Randomized Controlled Trial of Adding Telephone Follow-Up to an Occupational Rehabilitation Program to Increase Work Participation

Purpose Transfer from on-site rehabilitation to the participant's daily environment is considered a weak link in the rehabilitation chain. The main objective of this study is to see if adding boosted telephone follow-up directly after completing an occupational rehabilitation program effects work participation. Methods A randomized controlled study included participants with chronic pain, chronic fatigue or common mental disorders on long-term sick leave. After completing 3½ weeks of acceptance and commitment therapy based occupational rehabilitation, participants were randomized to boosted follow-up or a control group before returning to their daily environment. The intervention was delivered over 6 months by on-site RTW coordinators mainly via telephone. Primary outcome was RTW categorized as participation in competitive work ≥1 day per week on average over 8 weeks. Results There were 213 participants of mean age 42 years old. Main diagnoses of sick leave certification were mental disorders (38%) and musculoskeletal disorders (30%). One year after discharge the intervention group had 87% increased odds (OR 1.87, 95% confidence interval 1.06-3.31, p = 0.031), of (re)entry to competitive work ≥1 day per week compared with the controls, with similar positive results for sensitivity analysis of participation half time (≥2.5 days per week). The cost of boosted follow-up was 390.5 EUR per participant. Conclusion Participants receiving boosted RTW follow-up had higher (re)entry to competitive work ≥1 day per week at 1 year when compared to the control group. Adding low-cost boosted follow-up by telephone after completing an occupational rehabilitation program augmented the effect on return-to-work.

Floor Effect of PROMIS Depression CAT Associated With Hasty Completion in Orthopaedic Surgery Patients

BACKGROUND

The Patient Reported Outcomes Measurement Information System (PROMIS) was developed to provide valid, reliable, and standardized measures to gather patient-reported outcomes for many health domains, including depression, independent of patient condition. Most studies confirming the performance of these measures were conducted with a consented, volunteer study population for testing. Using a study population that has undergone the process of informed consent may be differentiated from the validation group because they are educated specifically as to the purpose of the questions and they will not have answers recorded in their permanent health record.

QUESTIONS/PURPOSES

(1) When given as part of routine practice to an orthopaedic population, do PROMIS Physical Function and Depression item banks produce score distributions different than those produced by the populations used to calibrate and validate the item banks? (2) Does the presence of a nonnormal distribution in the PROMIS Depression scores in a clinical population reflect a deliberately hasty answering of questions by patients? (3) Are patients who are reporting minimal depressive symptoms by scoring the minimum score on the PROMIS Depression Computer Adaptive Testing (CAT) distinct from other patients according to demographic data or their scores on other PROMIS assessments?

METHODS

Univariate descriptive statistics and graphic histograms were used to describe the frequency distribution of scores for the Physical Function and Depression item banks for all orthopaedic patients 18 years or older who had an outpatient visit between June 2015 and December 2016. The study population was then broken into two groups based on whether they indicated a lack of depressive symptoms and scored the minimum score (34.2) on the Depression CAT assessment (Floor Group) or not (Standard Group). The distribution of Physical Function CAT scores was compared between the two groups. Finally, a time-per-question value was calculated for both the Physical Function and Depression CATs and was compared between assessments within each group as well as between the two groups. Bivariate statistics compared the demographic data between the two groups.

RESULTS

Physical Function CAT scores in musculoskeletal patients were normally distributed like the distribution calibration population; however, the score distribution of the Depression CAT in musculoskeletal patients was nonnormal with a spike in the floor score. After excluding the floor spike, the distribution of the Depression CAT scores was not different from the population control group. Patients who scored the floor score on the Depression CAT took slightly less time per question for Physical Function CAT when compared with other musculoskeletal patients (floor patients: 11 ± 9 seconds; normally distributed patients: 12 ± 10 seconds; mean difference: 1 second [0.8-1.1]; p < 0.001 but not clinically relevant). They spent a substantially shorter amount of time per question on the Depression CAT (Floor Group: 4 ± 3 seconds; Standard Group: 7 ± 7 seconds; mean difference: 3 [2.9-3.2]; p < 0.001). Patients who scored the minimum score on the PROMIS Depression CAT were younger than other patients (Floor Group: 50 ± 18 SD; Standard Group: 55 ± 16 SD; mean difference: 4.5 [4.2-4.7]; p < 0.001) with a larger percentage of men (Floor Group: 48.8%; Standard Group 40.0%; odds ratio 0.6 [0.6-0.7]; p < 0.001) and minor differences in racial breakdown (Floor Group: white 85.2%, black 11.9%, other 0.03%; Standard Group: white 83.9%, black 13.7%, other 0.02%).

