplation (2) Prepared for Action-Self-evaluative and (3) Prepared for Action-Behavioural. The precontemplation stage was not identified within this sample of injured workers. For claimants who were job attached/working group in some capacity (n = 224), two factors were identified (1) Uncertain Maintenance and (2) Proactive Maintenance. Expected relationships and statistically significant differences were found among the identified Return-To-Work (RTW) readiness factors and related constructs of pain, physical and mental health and RTW expectations. Conclusion Construct and concurrent validity of the RRTW Scale were supported in this study. The results of this study indicate the construct of readiness for RTW can vary by disability duration and occupational category. Physical health appears to be a significant barrier to RRTW for the job attached/working group while mental health significantly compromises RRTW with the non-job attached/not working group.

Motivational Interviewing for Workers with Disabling Musculoskeletal Disorders: Results of a Cluster Randomized Control Trial

Purpose Although functional restoration programs appear effective in assisting injured workers to return-to-work (RTW) after a work related musculoskeletal (MSK) disorder, the addition of Motivational Interviewing (MI) to these programs may result in higher RTW. Methods We conducted a cluster randomized controlled trial with claimants attending an occupational rehabilitation facility from November 17, 2014 to June 30, 2015. Six clinicians provided MI in addition to the standard functional restoration program and formed an intervention group. Six clinicians continued to provide the standard functional restoration program based on graded activity, therapeutic exercise, and workplace accommodations. Independent t tests and chi square analysis were used to compare groups. Multivariable logistic regression was used to obtain the odds ratio of claimants' confirmed RTW status at time of program discharge. Results 728 workers' compensation claimants with MSK disorders were entered into 1 of 12 therapist clusters (MI group = 367, control group = 361). Claimants were predominantly employed (72.7%), males (63.2%), with moderate levels of pain and disability (mean pain VAS = 5.0/10 and mean Pain Disability Index = 48/70). Claimants were stratified based on job attachment status. The proportion of successful RTW at program discharge was 12.1% higher for unemployed workers in the intervention group (intervention group 21.6 vs. 9.5% in control, p = 0.03) and 3.0% higher for job attached workers compared to the control group (intervention group 97.1 vs. 94.1% in control, p = 0.10). Adherence to MI was mixed, but RTW was significantly higher among MI-adherent clinicians. The odds ratio for unemployed claimants was 2.64 (0.69-10.14) and 2.50 (0.68-9.14) for employed claimants after adjusting for age, sex, pain intensity, perceived disability, and therapist cluster. Conclusion MI in addition to routine functional restoration is more effective than routine functional restoration program alone in improving RTW among workers with disabling MSK disorders.