CONCLUSIONS

In an orthopaedic surgery population that is given PROMIS CAT as part of routine practice, the Physical Function item bank had a normal performance, but there is a group of patients who hastily complete Depression questions producing a strong floor effect and calling into question the validity of those floor scores that indicate minimal depression.

LEVEL OF EVIDENCE

Level II, diagnostic study.

Correlation analysis between work-related musculoskeletal disorders and the nursing practice environment, quality of life, and social support in the nursing professionals

We aim to analyze the correlated influential factors between work-related musculoskeletal disorders (WMSDs) and nursing practice environment and quality of life and social support.From January 2015 to October 2015, cluster sampling was performed on the nurses from 12 hospitals in the 6 areas in Xinjiang. The questionnaires including the modified Nordic Musculoskeletal Questionnaire, Practice Environment Scale (PES), the Mos 36-item Short Form Health Survey, and Social Support Rating Scale were used to investigate. Multivariate logistic regression analysis was used to explore the influential factors of WMSDs.The total prevalence of WMSDs was 79.52% in the nurses ever since the working occupation, which was mainly involved waist (64.83%), neck (61.83%), and shoulder (52.36%). Multivariate logistic regression analysis indicated age (≥26 years), working in the Department of Surgery, Department of Critical Care, Outpatient Department, and Department of Anesthesia, working duration of >40 hours per week were the risk factors of WMSDs in the nurses. The physiological function (PF), body pain, total healthy condition, adequate working force and financial support, and social support were the protective factors of WMSDs.The prevalence of WMSDs in the nurses in Xinjiang Autonomous Region was high. PF, bodily pain, total healthy condition, having adequate staff and support resources to provide quality patient care, and social support were the protective factors of WMSDs in the nurses.

The Effect of Self-Efficacy on Return-to-Work Outcomes for Workers with Psychological or Upper-Body Musculoskeletal Injuries: A Review of the Literature

Purpose Work absence can result in substantial losses to the economy and workers. As a result, identifying modifiable factors associated with return-to-work (RTW) following an injury or illness is the focus of many empirical investigations. Self-efficacy, the belief about one's ability to undertake behaviours to achieve desired goals, has been identified as an important factor in RTW for injured workers. This paper systematically reviewed the literature on the association between self-efficacy and RTW outcomes for workers with an upper-body musculoskeletal injury or psychological injury. Methods A systematic search was conducted across five databases using two main search concepts- 'self-efficacy' and 'RTW'. After removing duplicates, our search strategy identified 836 studies, which were screened for relevance using titles and abstracts. Results A two stage screening process reduced the study pool to six studies using psychological injury cohorts and three using upper-body musculoskeletal (UB-MSK) cohorts. Eight cohorts from seven prospective cohort studies and one sample from a randomised control trial (RCT) were subjected to a risk of bias assessment. Higher levels of self-efficacy appeared to have a consistent and positive association with RTW across return-to-work status and work absence outcomes, injury type and follow-up periods. Effect ratios ranged from 1.00 to 5.26 indicating a potentially large impact of self-efficacy on RTW outcomes. The relationship between self-efficacy and RTW strengthened as the domain of self-efficacy became more specific to RTW and job behaviours. Studies assessing workers with psychological injuries were of a lower quality compared to those assessing workers with UB-MSK injuries. Conclusions Higher self-efficacy had consistent positive associations with RTW outcomes. Further empirical research should identify the determinants of self-efficacy, and explore the processes by which higher self-efficacy improves RTW outcomes.

Associations Between the Readiness for Return to Work Scale and Return to Work: A Prospective Study

Purpose To explore the usefulness of the Readiness for return to work scale in individuals participating in occupational rehabilitation, by assessing the association between the scale and return to work (RTW), and comparing the scale to a question assessing individuals' expectations about length of sick leave. Method Prospective cohort study with 9 months follow-up. Participants took part in one of two randomized clinical trials. Associations between the Readiness for RTW scale and RTW was analyzed using linear and logistic regression, with adjustment for age, gender and education. The Readiness for RTW scale was compared to a self-reported question assessing participants' expectations about length of sick leave using adjusted/pseudo R². Results For participants not working (n = 96), high scores on two dimensions (Prepared for action-self-evaluative and Prepared for action-behavioral) were associated with a higher probability of sustainable RTW and more working days. For those working (n = 121), high scores on the Uncertain maintenance dimension was associated with a lower probability of sustainable RTW and less working days. Generally, models including the Readiness for RTW dimensions were not as good at explaining work outcomes as models including a single expectation question. Stage allocation, allocating participants to the dimension with the highest score, was problematic due to several tied scores between (not necessarily adjacent) dimensions. Conclusions Three of the Readiness for RTW dimensions were associated with RTW. However, several weaknesses with the Readiness for RTW scale were established and we particularly do not recommend the stage allocation approach for clinical use in its current form.

Effect of Inpatient Multicomponent Occupational Rehabilitation Versus Less Comprehensive Outpatient Rehabilitation on Sickness Absence in Persons with Musculoskeletal- or Mental Health Disorders: A Randomized Clinical Trial

Purpose To assess effects of an inpatient multicomponent occupational rehabilitation program compared to less comprehensive outpatient rehabilitation on sickness absence in persons with musculoskeletal- or mental health disorders. Methods Randomized clinical trial with parallel groups. Participants were individuals 18-60 years old on sick-leave for 2-12 months with a sick-leave diagnosis within the musculoskeletal, psychological or general and unspecified chapters of ICPC-2, identified in a national register. The inpatient program (4 + 4 days) consisted of Acceptance and Commitment Therapy (ACT), physical training and work-related problem-solving including creating a return to work plan and a workplace visit if considered relevant. The outpatient program consisted primarily of ACT (6 sessions during 6 weeks). Both programs were group based. Primary outcome was cumulated number of sickness absence days at 6 and 12 months follow-up. Secondary outcome was time until sustainable return to work. Results 168 individuals were randomized to the inpatient program (n = 92) or the outpatient program (n = 76). We found no statistically significant difference between the programs in median number of sickness absence days at 6 and 12 months follow-up. In the outpatient program 57% of the participants achieved sustainable return to work (median time 7 months), in the inpatient program 49% (log rank, p = 0.167). The hazard ratio for sustainable return to work was 0.74 (95% CI 0.48-1.32, p = 0.165), in favor of the outpatient program. Conclusions This study provided no support that the more comprehensive 4 + 4 days inpatient multicomponent occupational rehabilitation program reduced sickness absence compared to the outpatient rehabilitation program.

Work-related physical, psychosocial and individual factors associated with musculoskeletal symptoms among surgeons: Implications for ergonomic interventions

This study evaluated the effect of physical, psychosocial and individual factors on the presence of musculoskeletal symptoms (MSS) among surgeons (n = 312) in Iran. Data were collected using questionnaires and analysed by multivariate logistic regression. The prevalence of MSS, particularly in the knees (48.7%), neck (45.8%), low back (42.3%) and shoulders (40.1%) was relatively high. Work-related factors including time spent on surgeries each week (>25 h/week), number of hours working in standing position per day (>4 h/day), moderate to high levels of work-family conflict, duration of each surgery (>3 h), number of years worked as a surgeon (>10 years) and surgical specialty (particularly cardiothoracic and obstetric/gynecologic surgeries) were independently associated with the presence of MSS in different body regions. Individual factors including gender (being female) and little or no involvement in sport and physical activity were also independently associated with the occurrence of complaints. Implications of the findings for further research and development work for improving the working conditions and consequently reducing MSS among this working group are discussed.

Dissatisfaction with work as a risk factor of musculoskeletal complaints among foresters in Poland

INTRODUCTION

Researchers indicate an important relationship between the level of job satisfaction and the state of health of the employees. Some elements of work related with its character, organization, and interpersonal relationships may evoke strong stress, manifested by, among others, an increased musculoskeletal tension which, in turn, may lead to permanent dysfunction of this system.

OBJECTIVE

The objective of the study was analysis of the relationship between the level of job satisfaction and occurrence of musculoskeletal disorders among employees of the State Forests.

MATERIAL AND METHODS

The research material was collected using two instruments: the modified Nordic Questionnaire for assessment of musculoskeletal disorders, and a questionnaire concerning job satisfaction. The study was conducted in a group of 396 employees of the State Forests from 8 regions of Poland.

RESULTS

The results of analysis confirmed a significant relationship between job satisfaction and the occurrence of musculoskeletal disorders. The lower the level of job satisfaction, the more frequent the experiencing of musculoskeletal disorders.

CONCLUSIONS

Low level of job satisfaction is a risk factor for the occurrence of musculoskeletal disorders. Shaping of work conditions, which are the source of job satisfaction, should be considered as one of the main elements of prevention of musculoskeletal complaints.

Psychometric Properties of the Obstacles to Return-to-Work Questionnaire in a Brazilian context

Purpose To evaluate the psychometric properties of the Obstacles to Return-to-Work Questionnaire (ORTWQ) among Brazilian workers on sick-leave due to musculoskeletal disorders. Methods Confirmatory factor analysis was conducted to evaluate the factor structure validity of the ORTWQ. Model fit indices and salience of factor loadings were assessed. The convergent validity was estimated using the Average Variance Extracted (AVE) and Composite Reliability (CR). The correlational analysis was verified using the Spearman Correlation between the ORTWQ and other specific tools. Discriminant Validity, internal consistency, stability (test-retest) and floor/ceiling effect were also assessed. Results A total of 301 participants completed the ORTWQ with a mean age of 45.0 (9.9) years. After refinement, the factor structure indexes of the oblique model were [χ²/df = 1.8; CFI = 0.9; TLI = 0.9; PGFI = 0.7; PCFI = 0.8; RMSEA = 0.05 (90% CI 0.05-0.06)]. Only Depression, Physical Workload and Perceived Prognosis subscales presented suitable AVE indices: 0.63, 0.51 and 0.52 respectively. The correlations between ORTWQ and the other questionnaires were appropriate for almost all subscales. Reliability evaluation showed adequate estimates for all subscales except for the Worry Due to Sick-Leave (CR = 0.45; α = 0.44; ICC = 0.69). A higher order hierarchical model is suggested, in order to estimate an overall score to ORTWQ in a Brazilian population. Conclusions The psychometric properties of the Brazilian version of the ORTWQ were evaluated and after refinement, the validity, reliability and floor/ceiling effects indexes were suitable when applied to a sample of Brazilian workers on sick-leave due to musculoskeletal disorders. However, the factor structure presented some issues regarding convergent and discriminant validity.

Economic Theory and Self-Reported Measures of Presenteeism in Musculoskeletal Disease

This study had two objectives: to describe the historical development of self-reported presenteeism instruments that can be used to identify and measure presenteeism as a result of musculoskeletal disease (MSD) and to identify if, and how many of these, presenteeism instruments are underpinned by economic theory. Systematic search methods were applied to identify self-report instruments used to quantify presenteeism caused by MSD. A total of 24 self-reported presenteeism instruments were identified; 24 were designed for use in general health, and 1 was specifically designed for use in rheumatoid arthritis. One generic self-reported presenteeism instrument was explicitly reported to be underpinned by economic theory. Overtime, self-reported presenteeism instruments have become more differentiated and complex by incorporating many different contextual factors that may impact levels of presenteeism. Researchers are encouraged to further develop presenteeism instruments that are underpinned by relevant economic theory and informed by robust empirical research.

How Do Organizational Policies and Practices Affect Return to Work and Work Role Functioning Following a Musculoskeletal Injury?

Purpose Organizational-level policies and practices that promote safety leadership and practices, disability management and ergonomic policies and practices are considered key contextual determinants of return to work. Our objective was to examine the role of worker-reported organizational policies and practices (OPPs) in return to work (RTW) and work role functioning (WRF) and the mediating role of pain self-efficacy and work accommodation. Methods A worker cohort (n = 577) in Ontario, Canada was followed at 1, 6 and 12 months post injury. Both RTW (yes/no) and WRF (WLQ-16) status (3 levels) were measured. OPPs were measured (high vs. low) at 1 month post-injury. Pain self-efficacy (PSE) and work accommodation (WA) were included in mediation analyses. Results OPPs predicted RTW at 6 months (adjusted OR 1.77; 95 % CI 1.07-2.93) and 12 months (adjusted OR 2.07; 95 % CI 1.18-3.62). OPPs predicted WRF at 6 months, but only the transition from working with limitations to working without limitations (adjusted OR 3.21; 95 % CI 1.92-5.39). At 12 months, OPPs predicted both the transition from not working to working with and without limitations and from not working or working with limitations to working without limitations (adjusted OR 2.13; 95 % CI 1.37-3.30). Offers of WA mediated the relationship between OPPs and both RTW and WRF at 6 months follow-up. PSE mediated the relationship between OPPs and RTW and WRF at 6 months. At 12 months neither mediated the relationship. Conclusions The findings support worker-reported OPPs as key determinants of both RTW and WRF. These results point to the importance of WA and PSE in both RTW and WRF at 6 months.

Effect of acupuncture on pain and quality of life in canine neurological and musculoskeletal diseases

This prospective study investigated the effects of acupuncture alone or combined with analgesics in chronic pain and quality of life assessed by owners for up to 24 weeks in 181 dogs with neurological and musculoskeletal diseases. The scores before and after the onset of treatment were evaluated using the Wilcoxon test and the evolution of success was evaluated by Kaplan-Meier curves. Differences were considered significant at P < 0.05. The success rates for Helsinki chronic pain index (HCPI), quality of life assessment, and visual analog scales (VAS) for pain and locomotion were 79%, 84%, 78%, and 78% of the animals, respectively, when both diseases and groups of treatment were combined. Dogs with musculoskeletal disorders had greater improvement in HCPI (P = 0.003) and VAS locomotion (P = 0.045) than those with neurological disorders. Use of acupuncture alone or in combination with analgesics reduced pain and improved quality of life in dogs with neurological and musculoskeletal diseases.

Development of the Return-to-Work Obstacles and Self-Efficacy Scale (ROSES) and Validation with Workers Suffering from a Common Mental Disorder or Musculoskeletal Disorder

Introduction Common mental disorders (CMDs) and musculoskeletal disorders (MSDs) lead the list of causes for work absence in several countries. Current research is starting to look at workers on sick leave as a single population, regardless of the nature of the disease or accident. The purpose of this study is to report the validation of the Return to Work Obstacles and Self-Efficacy Scale (ROSES) for people with MSDs and CMDs, based on the disability paradigm. Methods From a prospective design, the ROSES' reliability and validity were investigated in a Canadian sample of workers on sick leave due to MSDs (n = 206) and CMDs (n = 157). Results Exploratory and confirmatory factor analyses revealed that 46 items spread out on 10 conceptual dimensions (e.g., Fears of a relapse, Job demands, Difficult relation with the immediate supervisor), with satisfactory alpha coefficients and test-retest reliability for all subscales. Finally, several dimensions of ROSES also predict the participant's RTW within 6 months for MSDs (e.g., job demands), and CMDs (e.g., difficult relation with the immediate supervisor), even when adjusted by several variables (e.g., age, severity of symptoms). Apart from the job demands dimension, when the ROSES dimension is more external to the individual, only the perception of obstacles remains significant to predict RTW whereas it is the opposite result when the dimension is more internal (e.g., fears of a relapse). Conclusion The ROSES demonstrated satisfactory results regarding its validity and reliability with people having MSDs or CMDs, at the time of the return-to-work process.

EQ-5D studies in musculoskeletal and connective tissue diseases in eight Central and Eastern European countries: a systematic literature review and meta-analysis

EQ-5D is becoming the preferred instrument to measure health-state utilities involved in health technology assessment. The objective of this study is to assess the state of EQ-5D research in musculoskeletal disorders in 8 Central and Eastern European countries and to provide a meta-analysis of EQ-5D index scores. Original research articles published in any language between Jan 2000 and Sept 2016 were included, if they reported any EQ-5D outcome from at least two musculoskeletal patients from Austria, Bulgaria, the Czech Republic, Hungary, Poland, Romania, Slovakia, or Slovenia. Risk of bias was assessed with the Cochrane Collaboration's tool. Twenty-nine articles (5992 patients) were included on rheumatoid arthritis (n = 7), osteoporosis (n = 5), chronic pain (n = 5), osteoarthritis (n = 4), ankylosing spondylitis (n = 2), psoriatic arthritis (n = 2), total hip replacement (n = 2), and scleroderma (n = 2). Low back pain was under-represented, while studies in neck pain, systemic lupus erythematosus, gout, and childhood disorders were lacking. EQ-5D index scores were reported in 24 studies, while the version of the instrument and the value-set was not specified in 41% and 46% of the articles, respectively. Meta-analysis was performed on 24 disease states involving 6876 observation points. Intervention effect was reported in 22 subgroups, out of which risk of bias was low in 41%. This review provides recommendations to improve reporting standards of EQ-5D results and highlights potential areas for future research. Coordinated research in conditions with greatest public health impact as well as a development of a regional value-set could provide locally relevant health-state utilities that are transferable among countries within the region.

Sensitivity, reliability and the effects of diurnal variation on a test battery of field usable upper limb fatigue measures

Fatigue has been linked to deficits in production quality and productivity and, if of long duration, work-related musculoskeletal disorders. It may thus be a useful risk indicator and design and evaluation tool. However, there is limited information on the test-retest reliability, the sensitivity and the effects of diurnal fluctuation on field usable fatigue measures. This study reports on an evaluation of 11 measurement tools and their 14 parameters. Eight measures were found to have test-retest ICC values greater than 0.8. Four measures were particularly responsive during an intermittent fatiguing condition. However, two responsive measures demonstrated rhythmic behaviour, with significant time effects from 08:00 to mid-afternoon and early evening. Action tremor, muscle mechanomyography and perceived fatigue were found to be most reliable and most responsive; but additional analytical considerations might be required when interpreting daylong responses of MMG and action tremor. Practitioner Summary: This paper presents findings from test-retest and daylong reliability and responsiveness evaluations of 11 fatigue measures. This paper suggests that action tremor, muscle mechanomyography and perceived fatigue were most reliable and most responsive. However, mechanomyography and action tremor may be susceptible to diurnal changes.

The RUDY study: using digital technologies to enable a research partnership

Patients have extensive experience of their disease that can enhance the design and execution of research leading to significant innovations and efficiencies in the research process. The research community on the whole have been slow to adopt practices that enable patients to become active partners in research. Digital technologies are providing the means to do this more easily and so are increasingly being used to interact with patients and involve them in the design and execution of research. The RUDY (Rare UK Diseases of bone, joints and blood vessels) study's pioneering approach applies a custom-developed electronic platform where patients can contribute information over time about their disease experience, lifestyle and clinical history. This is combined with a state-of-the-art Dynamic Consent model and a commitment to patient-driven research, to further our understanding of rare diseases. This paper describes the RUDY study and the benefits that have been gained from adopting this partnership approach to research.

Psychometric evaluation of the Chinese version of the revised American Pain Society Patient Outcome Questionnaire concerning pain management in Chinese orthopedic patients

The present study tested the clinical efficiency (item grouping, internal consistency of the subscales, construct validity, and clinical feasibility) of a widely used pain assessment system, the Mandarin version of the American Pain Society Patient Outcome Questionnaire (APS-POQ-R-C), in Chinese patients. We also attempted to investigate the current quality of pain management provided in orthopedic inpatient units in China and provide baseline data. First, we investigated the test–retest reliability of APS-POQ-R-C. In total, 236 orthopedic patients were evaluated. Our results showed that APS-POQ-R-C has satisfactory internal consistency and construct validity, although some items are not appropriate for orthopedic patients. Test–retest reliability outcomes indicated that APS-POQ-R-C is a satisfactory battery with acceptable validity and reliability, and is therefore recommended for pain management in future studies.

[Occupational Exposure to Psychosocial Factors and Presence of Musculoskeletal disorders in Nursing Staff: A review of Studies and Meta-Analysis]

BACKGROUND

There is scientific evidence that psychosocial factors are significantly associated with discomfort and / or pain musculoskeletal complaints in nursing staff. The objective of the research was to analyze the association between occupational exposure to psychosocial factors at work and musculoskeletal damage in nursing staff.

METHODS

Systematic review and meta-analysis of studies published up to 2015 in English, French, Italian, Portuguese or Spanish evaluating the association between musculoskeletal disorders and psychosocial factors in the work of nursing staff. A search was made using the same strategies in the bibliographic databases Web of Science, MEDLINE (Pubmed), NIOSHIC and CINAHL. We assessed the quality of eligible studies, heterogeneity, and sensitivity analyzes.

RESULTS

64 studies were reviewed and quality criteria were accepted, accepting those of medium and high quality (n = 47). In a second screening, those that did not meet inclusion criteria were eliminated, with 36 studies being included in the meta-analysis. Statistically significant associations were found between high demands with discomfort and / or pain neck (OR 1.55, IC95%: 1.39-1.72). And between the effort-reward imbalance with discomfort and / or pain in any body region (OR 2.56, IC95%: 1.59-4.11). Heterogeneity was generally average and low for most subsets of the meta-analysis.

CONCLUSIONS

Occupational exposure to psychosocial factors is associated with discomfort and / or pain in different body areas. Therefore, the improvement of the psychosocial environment has an impact on the reduction and prevention of musculoskeletal disorders.

Disease-related everyday communication of persons with rheumatic and musculoskeletal diseases-Results of a participatory research project

OBJECTIVE

The aim of the present study is to describe and analyse significant factors of disease-related everyday communication of persons with RMDs in a nationwide project in Germany funded by the Deutsche Rheumaliga Bundesverband e.V. (German League against Rheumatism).

METHODS

In this participatory research project four persons with RMDs are involved. An online questionnaire addressing context, difficulties, and burden of disease-related everyday communication was answered by 1.015 persons with RMDs. Social and communication skills were recorded by questionnaires to capture social insecurity and patient communication competence.

RESULTS

More than half of the participants reported difficulties in disease-related conversations across various situations. The majority of these persons suffer from this experience particularly in conversations at the work environment or with staff members of authorities. They feel unconfident especially in situations which require saying "no". Furthermore, compared to the general population persons with RMDs have more anxiety about contact with others.

CONCLUSION

Strengthening the social skills of persons with RMDs in conversations related to everyday situations can promote a self-determined life and contribute to the maintenance of social participation.

PRATICE IMPLICATIONS

Based on the results, a communication skills training for persons with RMDs will be developed.

People with dyslexia and heart, chest, skin, digestive, musculoskeletal, vision, learning, speech and mental disorders were more dissatisfied with neighbourhoods: Scottish Household Survey, 2007-2008

Rarely do we know the perception toward neighbourhoods in people specifically with health conditions. Therefore, the aim of the present study was to understand the perception toward neighbourhoods among adults with a series of the existing health conditions in a country-wide and population-based setting. Data were retrieved from and analysed in Scottish Household Survey, 2007-2008. Information on demographics, self-reported health conditions and perception toward neighbourhoods and the surrounding facilities was obtained by household interview. Analysis including chi-square test, t test and logistic regression modelling were performed. Of 19,150 Scottish adults (aged 16-80) included in the study cohort, 1079 (7.7 %) people were dissatisfied with their living areas; particularly for those who experienced harassment (15.4 %), did not recycle or with dyslexia, chest, digestive, mental and musculoskeletal problems. Twenty to forty per cent reported common neighbourhood problems including noise, rubbish, disputes, graffiti, harassment and drug misuse. People with heart or digestive problems were more dissatisfied with the existing parks and open space. People with arthritis, chest or hearing problems were more dissatisfied with the waste management condition. People with dyslexia were more dissatisfied with the existing public transportation. People with heart problems were more dissatisfied with the current street cleaning condition. People with hearing, vision, speech, learning problems or dyslexia were also more dissatisfied with sports and recreational facilities. People with heart, chest, skin, digestive, musculoskeletal, vision, learning, speech and mental disorders and dyslexia were more dissatisfied with their current neighbourhood environments. Upgrading neighbourhood planning to tackle social environment injustice and put pleasant life experience as priorty would be suggested. Graphical abstract interrelations of individual health and neighbourhood health.

Prevalent musculoskeletal pain as a correlate of previous exposure to torture

Aim: To research possible associations between previous exposure to specific torture techniques and prevalent pain in the head and face, back, and feet. Methods: 221 refugees, 193 males and 28 females, previously exposed to torture in their home country, were subject to a clinical interview at a rehabilitation clinic for torture victims. The interview focused on exposure to torture and somatic symptoms prevalent at examination. Results: The mean number of times imprisoned was 2.3; the mean number of months imprisoned was 19.7; the mean duration from initial imprisonment to final release was 3.7 years; and the mean duration from final release to preliminary interview was 8.4 years. The most frequent physical torture method reported was beating (92.3%) and the main mental torture method was deprivation (84.6%). Pain in the head and face was found to be strongly associated with torture against head and face (OR 3.89, 95% CI 1.49—10.20) and with the cumulative number of physical torture methods exposed to. Pain in the back was associated with sexual torture (OR 2.75, 95% CI 1.07—7.12). Besides beating of the lower extremities (OR 5.98, 95% CI 2.47—14.48), the strongest predictor for pain in the feet was general abuse of the whole body (OR 5.64, 95% CI 1.93—16.45). Conclusion: In spite of many factors being potentially co-responsible for prevalent pain, years after the torture took place it presents itself as strongly associated with specific loci of pain, with generalized effects, and with somatizing.

The first encounter with Norwegian psychomotor physiotherapy: patients' experiences, a basis for knowledge

Aims: The intention of this study was to elucidate patients' experiences of the examination of the body given in Norwegian Psychomotor Physiotherapy. Methods: A qualitative approach was used, based on interviews with nine women and one man aged between 41 and 65 years. The data were analysed with the aid of grounded theory, using the first two steps: open and axial coding. Results: Three categories were identified from the patients' experiences. The first category "The Situation before Treatment'', emerged from the subcategories "Prejudice concerning the prefix `psycho''', "Difficulties in recognizing the body's information'', and "The body is ambiguous''. The second category, "Establishing the Relationship'', emerged from the subcategories "Getting to know the therapist as an empathic person'' and "Discovering professional skills''. The third category, "Examination is Interaction'', emerged from the subcategories "Dialogues - room for reflection'', "Undress, the feeling of disclosure'', and "Personal boundaries - good to be seen''. These three categories emphasize the importance of cooperation between the physiotherapist and the patient in exploring the social and emotional context in order to understand the meaning of the body's symptoms. There must be no doubt about the skill and competence of the therapists, including their insight, personal responsibility, engagement, attentiveness, and awareness. Conclusions: Our material reflects the great impact the body examination had on the informants. Examination requires mutual interpretation. The patients' knowledge represents a significant potential for understanding of their own situation.

Associations between work-related musculoskeletal disorders, quality of life, and workplace stress in physical therapists

This study was performed to determine the associations between work-related musculoskeletal disorders (WMSDs), quality of life (QoL), and workplace stress among physical therapists (PTs) in South Korea. Self-reporting questionnaires were given to 855 PTs. Variables examined included general characteristics, WMSDs, QoL, and workplace stress. Of the 788 PTs who responded, 745 (94.5%) reported WMSDs affecting at least one body site. The most affected WMSDs site was the shoulder (23.3%), and the most reported number of body sites affected by WMSDs was one (50.9%). QoL was significantly improved (p<0.05) among PTs over 39 years old, who had 10-15 years of professional experience, worked in general/university hospitals, and had only one site affected by WMSDs. Factors influencing QoL included number of body sites affected by WMSDs, presence/absence of WMSDs, working venues, workplace stress, and age. Factors affecting workplace stress included number of body sites affected by WMSDs, QoL, work hours, and gender. The results showed a high prevalence of WMSDs among PTs in South Korea, and this negatively affected both QoL and workplace stress.

Dyadic Associations Between Physical Activity and Depressive Symptoms in Older Adults with Musculoskeletal Conditions and Their Spouses

This study examined the association between physical activity of older individuals with musculoskeletal conditions (IMCs) and their spouses' physical activity, how physical activity related to one's own and one's partner's depressive symptoms, and whether the similarity of partners' physical activity related to each partner's depressive symptoms using the actor-partner interdependence model. Seventy-seven dyads completed self-report measures of physical activity, depressive symptoms and potential covariates (socio-demographics, physical health conditions and marital satisfaction; IMCs' functional impairment and pain; and spouses' support-related stress). As hypothesized, we found a positive association between the IMC's and the spouse's physical activity. Also, spouses had more depressive symptoms when IMCs engaged in less physical activity. However, for both partners, one's own physical activity was not significantly associated with one's own depressive symptoms. The spouse's physical activity was also not significantly associated with the IMC's depressive symptoms, and the similarity between partners' physical activity did not significantly relate to either partner's depressive symptoms. Our findings suggest that interventions that help increase the physical activity of both partners, but particularly IMCs, may benefit spouses' well-being. Copyright © 2014 John Wiley & Sons, Ltd.